Cranky Old Man

      It's so dark out, you can't find what you sit on with both hands. You're in the middle of nowhere, looking for a guy who drove his pickup through a fence and into a power pole. Just when you're about to give up looking, you see flashing lights in the distance. Soon enough, you arrive at a small farmhouse where a sheriff's deputy has a 70-year-old guy sitting on the tailgate of a banged-up '64 Ford. Its tracks say it abruptly veered off of a straight dirt road, jumped a ditch, penetrated a chain-link fence, missed a farmhouse and nailed a power pole. There's no good reason for a mishap here, but it's a holiday weekend and the bars would have closed about 45 minutes prior to your time out. There's one dim light other than what you brought along, and it's 30 feet above you on the other end of the truck.

   The man's only complaint is a briskly bleeding laceration on his anterior left forearm, which he's clamping with a wadded red bandana in his other hand. His skin is a little tachy, he doesn't remember the incident, he doesn't know where he is, and he's worried somebody is going to steal two handguns from the cab of his truck. (Like there's a crowd, right?) He won't tolerate c-spine, he won't lie down, he doesn't want oxygen, he doesn't want to hear about any hospital, and he wants you to get out of his face. He's belligerent about that, he's rambling, and he's angrily insisting that you procure his guns for him.

   You weren't born yesterday, so you ask the deputy for help, and he imposes a legal mental health hold empowering you to restrain the old man, treat him and get him to a hospital. A week later, your chief calls you. There's a smokin' complaint, so long and so detailed its writing probably spanned the whole interval.

   Q. What are we supposed to do? Some people are just dying to show us how stupid they are. Then, when we try to help them, it's all our fault. We were thinking, if we could get this guy on O2, he might not be so cranky and maybe we could communicate with him a little better. But he wasn't having it. We couldn't exactly leave him there. And the last thing we wanted to do was arm him.

   A. I'm the last person on earth who should tell you there are no stupid calls. Some calls you could use to define the term stupidity. But people always do what they do for a reason, and that reason can be the most important thing you need to learn about them during a one-hour encounter. Are they impaired by chemicals? Are they seeing and hearing stuff you don't see and hear (hallucinating)? Are they being pursued by someone? Those are all answers you need to get while you're still on scene.

   Q. Right, but we don't have all night, and this call was outside of our normal response area. You would think, now that the crisis is over, this guy would be a little more reasonable. And now we have a complaint in our files.

   A. Restraint calls generate more complaints than any other kind, especially when the patient is placed under a hold. If your chief is the least bit reasonable, he'll treat this call a lot differently than a typical service complaint. Especially if the guy's letter seems illogical or unreasonable.

   Q. Maybe so, but you know when we get a complaint from a patient, it doesn't look good for us. Better if we just run calls and don't cause trouble, otherwise we're pretty much guilty until proven innocent.

   A. Actually, that's unreasonable. Trouble's your game. If you don't get at least a couple of complaints a year, you've been lucky. Most of the people you meet on calls are in some kind of crisis. If you just stop and think about it, anger is a fairly common response to crisis. Some people lie, some people laugh, some people cry, a few take it in stride, and lots more get mad. Sooner or later a few of those folks who get mad are going to blame their problems on you, no matter how well you treat them. And, you know what?

   That's not your fault.

   Thom Dick has been involved in EMS for 39 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.

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