Sunday, December 28, 2008

Top 10 Questions Not to Ask (from our EMS Friends)

I wish I could take credit for this but it is by one of our most astute EMS Colleagues who somehow has survived living in the "Deep South" and is probably too classy to read us anyway..

''Have you given him any Tylenol?'' Of course they haven't given him any Tylenol. If they had given him any Tylenol by the time the ambulance arrived, the patient may no longer have a fever, and then what use would an ambulance be? Don't even ask the question and you'll never have to ponder the merits of forced sterilization, or wonder how some nursing home personnel ever made it out of school.

''How much have you had to drink?'' You know darned well how much they had to drink — two beers. I mean, take a good look. I know the reek of ketoaldehydes on his breath, the vomit stain on his shirt front and the fact that he's wearing Burger King ''Home of the Whopper'' boxers — outside his pants - might lead you to believe he's perhaps imbibed ''tee many martoonis,'' but doesn't he have an honest face? Who are we to disbelieve? Two beers can do that to a person … if each of them came in a keg.

''How fast are we going?'' Honestly, do you really want to know? Suffice it to say that if a) you are over 40, and b) your partner is younger than 25, and c) said partner plans his vacation around Speed Week in Daytona, the answer is not one you want to hear. I asked this question once, in an old gas-burner Ford ambulance on a dark country road. My partner looked down at the speedometer, shrugged and said, ''Beats me. The speedo goes to 85 and I've got it wrapped all the way back around to 10.''In those situations, it's best to just close your eyes, tighten your seatbelt, and pray that your service implements an Allsafe program soon. And perhaps ask your partner to rock you a bit when you get to the call, to break the suction on the seat.

''So, how many of these did you take?'' Well, doesn't it say right there on the bottle? I know that, objectively, the fact that you find the patient licking the dust from inside their Vicodin bottle, even though the prescription was refilled less than a week ago, should have lasted them roughly until the implosion of our sun. But surely there must be some other explanation. If you can wake them up from their stupor long enough to hold a conversation, they'll tell you they're still in extreme pain. Or that their pain specialist doesn't understand them. Or their shiftless nephew stole them all. Or the evil Vicodin Fairy came and took them all back. But they certainly wouldn't take more than 1 tablet, q 12 hours, PRN for pain. That would be unethical, immoral and maybe even fattening.

''So, what did the poop look like?'' Yeah, I know this is a germane question. You want to know if it was melena, or hematochezia or just plain old bloody-streaked poop from chronic hemorrhoids. But invariably, they'll apologetically tell you they already flushed the toilet, and if they don't, do you really want to open the Cool Whip container they so helpfully provided? Better to just get some orthostatic vital signs and let the ER doctor find out what's behind Lid #3. Or if you must know, have your partner open it.

''Do you feel anything out of the ordinary down there?'' Yes, I suppose if the guy complains of groin pain, we'd need to know if the patient has an incarcerated inguinal hernia, if for no other reason than to recognize the need for pain relief and the need for a surgeon. But what do you do if they tell you they're not sure? Because then, you're honor-bound to examine the area in question, and possibly even palpate it. Aside from directly violating EMS Rule #1 (Handle no one's junk but your own), it can also lead to a number of nasty surprises, like the aforementioned hernia, or testicular torsions, or genital warts. Or maybe even the partially absorbed skeleton of his unborn twin. Ignorance is bliss, folks.

''How do you spell that?'' Better to just get a first name, then copy the rest from the face sheet after the ER clerk signs ‘em in. That way, you never have to endure the exasperated eye roll because you didn't know that Chopaquelethia Da'Nae Desdemonaretha Smithe has a silent ''e'' at the end.

''Does anyone have a handcuff key?'' Context is everything here. If it's the prisoner who desperately needs IV access, by all means ask the cop to release the cuffs. But if it's an unconscious man wearing nipple clamps and a leather corset, still handcuffed to the frightened hooker who called 911, some cop is going to have just the type of key needed to free them both. And when that happens, it ruins a perfectly good war story.

''Can you show me your teeth?'' If you're checking for facial droop in a potential CVA patient, a better way is to simply ask the patient to smile. Otherwise, you'll forever be the butt of jokes when the elderly patient obediently points to the bedside table where she keeps her dentures soaking in a water glass.
And the number one question you're better off not asking:''How did that get in there?'' While I understand that we all possess a certain curiosity as to how a Fabergé egg can wind up stuck in someone's rectum, is it worth the mental picture that the truth will conjure, or the aggravation of being lied to? Just accept at face value that some people paint their houses in the nude, leave paintbrushes sticking out of paint cans, and then fall backwards off the stepladder onto that can. Seriously, it could happen to anybody.

Have a nice day


  1. Another one, asked by a doc in the ER,directed to my idiot son," Why would you want to do that?" ("breathe fire" and catch your beard on fire). Next comment was,"Well, I guess you won't be doing that again..."
    Have a Happy New Year OF! And stay away from bathrooms with bad karma.

  2. ROFLMAO may thanks for them the mental images conjured up had me rolling.

  3. I've been in this long enough, and I know you have old fart. I don't even ask anymore. Anything. If it can't be answered with a bevy of tests and visual cues, then it doesn't need to be answered.


  4. Although, if I'm feeling randy, I will ask the drunks or a-holes, in respect to the great Groucho Marx, "When did you stop auto-erotic self asphyxiating?", and then wait for the response. That's always a fun one.

  5. So many truths. But then again, sometimes, I'd actually want to know the answer, teeth and all.

  6. The remark about the name with a silent "e" at the end is hilarious. Best wishes for 2009, with fewer dangerous nocturnal trips to the bathroom ;-)

  7. Hey, as long as you've got a serviceable Carotid Body, a little auto-erotic self asphyxiation never hurt anybody, except that guy from INXS, which is such a shame.....

  8. ok you want to play that game? When EMS brings in a woman in preterm labor who is 25 years old and 24 weeks pregnant. DONT hand me a EKG. I don't need one. DO let the woman urinate. It stops contractions.

    This game goes both ways.... I am forced to ask all kinds of stupid questions because of Jacho. I don't like it either. Just like some EMS folks have a standard of care that says "hey take an EKG on every patient regardless on whether they need it.

    Also EMS be nice and when you do bring in a truama, give the patients license to the secretary. Is that so hard to do? It happens to be very important to identify who the F you brought in....Before I was a nurse I was the poor sap who needed to register that almost dead body you just brought in. It is important. The ER team is going to draw blood. And they prefer not to label the blood with the identification of almost dead guy in the ER. It is just poor form.

    I know, it is a joke. I don't mean to be over reacting. But I treat all the EMS folks who bring in patients with respect. I expect the same back.

  9. Dont ask if they saw their PMD. They will only look at you funny, shocked at the idea of continuity of care, outpatient clinics, having to make an appointment. The PMD is a mythical beast conjured up by ER doctors who don't want to see another viral illness at 4 in the morning on New Years. They don't really exist.

  10. WTF, pinky. What's with the hostility? We will hand you their fucking ID if we have it, if not do your god damn job. We will hand you the EKG if we performed one, and you will take it. Why do they need to pee in the ambulance if they are just going to be at the hospital in all of three seconds? You treat us with respect, we will treat you with respect. You're a bitch, we can beat you at that game, I can guarentee it.

  11. Too classy to read you?

    Au contraire, mon médecin ami!

    I'm so damned low-class, I've got you blogrolled right up there in the sidebar of my blog!

  12. See, I did have a shiftless nephew steal my Vicodin. The only funny part of the situation is when my husband and I were discussing whether I should try to get them replaced. Because of all the doctor blogs I read, I knew no one would believe me! Luckily, the pain was gone and I didn't need them anymore.