Saturday, February 17, 2007

The Politics and Red Tape of Paramedics

Riding along with the paramedics was indeed thrilling, though at about 11:00 am on the day of my ridealong, that would've been a hard sell.

"My friends think this job is all blood and guts," said Jim, the paramedic I was shadowing. It was funny because we were in our second hour of waiting around at a hospital. If there are no beds in the emergency ward for the patients that paramedics bring, then there is no nursing coverage for those patients, so the paramedics are required to stand around and wait at the hospital. "At some hospitals, there will be an ambulance crew standing around for entire shifts." This pulls ambulances off the roads, and if someone needs help, the nearest ambulance is then called in. "Nearest" is used loosely - the next community over may be fifty kilometers away.

I got another glimpse into the red tape tangle that is the ambulance service. While there are transfer ambulances, glorified taxicabs dedicated specifically to transfer patients who can't get a ride on their own to get simple tests done, (ie. patients in nursing homes and the like), there aren't enough of those cars, so the load invariably spills over into the lap of the paramedics who are trained to save lives. Some provinces / regions have private transfer ambulances but apparently we don't. This means that instead of being able to respond to a call within minutes, the paramedics are taking Papa to his stomach ultrasound. Well, I shouldn't make generalizations; it's not all old people that are transferred. One of the people we transferred was a young man of about 35. He was involved in a car accident years ago, and had no family or insurance to really take care of him. So, he spends his days in a nursing home surrounded by geriatrics, paralyzed, unable to get out of bed on his own or do anything for himself. My heart went out to him.

At one point the paramedics told me, "When you're a doctor, don't order an ambulance for people who clearly don't need it." Doctors apparently have this power. The paramedics were getting pretty frustrated taking this old woman home from the ER who clearly could have just gone in a cab. I could see their annoyance... they could've been out doing a real call instead of playing cabbie. "I thought taxicabs were supposed to be yellow," I joked.

The best example of red tape, which had the paramedics I was shadowing hopping mad, was the time we dropped off a patient at a hospital for a test. When we pulled in, there were 4 other ambulances plus a supervisor car. "Is there something going at St. Sickkus Hospital that we should know about?" radioed in the driver. Turns out the hospital was closing down the ward, so they brought a bunch of ambulances to bring the patients out. Eight paramedics and a supervisor milling about waiting to be told which patients they would take. It turned out there were only eight patients in that ward. "They could've just double-stretchered and gotten the transfers done in one trip."

The politics don't end at paramedics, though; I've got some good times to look forward to, apparently. My friend shadowed in the ER the other day and told me that they had a patient who was bleeding from his rectum after his surgery. The ER docs called surgery, who sent down their first-year resident - a doctor of, oh, perhaps six months - to deal with the problem. Surprise surprise, he had no idea. He suggested they call GI. "Not my problem," said the GI doc, and wouldn't show up. "Call internal" somebody suggested - no dice. Frantic, they called trauma surgery as a last resort, and pretty much got laughed at as they tried to advocate for the patient and explain how this could be considered trauma. The ER doctor ended up having to deal with the situation on his own.

But I suppose every job is like that. I interned in an office where you couldn't go elsewhere for your graphic design needs because everything had to have a uniform look, but then again, the graphic design department there took weeks to get even a simple invitation or notice done. People caught wind of my knack for composition and I started getting a lot of requests to help other departments with their design needs. The funniest part was having to be discreet about it. Can't let the designers catch on. Don't want to get a talking-to.

You think I would have learned my lesson working in one office... perhaps I haven't. In a feeble attempt to figure out what I want to do this summer, I put in an application this week to work for the national medical association as an intern. I have a funny feeling that such a job just might end up being laden with politics as well.


SuperStenoGirl said...

Unfortunately, no matter what job you go into there's going to be politics. From burger flipper to gas jockey there's always politics it's a most unfortunate fact of life. Although some jobs have less than others.

Helen said...

I guess politics is pretty much unavoidable. I think it's a good thing you'er shadowing paramedics, so when you're a doctor you can see the other side of the story. Not just 'Get this patient out of my way so I can get back to work!' but ctually considering the millions of things that an ambulance is needed for.

You seem to really care about patients, I think you'll be an awesome doctor!

Rory said...

ems is a messy conglomeration of firefighters forced to be medics by their departments (these folks subsequently hate ems work and their patient care duties), very very smart medics whom i would trust my life with over an EM resident any day of the week, and then the plain old dumb people who managed to bumble their way through paramedic school. i don't envy the physician who has to discern which is which at 3am...

take care, best of luck.

Anonymous said...

Just another reason for privatization.