Ambulance Driver

We had 70 runs today during my shift. Ambulance Driver was assigned 7 of them.

• Call #1 was for a non-English speaking patient with back pain that resulted from a chronic condition. A friend was present that spoke passable English and was able to translate. Patient was given pain medication and transported. The funny thing about this call was the friend. He was an amiable sort and was very helpful. As we lifted the patient from the floor, the guy was giving us directions. His last bit of help was a lusty, “one, two, three,” followed by a grunt. We got a kick out of it. We told him that he was going to assimilate well into this culture.
• Call #2 was for a young patient with abdominal pain that had been persistent for a couple of weeks. Had not had nausea, change of stools, fever or recent history of trauma.
• Call #3 involved a foreign visitor to this country with a fever and hypotension. Also nausea, vomiting and diarrhea. Very pale and weak as well. Sad thing about this was the patient had no insurance but had to go by ambulance. Ouch.
• Call #4 was for a very elderly patient who stumbled getting on a city bus. No obvious injury but was aphasic and could not write. The patient seemed to understand what was being said but had a very hard time communicating. This condition was obviously chronic. The patient provided a phone number but no one was home. We transported to the nearest hospital to let them sort it out.
• Call #5 was for a seizure patient housed in a shelter for those with chemical dependency issues.
• Call # 6 found us in the home of an elderly patient who had fallen in the home and discovered by “Meals on Wheels.” Patient had been lying there for several hours.
• Call #7 was for a patient who had gall bladder problems and had been putting off surgery for several months. Now had very severe upper right quadrant abdominal pain.

It was a busy enough day to keep us interested and the time went by fairly quickly. See you tomorrow.

Let’s say you went to get an oil change for your car. Upon driving in, you asked the attendant what the price would be for the service. “I don’t know,” he replies.

He hands you a telephone number to call for pricing information. You find yourself on hold for several minutes but finally discover that the oil change will cost $50.

“Wait a minute,” you tell the attendant. “That is way more than I’m prepared to pay.”

“Too late,” you’re told. “The job is already done.”

Outrageous? Sure it is. But that is what reportedly happened to to a Hopkins, MN couple during an emergency room visit at a Twin Cities’ hospital.

Stories such as these are always difficult to unravel. One always questions whether the story is true and/or complete. The public is woefully ignorant on the subject of health care delivery and providers have a history of not being terribly forthcoming in explaining things. On top of that, news reporters are notorious for inaccuracy when writing about health care.

Nevertheless, this story has the ring of truth to it, in my opinion.

First of all, why couldn’t the hospital give pricing information when requested? Answer – there is no good reason, expect for the fact that no one in health care knows (or seemingly cares) what anything costs. To simply give the customer a phone number so he can investigate the matter himself is ridiculous.

Secondly, there was no reason that the scan could not have waited until the customer’s questions were answered to their satisfaction. No emergency existed. For the hospital to rush this procedure in the manner reported and not allowing the customer to make an informed decision is just a poor business practice.

If this situation occurred as reported, then I’m afraid that the hospital in question is way out of bounds.

The service responded to 83 911 calls during my 12 hour shift today. Ambulance Driver was assigned 6 of them.

• Call #1 was for a man who had subtle complaints of “just not feeling well.” He was hypertensive with a pulse rate too fast for me to count. EKG showed him to be in a supraventricular tachycardia with a rate of 200 beats per minute. The administration of 6 mg of Adenosine broke the rhythm and he settled into a atrial fibrillation with a rate of 90.
• Call #2 was for an elderly man in a nursing home who suddenly developed a fever. He was weak as a kitten, had a decreased level of consciousness, fever of 102 and with a low blood pressure.
• Call#3 involved an elderly male with a history of drug seeking behavior. Appeared to be shopping for a new hospital/physician since he had been recently dropped by the last doctor.
• Call #4 was for a nursing home patient who experienced a simple partial seizure that lasted 2-3 minutes. This was apparently a first time event.
• Call #5 was to a chronic inebriate who had fallen and fractured several ribs in recent days. The patient had been to the hospital twice already and now was treating the pain with Vicodin and several bottles of mouthwash.
• Call #6 saw us walk into a scene that reminded us of the set of the Jerry Springer Show. Several women had gotten into a shouting match that had deteriorated into a knife fight. The result was minor cuts and bruises. No one wanted treatment – which was just fine by me.

This amusing story comes to us from a co-worker.

He responded to a 911 call to find a man unconscious on the floor. His friend reported that he had found him there minutes before.

“Does he take medicines? asked the medic.

“Yeah, he does. What was that? – Oh, I remember, ‘Peanut Butter Balls’,” he said. “That’s it.”

“Huh?” the medic replied. “Where’s the pill bottle?”

The victim’s friend handed over a bottle labeled, “Phenobarbital.”

Today was an 8 hour shift during which our service responded to 48 calls to 911. We snagged 6 of them.

• Call #1 was for a patient who was suffering an apparent allergic reaction to a prepackaged nutritional supplement. Skin was flushed with no other symptoms. Benadryl was administered.
• Call #2 involved a drunk sitting on a sidewalk and was unable to walk away. He was amiable enough and taken to Detox.
• Call #3 concerned a nursing home patient with profound hypotension. While he was mentating and sitting up when we arrived, he had no palpable pulses. Very sick individual
• Call #4 was for an apparent cellulitis that had caused a leg to swell about three times the normal size. It occurred over night. Patient could not bear weight. Luckily, they were not heavy.
• Call #5 was a young person who was either very anxious because their pulse was 140/min or had a fast pulse because they were anxious. We didn’t know which, but weren’t overly concerned either way.
• Call #6 was in response to a diabetic who knew their blood sugar was low. Turned out they were correct, the reading was less than 15. An IV bolus of Dextrose made everything better.

That’s it. Ambulance Driver is going to be a soccer dad this weekend out on the East Coast. Blogging will be minimal.

Over the past few days Ambulance Driver has had several conversations with the ambulance department operations manager concerning this blog’s 911 Update series. On my initiative alone, and not at the urging of my employer, the following changes have been made – in addition to those policies referenced here.

• My bio, which only appeared for a very few days, has been removed.
• My employer is not named on the blog
• In the 911 Update series, the reader cannot trust the day of service, the patient’s age, sex, or location. The order in which the runs occurred also cannot be trusted.

What remains could be described as a “fictionalized” account of a typical day in the life of an urban Paramedic. Were the runs actually made and was the “essence” of the calls preserved?  The answer is “yes.”  Will the reader be able to track a specific call to a specific patient?  My answer to that is, “I don’t see how anyone could.”

In addition to all of this, it has come to the Ambulance Driver’s attention that many of his co-workers are using MySpace, Facebook and Twitter in a manner that has not been as circumspect as this writer has attempted to be

Be forewarned.

Sorry, but Ambulance Driver is a couple of days behind in the Update. On March 9th our Department had 98 calls in my 12 hour shift. Busy day, but we only handled 6 of them.

• Call #1  was for a elderly lady in a nursing home that was mildly hypotensive, weak and thought to be suffering from dehydration.
• Call #2 was for a young man with a chronic disease who had stopped taking his meds and hadn’t seen a doctor for while. Ended up at a clinic wondering why he felt so bad.
• Call #3 was for a middle age man who broke his ankle running down the basement stairs. He really like the morphine.
• Call #4 was for a nursing home patient with a sudden allergic reaction that threatened to close the airway. Epinephrine and Benadryl came in very handy.
• Call # 5 involved an elderly lady with non-traumatic hip pain. Previous hip replacement
• Call #6 was for a jaywalker who got run over by a car that was exiting a parking lot. The tires ran over the paitent’s legs, at least one of which was fractured. No other injury.

A patient said something funny today and it generated an idea for a new category of posts. It will be titled, “You Can’t Make This Stuff Up.”

Under this category Ambulance Driver will relate funny things that have happened over the years either to me or my co-workers.

The first will be about a patient encounter Ambulance Driver had many years ago:

“Lord, help me,” the patient said as we arrived, “I’m having contraptions.”

“You mean contractions?” I asked, trying to be helpful.

“Yes sir, I hurt from my Eucharist all the way to my vagina bone.”

The Sunday Minneapolis Star Tribune had an excellent article about a physician who performs house calls in the Twin Cities area. Dr. Edward Ratner obviously enjoys working outside the limiting confines of a clinic office and makes a convincing argument that it serves the patient better.

However, it is equally obvious that the health insurance plans are not convinced of the efficacy of this method of health care delivery.  Julie Brunner, executive director of the Minnesota Council of Health Plans, has this to say:

“That’s a really expensive use of a physician’s time,” she said. As a practical matter, home visits by nurses or other caregivers are much more common and affordable, she noted. “We would all love to be seen by a physician in our home, but we’re being killed in health care costs in this country right now. There’s a crisis, so we may not have [that] luxury.”

Once upon a time the health plans would not reimburse EMS providers for on-scene treatment of hypoglycemic patients with no transport. Their reasoning was that it would not save health care costs. The fact is that paying EMS $175 for scene treatment, including a physician consult by phone, saves money by eliminating the ambulance transport, the ER visit and the physician charges. The Plans didn’t have a leg to stand on and eventually started to pay – but the lesson is instructive.

What the Plans don’t want (or any other provider, for that matter) is to lose a revenue stream. With regulations and reimbursements the way they are, providers have learned how to “make it” with volume. High volume, even though accompanied by low reimbursement, is doable. Cut into the volume, however, and the system begins to be stressed.

So it is not at all surprising that health plans are leary of physician house calls. It has the potential to cut volume.

The chase after reimbursements is one of the biggest problems in health care and its genesis has been due to over-regulation, chiefly by government.

Steady day at the ambulance service. We had 77 calls during my 12 hour shift, the Ambulance Driver responded to 7.

• Call #1 Spent a delightful 45 minutes with a gentleman in his mid-90’s. Active, vigorous and with all his marbles. Had lived in the same house for nearly 70 years. The downer is that he stumbled on a doorway threshold and broke his hip.
• Call #2  One reason we have overuse of hospital emergency rooms is that our public health care programs in Minnesota incent people to do so. No co-pays for ambulance service, ER visits or medications in most cases. Goods or services that are highly valued, such as health care, will be over used if it costs little or nothing. Call #2 was a fella that had been constipated for 5 days. He walked out to meet us as we arrived.
• Call #3  was a female who got drunk last night, woke up woozy and fell in the bathroom. Nice shiner over right eye with a small laceration.
• Call #4  Even under the best of circumstances, nursing home patients fall down a lot. Female toppled over while using a walker. Forehead laceration. No other injury noted.
• Call #5  A road rage incident between 2 vehicles ended up with 2 innocent vehicles being run off the road. Moderate damage to vehicles, minor damage to 2 of the total of 7 occupants.
• Call # 6 As we have seen, not all chest pain is cardiac related. Male with chest pain, normal EKG, not relieved by NTG. Confirmed non-cardiac by ER later but still didn’t have a diagnosis.
• Call #7.  Isolated femur fractures are a relatively rare occurance. I seem to see one every 2-3 years. Today I saw my second one in three months. Young male slipped on an icy driveway while collecting his mail. Traction splint and morphine helped ease the pain during transport. He’ll probably heal fine but will have a tough time over the next 4-6 months.

That’s it. We’ll do it all over tomorrow.