“RAT” – a Cologne for EMS

A typical BLS call involving a patient ready to be discharged from the ER. She had arrived via 911 with a chief complaint of “difficulty breathing” but was now in no distress. Since it was BLS, my partner was AIC on the call and got the full report from the nurse.

The patient had some other issues going on, was contracted in all extremities and immobile, non-verbal, but could speak well with her eyes, nod her head, and smiled largely at my jokes (a sure sign that something wasn’t quite right.) The RN performed some quick “back of the throat” suction just before we loaded her. There were some secretion issues but nothing requiring hospitalization.

Uneventful transport, but the patient did require one suctioning during the five minute ride to the group home. Door-knocking and bell-ringing drove the home-care trolls from beneath their bridge to allow us ingress, and the patient was transferred to her bed without incident. DTs the Dutiful left the premises and took the cot outside for cleaning, clean the unit, etc., while the AIC gave report.

The AIC arrived about five minutes later. “Man,” he said, “I’m calling Adult Protective Services.”

“Whyzzat?” asks DTs. The placed looked okay, no bad odors – not the Ritz, but we’ve seen worse.

“They,” replied his partner, “Do not have suction.”

“Say WHAT?”

“No suction.”

“But- that patient will probably need suctioning through the night!”

“Yeah, well, I didn’t find out they didn’t have it until I’d turned over the patient.”

“Crap!” exclaimed DTs. Had we known, we could have returned the patient to the ER at the very least, or even stayed on scene until something was worked out. As it was, to take the patient now would be kidnapping; to stay on scene after the patient was no longer “ours” and care for her was way, way outside our scope of practice.

“Well, hell’s bells.” What to do, what to do?

In the end, we alerted APS and tried to get them to understand this was “stat”, and returned to the releasing ER to notify the Charge Nurse that the patient would in all probability be coming back, and why – so they’d not release her again until the situation was fixed at the receiving end.

Odd thing about this is we’re usually very, very proactive in checking on the destination. Patient is going home, but on O2? Has the O2 guy been to the home, is there equipment there, has the family been trained on it? I usually call and check before taking the patient from a facility. This one slipped by ol’ DTs, but that’s how we learn, I suppose.

Oh, and to the facilities which are, um, “inadequate”: I definitely got no problem ratting you out. Get it together for your patients, please.

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