Pet Peeves

     EMS Reruns addresses dilemmas in EMS. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     It's your first wake-up, and you're surprised to find yesterday's clear skies have given way to a steady rain. You're responding to an address on a street whose name you really should recognize but don't, so you're leafing through the map as your ambulance rolls out of its bay and into the weather. Your world is all panel lights, the grumbling diesel beneath you and the steady plopping sounds of big raindrops splattering on your clean glass. Your partner, Steve, pauses for a moment before you direct him south, then a moment later, east on Telegraph Canyon. Soon, you're lit and splashing through the night.

     There's an engine on scene at a neat ranch-style home. Brad, the engineer, spots you and exits the front door. He pulls a scoop out of a chute, throws it on your cot, and describes an elderly woman lying on her kitchen floor with a probable broken hip. He wants to warm your scoop in her shower.

     Your exam confirms Brad's suspicion about the lady's hip. Her name is Janice Felix and it turns out she's an old ambulance dispatcher. She remembers tripping and there seems to be no other trauma. Mild traction seems to help, and you give her some fentanyl to ease her pain. Her work experience should make it easy for you to communicate with her but Janice has a Chihuahua named Barney, and right now that dog is the only thing on her mind. Barney is docile, but totally focused on her—gently licking her face, whining, fidgeting and frantically inspecting her body from head to toe. In fact, a couple of times the crew nearly trips in their efforts to avoid stepping on the dog, but she won't be separated from him. Bottom line: She absolutely won't go to the hospital without Barney.

     Steve tries to explain the facts of life to her, but they're clearly not the facts of her life. Nope, she won't go. He's kind at first, but eventually he gets cranky and turns to you. "All yours," he says.

     Q. What do you do with a mutt? More specifically, what do you do when a patient who absolutely must go to a hospital refuses to leave an animal?

     A. Obviously, "no" comes to mind, but don't go right there. Instead, concentrate on alternatives. Is the dog a sole companion? In a patient's mind (especially an elderly patient), an animal that's a sole companion deserves almost the same kind of consideration as a spouse. If you fail to recognize that, you'll just agitate her, and she won't hear a word you say. Whatever you do, make sure you do everything you can to control her pain.

     Q. What do you mean, alternatives?

     A. Find out who is Janice's closest support person. Does she drive herself to the grocery store, or does she rely on someone else? Who is her closest friend next to Barney? Try phrasing your question just that way; it tells her you appreciate her predicament, which may help her to see you as an advocate.

     If there is somebody like that, have a team member call them. Describe the situation, and ask them if they're willing to care for the dog, in Janice's home or theirs. Get a sense for their level of concern and their willingness to help. If they sound like an advocate, put them on the phone with Janice —preferably in speaker mode, so you can all hear the whole conversation. They may be able to negotiate better than you can.

     If you locate someone who can pick Barney up within 24 hours, make sure he has plenty of water and food to last that long, provide Janice with written names and phone numbers for them and for your agency, maybe for you (or another crew member) personally. Let her put those phone numbers in her wallet so she knows where she can physically access them.

     Q. What if she still says no? It happens, and this lady is going to be laid up for a while. The sad truth is, she may never see Barney again, no matter what you do.

     A. Hope that doesn't happen, but it's realistic. Is there a dog person on the crew? Maybe Barney could go in a carry cage as far as the fire station, at least until tomorrow. Perhaps then he could go home with one of you, temporarily. Insist if you must, but negotiate. Don't just think rules and procedures; be creative! If this were easy, anybody could do it. Of course, we both know that's not true.

     Thom Dick has been involved in EMS for 38 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.