There Is No Protocol For That

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I read a lot of Patient Care Reports these days. It’s not as exciting as actually responding to calls, but then again, I don’t have to do it a 0300. Some of them make me want to bang my head on my desk because the problem is so obvious and yet the paramedic (or EMT) doesn’t see how sick the patient is. Some of them are amusing, if for the creative spelling if no other reason. Some of them are head scratching, because the patient complaint is so vague or odd that it’s impossible to know what is going on.

Part of the process of reviewing the calls is that I have to pick from a list of Clinical Impressions. That list is based on our “comprehensive” statewide treatment protocols. Which are comprehensive in the Wolkenkuckucksheim in the puzzle palace I refer to as “Our Friends at the State Office”.  The protocol book has sections on medical problems, cardiac issues, major and not so major trauma. All the exciting stuff that EMT and paramedic programs as well as the shiny recruitment brochures from private ambulance companies promise to prospective students and employees.

None of it really reflects the day to day grind of real world EMS. It’s worse in the private sector, but even exclusive 9-1-1 services have more than their fair share of non emergent emergencies.

Here are some frequent complaints that I see when reviewing PCRs. There just isn’t any protocol that covers them, so I usually just use the catchall “Other”, although “None” is probably more accurate. These are not what the calls were dispatched for, but what in fact was the reason an ambulance was summoned.

New Baby, No Instructions, also known as “My baby’s crying, he must be sick”.

Police didn’t feel like dealing with this knucklehead, so they signed a commitment order (I’m old enough to remember when someone threatened to kill someone else, it was a crime, not a “psych call”

School official was afraid of being sued, so he called an ambulance to make the problem go away

Adult child was tired of dealing with ill parent, so called ambulance

Doctor didn’t want to see the patient in his office, so told them to call 9-1-1 for transport to ED

Parents unable to discipline child, so ambulance called to bring the kid to the ED for “evaluation” (This is what Ambulance Driver refers to as “Chronic Hickory Deficiency”)

I didn’t take the medicine that the doctor prescribed for me, and I can’t figure out why I’m not better

There’s nothing wrong with me, but no one is paying attention to me

We don’t want this person flying on our plane, so we made something up

There’s nothing wrong with him, but he’s homeless and should be in the hospital

Home health aid couldn’t get patient on or off the toilet, in or out of bed, etc…

There’s no problem but since you’re here…

People who are just plain stupid even though we can’t cure that

Yeah, there are no protocols for that other than, “Put patient in the ambulance and drove him to the hospital where I put him in the waiting room.” Only you can’t get away with writing that, either.

That might explain why so many people enter EMS with such high hopes and soon leave disillusioned and cynical.

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