Maybe Lose the Hood and Scythe?

Sunday, July 03 2005

Not too long ago we had another “theme” day. Theme days pop up fairly regularly in EMS – Car Crash Day, Pedestrian Struck Day, Baby Delivery Day. The word “day” is of course used loosely. Many of our calls are at 2:30am where the patient suddenly decides that the leg pain they’ve been experiencing for three weeks suddenly needs attention (“It Can’t Wait Another Week” Day).

The particular theme of our day, then, was Patient Refusal Day. To all those who participated, thank you! You made it another wonderful event. The ad campaign, “C’mon out to Northern Virginia, dial 911, then refuse to be examined or transported! Bring the kids!” was especially effective.

First call: Middle-aged male, syncopal episode in a public place. We arrive, he’s vomited down the front of his shirt but is now alert and awake – and “fine, fine. I don’t wanna go to the hospital.”

“Sir, you passed out. You ever do that before?”

“No, nah, it never happen before.”

“Well, you know, that’s not normal, passing out like that. Maybe we should get looked at.”

“Nah, hate hospitals. I go if I pass out again.”

Many bartenders will serve you drinks as long as you can stand and coherently order them. As long as an adult is coherent with EMS, they may refuse treatment. We’ll try to talk them into going, if we think it’s really necessary, but we can’t force ’em.

There are of course exceptions to that – for instance, we can have PD arrest suicidal folk, then treat them once they’re in custody – and tricks – if “I don’t wanna go!” is bleeding heavily, just wait until he passes out, because it’s now “implied” consent. And so on.

Now, if we get a call for something minor, tiny, nothing – a cut finger – we never try to talk someone out of going to the hospital. If that’s what they want to do, we’re happy to take them. We do however point out that going by ambulance does not bump them up the line to be seen – not at all.

Similarly, if someone simply wants to be “checked out” – feeling dizzy or something – we’re glad to do that, too. When asked, “Should I go to the hospital?”, we can’t say “Yes” or “No” because we’re not docs. We can say, “If that’s what you want to do, we’re right here to take you”.

Anyway, so it went on Patient Refusal Day. The guy who fell off a roof and dislocated his shoulder – “Nah, I’ll go home and rest a while,”; the mom whose kid passed out at the mall, “Well, we keep an eye on her, taker her in if she don’t feel well soon”.

Over and over. Got to where we climbed into the unit and sniffed our underarms, wondering how we were offending these fine folk.

Oh well. Perhaps next week’s Iron EMS ingredient will be: “OB/GYN”. Whee.

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