Wednesday, December 17, 2008

Why EMT's Treat People Like Brain-damaged Three-year-olds...

Here's an e-mail I recently received from a blog reader...

"I've read through your blog and enjoy it. Unfortunately I can't even laugh anymore at the stupidity of most people, I just shake my head and weep for humanity. Is it just my imagination, or is it whenever paramedics respond to a nonobvious broken bone (i.e a vertebra) they treat the pt like a brain-damaged three-year-old? Just would like your insight into this behaviour, as I've come across it before and never understood it."

A few days ago, we were called to a 2-car MVA by a (brain damaged) police officer, who wanted us to come and "check a patient out." We arrived on scene approximately 30-40 minutes after the accident had occurred, and everyone was out of their cars, walking around. The alleged patient was a 25 HF, who was the restrained driver of a moderately damaged 4-Runner, which T-boned a sedan. Our patient was not at fault in the accident, according to witnesses, so the other guy's insurance had to pay for medical expenses.

The patient complained that she had pain and tingling on the left side of her face from hitting her face on the side window (of the door). The patient told us she didn't want to go to the hospital, and she didn't even know why we were there; she said she didn't request us. We asked her if we could take her vitals, and while we took her vitals, which were normal, we offered to transport her to the hospital by ambulance. She refused transport and signed a refusal statement.

We stayed on scene for a while, because we were teaching a rookie how to call a supervisor for a refusal. Approximately 20-30 minutes later (now 1 hour after the accident occurred), after the patient talked to her ignorant friend (who had a working car, on scene), the patient came up to us and asked if it was too late to go with us to the hospital. Apparently her friend told her the other guy had to pay for the ambulance, she would be more likely to GET PAID if she went by ambulance, and she would get seen more quickly by the hospital if she went by ambulance (I actually overheard some of the conversation). So I said nothing but "sure," while giving her and her friend a look like they were both brain-damaged 3-year-olds. We took her to the hospital, and the boyfriend followed us in his car. When we got to the hospital, she actually asked, "when can I take this thing off?" ...referring to the C-collar.

So, why do EMT's treat people with non-obvious broken bones like they are brain-damaged 3-year-olds? Because they act like brain-damaged 3-year-olds.

What's an ambulance going to do for a patient who's already been walking around an accident scene (in this case, she was walking around for about an hour)? At that point, what's the difference between going to hospital in the ambulance and going by private vehicle? The only thing we CAN do is immobilize the patient's spine. Immobilizing the spine doesn't do a whole lot of good when the patient is already walking around, or when a patient wants to remove the C-collar. Sometimes people even call us three days after an accident (which happens often).

It's fairly common for patients to complain about the backboard and C-collar or refuse the backboard and/or C-collar, like brain-damaged 3-year-olds, but they still want to go to the hospital by ambulance. What's people's infatuation with the damn ambulance? What do they think it's going to do for them?

Sometimes, after a car accident, people say they feel OK, but then they later decide they want to go by ambulance when they feel like their muscles are starting to stiffen up a little bit. What's an ambulance going to do for stiff muscles?

Most of the time, people just want to go by ambulance because they figure they'll have a better lawsuit if they go by ambulance, or they figure they're not paying for it, so why not? People who are not at-fault in an accident go to the hospital far more often than people who cause accidents. I wonder why.

When I, and most other EMT's, suspect a patient truly does have a broken vertebrae, we take it very seriously, and we do whatever we can to make sure the person doesn't end up paralyzed. Usually, when a person is still sitting in the car, or laying outside of the car, making some attempt to remain immobile, we are far more likely to NOT treat that person like a brain-damaged 3-year-old.

Know-it-all EMT's, spare all of us your stupid stories about, 'one time...this dude was walking around the scene of a minor accident, and I heroically talked him into going by ambulance, and..., and..., I saved his life, caused he had a C3 fracture, which goes to show,...' It goes to show you're a self-promoting blow-hard. Yeah...I get that it happens sometimes...and I get that adrenaline masks pain sometimes, which is not very likely. We just treat people like brain-damaged 3-year-olds when they act like brain-damaged 3-year-olds.


Walt Trachim said...

You are right, Crusty.

I can't think of any time I've responded to an MVC where there wasn't at least one (and usually more than one) brain-damaged three year-old adult on scene.

It happens all the time, and it is really, really frustrating because of what you spelled out about the beliefs of people who think they'll get seen faster than everyone else. And, it happens EVERYWHERE!

Chances are they won't be seen any faster (unless they are seriously injured, which isn't the case most of the time), plus they end up boarded and collared for long periods of time, bitching and complaining about it when it was their own doing in most cases.

Not only do people act like the brain-damaged three year-olds you describe, but they are stupid about it as well. And when I see that, it's enough to put me over the edge.

Ginger said...

Or maybe some people just want to say they got to ride in ambulance?!

Not that I would do this of course :)

Flanders said...

I have met brain-damaged three-year-olds and I have met dumb-ass system abusers. I try to treat the brain-damaged three-year-olds far better.

Anonymous said...

I'm confused. You had no patient, but half an hour later you were still there for this hood rat to decide to scam the system?

Evil Transport Lady said...

Anon- If you read the whole post, you'd see he was training a newbie on how to call a stupor.

Tsk, Tsk.

Joeymom said...

Unfortunately, with family in the insurance business, the brain-damaged friend was partly correct. The insurance company will pay only if she is treated. However, she could have gone by the comfortable private vehicle, instead of by germ-infested ambulance.

Anonymous said...

Instead of arguing over our differences, we should be celebrating our similarities. Start with finding ways to love each other. This will help: Definition of Love

Anonymous said...

err... Definition of Love

Stephen Hawking said...

I had never really heard love explained like that before, but it seems to make a A LOT of sense.

It makes me wonder...

If that's love...which is hard to argue against...and God is love, and God created the universe; do you think that's maybe what set the universe in motion?

Flanders said...

Wrong blog for meaning of life discussion....

The bass player chick is hot.

Anonymous said...

Crusty - as an ED nurse, I love your blog - more please.
yesterday, ambulance pulls up, regular mental health patient is walked in.
Patient says she is depressed.
Patient has packed suitcase / handbag.
Free "taxi" ride, anyone for a patient who knows the system ????.

Meanwhile, the day before, an ill man awaiting transport to another hospital waits over 3 hours for the ambulance to take him.

Medic Sierra said...

When pulling onto an MVA scene, you can pretty well tell who is putting on a show and who thinks they are going to get some money out of it ( which is kind of funny up here in Canada... no fault insurance means it's a hell of a lot harder to win any sort of law suit when it comes to MVAs) Anyhoo... as I was saying...

When we pull up to a scene and there is hardly a scratch on the bumper and the drover of the scratched bumper is sitting in the car crying the blues.. oh my neck, oh my back, oh I can't feel my legs! Until of course you put them on the backboard in a C collar and just happen to lightly bump their knee on the door... Oohh.. yeah, the feeling JUST came back! WE'RE MIRACLE WORKERS.. blahh blah whatever.

Next favorite is the 'nah mah foat, nah mah foat! the second they see a uniform. Ohh painning, very much pain til you whisper ( you can't sue for this) and MIRACLE #2!

The reason people get treated like brain dead 3 year olds is because they ARE acting like brain dead 3 year olds.

We're not stupid, we know what kind of events need to take place in order to cause significant damage. Yeah yeah, some surprise us from time to time but then the patients over all appearance combined altered vitals or something else will alert us to the fact something is wrong.... things that we are trained to notice.

One of the things we've become experts in noticing is when someone is being a brain dead 3 year old! Hell I don't know.. perhaps they think they are smarter than the rest of the world and can be more convincing?? Fake it all you want, there are many tricks to find out if you're faking it and we know them all... some of them even the genius 'fake it better than the rest of the world' wouldn't have thought about in their wildest dreams.

Keep the blog going Crusty! I love the fact you bring the bare bones truth to every situation. Say it like it is, no sugar coats... love it.

TOTWTYTR said...

I once responded to a typical low speed parking lot type accident (~ 2 MPH) where the driver of the cab told me that he wasn't injured and needed no ambulance. We left only to be called back less than ten minutes later by the fire department. The same person now complained of excruciating pain everywhere. He so pissed off the fire department that they used the jaw to remove his completely undamaged door. My partner and I then did a text book immobilization job, followed by a complete trauma assessment including cutting off every stitch of his clothing, including the shoe laces of his sneakers. We then took him to the nearest trauma center, where his complaint of abdominal pain triggered a thorough exam, including a rectal.

Six months later I was called in for a deposition because he was suing his employer. My testimony and documentation were so good that his suit was rejected AND the case was referred to the District Attorney for fraud.

Turns out he had two other similar accidents with no damage, but "serious injuries".

One of my happier moments in EMS.

randompawses said...

Love the blog, Crusty! And you're right, some people really do need to be treated like a brain-damaged three year-old. My dad was in law enforcement for almost 20 years and saw way too many cases of Dumbass Syndrome in action. Too many idjits out there working the system, making things more difficult & more expensive for the rest of us - very frustrating. That makes it so much sweeter when Karma comes back to bite some deserving S.O.B. in the arse, like the person TOTWTYTR mentioned.

Too bad the morons who are abusing the ambulance system can't be "accidentally" exposed to something that'd make them think twice about doing it again. Maybe a paralytic, followed by a trache tube and a couple of large-bore IV cannulas would get the point across? Without benefit anesthetic or analgesic agents, naturally.....

Anonymous said...

I started having a heart attack on a Saturday. I came inside took three adult aspirin, and told my wife to take me to the hospital, I then went and immediately got in the car. Once I was in my car I knew I would be ok, as I knew my wife could get me very quickly to the hospital. Which she did. I quickly got the clot buster shot which ended the pain almost right then. There was no damage to my heart.

Had I called an ambulance and waited, I would have been in a great deal of pain for much much longer.

If you can get around, have some one take you to the hospital its faster and better for everyone.

Crusty said...

Way to go, Anonymous heart attack patient, you probably saved yourself from dying by NOT calling an ambulance. In most cases, patients are better off just driving themselves, as opposed to calling us, waiting 10 min for us to arrive, waiting another 15 min for us to assess you, waiting another 10-15 min for us to go through all our protocols to give you 1 aspirin, 10 more min to load you into the dirty, uncomfortable ambulance, 20 min to drive to the hospital, 10 min to wait in the line of patients, and more 10 min to check in.

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