Prepare to Defend Yourself ... How to Navigate the Healthcare System and Escape with Your Life

Chapter 3. Ambulances: You Wanna Go where Everybody Knows Your Number

C H A P T E R 3 AMBULANCES YOU WANNA GO WHERE EVERYBODY KNOWS YOUR NUMBER 48 CHAPTER 3 I n the United States it’s a pretty good bet that almost all of us have a somewhat similar expectation when we say, “Get me an ambulance” or “Call 911.” It’s almost like someone saying “I’m in love!” We all recognize the words and what they mean in concept, but the differences in each mind are as unique as the person speaking and the person hearing that phrase. So it is probably useful to start off with a couple of assumptions. The way you enter the healthcare system will have a lot to do with how you are treated, how quickly you are treated, how your medical problem is perceived, and how you will perceive the situation. If your physician or healthcare provider determines that you need a procedure or further evaluation (X-ray, CT scan, MRI, or the dreaded, intrusive ’scoping) after an examination, he or she will likely facilitate the arrangements, and the pace and pressure will be less. Communication and dialogue will be generally optimal, and the experience will be more to your control and liking. If your physician or another healthcare provider determines you are teetering on the yawning maw of death and need emergency care within the next minutes or hours, he or she may call an ambulance, and the pace and pressure of the situation will be very different. Communication and dialogue may be hurried and/or nonexistent, and the experience will be less in your control and probably less enjoyable. Now—and bear with me on this—let’s pretend you have a pet wolverine , ignoring the multiple issues that indicates about judgment. Let’s then suppose you are out walking your pet wolverine so he can get some exercise . You stroll past the hospital and a car backfires, frightening your pet wolverine, who is normally very easygoing. Your wolverine reacts badly, and the result leaves you with a need and a desire to alter the planned walk and head on in to the emergency department (ED) at the hospital. Your physician or healthcare provider’s involvement will be a secondary consideration . Chances are the pace and pressure of the moment will be a lot more accelerated and dynamic, and communication and dialogue with the triage nurse in the ED will probably be much more hurried and direct. (Triage is the process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment.) The experience will be less in your control and, I’m betting, less enjoyable. AMBULANCES 49 Now, if you are at home giving your pet wolverine a bath in the tub and he is having a bad day and acts accordingly, you may be calling 911 or accessing the system through an emergency dispatcher, and your physician or healthcare provider will not be a part of the conversation at all. The pace and pressure will definitely be accelerated and different—and I am going out on a limb here—but I would guess it won’t be in your control at all and will probably be a whole lot less enjoyable for a bunch of reasons. So let’s imagine the conversation goes like this: 911 Operator: This is 911. Do you need fire, police, or ambulance? You: I need an ambulance. 911 Operator: Stay on the line. I am transferring you to EMS. Most people have a pretty good idea about what EMS is. It’s the ambulance service that provides municipal emergency medical transport and associated treatment while en route to the hospital. That is exactly correct yet incredibly nonspecific. And it matters. EMS came into existence in the United States during the Civil War, when extraordinary numbers of combat casualties in the aftermath of battle required transport to field hospitals. It has carried over to the modern era of domestic accident and illness response with significantly different outlays every decade or so. Over the last 30years, EMS has transformed from a patient-retrieval service operated by funeral homes and staffed by inadequately trained crews, to advanced, out-of-hospital healthcare providers , with commensurate stabilizing medications and medical equipment brought to the patient. The education and knowledge expected from EMS have increased greatly as the concept of prehospital patient care has evolved. To keep pace with...