Sunday, June 27, 2010

Near Misses

I worked this past Friday instead of yesterday. And I have a couple of observations to make.

First, the tempo on a weekday is a little bit different than a Saturday. Not so much busier as different. I suspect that is mainly due to the difference between Friday and Saturday as days of the week go. And it seems that the types of calls are different also.

Here are some comparisons.

First, last Saturday I handled a situation that could have happened on a weekday but didn’t. That made handling it a little more complicated than it normally would have been. An 86 year-old male who was discharged from one of the Boston hospitals to his home not far from where the hospital is located. He’d been treated for aspiration pneumonia and was, I suspect, still somewhat hypoxic when he was discharged. The nurse taking care of him did not want to see him be released, but the attending physician taking care of him signed off on his discharge.  During the very short trip home the patient decompensated more, causing them to not feel particularly comfortable with his being left home. The crew called their dispatcher, who in turn called me. So I went out to the scene. On the way there I had two conversations, one with my director and another with one of the medical control physicians at our resource hospital.

When I arrived I assessed this patient. I found a couple of things that concerned me: he was pale and cool, he had a thready radial pulse, and he was hypotensive. He denied pain or difficulty breathing although the EMT’s that transported him told me that he had increased work of breathing when he attempted to stand and walk. Apparently he also told them he wanted to go to the apartment building’s common area and removed the cannula that was connected to his home oxygen source.

I had no choice but to see him be transported back to the hospital. As it is, I believe he never should have been discharged in the first place.

On the other hand, this past Friday had two situations that I don’t know all of the details about because I couldn’t get to either of them fast enough to witness how they were handled. The first was an incident on a bus that was traveling out of Boston. An apparent attempted child abduction. The second was a near-drowning of a three year-old at a public swimming area in Newton. In both cases the crews responding to the incidents did their job. They did it well. And I couldn’t get to either scene because of distance and traffic. I did, however, talk to the crews involved to get details for my own reporting.

They were both difficult incidents. But both outcomes were good. Very different from my situation on Saturday.

Thank goodness.


TOTWTYTR said...

I don't know (nor should I) which hospital sent the elderly patient home prematurely. I DO know that the hospital that you used to work out of, which I detest, has a habit of sending chest pain patients home from the ED only to have the labs come back with numbers that indicate an MI. They then call, guess which municipal service, to race out and bring their discharges back in for treatment.

I don't know if it's lax medical care or financial reasons, but I do know that it's poor medical care.

I heard the abduction call on the BPD radio channel. I didn't hear the EMS part, but I don't doubt that your guys did a good job. The cops certainly did.

Fun being a supervisor, isn't it?

CBEMT said...

Good on your EMTs for actually paying attention to their patient. The place I used to work for wouldn't have even taken vitals on him. said...

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