Swalwell 405…where are you?

On a recent job I needed my old Pal in green, Mark Glencorse, to come to the rescue in his Ford hatchback.

You see, Mark has so many more options than just a reclined cot ride to the ER for his clients and patients.  When I am presented with a situation that does not need that resource, but something both simpler and less expensive, I am told I am crazy. “It will never work” they say. “The abuse will kill it before it starts.”

I hate being proven right.  OK, not really.

On a recent job I was reminded that sometimes people just need a helping hand and a few minutes more than we can offer before they feel better.  Sure a reclined cot to the ER will help them, but so would 10 minutes of chit chat with someone who can help, listen and not judge and point them towards a resource that can help them in the long run.  Instead we sent them ALS to the ER.

We begin our tale in the usual HIPAA fashion, by obliterating the educational aspect of what I want to tell you, and change the facts beyond the letter of the law.

Claustrophobia can be debilitating.  I often think about small spaces and cringe.  Heck I even have trouble tying my shoes or zippering up my boots at work.  Now imagine a full blown, 100% authentic claustrophobic person finally getting up the nerve to ride in an elevator.

And it gets stuck between floors.

Needless to say that when we arrived the person was less than enthusiastic about her condition and her friend inside with her told us she was having an asthma attack.  It wasn’t asthma, but a psychosomatic reaction to her fear which elevated her respiratory rate, heart rate, blood pressure and decreased her sense of reason and hearing.  When the heroes (the Truck) got her free she calmed.  Only after some breathing exercises while pacing the large lobby of the building did her vital signs return to a somewhat acceptable range to discuss her options.

There was no cardiac component, no assessable sign was abnormal for her and she stated the fear and response to the fear had passed.

Then she apologized.  Apologized for bothering us with her “stupid crying.”  I assured her this was exactly what we are for and will always be there to help when she needs it.  She then informed us she would not be going anywhere in the ambulance that was arriving to transport her and if she needed help she would have her sober licensed driver friend take her to her hospital of choice not far away.

We agreed and I gave my usual speech about calling us back, things to watch for, odd sensations that may develop in the coming hours and suggested she contact her doctor and mention the issue.  Then I advised taking the stairs for a few days and we shared a laugh and, surprisingly, a hug.

10 minutes later, while returning to the station I hear other units being sent code 3 to the same address for a person of similar description for asthma attack, worsening, from being stuck in an elevator.

It seems she had a relapse of the fear which her friend could not control and anxiety got the better of her…again.

After speaking to the ambulance crew later, after they transported her to the local ER (while choking and MVA calls went out without ambulances assigned to them), they informed me she again calmed with discussion and distraction, but never had a treatable component.   They never administered medication or initiated treatment, other than a calming conversation, which in this case she needed more of.

My thoughts immediately went to the future, where I could put her in my response vehicle and give her a ride to her doctor’s office to be evaluated for issues related to the claustrophobia.  Instead she took up a space at the local ER and, if I am correct about how busy they were, was likely sent to the waiting room.  The small, cramped, crowded waiting room.

This person was never in danger of losing her life, but no amount of conversation would convince her of that.  This was an emergency, one where it wasn’t my ability to drop an ET tube or cardiovert on site that was needed, but my ability to assess, evaluate, establish a differential diagnosis, then act on it.  Only problem was, I couldn’t.  My system does not allow for what this patient, MY patient, needed, which was a few more minutes of calm conversation and distraction followed by evaluation for a specific condition.

Because of the failure to recognize this needed flexibility, patients all over the US are being strapped to cots with care givers unsafely restrained (if they’re lucky enough), watching them.  Not treating, just reassessing and watching.

Remind me again how 1 person in a hatchback can’t do what my patient needed?

Swalwell 405…where are you?

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4 thoughts on “Swalwell 405…where are you?”

  1. Did she even need a trip to the doctor, or just some oral anti-anxiety medication?

    Why doesn’t a claustrophobic patient carry some oral medication? There are plenty of valid reasons, such as she was going to the store because she ran out, the dog ate them, someone stole them, they spilled in the sink and went down the drain when she was getting a glass of water to take some, or she has never before needed anything. Imagine people dealing with their problems without medication.

    I have no problem with a requirement for medical command contact on all of these calls – it isn’t as if the call is going to delay patient care.

  2. I’d love to see this response model in the US. Several problems however…

    1. Reimbursment. The big, overbearing elephant in the room. There is money to be made giving this lady a ride to the ED in an ambulance. There is no money to be made giving her a ride to a physicians office or urgent care in a station wagon.

    2. Education. How many medics in the US take a complete history, but then fail to do anything with it? I see too many medics that can’t even name which side of the abdomen major organs are on.

    3. Work ethic and abuse. No, not by the public, by other medics. How many would try to send inapproprite patients in the car because they’re lazy?

    4. Legality. I’m not even sure you could do this in a lot of states with out the regulatory body passing masonry building materials.

    Could it work? Sure, with the right small group of medics, strong education, tight QA.. That still doesn’t pay for it though, which is a major problem for most EMS agencies.

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