Sunday, October 21, 2007

To Go or Not to Go

When we were called to a job at a persons house for a medical complaint there sometimes arose a dilemma deciding whether a patient should actually go to hospital or not. Making the call was often a tough decision.

For example, a person who collapses for no apparent reason and then fully recovers might refuse to go to hospital. The patient may exhibit no apparent irregular signs or symptoms and may well be ok to stay at home. They almost certainly don’t want to be sitting in an A&E waiting room for hours on end to be looked at only to be discharged. We also had to be mindful of unnecessarily taking patients into an already over stretched emergency department. But the fact remains – they collapsed and people don’t normally collapse. So what do you do?

It’s not unheard of to leave a recovered patient at home only to have them collapse again or worse die at a later hour. Certainly some strong questions would be asked why we didn’t transport in the first case.

However we were not the police. We didn’t have the power to insist patients come with us or else! It was always up to each ambulance officers judgement call at the time and to be honest we didn’t always get it right.

Whilst writing this book the ambulance service was in the media for a classic example of this very dilemma.

An ambulance was called to a private residence in the middle of the night where a patient was apparently complaining of symptoms similar to indigestion. The ambo told the patient to go to bed with a Milo to settle his stomach but was called back a short time later after the patient collapsed and suffered a cardiac arrest.

Our official motto was simply ‘if in doubt – transport’ but this didn’t always marry up with the client or their families wishes and that always made the situation a wee bit trickier.

I attended a job involving a mature male patient, who was staying with one of his adult daughters. Despite his age he was a real attention seeker and when we arrived he was sitting up in his bed with his family fussing around him. I can’t quite remember was his complaint was but it did warrant further investigation but he blatantly refused to go with us to hospital.

His stubbornness resulted in more sympathetic appeals from his family who desperately pleaded for him to come with us. I could tell he was enjoying all the attention he was getting and he continued to decline their appeals.

The senior ambo I was working with could also see that he was just seeking attention and said “oh well just sign our patient report book and we will be on our way.” He passed the book to me to get the required signature, picked up our equipment and started walking out the door. Having seen this scenario many times he wasn’t about to join in with this mans mind games.

This immediately spoiled the patient’s attention seeking scam and he quickly changed his tune saying “if we really thought he should go to hospital he will make the effort” and he promptly got out of his bed and accompanied us to the ambulance.

It was a good lesson for me to remember. If patients wanted to refuse transport I decided it was their prerogative and we had better things to do than force people to comply or worse still play mind games.

Another job I attended involved a similar scenario but this time with a patient who really did need to go to hospital but also refused to do so.

The job we were called to was at an attempted homicide in the city.

A female patient had apparently been arguing with her boyfriend when he allegedly pushed her out the second floor window of their apartment. She landed on her bum onto grass and proceeded to crawl back upstairs to her apartment.

We arrived with the police in attendance and found her sitting at the top of her stairs outside her apartment conscious. I carried out a detailed examination and discovered her chief complaint was pain to her coccyx. Naturally, with the height of the fall we thought she may very well have fractured her pelvis which is potentially very serious.

Unfortunately she was completely unco-operative and absolutely refused to come to hospital.

The police were reluctant to enforce her as they wanted her to lay charges against her partner so they could arrest him for attempted murder but she wasn’t co-operating with them either. It was a stale-mate.

The call came through about 7pm and was our first job of the night shift. I hadn’t eaten dinner yet so I was hungry and my blood sugar was low. Now I don’t know about you but when Im hungry and my blood sugar is low I tend to be lot more impatient and my tolerance level dramatically decreases.

After an hour of hanging around with no compromise I was starting to get really pissed off with the situation. I could see no use in sitting around doing nothing when I could be chomping down my dinner. Suddenly the control room called us up. There was a motor vehicle accident in the main St – Queen Street and they had no one to send. Could we attend? We consulted with the police and decided to take a look because we were close. I was relieved we were out of there.

We raced off to the location but found no sign of the accident. It was a hoax. “Oh well” I said, “at least we can go back to station and I can have my food”!

Unfortunately the senior Paramedic I was working with, who had wisely eaten his dinner, insisted we pop back to our previous patient in case she had changed her mind. I held back a string of tyrant language that was on the tip of my tongue and sat sulking as we made our way back to the original job.

An hour and a half later, after more coaxing she finally decided to come with us but only if the police went to a South Auckland suburb first to uplift her sister and bring her to see her.

By this time I had used up all my blood sugar reserves as well as my patience and tolerance reserves. I was irate and getting very angry. I let my offside know in uncertain terms what I thought of the situation. He wasn’t terribly impressed with me and it wasn’t very professional but I was past the point of caring.

Finally her sister arrived in a patrol car and she decided to come with us to the ambulance. As we gently lead her to the back steps of the ambulance she froze and put her hand out to stop going any further. She pointed to the reflective number on the back door of our ambulance (our call sign) and said that the ambulance vehicle number was evil and that she couldn’t go inside.

I almost lost it once again and really had to bite my lip. She was clearly a psychiatric patient and had wasted enough of everyone’s time. I grabbed her arm firmly and with a little persuasion helped her into the vehicle telling her she was coming with us now whether she wanted to or not. Surprisingly the hospital found she had no major injury and after three and a half hours I finally got my dinner!

1 comment:

barb michelen said...
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