spenac Posted May 2, 2007 Share Posted May 2, 2007 A recent scenario I did got some interesting responses, discussion and arguments, but really makes me want to see how things are done in different areas. Are all callers actually transported or was what went on in the other scenario the result of the distractions of the scenario. So this scenario will not have any misleading info to distract from the goal of seeing if transport by ambulance is always required. I will try my best not to go into a rant. Thank you for honestly answering the poll on this and for your responses. Scenario: You are at your current station. You are dispatched by 911 (or other emergency number for your area) to a person that just said "send the ambulance" and hung up. It is 1 block from your station to caller. Upon arrival you find a clean healthy 30 year old person. Before you and your partner can exit the ambulance the person has already entered the box by the side door. You enter and ask what you can do to help and get this reply, "You can hurry up and drive me to the hospital before the lunch special ends". Patient becomes agitated that you want vitals and tells you "Do not touch me just get me to the hospital before the lunch special ends". Only thing you know is ABC's and that the patient is alert and oriented as gives name, birthday, address, what day is it "it's discount hamburger day at the hospital", when asked complaint "I'm hungry", asked when complaint began "about half an hour ago", what makes it worse "you making me miss the lunch special, now get to driving". What do you do based on your services policy, protocol, orders, etc.? Link to comment Share on other sites More sharing options...
Dustdevil Posted May 2, 2007 Share Posted May 2, 2007 Before you and your partner can exit the ambulance the person has already entered the box by the side door. My protocol would be to fire both you and your partner for violating the written policy that states ALL doors will be locked at ALL times. :wink: Link to comment Share on other sites More sharing options...
spenac Posted May 2, 2007 Author Share Posted May 2, 2007 My protocol would be to fire both you and your partner for violating the written policy that states ALL doors will be locked at ALL times. :wink: Cool a locked door, whats that? OK lets not get distracted by the door. In my part of the world I'm probably the only person that locks my car or house. I forget that some of you have to deal with junkies stealing your happy meds or terrorist wanting to use your vehichle to send people to the happy hunting grounds. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 2, 2007 Share Posted May 2, 2007 WEll first off I'll be calling the police for a possible dangerous subject in the ambulance. If he ever got past me and got in the ambulance without me in there first or me assisting him then my ambulance is no longer safe and I'll wait till the police get there to find out what this moron's hurry was. No matter if it was the blue light special. In my opinion, once you lose control of your unit and someone else is in there that you did not specifically put in there, then the ambulance becomes a potential crime scene or dangerous scene until ruled otherwise. the person in the ambulance now has the upper hand and is in control of the ambulance because you are not. This just emphasizes the LOCK YOUR DOORS way this thread has begin to go. Link to comment Share on other sites More sharing options...
spenac Posted May 2, 2007 Author Share Posted May 2, 2007 WEll first off I'll be calling the police for a possible dangerous subject in the ambulance. If he ever got past me and got in the ambulance without me in there first or me assisting him then my ambulance is no longer safe and I'll wait till the police get there to find out what this moron's hurry was. No matter if it was the blue light special. In my opinion, once you lose control of your unit and someone else is in there that you did not specifically put in there, then the ambulance becomes a potential crime scene or dangerous scene until ruled otherwise. the person in the ambulance now has the upper hand and is in control of the ambulance because you are not. This just emphasizes the LOCK YOUR DOORS way this thread has begin to go. Come on guys play nice as I mentioned to Dust lets ignore the door. Hows this you meet patient on curb and patient only enters ambulance if you politely invite and assist them. Darn it I did it again I put to much into the scenario and ya'll are going to beat me up for it. Mommy :violent1: :crybaby: Link to comment Share on other sites More sharing options...
spenac Posted May 2, 2007 Author Share Posted May 2, 2007 SCENARIO CORRECTION. HERE LOOK HERE BEFORE BEATING ME UP PLEASE. All doors are locked unless you or your partner choose to hit the magic button and unlock them. Patient meets you at curb, never comes near your ambulance, conversation occurs on the curb unless you choose to invite the patient into the ambulance. If you choose to invite the patient in you assist them into the ambulance by whatever means you deem most professional. Hope this makes it so we can focus on what I am asking in the poll. I should have included report person for abusing 911 system as a poll option. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted May 2, 2007 Share Posted May 2, 2007 I would inform him the rules of transport. I will examine and assess him or no go, this is my unit and my way or no way. As well if there is no chief complaint other than hunger he can call a taxi. I would suggest checking a FSBS to be reassure it is not hypoglycemia talking.. If he continues to be cantankerous and everything checks out okay, then a visit from the local P.D. is warranted. As well, inform him the special had been changed... *As for locked doors, our newer units have locks in back, but the older ones do not. We do not routinely have locked doors while responding only after arriving and exiting the vehicle. Link to comment Share on other sites More sharing options...
spenac Posted May 2, 2007 Author Share Posted May 2, 2007 I would inform him the rules of transport. I will examine and assess him or no go, this is my unit and my way or no way. As well if there is no chief complaint other than hunger he can call a taxi. I would suggest checking a FSBS to be reassure it is not hypoglycemia talking.. If he continues to be cantankerous and everything checks out okay, then a visit from the local P.D. is warranted. As well, inform him the special had been changed... *As for locked doors, our newer units have locks in back, but the older ones do not. We do not routinely have locked doors while responding only after arriving and exiting the vehicle. When I made the scenario hypoglycemia would have been the medical concern or head trauma but since alert and oriented he has right to refuse being checked, which he did by the don't touch. But when you explain to him the rules as you said he has all perfect textbook recommended vitals and perfectly mid line BGL. Gets mad that you messed up his hair but no signs of trauma on him and he denys any possible trauma. Then says "lets get on the road it's lunch time". Like that "special has changed" what you think liver and onions with a side of spinach maybe that will scare him off. We don't lock up here either and one of these days because of it we'll probably watch our unit going over the bridge into Mexico, but hey I don't set the policy. I have recommended to start locking up or at least shutting down and taking the keys if we're out but got no for answer so far. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 2, 2007 Share Posted May 2, 2007 well if he just says "take me to the hospital so I don't miss lunch" and has no medical complaint then I'm not gonna transport him, simple as that. If he starts to say he has a medical complaint then I'll transport. He has the right to refuse to allow you to touch him or examine him but I also have the right to attempt to get him to allow me to examine him. I've been on the end of this call before where the patient would not allow me to do anything to her and she only gave me her name. She came out of the house all gussied up and her hair was made up and her makeup was on quite nicely. She let us put her on the stretcher and that's all she allowed. She then went in to the ER with us and promptly refused treatment, signed AMA and walked out of the er. We last saw her as she walked into the bar across the street. I'd have been angry except we're hospital based so we were going back to the hospital anyway. I'm sorry but I think you are making a mountain out of a molehill with some of your scenarios. You deal with these situations as best you can. Good attempt at making all of us think but I'm not sure where the educational value is in some of the situations. You go with what you have to go on. No more no less. I have transported thousands of patients over the last 16 years and I can count on the number of fingers of one hand where the person only wanted a ambulance ride to either get lunch or go to the bar. Sure abuse like this must occur or we wouldn't be discussing this. I feel for your situation Spenac as to your limited resources but those I feel more sorry for are the ones who live in your area. Your resources are limited and you by your own admission say you only have one ambulance available and the next unit is 60 miles away. That my friend, no offense is the crux of your problems. Too few resources. The people who live in your area suffer because of so many variables. I'd hate to be in your administrators shoes when you are transporting a patient who only wants lunch when someone who really needs your ambulance has to wait 60 minutes to get the nearest ambulance to get them. Like I said, I truly feel for your situation. It is not a situation that I would want to be in on a regular basis. We could go on and on about this immigration debate or the abuse of ems which we have over and over time and time again but unfortunately there are no easy answers to your scenarios or your situation. Or the situations that countless others face daily. Link to comment Share on other sites More sharing options...
spenac Posted May 2, 2007 Author Share Posted May 2, 2007 Ruff appreciate the input. This is so we we can learn what others do. Thats why I left this extremely generic, this has nothing to do with the immigration issue or my remote area it has to do with whether some people actually have to transport every caller that wants to go regardless of complaint or lack of complaint as some said in other posts. I am trying to get my mind wrapped around having no procedure in place that would allow you to say no to a request like this one. At least some have said in the poll they would contact MC to deny transport so they do have a mechanism available to say no way. I want to understand the way things work, that was the intent of the post the other day that went everywhere but where it was intended. We're not going to solve all the problems here but just maybe it will get us thinking out of our little boxes that we live and work, see the bigger picture then maybe we'll quit tearing each other apart. Comments on this and other forums have helped me open my mind to other methods some I now use. To address the other comments. As to the biggest abusers in my area calling with no real complaint are actually USA citizens. Most illegals are afraid to draw attention to themselves, so they wait till in bad shape or if faking they're prepared to leave. Some illegals may fake but at least we get to proceed as if something is wrong and we treat them as if what they say is happening is happening because as others have said we're not Doctors and we do not have all the tools to rule out the problems. We keep IV therapy, ECG, and other skills sharp because we must treat it as real, so we must be prepared in case it is. And many of the illegals that call do have actual problems or risk factors that come from limited or no medical care. OB patients no prenatal care, lots of untreated diabetes, hypertension, TB, etc. Health education is limited, it is sad that you are the first person to explain to the 12 year old girl what is happening and going to happen when she goes into labor. The only thing she knows is her mother tells her she needs to come to the USA so the baby will have a better life, so she sneaks into the USA and hides tell the pains start. So again please in this scenario just let me know what procedure you must follow whether it is just load and go with everybody or do you have options. If you want to explain the process or if I missed anything that in your opinion could affect your process just ask. Link to comment Share on other sites More sharing options...
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