This may be controversial, but I would like to suggest adding appropriate use of emergency medical services to our list of patient education topics. We make jokes about “cabulances” and mutter darkly to ourselves about patients arriving by ambulance to the ER for blisters on their feet caused by too-tight shoes (seriously), but misuse of EMS is actually a serious problem.
Scenario: person A feels sick. He has had a fever and cough for a few days. He doesn’t have a car and doesn’t feel well enough to walk to the urgent care center near his house. He does not have health insurance. He has taken no over-the-counter medications for his symptoms (a week of flu medication costs about the same as a pack of cigarettes).
Person B has been working in the yard all afternoon and ignoring his steadily increasing chest pain. He doesn’t like hospitals and isn’t the type to admit it when he’s in pain. He has good health insurance through his job but rarely uses it and doesn’t want to. He takes a few Tums and goes back to his yard work.
Both people live in the radius served by one EMS unit.
Person A decides he needs to go to the ER. He’s been sick for a few days, after all. He calls 911. Twenty minutes later, person B’s wife sees him crumple in the yard. She calls 911.
There is one ambulance for two patients. Both have called 911, which should mean that they believe they’re having a medical emergency. The ambulance has probably reached person A already by the time they get the call about person B.
The EMS system will now disintegrate. The paramedics have begun to treat and transport a person with a cold or maybe even the flu, and therefore they cannot respond to a person who has just had a massive myocardial infarction and collapsed, unconscious. Another nearby unit may be able to respond, thus robbing Peter to pay Paul, but then local resources will be stretched even tighter. What if a third person, in either of the two areas served by the two units, has a legitimate emergency? Will yet another unit have to abandon its area to bail out the others?
This scenario happens hundreds of times a week all over the country. People do not stop to think that if they are using an ambulance, no one else can. Also, people who have insurance that will pay for the ambulance transport are the people who don’t want to call an ambulance. They will drive across town barely able to breathe rather than call EMS. In contrast, people without insurance who have no intention of paying the bill are quick to call. I have asked patients out of curiosity why they called an ambulance for their visit to the ER and been repeatedly told “I didn’t have enough money for a cab.”
Education is, then, required from two directions. One is for people who misuse emergency resources, and the other is for people who should be using emergency resources but don’t.
This second group needs to consider things such as traffic delays when they think they can get to the hospital faster without waiting for an ambulance. There is also the safety of others to think about; heart attacks, strokes, and many other serious conditions can cause a driver to lose consciousness and lead to a crash.
Check out the information at http://www.whentocall911.com. I think nurses should take this education seriously. It is difficult to approach the subject because it can be a sensitive issue, but it is nevertheless important.