Posted by: medicblog999 | December 13, 2009

The completion of my first Ambulance Shift in SF.

CoEMS

As we moved on to the next post of the day we sat and chatted about this and that.  Justin told me some of the history surrounding the merger of the Fire and Ambulance service which was surprisingly recent, but more about that later in the story.

The radios went off and we were sent to another location for an elderly female who was allegedly “deteriorating” in her general health and seemed confused.

Jim drove lights and sirens for a fairly short distance until we arrived at the patient’s house. Again, the engine crew was already there and had made contact with the patient. Another quick handover and a universal look between two paramedics when you just cannot say the words out loud:

” there is something a bit odd about this one ”

The patient, Joan, was assisted to the Ambulance and placed on the stretcher for a full assessment by Justin and Jim. Justin starred off with his History taking whilst Jim pottered around and helped with getting a set of observations before he sat down in the captain’s chair and started taking some notes on the electronic care record.

The history taking revealed that the call had come in via Adult Services (like our social services) after they had received a call from the patients landlord stating that she was ‘acting a little odd and seemed confused’ Someone on scene, from adult services I think, stated that she felt the call was more to do with the fact that Joan had missed her rent a couple of times and in reality, the landlord probably just wanted her out of the house so that he could evict her and change the locks.

Just looking at Joan, you could see all of the classical signs of chronic illnesses left untreated. She obviously had an element of COPD, her legs were very oedematous and one had an obvious cellulitis. She seemed unkempt and quite lethargic, but was a very sweet lady who was very personable and quickly wangled her way into the ‘what a lovely patient category’

As Justin asked about her medical history she stated that she had never been in hospital and had never been to see a primary care physician. Apparently this was due to a lack of insurance and the lack of money to pay for any treatment! What hit me like a brick to the chest though was when she was laying on the stretcher and she looked at Justin and said:

“Oh dear, how much is this going to cost me?”

Now, whenever someone says that to me in the UK (which they do sometimes for some reason) I always enjoy being able to say

“oh don’t worry about that, it’s free, let’s just get you sorted and you can repay me with a bacon buttie when you feel better!”

But in this case that wasn’t true, however Justin still went down the route of

“let’s worry about that later Joan, we just need to get you some help to get you on your feet again don’t we?. We are going run you up to hospital to get you feeling better ok?”

Joan agreed but you could see the concern on her face about it all. From that moment on, during this patient care episode, I hardly heard anything else in the back of the ambulance. My mind was just wandering around trying to rationalize what I had just heard.

Over in the UK, this is the kind of thing we assume happens all the time in America. A patient unwell and not treated because they can’t afford health Insurance, surely that’s the whole problem with the system right?

Maybe that is part of it, but what I saw during my time there was the rampant abuse of the system by those without adequate health care insurance who use 911 as their access for primary health care issues and minor illness and injury, as they know they can access that service and virtually have nothing to pay for it due to their own personal circumstances.

That wasn’t the case for Joan though; she was just a lady who couldn’t afford health care, so she didn’t get any!

As we drove to the hospital, I was surprised to feel myself getting a little upset. Here was a woman who would not be in this situation if she was in the UK, unless she chooses not to access health care. If she wanted it, she would be having regular checkups for her COPD, she would most likely have a specialist respiratory nurse reviewing her periodically in her own home, she would have all the medication she needed delivered to her door and she would have been given a nebuliser machine too. And that’s just for her breathing problems!

All I kept thinking over and over again was just how wrong it seemed. I looked over at Justin and can remember feeling a little odd that he didn’t seem to be too bothered about the whole thing, then I put myself in his shoes and realised that this must be something that he sees day in, day out for the entirety of his EMS career so far, so maybe this was just routine run of the mill stuff after all.

However, when we discussed it later, it was obvious that this is as frustrating and maddening to most all of the Paramedics and EMTs of the SFFD, and they will go as far as they can within the realms of their remit and professional obligations to ensure that the patient gets the care they need. It is a problem with the system that, at this moment in time, no one can do anything about. But as I was told by some of the men and women that I had the fortune to talk with during my time in San Francisco, there is always something someone can do to make it easier for the genuine patient who just cant afford healthcare, and it was heartwarming and reassuring to realise that there are professionals out there who will do all they can for their patients, more than just caring about their physical needs.

We arrived at a different hospital and handed over our patient in the same fashion as in the other hospital. I wonder if it is a legal thing or a trust/professionalism thing that requires the nursing staff to repeat all of the observations that Justin had taken mere minutes before in the back of the ambulance, before they actually accept the patient.

As soon as we got outside, Ted and Chris were waiting to pounce.

“How did that make feel?”
“You look a little upset, are you upset by that?”
“Tell us your thoughts?”

I know he was looking for TV gold and hoping for a tear to be trickling down my cheek, but there was no way that was going to happen.

It did however, leave a certain mark on me and it did confirm my continued belief in the NHS and the system that I work for.

The NHS is not perfect; there can be mistakes and inefficiencies. Some may not have the best service ALL of the time, but it is there for EVERYONE regardless of their personal circumstances and that is something that I will cherish and believe in for the rest of my career.

Time for lunch now though…….

Jim and his amazing knowledge of all things food related around the city came to the rescue. No matter which intersection we were passing, I would hear him say from the front seat

“Oh there is a great Chinese/Indian/Vietnamese/Italian/Steak house restaurant down there”

I’m sure he must spend his entire free time going around different places to eat and learning where all the best spots are. I really think he has missed an opportunity to be the first EMS celebrity restaurant reviewer.

Anyway, this day, he decided to take us to a local authentic Vietnamese restaurant.

Jim and Justin tucking into our Vietnamese lunch

Jim and Justin tucking into our Vietnamese lunch

As we arrived, I asked what we would do if a job came in and we were sitting at the table, to which I got the obvious answer, “we just go!”

It seemed a little risky to go for a sit down meal, but what I hadn’t counted on was the speed that the meal arrived at the table. Justin and Jim told me that there are many restaurants around the city which become regular stops for many of the SFFD Ambulance crews, even to the point that some just start cooking the house specials or a selection of dishes as soon as an ambulance pulls up outside and the food is virtually at the table as the crew sits down.

I glanced at the menu and realised that I didn’t have a clue what I was going to order, so I am afraid that I bottled it and went for a safe bet of an omlette of sorts, can’t go wrong with that right?

The food arrived in quick order and we tucked in. Justin, Jim, Ted and Chris all had some sort of soup with varying degrees of heat and spiciness. It was fun to watch Ted starting to sweat after a couple of minutes and I am sure that he paid for that some time in the near future!

We finished our food without getting a job, and moved back to the vehicle.

We were then sent on another couple of calls, the last one of which was a pedestrian V Car RTC. It was obviously a Code 3 call, so Jim drove us the few minutes to the job and we arrived on scene shortly after the engine company. They had already immobilized her and had started to log roll her onto the spinal board when Justin and Jim moved in to offer assistance and to get another quick handover. I had a quick glance over the scene and noticed the car with a bulls eye to the windscreen (always a worrying sign), however from what I could see of the patient between the 6 qualified ambulance staff on scene (FOR 1 PATIENT!! – that is something that you would never ever get in the UK, but something which obviously has great benefit when the situation calls for it!), she seemed to be alert, conscious and orientated, with no obvious traumatic injuries. However, the team clicked together and moved into action. Before I knew it she was in the back of the ambulance with Justin, Jim and I.

Justin did his quick head to toe whilst Jim did some quick basic obs and started the patient care record on the computer. Shortly after it was off on the Code 3 run to the hospital, which was about 15 minutes away.

Our patient was very distressed and really getting herself anxious and upset, I could see Justin was busy trying to do what he needed to do, and I knew I wasn’t meant to have any physical patient contact, but surely I could help out with one of the best tools we have as paramedics and EMTs?

I moved over into the captain’s chair at the head of the spinal board and reached forward and held her hand. I introduced myself as the funny talking one from the UK, which lightened the mood for a couple of moments, then spent the rest of the journey trying to distract her, reassure her that everything seemed fine and calm her down.

It worked to a point, but it was really good to feel that I was actually being part of the team rather than just standing on the edge and looking in.

In the end, she apparently suffered no significant injury, and that was to be the only real potentially traumatic job that I would see in my time there, but it was enough to see what I had expected from American EMS, rapid trauma care in a very methodical and structured way. Although I still didn’t get to hear Justin should ‘STAT’ to anyone, or pound on someone’s chest whilst looking to the heavens and shouting ‘IM NOT GOING TO LET YOU DIE, NOT ON MY WATCH!!!”

The Medic99 Crew - Jim, Justin and I

The Medic99 Crew - Jim, Justin and I

In total we did 6 jobs in the 10 hours that we were on shift. Quite a quiet day according to Justin, but it was a great introduction to SFFD. It was a shorter shift than I work back home and it was quieter, but it felt longer and more tiring, due to not being able to get any rest in a station and not having any period of the day when you know that you are not going to be called out, even if it is only for 30 mins.

Justin dropped me off at my hotel as I was moving to a different hotel that night as I was getting sick of not being able to use the Wi-Fi that I had paid for. I quickly packed my stuff and Justin kindly came back after dropping the Ambulance back at the depot so that he could move me over to my new hotel.

I was shattered, and after posting a couple of videos up on the Chronicles of EMS web site, I collapsed into my new bed and went straight off to sleep, wondering what day 2 of my Ambulance shifts would bring………

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Responses

  1. That soup was divine!

  2. One thing to keep in mind is that the US government does insure the elderly (Medicare) and the indigent (Medicaid). Unfortunately, the majority of the system abusers are too sick/stupid/drugged/or indifferent to go through the effort to register.

  3. That soup was divine!

  4. One thing to keep in mind is that the US government does insure the elderly (Medicare) and the indigent (Medicaid). Unfortunately, the majority of the system abusers are too sick/stupid/drugged/or indifferent to go through the effort to register.

  5. “Here was a woman who would not be in this situation if she was in the UK, unless she chooses not to access health care.”Happens more than you might think. I was recently in triage and saw another crew bring in an elderly woman and her slightly less elderly elderly daughter. The nurse asked the EMS crew for her medical history, to which he replied “No idea. She hasn't seen a doctor since the last time she gave birth- 70 years ago!”topv7051 is also exactly right. This woman sounds like she's plenty old enough for Medicare and or Medicaid. She can have all the health care she wants for free. I won't be so bold as to suggest she's to sick/stupid/drugged/or indifferent to register, but her lack of healthcare is not because of her lack of money. Of that I am confident.

  6. Thanks for the information chaps, Im still trying to get my head around how it all works.I wonder though, surely the fact that this lady couldnt access full health care until she was in the category where Medicaid/Medicare kicks in had a huge detrimental effect on her overall health??I would also like to know if the free care that is available to her in her old age would entitle her to a full range of health care, no matter what her problems were or if it would be some sort of reduced coverage?

  7. Thanks for the information chaps, Im still trying to get my head around how it all works.I wonder though, surely the fact that this lady couldnt access full health care until she was in the category where Medicaid/Medicare kicks in had a huge detrimental effect on her overall health??I would also like to know if the free care that is available to her in her old age would entitle her to a full range of health care, no matter what her problems were or if it would be some sort of reduced coverage?

  8. Possibly. No way of knowing, really. Did she have COPD as a younger woman? “I would also like to know if the free care that is available to her in her old age would entitle her to a full range of health care, no matter what her problems were or if it would be some sort of reduced coverage?”When I worked at a private service, we dealt with Medicaid patients all the time, and sometimes we'd actually get jealous- they got the same healthcare we did, but didn't pay a dime for it. All they had to do was find a doctor willing to certify them as “disabled,” due to mental or physical issues, and they were set for life. They could collect Social Security as their income, get Medicaid for their healthcare, and they never had to work another day or contribute to society in any way. It's a whole different level of system abuser- people who realized that all they have to do is convince someone that they're “depressed” or have “chronic back pain,” and they get the world handed to them for life. Meanwhile, I was making $10 an hour and paying $35 a week for health insurance with copays. They weren't paying a dime out of pocket. Meanwhile, folks like this poor woman are sitting in their apartments wasting away. So to finally answer your question, yes- Medicare and Medicaid patients receive the full measure of care available to them, including preventative and primary care, for almost nothing. Medicaid patients have it the best (whether they deserve it or not….), Medicare patients will often have a supplemental private insurance to cover what Medicare falls short on (unfortunately I couldn't give you examples). I'm pretty sure there are many low-cost insurances available from organizations like AARP that are affordable (or at least, designed to be) for people on Social Security.

  9. Possibly. No way of knowing, really. Did she have COPD as a younger woman? “I would also like to know if the free care that is available to her in her old age would entitle her to a full range of health care, no matter what her problems were or if it would be some sort of reduced coverage?”When I worked at a private service, we dealt with Medicaid patients all the time, and sometimes we'd actually get jealous- they got the same healthcare we did, but didn't pay a dime for it. All they had to do was find a doctor willing to certify them as “disabled,” due to mental or physical issues, and they were set for life. They could collect Social Security as their income, get Medicaid for their healthcare, and they never had to work another day or contribute to society in any way. It's a whole different level of system abuser- people who realized that all they have to do is convince someone that they're “depressed” or have “chronic back pain,” and they get the world handed to them for life. Meanwhile, I was making $10 an hour and paying $35 a week for health insurance with copays. They weren't paying a dime out of pocket. Meanwhile, folks like this poor woman are sitting in their apartments wasting away. So to finally answer your question, yes- Medicare and Medicaid patients receive the full measure of care available to them, including preventative and primary care, for almost nothing. Medicaid patients have it the best (whether they deserve it or not….), Medicare patients will often have a supplemental private insurance to cover what Medicare falls short on (unfortunately I couldn't give you examples). I'm pretty sure there are many low-cost insurances available from organizations like AARP that are affordable (or at least, designed to be) for people on Social Security.

  10. Possibly. No way of knowing, really. Did she have COPD as a younger woman? “I would also like to know if the free care that is available to her in her old age would entitle her to a full range of health care, no matter what her problems were or if it would be some sort of reduced coverage?”When I worked at a private service, we dealt with Medicaid patients all the time, and sometimes we'd actually get jealous- they got the same healthcare we did, but didn't pay a dime for it. All they had to do was find a doctor willing to certify them as “disabled,” due to mental or physical issues, and they were set for life. They could collect Social Security as their income, get Medicaid for their healthcare, and they never had to work another day or contribute to society in any way. It's a whole different level of system abuser- people who realized that all they have to do is convince someone that they're “depressed” or have “chronic back pain,” and they get the world handed to them for life. Meanwhile, I was making $10 an hour and paying $35 a week for health insurance with copays. They weren't paying a dime out of pocket. Meanwhile, folks like this poor woman are sitting in their apartments wasting away. So to finally answer your question, yes- Medicare and Medicaid patients receive the full measure of care available to them, including preventative and primary care, for almost nothing. Medicaid patients have it the best (whether they deserve it or not….), Medicare patients will often have a supplemental private insurance to cover what Medicare falls short on (unfortunately I couldn't give you examples). I'm pretty sure there are many low-cost insurances available from organizations like AARP that are affordable (or at least, designed to be) for people on Social Security.

  11. Possibly. No way of knowing, really. Did she have COPD as a younger woman? “I would also like to know if the free care that is available to her in her old age would entitle her to a full range of health care, no matter what her problems were or if it would be some sort of reduced coverage?”When I worked at a private service, we dealt with Medicaid patients all the time, and sometimes we'd actually get jealous- they got the same healthcare we did, but didn't pay a dime for it. All they had to do was find a doctor willing to certify them as “disabled,” due to mental or physical issues, and they were set for life. They could collect Social Security as their income, get Medicaid for their healthcare, and they never had to work another day or contribute to society in any way. It's a whole different level of system abuser- people who realized that all they have to do is convince someone that they're “depressed” or have “chronic back pain,” and they get the world handed to them for life. Meanwhile, I was making $10 an hour and paying $35 a week for health insurance with copays. They weren't paying a dime out of pocket. Meanwhile, folks like this poor woman are sitting in their apartments wasting away. So to finally answer your question, yes- Medicare and Medicaid patients receive the full measure of care available to them, including preventative and primary care, for almost nothing. Medicaid patients have it the best (whether they deserve it or not….), Medicare patients will often have a supplemental private insurance to cover what Medicare falls short on (unfortunately I couldn't give you examples). I'm pretty sure there are many low-cost insurances available from organizations like AARP that are affordable (or at least, designed to be) for people on Social Security.


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