Another of Kyle's Paramedic ride-a-long experiences. He has to write this mini paper for his ParamedicSchool. And as usual I edited it, so I figured I could steal it! I hope he does not care. I like hearing about all of his amazing experiences and watching his face light up with excitement as he shares them with me. We are on a interesting journey we never thought we would have, but we are enjoying it and all the mountains we are climbing to get to where we want to be. Enjoy. He wrote this very quickly, so it is not his best work, but it is great to read!
The pre hospital setting can be a scary place for a paramedic. To give good patient care and stay safe while making thoughtful decisions can be very intimidating, to say the least. There was a specific call that I had on one of my ride alongs that opened my eyes to a whole new side of para-medicine. Not because it was bloody, gory or overly exciting, but because it involved a very important, split second decision.
We arrived on scene to a gas station at about 2 am. Fire and PD were on the scene. There appeared to be only one patient with two other bystanders being questioned by the PD. The patient was standing with the fire fighter who was holding a manual c-spine. Every few seconds the patient would start to squirm and try to get away. The fire fighter would calm him and let him know he needed to hold still for his safety. It turns out that the patient was struck in the back of the head and hit his face on a car before hitting the ground and losing consciousness. The patient was not being cooperative and did not want to go to the hospital. “Who’s gonna pay my hospital bills!” He yelled over and over again. The paramedics tried to explain to him that he could have something seriously wrong with him and it would be foolish to worry about the money. It sounded to me as though this patient, being in his late twenties, was going to AMA. I was wrong. The paramedic began to ask orientation questions. “What is your name?” The patient answered correctly. “What city are we in?” “uuuuuuuuum, uuuuuuuuum San Diego?” The patient answered slowly and with confusion. The paramedic looked at me with a half smile and asked the last question. “What year is it?” “I don’t know.” answered the patient. Apparently, that was all the medics needed to hear. No one said a word. The medics looked at the firefighters as though they were all thinking the same thing. “ This guy is altered and can’t make decisions for himself.” With 2 firefighters and 2 medics the patient was carefully forced to the gurney. He was extremely upset, to put it lightly. Lucky for us, the patient was calmed during transport and ended up being more pleasant then a problem.
The idea of using force to make someone go to the hospital is new to me. I felt like we were taking away someone’s right to refuse care. Having said that, I do understand that this man had serious neurological deficits that could cause very long term damage. The paramedics had three facts to base their decision on. This patient was obviously altered, he had lost consciousness and he had a bleeding laceration to his forehead with a hematoma on the back of his head. When I looked at it with the facts in mind, I quickly changed my view. He needed to go to the hospital and he was in no condition to make that decision for himself at the time.
This was an example of a very important lesson learned on a ride along. This is proof to me of the importance of doing as many ride alongs as possible. If I run into this type of call in the future I will know what to do. With out experiencing this 1st hand before my internship, I don’t think I would have had the confidence to restrain this patient. You can read the protocol book all day but using what it says in the field in split second decisions can be quite intimidating.
