Sunday, October 09, 2011

The Stressed

This one isn’t a school-related post, believe it or not…

I worked yesterday in Boston. The shift I didn’t give up – I still have command on Saturdays of all the Boston-based crews as well as the city of Newton. It was one thing the manager I work for asked me to keep, in terms of work schedule, only because of the people that are there. For reasons I still don’t understand, many of them seem to like having me around. To be totally honest, after almost a 18 months I still haven’t figured out the reason why.

It was an interesting day. Because it was Yom Kippur Friday and yesterday, that added the possibility of things going wrong. But as it turned out, there was only one call that I am aware of, and it was a refusal. An 89 year-old male who was a little dizzy and blacked out for a minute. Probably because he did the 25 hour fast that is part of the observance; at least that’s what we (and his physician, who was also there) suspected. He refused to go anywhere, so the crew who responded let him be.

The one incident I went to turned out to be a problem for more than just me, and I wasn’t even directly involved. A 51 year-old female being transported from one of Boston’s major hospitals to one of the hospitals outside of the city to be evaluated for suicidal ideation. From what I was able to gather, she was on the verge of losing her home and the stressors were just too much for her to handle. So she told her family she was going to hurt herself.

The only history I am aware of is one of hypertension. She has no other history, medical or psychiatric, that anyone was able to learn anything about. Also, English wasn’t her primary language; I believe it was Portuguese with the ability to understand Spanish.

I was told that until the crew who was assigned to transport her arrived, she was cooperative. When they showed up, however, the situation changed; she didn’t want to go anywhere, she wanted her family, and then she started being physically abusive to everyone around her. I guess she started biting, kicking, and spitting. That was enough to bring out the chemicals and the physical restraints, but in talking with the ED staff later on, they didn’t want to “snow” her; they just wanted to get her out of there. And they have a point; while chemical restraint is practiced regularly in many places, you can’t put someone down to the point where they aren’t able to make some choices. And one of the hallmarks of Psychiatric care is precisely that; the patient has to have the ability to choose. At the same time, there has to be some level of safety for the people around her, which was why the physical restraints were used.

In my assessment after this was all done, there were things that should have happened which didn’t. First, the crew should have called for help if there was an issue. They didn’t do that. In fact, the ED nurses who were taking care of this patient showed no indication of any problem with the way this was going. The crew told me that it wasn’t that they weren’t comfortable with the situation, but they were concerned about this patient’s safety. Also, the sending hospital didn’t notify the receiving hospital that the patient was going to be restrained. If the receiving hospital had known that, they could have prepared for it. As it was, the Administrator On Call (at the receiving hospital) told the staff that if anything like that were to happen again they wouldn’t take anymore patients under these circumstances.

One individual I didn’t mention was the Psychiatrist who was the attending at the receiving hospital. He told me he had no knowledge of this patient’s impending arrival. Apparently, the doc on the receiving end who accepted the transfer wasn’t even in the building, but her name was on the paperwork. When I brought that up to both hospitals, neither one seemed to know what I was talking about. That made me just a little angry…

My concerns in all of this were for the patient and for my crew. What if something had happened to either of my crew members or to that patient during transport? Potentially, if something were to happen it could have terrible consequences. And – it was a stressful situation for all involved.

I hope to never have to handle something like that again, but the way things go, anything is possible.


TOTWTYTR said...

This appears to be another case of hospitals (or at least one) dumping their problem on EMS. I can guess who the sending hospital was, so that doesn't surprise me. I bring patients there when I have no choice and their disdain for EMS is pretty evident.

They did what was good for them, not the patient, and certainly not your crew.

Susie Hemingway said...

Thank goodness for good caring men/woman like you and your crew. How difficult it must be some days making these decisions and assessments. Every good wish for your further studies.

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