The Back of the Medic

Things are getting busy again, EMS-wise. Been working A LOT lately, especially as mountain biking season is really here. People are getting on their bikes again, ready or not, and having fun in the hills riding around at MTB races. Its great to see! Problem is, mistakes happen, riders crash, and we are there to find them, stabilize their injuries, and then either have them transported by a nearby agency or provider, or they go to the hospital themselves sometimes. Then there are those who won’t go no matter what. Yes, they are hurt, but they will self-treat.

Last weekend, I saw both of the first two types of patients. Had a patient with an injury from a bike crash that I felt really needed transport to the hospital by ambulance, but he “AMA’d” (Against Medical Advise) on me. Basically, we have a document that explains that we feel he should be transported, but that he declined, knowing it could cause worsening injury or illness. It happens. And it is his right to do so. I had no reason to believe that he was not able to make his own decisions at that time. I did let him know that if things got worse, he could still be transported. He went to the E.R. with a family member driving.

The other was also a bike crash, but in this case, due to his injuries, I assumed control of this patient. In essence, he didn’t have a choice about going. Certain criteria, such as a positive loss of consciousness, or being under the age of 18, among others, allow us to make decisions for a patient. He wasn’t in a position to argue, unlike my first patient. We stabilized him, and transferred care to the transporting ambulance service, who delivered him to the hospital for further emergency care.

The third type of patient is one that causes me some angst. Many times, I know they don’t have insurance, and really cannot afford to get seen, yet they need to be. I’ve seen some self-treat HIGHLY SUSPECTED fractures. As an adult, they have this right, unless I have cause to make decisions for them. It still leaves me with an uneasy feeling when it happens. Sometimes, even weeks later, I manage to convince them they need to be seen. With the type of EMS I provide, I see many of my patients at multiple events (and yes, even treat them multiple times… we have our own “frequent flyer” (no pun intended) club of sorts. So, frequently, I get followup on many of my patients, either through them, or friends who are racing with them. I have to admit, its odd being on a first name basis with a lot of them. But a good sort of odd.

So, a question for you… Do your patients who AMA or self-treat get you thinking, and yes, worrying? Or do you put it out of your mind once you are done?