A Job

12 hours, ten calls. Lots of transfers. Felt a lot like a job today.

***

One interesting situation. We get called for chest pain. 15 year old, says he has a heart murmur, felt chest pain after smoking marijuana. Says he's fine now. I tell him we can't let him go. We have to call his mother. He doesn't have a phone, so I march him over to a pay phone, drop a quarter in the slot, he calls his mom. I talk to her, she says she'll be right down. Then the kid grabs his chest and says he doesn't feel well. I get him in the back of the ambulance, check him out. Pressure's good. Put him on the monitor. Normal sinus. Heart murmurs are really not a big deal. The kid says he feels better. I'm not to concerned about him.

While I'm checking him out, this bearded homeless guy sticks in the back door and says his buddy isn't doing too good, can I check him out. I've got a patient, I say. He's really not doing to well, he says. I nodd to my partner to check him out and call another ambulance if he has too.

A minute later, my partner comes back and says, maybe I should check him out, he really doesn't look very good. Call another ambulance, I say. I've got this kid on the monitor. He calls another ambulance, but they are five minutes away. He comes back and says, this guy looks like he's about to go out, I really need to check him out. He's cold and diaphoretic.

Now, basically once I have established care with one patient at an ALS(heart monitor in this case) level, I can't abandon him. My partner is not rookie, so if he says, this guy is bad, I'm concerned. I picture the guy going into arrest while I babysit the kid waiting for his mother.

I make my decision. I disconnect the monitor, tell my partner to sit with the kid, then take my bag and go to the other patient who is sitting inside a conviience store. He is in his thirties. he is dripping water and is very cold to the touch. Fortunately, I can now hear sirens approaching. I take his pulse and pressure. Not as bad as I expected, 98/60, heart rate in the 80's. I put him on the monitor. Normal sinus, no ectopy or ST changes -- at least in the inferior leads. I try to call to my partner to bring some oxygen for the man, but he can't hear me. The guy denies any pain, but says he feels lousy.

The other medic arrives, and I give a brief report. I take my monitor off and go back to my patient, only to find the back of the ambulance empty. I ask my partner where he went and says, his mom came and snatched him. He at least got her signature on the back of a form.

Turns out that the other crew couldn't convince the other guy to go either and they ended up with a refusal AMA.

The call just illustrates some dilemnas, you can get yourself in: What if the kid suddenly coded while I was checking out the other guy, who might be coding at the same time? What if my partner hadn't gotten the refusal and the kid coded on the way to the doctor's, which is where his mother said she was hgoing to take him? What if I stayed with the kid and the guy coded and then his buddies dragged me out of the ambulance to help him?

All you can do is try to use your best judgement at the time. Sometimes I think your best judgement might cross the line of what you are supposed to do. I judged the kid to be okay, and guessed the guy needed urgent help, and had assistance on the way.