Frequent Flyers, Headaches and Social Services

[Aeromedic]

I've been taking a frequent flyer about once a week lately. Really, nothing new for EMS, actually, he's not as frequent as some others, but this one has a twist. This is a legit patient, post-dialysis hypotension often resulting in fall/ataxia and dizziness. I know what you're thinking... suck it up, these happen... Personally, I don't care if I take him weekly, he's a nice guy, we have a good chat on the way in. Although he is heavy, lives on an awkward 2nd floor apartment (with no elevator, of course) so our stair chair gets a good workout, I don't mind too much because he does try to help us as much as possible. My big concern is for his own safety, he lives alone with only occasional visits from a home care nurse. We are in a Rural Area, and even a full hot response, we're 10-15 minutes out (in ideal conditions) so if something happens, help is quite a ways away. I know I've mentioned to the receiving nurse each of the 3 times I've taken him this month that he should be assessed for placement in a care facility. I'm not totally sure what all is going on behind the scenes, but I tend to get the smile and nod from the nurse, and then we get the call the day after he gets home to pick him up again. IMO, if he had even LPN care in a facility, he probably wouldn't end up in hospital at all (besides for dialysis). As far as my options, I've talked to him about it (he's not really keen on the idea himself), I've talked to the nurses and the social worker. As a sidenote, an EMT in my province was recently sued for using family contact information to discuss long-term care (in addition to having his license revoked and being fired), so family involvement from my position is not an option.

I feel I've done everything I can to try to get him the help he needs, and honestly, I'm kinda frustrated by the lack of action on the part of the rest of the system. Anybody else have ideas? Similar patients?

[Adam Swartz]

In my opinion there really isn't much more you can do that I'm aware of. Have you expressed your concerns to all parties you're allowed to? Maybe talk to the county if the nurse isn't helping out as much as you want? What about talking to the homecare nurse and see what she can do? Just my thoughts. Otherwise I don't really know what you're able to do at this point. Eventually something will be done.

[FireMedic65]

First of all.. I commend you for not getting aggervated with transporting this guy frequently. His emergency may not be an emergency to someone else... but it is to him.

As for his condition; are these episodes only after dialysis or are they random? If they are happening post dialysis.. then he should be in a proper facility. There are many "nursing homes" where the patients are free to roam around, leave and come back as they wish. However, there are nurses on staff to assist the residents when in need and routinely check up on them. I recommend this route. Independent living is what it is called around my parts.

You also mentioned he is not happy about the idea of a nursing home. This may be a reason why he is not at one. If the is able to take care of himself, is not a threat to others or himself... then he cannot be forced to go to one.

[Just Plain Ruff]

All good points. Your other option would be to bypass miss I'm not gonna do anything but nod at you Nurse, and go to the social work office of the hospital you transport him to.

They are the best people you can go to in my opinion. They can evaluate his placement possibility and go further than the nurse in the ER.

I'll be what you tell that nurse goes in one ear and out the other and she may mention it to the ER doctor but seriously, the ER is ill equipped at times to effect a nursing home placement or even a assisted living arrangement.

The Social work is where to go. If he's elderly then you could hotline him to the elder hotline. It's not an abuse case but he is not getting the care he needs so they can also get the ball rolling.

To many medics and EMT's this patient would be a burden to them, taking them away from either their recliner or the "Good calls" and I applaud you for not being a butthead about this guy.

Besides, isn't transporting patients of all makes and models part of our job?

[Aeromedic]

The biggest issue that I see now is the frequency. I have probably transported him 30+ times in the 2 years I have been here. At first it was once every 3-4 months for a similar issue (usually 12-24hrs post dialysis), then it became once a month, and now it is weekly. He wasn't even home 24 hours from the hospital when I last picked him up. He's a fairly large man who will have a pressure in the mid 80's throughout the trip. The highest I've ever seen it was 98. What he really needs is a hand to get around sometimes, a lot of supervision if he falls or feels dizzy. I do know that there is a significant isolation from family, as he is mostly looked after in the community by a neighbor.

Where I think things are failing is that he is apprehensive about what a care home (whether independent or full care) entails. I did find out that I can talk to one of the social workers directly (without crossing any boundaries) so I may see if he would be able to arrange for a tour or even a "transfer" to one of the homes here that is used as a triage and pre-placement facility so he can get an idea of what to expect and he may consider voluntary placement. Honestly, I'm worried about the guy, especially because of the amount of fluid he retains. If he were to fall in a supine position for an extended period of time, pulmonary edema is a definite possibility.

[Just Plain Ruff]

I think that since it's directly related to this guys care that you can talk to anyone with a need to know the info. Social work would fall into that category.

Next time you haul him into the ER during the day, go to a ER phone and dial the operator and then ask for social work. Explain who you are and then tell them what the issue is. They will take it from there.

I got this advice directly from a social worker at one of the busiest hospitals in Central Florida.

Remember, if you don't think anything has been done for this guy then you are probably right. Good way to take the iniative.

One other thing, I'll bet your service will tell you that as long as you tell the ER nurse then your butt is covered. I say go the extra mile like I think you will.

[Chief1C]

I call the local Area Agency on Aging when we have elder folks who live alone, and can't walk, but the home isn't equipped for them to be unable to ambulate. My concern is egress method in a fire, etc. At least suggest they get a Link to Life, Life Line, et al.. eg. an "I've fallen and can't get up" alarm. Not just for falls, feels ill, can't call, push the button. I know your issue isn't the same, but they may be able to sign up for some sort of program where someone comes to check on them on weekdays. Like Meals on Wheels. They may not like that idea, but I did that, and one of our chief objectives was to check their well being and mental status. Out here in the sticks, where you may not have a next door neighbor for a couple miles, it's a worthy service to those who live alone. And it's not just for the elderly, it's for anyone disabled, ill, etc that qualifies.

Edited June 30, 2010 by 4c6

[FireMedic65]

If you feel this gentleman is not properly being taken care of ie... not getting him proper care, that could be considered a form of abuse. If you do not report it you are just as liable.

[Aeromedic]

As an update for you guys, I did call the social worker that has been assigned to his case (along with 200 others, so not much "face time" with the patients) but he will be looking into options for placement for him. Of course he mentioned that he had been informed by the ER staff about our concerns and would take them under advisement, but when I mentioned the frequency of his trips, his general condition as well as the circumstances around his living arrangements he seemed to become more concerned.

I'm not really worried about the "reporting requirements" as when I mentioned to the ER nurse I'd done "due diligence". I do feel somewhat better now after talking to the Social Worker because it has moved his case up above a lot of the general "possible placement needed" cases that come in on a daily basis. Now it is completely in the hands of the Health Region to decide what needs to be done, but at least I've been able to make an impression on the case worker. Only time will tell now.

[FireMedic65]

I am happy to hear he will be getting the care he needs. More people need to take the extra step like you did.