In my short EMS career, I’ve already gone on those calls that make you go “you called 911 for this” several times. The reasons that people will call an ambulance in the middle of the night are more varied than I would eve want to attempt to dissect here but I’ve run a couple recently that made me want to kick something. Hard.
We got a call from a lady who called and said she needed an ambulance because “my foot is hurting.” Now, before I go any further, all of us in EMS know of the stereotypical call where someone will call an ambulance for a hurting foot or a stubbed toe but I never actually thought this would happen. I almost had to stifle a laugh but I acted like a pro. Anyway, my medic partner was listening on the extension and just shaking his head. After we got off the phone he looked at me and said, “that foot better be about to fall off.” We rolled to her house (code 1, in case you’re wondering – no way we were turning on the disco for this) and she met us in the living room. As you might have guessed, her only complaint was non-traumatic foot pain. “I think it’s gout and I don’t have any pills.”
I should also note that there was a car in her driveway. Also, she evidently couldn’t find a ride back home because another truck took her home later that morning.
On the same shift at about 0300, the phone in the sleep room rings. The ER had taken a call for an ambulance. I should have known it wasn’t a good sign when the nurse said, “don’t be in a big hurry getting down here.”
Uh-oh.
We get downstairs and get our call slip. “Itching?! He’s itching. At three in the morning, itching is an emergency.” My partner was clearly pissed (as was I). “He’d better have scratched a hole in himself and be bleeding” was my partner’s response. Again, we roll code 1 and find the guy waiting for us in the living room (I’m sensing a theme here). “My doctor said several years ago that I have dermatitis.” I asked him, “Sir, if you’ve had this condition for a long time, what changed to make you call for an ambulance in the middle of the night?” “I can’t sleep because of the itching, it’s driving me crazy.” So we take him despite the fact that he, too, had a car and even had a wife to drive him to the hospital and despite he not being in any sort of distress. I should also point out that neither I nor my partner saw him scratch himself the entire time we had contact with him.
My agency, like many others, has a policy that we can’t refuse a call and we have to transport, no matter what, if the patient wants to be transported. I understand this and everything but where does one draw the line? A blogger from the UK has also appeared in the EMS reality show “The Chronicles of EMS” and he mentioned during the pilot episode that EMS over there can refer a patient to their personal doctor rather than taking them to the ER. Why don’t we do this more in the US? Calls like the ones I just mentioned are a strain on resources, especially in a rural setting.
I shouldn’t have to state that calls like this can tie up a crew from being able to go to a real emergency but a lot of people don’t consider that. We have people who can either take themselves to the hospital have someone take them and people who don’t need to go in the first place who look at EMS as nothing more than a taxi with bright lights and a noise maker that they can call whenever they have a stuffy nose or a hurting foot. EMS is anything but a taxi service. How we remind people of that is a matter of much contention. How do you balance the right of someone to seek and receive medical attention with ensuring that resources are used properly? Education, sure, but how do you deliver it?
Quite honestly I think the only way people will learn these facts will be “the hard way.”
I’m not sure people will really “get it” until they call for a sore foot and we can tell them “sorry, you can take some OTC meds and follow up with your regular doctor if needed but we’re not tying up our ER or ourselves any longer. We are for emergencies only and this does not qualify as an emergency.” I’m not sure if any places in the US do this now but I sure wish we could at my place.
Abuse of the system is a huge problem everywhere and I’m glad that some agencies such as Cleveland (Ohio) EMS have taken steps to reduce the abuse that occurs. Part of the change we are seeking in EMS should be to get away from the “you call, we haul” mentality. This ties up often limited community resources (EMS), clogs up our emergency rooms with clinic-type traffic and sends the message that the ER is, in fact, a 24/7 clinic and that EMS is a taxi service. EMS personnel should be allowed to tell a patient that they don’t need to go to the hospital when they don’t and there should be some kind of punitive system in place for people who constantly abuse the system. I know that this would walk a fine line but a balance has to be there somewhere.
What do you think?
Rural EMT-B
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