Discharges and Disservice

Another interfacility shift was about to start. With Christmas around the corner; the shopping is done, really the only thing left to do it get the gifts wrapped. The slow gruesome financial bleed also known as Christmas has been controlled. After putting in some overtime the last two weeks I’m ready to a day or two with the kids and wife. First things first. A 12 hour shift roaming the streets and adjacent counties of one of the nation’s top six largest cities.

Tonight, would turn out to be different. Tonight, I’d experienced something that you don’t really think about when starting a career in EMS. We train for and can handle codes, traumas, and respiratory distress, however tonight I’d cross an emotional bridge I didn’t expect.

About midway through the shift we get dispatched to a local emergency room for a patient transport home. The majority of the calls were run we’re transporting to a higher or same level of care. Transports to and from the local airport for a post arrest transfer, or pickups from the local pediatric hospital for transport to the behavioral unit for suicidal ideations.

This call was unique.

As a medic a lot of the times I think about the legal aspects of the call. This along with what’s truly best for the patient can sometimes be a game of inches. Generally speaking, dropping a patient off at home feels like risky territory. We typically transport to some sort of definitive care, now it’s up to me to determine if the patient is stable enough to stay home. Nonetheless, I love these types of calls. When you take a patient home you get to see the opposite end of the 911 shuffle. Their done, treatment complete. Cleared from the hospital, ready to return home. The opposite end of the prehospital spectrum. You really can connect at the most basic level with the patient. The emergency room called. The patient is ready for discharge. You might be asking why an ambulance was needed? Oxygen via nasal cannula. As soon as I heard those words I knew this would be an interesting transport. I did have a few questions for the sending facility. Does the patient have oxygen at home? Will anyone be there to meet or check up on the patient post-delivery? The last thing I want is to take a patient home and dump them only to have them call 911 in a few hours due to shortness of breath or worst die due to a fall or some god-awful injury only to be found weeks later.

The discharging hospital has no information.

What If the destination is deplorable? We decided to check it out. Worst case we could always bring the patient back to the hospital or some other care facility.

If you can have someone else read the next paragraph I’d like to invite you on some guided imagery. Close your eyes as the other reader begins the next paragraph.

Picture a warm, stuffy apartment, with a stale smell of an overflowing trash can that’s weeks old and urine. It hits you square in the face as soon as you walk through the door. As you step in insects scurry down the hall, up the walls, and into every nook to escape the vibrations each foot step we took made on the sticky linoleum flooring. Very cluttered, open food containers here and there.

You can open your eyes now and escape that horrific visual we just experienced together.

We did what we could to help make the patient feel at home. However, feelings of disservice filled my body, anger at the emergency department who discharged her, and overall sadness for this sweet patient. A patient that was happy to be home. As we left I encouraged the patient to call 911 if help was needed for any reason. Somewhere deep down I was hoping they would. Providing them with an escape from the conditions if only for another night.

In the end the appropriate steps were taken, not only on scene but beyond the call to ensure follow up care would be provided. While on scene we spent extra time with the patient. We moved items that could cause the patient to trip, helped troubleshoot the patients home medical equipment, and ensured the phone worked and was nearby.

After the call my partner looked at me and said, “I’m sure glad it was you on that call.” I asked why? He said “Nine out of ten medics would have not taken the time to help the patient like we did.” As with most of the calls we run, once you turn over care the patient fades off into a distant memory. You never really have true closure. This is something I still need to work on. However, spending the extra times on scene assisting the patient with the little things like we did allows me to rest assured that we did everything we could.

  •  
  • 4
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •  
    4
    Shares

Leave a Reply

Your email address will not be published. Required fields are marked *