“Start Us a 7”

Mar 5, 2015

In my twelve years from Springfield, I heard the words “start us a 7” come over the police scanner more times than I could count. The number seven was the radio code for an ambulance.  Usually what this meant was the cops had found some indigent on the side of the road that they wanted transported to the hospital, or some assault victim who needed a routine transport for a stitch or two.

In a somewhat related incident, a friend shared a conversation that they were privy to that occurred between a fire and EMS dispatcher about a person stuck in the middle of the road in a broken motorized wheelchair.  I am paraphrasing but it went something like this:

Police Dispatcher: “We don’t have any way to move the wheelchair.  This is an EMS matter.”

EMS Dispatcher: “Neither do we.  It looks like a traffic problem to us.”

As always, the outcome was as expected: paramedics responded (eventually. . . it was a busy day) and had to deal with something that was well outside of their scope of practice.  Or how about this one that happened more times than I can count in my career:

You respond to a college campus for the intoxicated student.  On arrival, you find a mildly inebriated individual who is being sent by the campus police because it is the “campus policy” that intoxicated students get transported.  The student is defiant, and they are told by the police officer on scene that they can make a choice “hospital or jail.”  Mr. Defiant decides that he is going to be daring and he chooses jail.

The police officer responds by putting the patient’s hands behind his back and slapping the cuffs on him.  To you and your partner’s surprise though he does not put the patient in the back of his cruiser.  Instead, he marches him straight to the back of your ambulance where he sternly lectures the student, removes the cuffs and sends him off to the ER in your more than capable hands.

I am not saying that these people do not need help.  The problem though is their access point for their desired help, whether it be a turkey sandwich and a cot or rehab, seems to occur via the back of an ambulance.

There has been a paradigm shift in this country.  Being drunk on a street corner, or sleeping on a park bench used to be society’s problem.  With the introduction of a cell phone in every person’s pocket though they can now do their civic duty and dial those three magic numbers: 9-1-1 and make this person somebody else’s problem.  The cops don’t know what to do with them, so the ball rolls further down hill and lands in our laps.  While passing these people around like a hot potato might not be the best ultimate choice, we always seem to get stuck with them.

A number of years ago, the San Francisco Fire Department started a program which allowed them to operate a van to pick up patients like that person on the park bench and transport them to more appropriate facilities like homeless shelters if they were found to have no medical emergency.  The suspected “patients” started to figure out the pattern of what took place when that van rounded the corner, and they would scatter not wanting to deal with where they were about to be dropped.  While successful, the program was eventually eliminated presumably due to it not being adequately funded.

While at EMS Today I heard of another fire department that is currently doing a study where they do substance abuse interventions with patients in the back of the ambulance encouraging them to seek out help, and giving them information about how they can get to that help.  One of the paramedics participating in the study told me that they “feel like they are doing something.”  What used to be a ride to the hospital where you sit on the bench seat staring at a patient that you can do nothing for turned into a meaningful patient contact.

His hope, and mine as well, is that this project blossoms into something more, perhaps something as beneficial as an alternative destination for these patients who probably do not need an emergency room at all.  Who knows, maybe this can be an actual use for first response in a situation outside of cardiac arrest.  The bottom line is we need to get away from the mindset of “We don’t know what to do with them so I guess we will call an ambulance.”

If you are an EMT or paramedic you are a problem solver by nature.  You fix things.  You find solutions.  Maybe that is why they call us so often.  I don’t really know.  We need to find a better answer to this problem.  That does not mean that we turn and dump them on somebody else.  With the addition of community paramedicine, we are trying to take a more rounded approach to how we handle our patients, so maybe this will be another piece of that.

Maybe there will come a time when I won’t hear “start us a 7” over the radio quite as often.  Only time will tell.