Never Settle for "I'm Fine"
If your department is anything like mine, you have a pretty good number of medical calls that should never have happened.
Everything from small cuts to heartburn to a ride in the big white taxi, a whole gamut of conditions that you could certainly classify as “not an emergency”. You may start to think after a while that most people have a really over-inflated idea of what truly requires urgent attention.
And that’s why it can be so hard to make your mind do a 180 when you’re faced with an entirely different kind of patient. One who says, “really, it’s nothing, there’s no problem here. You and the nice ambulance men can just go on home”.
You might feel like you’ve finally come across somebody with some sense; clearly their family member who called you just over-reacted, and what do you know, you’re going to make it back to the firehouse by dinnertime.
Hold on, hot rod. It’s true that a lot of patients make a big deal out of nothing, but it can work the other way too. There are people out there who don’t think that anything is a big deal, and we can’t just take their word for it when they say everything is ok.
An example might help show just how wrong this could go.
In my area, we had an ambulance crew who went on the scene of a nice woman who was having some weakness and vague pain. Her daughter called 911 because she was worried, but the patient herself was totally unconcerned. When the ambulance arrived, she told them that she was really just fine, and didn’t need to go to the hospital. And you know what? It was believable. If you were to just listen to her talk to you, you’d probably agree that there wasn’t a problem.
But fortunately, this crew wasn’t ready to just take her word for it. Based on their impression from her vitals signs, symptoms, and her medical history, they were persistent in recommending that she allow them to take her to the hospital. Even then, she had filled out her AMA release form, and had practically signed it when her daughter finally convinced her that maybe it wouldn’t be so bad to just go and get checked out.
Halfway to the hospital, she coded.
What would have happened if she had been left at home? What if her daughter had gone home and she were by herself when she suddenly collapsed? I don’t know about you, but I don’t like those odds.
That’s why we have all this training beyond simply how to do CPR. As an EMT (of any level), we don’t need to be able to diagnose anything, but we do need to be able to do a little more work in our assessments than just listening to what the patient wants.
We need to be able to see the whole picture, synthesizing what the patient is saying with what their body is telling you and what you can reasonably suspect based on their medical history; and although we all know you can’t compel anyone to be taken the hospital against their competent will, there are times when it makes sense to put some extra oomph in your recommendation that they really, really should be seen at the hospital now.
Take this seriously, you don’t want a patient refusal that ends badly on your conscience.