Can-Do People

EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. 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. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right experts and share their advice with you. E-mail ideas to Nancy.Perry@cygnusb2b.com.

     It's Saturday morning when you're called to the street-level apartment of Mildred, a 500-lb. woman, whose motorized extra-wide lift chair has failed mechanically, costing her control of her body position. She spends nearly all of her life in this chair, so it's a critical issue for her.
     Mildred has a live-in caretaker, who obviously isn't a clean freak. There are spots all over the carpet and other fabrics, and, although there are no pronounced odors, the place is in general disarray. She's on home oxygen, but she is having trouble breathing and is experiencing pain in her legs, which are grossly swollen, purple and extremely sensitive to physical contact. Because of the disabled chair's forward tilt, she is struggling to remain seated in it. It won't elevate her lower extremities. Normally, its seat lifts her into a standing position so she can use her walker to get to the bathroom. That's not working, either.
     Mildred's brother came by last night to see if he could fix the chair and told her the frame is "all busted up." She says she called the furniture company that donated the chair through the Red Cross, and they instructed her to call the Red Cross. The Red Cross told her to call Medicaid, and Medicaid told her to call somebody else. Mildred adamantly refuses transport, and you detect a note of fear when she says so. She has no money for a new chair, and she is hoping you can fix the one she has.

     Q. What are we supposed to do? This is obviously not a medical emergency, and she doesn't want transport to a hospital.
     A. Our job is getting bigger all the time. More and more, we're becoming the go-to people in situations just like this, when other systems fail and people's problems get too big for them. Some just don't have anyone to turn to short of a 9-1-1 dispatcher. And dispatch sent you. As for the medical part, this lady's whole body is a medical emergency. Better get on the phone, eh?

     You call everyone you can think of. The furniture company where the chair originated has a new one in stock, but as soon as you say the patient has no money, the voice on the phone refers you to a corporate office--which is closed on Saturday. You try rentals, medical supplies, Medicare, Medicaid, her physician's office, a bariatric transport service and the county's office of adult protective services. If they're not closed for the weekend, they're all sure this is somebody else's problem.

     Q. What about fixing the chair? Maybe it's something simple.
     A. Good question. Here's what really happened in this case.

It's not simple. You seat the patient on her commode temporarily and turn the chair on its side. The hardwood frame is broken in two places. You contact an off-duty crew member who lives nearby, and he brings tools to help you. You cut the upholstery and work for two hours to clamp, bolt and glue the frame back together. You get her back in the chair, and, despite some ominous creaking noises, it works.

     Q. Isn't there some kind of legal liability for altering a chair like this? If it fails, aren't you likely to get sued or something?
     A. For some of us, legal liability is an excuse we make when we don't want to help people. The truth is, you're much less likely to get sued for helping people than for not helping them when it's your job to try.

     Q. Obviously, this lady's problems are much bigger than your temporary repairs to her chair. How do you make sure she gets the ongoing help she needs?
     A. Unless Mildred is incapable of thinking for herself or making phone calls, she needs to take some responsibility for her situation. Every community is different, but, chances are, there is a list of folks who can help her during business hours. Her primary care physician is right at the top of that list, and so are her next of kin.

     Make sure she knows that your repairs are only temporary and the chair is going to fail again. Encourage her to act in her own behalf before it does. Then do something not many EMS agencies ever do: Visit her again in a few days to see how she's doing.

Thom Dick has been involved in EMS for 37 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.