Location: SEMS HQ
Time: 8:21 Tuesday
Conditions: Cool and misty
Equipment: fully stocked
Dispatch
You’ve just finished checking out the truck, stocking a few items, and — feeling plucky — are starting to think about maybe washing it. Fortunately, you’re spared the trouble of trying to convince Steve this is a clever idea when the radio on your shoulder crackles… (click for audio)
[Ambulance 61, priority 1 to 1100 Massachusetts Avenue… 1100 Mass Ave, the City Heights building, apartment 709, welfare check. Third party caller reports no contact from the occupant for several days. Engine 2 is responding. A61?]
- Click to expand
Response
Ah well. Steve pulls out the truck, and you shut the garage door and slide into the passenger seat. “The people need us!” you exclaim.
“Grrrmpph,” he replies. He’s only made it a couple of fingers deep into his coffee.
1100 Mass Ave is one of the largest apartment buildings in the city, built a few years ago and quickly occupied with a mixture of regular folks and a substantial elderly population. You arrive just a moment behind the engine and park in the substantial off-street lot.
Just in case, you go through the usual ritual — piling the oxygen, first-in bag, and AED onto the stretcher, although you don’t plan or expect to use any of it. You catch the fire company outside the elevator as the doors open; it’s pretty big inside, but not big enough to fit five people and a stretcher, so the lieutenant says: “We’ll meet you there” and heads for the stairs.
On the seventh floor, you follow signs to the right and roll down the hall until you reach 709. Fire shows up at the end of the hall as you park the stretcher and knock three times on the door.
Scene
You all stand around for a bit waiting, but there’s no response. You try again, this time using the buzzer mounted to the door. No answer.
You’re lifting your hand to try one more time when the door suddenly opens.
Initial Assessment
Standing in front of you is an elderly male, perhaps in his 70s or thereabouts, who appears somewhat frail but generally well. He’s breathing with slight labor and his back is a little hunched, but his eyes are bright and are staring at you piercingly.
“What!” he exclaims.
“Ah… hi,” you say. “I’m Sam from the ambulance. Are you doing okay?”
“Yeah I’m okay! What do you want?”
“We got a call from someone who was worried because they haven’t heard from you in a few days. They asked us to come check in and make sure you’re doing all right.”
“You… who called you? Sarah?”
“I’m not sure.”
There’s a pause. “Soo…” you lead in. “No problems here?”
“No!”
“I believe we were called because someone was having trouble getting in touch with you. Is your phone working?”
“No!”
“Ah… okay. What’s wrong with it?”
“Don’t know. Dials fine, but the ringer won’t ring. Still blinks a light, but unless I’m staring at it I miss it.”
“Okay, well, maybe touch base with your family and friends so they don’t think you’ve disappeared.”
Peering around him, you see a small but neat apartment. With this sort of thing you always have a vague thought that there might be a dude with a gun waiting in the closet for you to leave, but that seems like a stretch. The gentleman here seems entirely undistressed and about as you’d expect to have five manly men suddenly appearing on his stoop.
“All right then, we’ll get out of your hair. Is there anything else we can do for you?”
“Nah, thank you. You boys stay safe now.”
He shuts the door, and you all exchange a few glances. “Compelling stuff.” You start retracing your steps.
Outside, you wave to Engine 2 and load the bags back into the truck, then take a moment to stretch your legs and crack your back before hopping back in. Steve clicks the radio. “Ops, 61.”
“Go ahead.”
“We’re going to be clear, no need for EMS. Good intent call.”
“Copy, you’re clear. Take the Charlie post.”
“Charlie.”
Discussion
Diagnosis: none
A not-infrequent cause for 911 responses is when a person calls on behalf of a third party, such as a friend or family member, due to concern for whatever reason. Sometimes it’s a motorist or passer-by who sees a person sleeping on the sidewalk, stumbling around, or involved in an MVA. Sometimes it’s a family member who has reason to believe the party has a complaint (such as a phone call expressing suicidal intent, with no further contact). But often it’s a neighbor or someone similar who simply hasn’t seen or heard from Mr. Jones in a while — perhaps his newspapers are piling up, or there’s a funny smell from his apartment — and wants somebody to check on him.
Sometimes, the result is someone who’s been stuck on the floor, unable to move for two days — or dead. But often they’ve simply been lying low, perhaps due to a marathon of As the World Turns. We should take care to ensure that there’s not only no medical complaint, including altered mental status or something insidious like “weakness” preventing their usual activities. But we should also consider social factors, because someone who can’t take in their mail or answer their phone may be someone with either an acute or a chronic inability to care for themselves. Although the ED is not really where these people need to go (and they’re usually reluctant to do so), from there, hospital staff can usually engage with the necessary social services in a way that’s tricky to do in the field. In severe cases, we may need to notify a state elder services agency or the like.
If there’s truly no complaint, then there’s no patient, and in most areas it’s acceptable to call it nothing done — “no need for EMS,” “unfounded,” “good intent,” or the like — and go on our way. This differs from a patient refusal, where there’s a medical or traumatic complaint — and if somebody called on their own behalf, there’s usually some complaint — yet the patient doesn’t want to go. Some services may still want a patient signature refusing transport on these, for a general reduction in liability, but it can be a bit ridiculous (“please just go away, I’m napping”); if you’re careful when you apply it, and perhaps document the circumstances briefly, there should be minimal risk.
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