Thursday, March 31, 2011

We're For Emergencies

Overheard at a call:
"Ma'am, we're an ambulance.  We're for emergencies.  Like someone having a heart attack.  We're not a taxi to the hospital."

Hadn't heard someone come out and say that before.
Every word of it was true.  In general, and for the situation in particular.
And yet.
Not the friendliest customer service I have ever witnessed.

We don't have a whole lot of calls out here where such a conversation would even be considered.  But we have a few.  And this particular one was in the wee hours.  There wasn't really anything the ambulance crew could do other than transport, and nothing at ALL that we could do.  I had to wonder why we were even called.  What was the point, exactly?  What did they WANT us to do?  Why DIDN'T they just go to the hospital by private vehicle?  What were they concerned about?

There's a whole lot about EMS that your average person doesn't understand.
There's a whole lot about the system that those of us inside it don't understand!

The main concern I have with EMS as a system is that it isn't, really, a system. It's part of a system, connected to parts of other systems, and there isn't always very good coordination of the whole thing.  Wouldn't it be great if every person had easy access to exactly the level of care they needed?  If, instead of one or two options (call an ambulance or not, go to the ER or not), there were a variety of available options, that were more tailored to what people actually need?

Sometimes, I'd just like to be able to help a little old lady back into bed, tuck her in, feed the cat, make sure she has food in her refrigerator, and then go on our way, without involving the ambulance, a refusal of care, a lot of flashing lights, etc.

Sometimes, I'd like to be able to wash a cut, put a bandaid on it, and have that be that. To stop a bloody nose, without calling in the cavalry.

Sometimes, I'd like to be able to "evaluate" a drunk by telling them yep, you're drunk. Drink some water, go to bed, sleep it off, and next time, don't drink so much.

Things are more complicated than that, though.
There is paperwork to be done, the ambulance on the way that either needs to be canceled, or, if it isn't, they need to bring more people and equipment in and make a bigger deal out of whatever it is.  People have to decide whether to go to the hospital for things that they probably didn't really need to have "emergency" care for in the first place.

The problem is that emergency care is all they have access to.
If options for help are either to get yourself to someone where they can help you, and you can't do that, or to call an ambulance to take you... people call an ambulance.  It's easy to do- and it should be.

I just wish that other options were easy, as well.

Getting an appointment at a primary care doc?  Not necessarily so easy.  Certainly not if you want to be seen soon.
Having someone just check something that you aren't sure is really a problem or not? No option for that.
Need minor first aid? Who does that?
Need help getting up, or a bandage changed?  Who is there to call?

I wish we had a Non-Emergency Medical Service to go along with EMS.
More like first aid, combined with some community service.  Like a visiting nurse service- except not necessarily nurses.
People who could go help someone who isn't really having an emergency, they just need a little help.  People whose primary interest is in caring for people, not in trauma or excitement or "saving lives."  People who are trained to recognize when it really IS an emergency, and call for help then.

They could help people up.  Change bandages. Put ice on things. Wrap and elevate. Check in on someone who has returned home from a hospital visit, make sure everything is going okay.  Check in on eldery people who don't have anyone else.

I'm sure I could make a very long list of things that could be done, that don't require an ambulance, that don't require waking people up in the middle of the night.  

Out here, people put off calling an ambulance because they don't want to bother anyone, and they aren't sure it's really an emergency and they don't want to be embarrassed if it isn't.  Plus, there will be all those people who show up, and the house isn't clean, and...  Wouldn't it be great if they had someone to call, early on, who could drop by and help evaluate whether they really need an ambulance or not?  Someone who could stop by and check on things, tell them what to be concerned about, when to call if things get worse?  Someone who could advise them to go ahead and call, before it's worse, or in the middle of the night, if that is what needs to happen?

I know having such a system, and having it be perfect, with well trained people, who are always available, and who don't miss anything, would be a daunting thing to establish.

But wouldn't it be great?

Wouldn't it be great if an ambulance was never called for someone who didn't actually need one, and WAS called, early on, for everyone who did?  If "You called us for this?" was erased from the thoughts of all EMS providers?  If, likewise, we didn't ever have to wish we were called sooner?  If, at the same time, everyone got whatever care they needed, in a timely manner, without overstressing the EMS system?

Ah, well. A fantasy, perhaps.  For now.

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