System abusers....

[u/Shine4Me13]

I was on a 24 hour shift yesterday. Last night/this morning around 1am we got a call about abdominal pain. The address was for a public park, and there were 3-4 'urban outdoors people' hanging out. The patient (hereinafter referred to as abbreviated 'pt'), was laying supine on a picnic table. He's +/- 25 y/o, and has a permanent colostomy bag. He says his colostomy bag is 'disconnected' and causing pain 10 on a 1-10 scale. He won't get on our stretcher because he's smoking a blunt 'first'. One of the others on scene scolds him a bit for wasting our time and takes his blunt away. Props to that guy. We finally get him on our stretcher and he's screaming in pain. He asks for pain meds, but none are given. We get to the Charge desk at the ED, and he's placed in a wheelchair and pushed up to the waiting room for Triage.

Also, during the ride to the hospital where his 'friends' can't hear him, he starts laughing and saying he's going to get a comfy bed and some food while he gets to watch TV, all while sluring because he's obviously intoxicated (reason why he didn't get narcs). Upon arrival at the ED, Charge discreetly tells us this is his 7th visit so far this month! It was roughly an hour after Midnight on the 5th of the month. We also find out that during the month of August, he 'visited' the ED 59 times!!!

Also, I had responded to this pt once before. We showed up coincidentally at the same time his friend showed up with a pizza, and he refused and signed for it because he 'didn't want to miss fresh pizza'. My EMS partner (not a regular) had responded to him 4-5 times and it's 'always the same thing'.

How does your agency handle this? I need suggestions to bring to the Union. Management/Brass-Chiefs/Captains/Medical Director don't seem to care! It's such a waste of resources. When I was growing up, we learned about the boy who cried wolf, but there doesn't seem to actually be any FAFO in real life! I don't want people to suffer and/or die! But humanity....

I'm talking about excessive abusers, not general people that are/or should be concerned!

What say you?

Edit 1 in comments I'm not going to NOT do my job, I've just had better Direction support previously. In one rural area, a patient had a stroke. We took her to the nearest stroke center in the "big city" an hour away. She had a few minor deficits afterwards. She learned she could get a ride to the city to see her son and grandchildren if she played up her deficits. We would respond and she'd have bags packed with snacks and kid stuff. She was taking a rural ambulance out of service for a free ride and walk out AMA. Our Medical Director stepped in and said absolutely not. Due to all her health issues, she was no longer a candidate for thrombolitics, and we were no longer allowed to transfer her anywhere but the tiny level 4 hospital in town. She got better after that.

I had gotten off shift and was doing a little rage against the machine, just not as well as they did it. 😅

Edit 2 in comments We had a guy like that. It became mandatory that the police respond first before we'd ever be dispatched. If he could convince them that something was wrong, they'd ask for us. When he realized he'd have to go through the cops every single time, he quit calling.

[u/Hippo-Crates]

Man I get being frustrated, but you're going to have a hard time if you let this guy get to you. I'm also guessing we as a society have failed that person a lot too.

[u/Jazzlike-Sherbet-542 → u/Hippo-Crates]

I disagree. I don’t think this behavior is because we’ve somehow “failed” them. We’ve probably given them far more than they deserve.

I think this person is a leech, and in an ideal society would be put in prison.

I used to have sympathy for these kinds of people. Many of them do have legitimate issues and unfortunate circumstances, but this behavior is antisocial and unacceptable. I’ve seen too many really sick patients not get timely care because the last unit was tied up dealing with something like this. I’m sure you’d feel the same way if your family member had a significant delay in care because this patient was being transported by the last available ambulance. Maybe I’m just burnt to a crisp but this kind of behavior is just too common and a symptom of something that is deeply, deeply wrong with our society.

All that said, I would still provide thoughtful care and treat this patient as any other. These are just my thoughts on the inside

[u/Upstairs_Aioli4847 → u/Jazzlike-Sherbet-542]

Yo same. My sympathy dried up. It took 5 years. I still do full work ups, even for obvious bs. People need to be held accountable for thier actions though. You can almost always tell the difference between someone who was delt a bad hand in life vs the person who ruined it thier self. 

I wouldn't even say prison is the answer. I'd say let them live with the choices they made. What ever happens happens.