calls

The idiocy that prompts someone to call 911 is baffling sometimes. I have had patients call for “the cotton from a q-tip stuck in his ear” (in the middle of a snowstorm), “the man that woke up with arm tingling” (after he slept on the arm all night), “the 45 year old woman with hiccups” and others just as insane. Every day I am astonished with the inability of people to care for themselves. Although these people have no idea what an emergency is, in my state-and in most states I imagine-I cannot refuse transport. If someone wants to go to the hospital because they brushed up against a cat and now think that they have fleas I cannot laugh in their face, well, not in good conscience, and I cannot tell them that the time that it takes me to bring them in, give report, and write up my paperwork is time that an ambulance in this city is otherwise unavailable for other, presumably real, emergencies. When that would-be flea victim gets to the hospital (5 minutes after the vehicle that their family took arrived in the emergency department parking lot) and they are incredulous that they aren’t immediately going into a bed, and that they are, in fact going to spend some hours in the waiting room, that is when I am repeatedly faced with reality. People don’t understand how to take care of simple things in life. People cannot look outside their world to make realistic comparisons. When flea-man asked why he wasn’t getting a bed and I said that the beds were all being used by elderly people with chest pain, or children with difficulty breathing, he couldn’t see what that had to do with him. He couldn’t possibly fathom why he should have to wait in line behind these people. Similarly I was once at a hospital giving report in triage for another patient that didn’t need to go to the emergency department when I overheard an irate boyfriend ask why his (seemingly otherwise healthy) girlfriend with abdominal pain was being made to wait for so long. His declaration was, “What if she got shot or something!?” and it dawned on me that having abdominal pain and having a life threatening traumatic injury were parallel on the scale of things that Someone Else Needs To Address Right Now for this gentleman. It seemed obvious to me, “If she got shot, she, you know, wouldn’t be in the waiting room.” I just couldn’t, and still cant, understand why he didn’t see that if she were experiencing a real emergency she would be immediately receiving treatment, in the EMERGENCY department.

  

I have often thought about what I would do if my son really needed a trip to the emergency department. He has graced the halls of two separate community hospitals once each. The first was for shortness of breath and a cough that had me more worried than it would have if my husband hadn’t been on a 24 hour shift at the fire department. The second time was after falling and hitting his head just as I was picking him up from spending the day at my grandparents house. There was no blood, and the crying-which started immediately-stopped quickly, but on the way home I realized that he was having a difficult time looking to his left, and that he wasn’t as chatty as he normally was. I brought him to the ed that my husband transports to, which is also very close to our home, and he was discharged with a diagnosis of having had his bell rung. What if, I often ask myself, there were an emergency? Like he choked, or had an allergic reaction to something, an acute problem that would require a 911 call. How would I treat those paramedics that showed up, and, more importantly, how would they treat my son? Whoever would come-assuming this imaginary emergency happened at my home-would work with my husband, and reasonably could be my husband 2 days out of every 8. What if they wanted to start an iv on him? What if they had to use some invasive measure to protect his airway? I know what its like to be in the back of an ambulance as a provider with a child staring up at you from the stretcher. Its terrifying and all reason and logical thought disappear. If you are lucky, instinct, experience and training kick in and you operate on auto-pilot. If you’re like me and have almost no fountain of experience from which to draw, the call becomes a nightmare. You talk out loud, to your partner if you’re in a system large enough to be able to provide another set of hands on pediatric calls, or to yourself if you’re not. You repeat over and over every idea that comes to mind in an effort to not miss anything. With kids though, you’re almost always thrown through a loop. If its serious, and it’s a child, its not ever going to go smoothly. It’s a desperate feeling, and I don’t want anyone to have that feeling while escorting my son to the hospital. And although I scoff at disparaging remarks that people carelessly make about my profession, after all, medics have more responsibility than nurses (and less pay, less attractive hours, and less inviting work environments), if an ambulance comes for my child, I want the crew to consist of an emergency pediatrician, an anasthesiologist, and one of those rotten nurses that is horrible and mean to even the doctors, but has seen more in her career than anyone on the face of the planet.

Not all of these grossly negligent ideas about emergencies are the fault of the general public that we serve however. There are multitudes of commercials on television as part of one association or other’s effort to get the word out about strokes, or heart attacks, and the need for immediate response and the inclusion in that response of a call to your friendly neighborhood dispatch center. The message is, ‘an ambulance will get you in quicker’, the message should be, ‘a paramedic crew can generally tell you with a high degree of accuracy if you actually need an ambulance, and can certainly tell you if you‘ll end up in the waiting room.’ Another problem is the state run health care system of which I claim to be no expert at all, but which seems too often to make it difficult to find a primary care physician. Just education in general needs to be dispersed about the appropriate way to seek medical care-if a person really felt it necessary-for nonemergent medical problems. Perhaps a person could look into an urgent care appointment for their child with a fever. Or they could learn about the appropriate use of Tylenol and Motrin to control a fever. These people could utilize so many other avenues to solve their medical issues, but they don’t. Because they don’t have a car or cab fare?