Frequent Flyers, Headaches and Social Services

[Aeromedic]

I'm lucky to have the time to be able to do this for somebody. If I was working in a busy urban service, I probably would have only seen him once out of 20 trips, made a mention about conditions to the nurse and I'd be off on my merry way. Working with a small rural service means I get to interact with everybody and get to know them. I know that my partners would do the same, and I'd think that a lot of others around would also. When I left my supervisors job in remote EMS and came to Rural for an R and R break, I was amazed at the community involvement and amount of community support we receive here. Our Ambulance Service is non profit and funded completely by donations (in addition to the trip fees of course) and I think that really makes you stop and look at the community you serve and go a bit beyond what is "required" in daily duties.

Personally, I would like to challenge EVERY other person reading this to get more involved in their community, whether sponsored through a service or just as an individual. Some of the things that we have done recently are our yearly "Mock Accident" for students against drunk driving. 2-4 of our staff come in on our off days to do makeup and stage the event with the local fire department (volunteer). We also ran a number of stem cell/bone marrow DNA match swab clinics for something in Canada called OneMatch. This is a great way to get into the community and get involved without requiring a lot of resources. With this program, people would swab cheek cells to be entered into a national/international DNA bank to help find stem cell and bone marrow donors for those in need. All the staff have to do is sit and help people with paperwork and collect the envelopes. I know that in a lot of large urban services it can be hard both logistically and bureaucratically to do any of these sorts of things, but for those in smaller services, I challenge you to help better your community beyond what you normally do.

[Just Plain Ruff]

Your community just got on the top 5 of the communities that I would look into relocating after the situation regarding my other post comes in.

But.... and theres always a but.

[ambodriver]

I've got a person who goes 1-2 times DAILY for BS. And theres nothing we can do.

Then we have someone that calls for a lift assist at least 3 times a week if not more.

It's ridic. I'm waiting till we miss a serious pediatric call while wasting our time with these drains of society.

Aero, I like your call to be involved with these communities, but in the ghetto areas I work in, people are pretty much hostile and don't give 2 shits about us. They'd rather berate us on a scene then help in most situations. I've stopped the "paramedic teaching moments" because most of these people are too ignorant and too far lost. I wasted my breath for so long.

If there was a better reception for us I'd be more then willing to get involved, but the truth is the gang bangers, basketball players and fake gangsta rappers are the true role models in the ghetto

Edited July 2, 2010 by ambodriver

[emtannie]

Vinny,

Do you know which renal clinic this patient goes to for dialysis? I wonder if the dialysis clinic is aware of how many times he is picked up by you guys for falls after dialysis. I suspect his nephrologist would be interested to know that.

I have had a lot of dealings with dialysis clinics in 2 hospitals in my region, and both have incredibly dedicated staff who go the extra mile for their patients. If you don't get any help anywhere else, this may be an option....

[Timmy]

I’m not familiar in regards to your health care system were you reside but there should be more resources available for this individual. Having been part of a discharge planning team it seems a little bizarre that no services apart from EMS and a home care nurse have been put into place.

Speaking in Australian terms here but hoping you guys have a similar program. This individual has a chronic illness which requires multiple and continues admissions for treatment so he falls into the criteria for:

Case worker – to oversee his care, resource funding and implement programs to assist in his optimal healthcare. Ideally a case worker should have been appointed by the discharge planning team at the hospital upon discharge considering their diagnosis and on going care needs.

There should be funding tools available like HACC (home and community care) which provides funding for an individual who are fail, old, young with a disability and carers. There should also be some form of funding available for people with a chronic illness.

Also, I assume you’re an ALS car? Being in a rural area I’m sure your recourses are stretched, is there any non emergency transport services available for permanent bookings?

I think it’s a little sloppy and negligent that the nurses, knowingly discharge this patient who is at high risk of falls and further injury without at least trying to implement some form of help. I state knowingly because a paramedic has spoken to the RN about the issue yet they haven’t acted upon it… Discharge starts at admission!

In all honesty if that was one of my patients when I was working in community health I’d expect the RN to make a referral to us based on the comments of the paramedics or general observation (EVERY patient should be assessed by the treating RN upon discharge to see if any further services are needed or if acopia will be a problem) Once the referral is received we have an interview with the individual and family (if applicable), ask some general questions about coping and management, based on the interview we might send in an assessment team (Community Health CNS, Physiotherapist and Occupational Therapist) to assess the patient within there normal home environment, there coping methods, nutritional status, hygiene, access and mobility and general activities of daily living would all be assessed. From there the team would report back to the case worker who would then source and implement the appropriate funding and interventions.

It sounds as though your patient is not as ambulate as he would like to be? You state having to use the stair chair every time you pick him up and he lives on the second floor… This is not acceptable, if this man requires two paramedics to get him outside then what normally happens? His isolated to his unit? Not ideal at all!

You could approach the local community services but they might come back and say you haven’t followed the food chain (referrals and the like). One option could be refusing to transport back to his residents based on safety issues, tell the RN you’re not taking him back unless they can guarantee his safety.

The best option probably is to remove him from the current situation. If this mean placement in a low care facility then as much as he won’t like, it’s probably a safer option. There’s also other options like independent living units and the like.

Most people are very apprehensive in regards to moving into care but I’m betting this man is socially isolated and maybe a little depressed so moving into a facility which is low care may be a good option. Once the situation is explained to the patient about what services are available and what low care facilities are all about there generally cautiously optimistic and willing to give it a go. I’ve had many patients in a similar situation to yours who are socially isolated and the general situation is less than desirable but there pride is very much intact go into care and very much enjoy it. There given privacy, independence but assistance if required, there social situation is very much improved and often there health status improves.

A lot of people fall between the cracks but it only takes one person to activate the system and the patients situation improves, there is help out there, keep at it!