Monday, November 17, 2014

THE AMBULANCE


My work in the Emergency Department involves meeting and interacting with many ‘Ambulance Doctors’ on a daily basis who come to transfer patients from some medical facility to our tertiary care hospital. Here is a report of my observation over the years. (Trust me every word of it is true and from real life scenarios)

1) Most ambulances always drive with their sirens on even if there is no patient inside. You will seldom come across an ambulance moving at a normal driving speed. While few motorists use this opportunity to drive bumper to bumper with the ambulance to beat the traffic (I do that often :p), I've seen young crack heads trying a stint of street racing with the ambulance too.

2) MOST doctors that are hired in this ‘money minting’ ambulance business are BUMS, BAMS and BHMS ie. Ayurvedic and Homeopathy ‘Doctors’ who have no/very little knowledge of modern medicines they use during the journey.
Note: There are centers across the country running a 6 month PGDEMS (Post Graduate Diploma in Emergency Medical Services) course that makes it easier for them to get jobs in such ambulances and a license to kill (Wow…they become qualified Emergency Physicians...why will MBBS people persue a 3 year MD/DNB Emergency Medicine degree then ?)

3) Their sole aim is to ‘dump an alive patient’ at the receiving hospital. Patients with no recordable blood pressure (but with a pulse), patients who have an oxygen saturation of above 85 % (with or without oxygen) and many such patients with life threatening vitals are STABLE FOR THEM. The vital parameters of the patient (Pulse, Blood Pressure, Saturation and Respiratory rate) are always stable during the journey, as reported by them and change as soon as the patient enters the hospital door, when we measure them.

4) One of their primary objectives is to get their hands back on the ‘patient transferring sheet’, (the one used to shift patients from their stretcher to the hospital bed). They make the uncomfortable patient roll right and left as soon as the patient is brought in (arre chain ki saans toh lene do patient ko). The doctor too is more interested in helping his attendants pull it out than briefing us what is wrong with the patient in the 1st place. The money can wait for 15 minutes, but the patient transferring sheet is the real treasure.

5) The oxygen mask used for patients during transit is reused for an unlimited time till the elastic straps on the side of the mask become loose or break. Even if they bring a patient with TB or pneumonia, they always want the mask back, as it’s the only one they have. (My hospital infection control nurse would surely kill them!!)

6) With the dressing sense and grooming of a few ambulance doctors, it can at times become difficult for us to recognize the doctor among the 3 people who wheel the patient in (the ambulance driver, the attendant and the real ‘fake’ doctor) until we see a stethoscope hanging in 1 someone’s neck.

7) The accompanying doctor’s are exceptionally good with ONLY 2 drugs.a) Dopamine – to increase the blood pressure. b) Nitroglycerine (NTG) to make the blood pressure fall.

Depending on what the reading shows on the monitor in the moving ambulance, they don’t even bother to manually check the BP and play with the infusion rates as they like.

8) Any patient who is irritated, non cooperative, moving about, there is a high probability that he/she will be injected with Midazolam/ Fortwin and Phenagan which puts the patient to a good sleep. The relatives feel that the doctor has done something, the doctor feel that the journey will now be uneventful. But the catch here is that with a wrong extra dosing, the patient can go into respiratory arrest developing hypoxia and carbon dioxide narcosis. Next step: Intubation in a moving ambulance --- damaged vocal cords --- a bathroom singer for life, if the patient survives.

9) Rarely does an ambulance doctor declare a patient dead at home and are more than happy to rush a patient who has been dead for more than 1-2 hours on AMBU (even a layman can tell that when the body is cold, pupils completely dilated, body is stiff- rigor mortis that the person is a goner) giving false hopes to the family of a miraculous recovery or securing a Death Certificate from the hospital the patient is taken to (both of which never happen).

My motive of the above article was not to disrespect any of my fellow medico colleagues, but was to highlight the plight of a very essential and ‘life altering’ (I say altering as it really can change the outcome of the patient, the future of the family members) service - The Ambulance.

It really is disappointing to see such practice and I really wish we could have better standards of care one day and may be an EMS services like 911 in our country too.

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