Not Lifting

     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 toNancy.Perry@cygnusb2b.com.

     It's 4 a.m. and you've already run 14 transports. You're filling in for someone who called in sick, and you hope you sleep for the rest of the night, but the alarm goes off, and you're on your way again. This time it's an "unknown medical" at the residence of a frequent flyer who typically calls with vague complaints when she gets lonesome.

     Your partner is a veteran paramedic who knows this woman well. He treats her kindly and completes a thorough physical. She complains of dyspnea, but the exam reveals no evidence of distress. There is no accessory muscle use and you see no retractions above, between or below the ribs. The lung sounds are clear. She is expressing spontaneous humor and spontaneous speech at about eight syllables per sentence. The skins and vitals are normal and the ECG is unremarkable. She wants to go to the hospital, nonetheless. Your partner opts to walk her out to the ambulance.

     Q. You're a new paramedic, but it doesn't seem right to walk someone who's short of breath. When you offer to get the cot, your partner politely shakes his head and helps the woman out of her chair. Is this a mistake?
     A. Doesn't sound that way. Once there was a widespread belief in EMS that you shouldn't walk patients who call for ambulances. Unfortunately, most of us who followed that rule have left, many with life-altering injuries. That's just me talking, because in those days nobody cared enough to study EMS injuries-so, there were no studies. But if you question the experienced people in your area, they'll all tell you about fine caregivers they've known who had to stop practicing as a result of back, knee and hip injuries.

     Q. Still it seems like laziness to you. Sick people shouldn't have to walk to ambulances.
     A. Sick people, no. People with non-pleuritic chest pain, people with signs of SOB, people with postural dizziness or other signs of shock, and people with many kinds of injuries should not walk or even stand up. Nor should people who get worse when they stand up, or people who say they can't walk. We're all about helping folks. But you should never do anything you know is stupid. And blindly lifting everybody is stupid. You shouldn't let anybody take your common sense away from you, and you shouldn't risk your well-being for nothing.

     Q. There are some EMSers who would take advantage of that kind of discretion, just out of plain laziness. How do you protect patients from them?
     A. We're all accountable for what we do, but rules don't fix lazy people. If a paramedic decides to walk a patient with the big MI because he's lazy (or, let's face it, simply tired), he'll do it regardless of rules. In a case like that, you would advocate for the patient and insist on bringing in the cot, but that's not the situation we've described here. This is about a woman who appears perfectly able to walk to the ambulance. There's no indication of risk to her if she does. If that becomes evident, the crew can always alter their strategy.

     Q. What risk is there to the crew, just because they opt to carry people rather than walk them? If you stay in good physical shape and you lift properly, you don't get hurt.
     A. Not true, actually. Your flexibility, strength and endurance help you to resist injuries. But the fact remains, our work precludes us from warming up prior to lifting and carrying heavy patients. Even the weight of our cots has doubled in the past 15 years. (Some of the self-lifting ones have more than tripled-an issue that mandates a whole new way of thinking about ambulance cots.)

     Some patients really can walk, and we should consider inviting them to do so. That does presuppose sound ethics and honest accountability to the public, but it's mostly just common sense.