This past week, my partner and I were dispatched through EMS on a call to assist a patient who could not get up off the floor after sliding off the bed. We call this a “lift assist”, and normally this call will be classified as a refusal for treatment and transport. The patient is not charged for this type of assistance. We help them up, check their vital signs, and get a signature. That’s it.
It was at the end of our 4 AM to 4 PM shift, around 3:35 PM. We had just wrapped up a “run” at one of two local hospitals and were en route to the station, when dispatch broke through with the call. We were on that side of town, so it made sense to send us over to the private residence where this woman had apparent weakness, tried to get up out of bed, and fell to the floor.
Dispatch is pretty good about screening callers about the situation. Typically, we do a lot of transfers from hospital-to-hospital or hospital-to-rehab (nursing homes). We do the occasional hospital-to-home. And, yes, we also run 911 emergencies. On those type of calls, we also get pertinent information regarding the patient’s COVID status.
If a patient has been in the hospital, there will always be a COVID screening. So, the information gets transferred to our dispatch laptop in the ambulance. This will read something like “Covid neg” or “Covid -”. Usually, we also get “negative Covid symptoms”.
On this particular call, we got nothing. Nada. Zero. Zilch. Dispatch has not screened for Covid even though we are heading into possibly hostile territory.
We show up and gain access through the front door via someone in the house, a male in his late 50’s. He and his wife are inside the house with our fall patient in the bedroom. He states that he doesn’t have the strength to lift her up. All are unmasked except my partner and me.
The patient is lying on the floor and explains her situation. My paramedic partner is asking questions to determine injuries.
She appears out of breath but she is resting on the floor. We get under each arm and plan to lift her up. She is to use her own leg strength (what little she has) to help at least stand so we can pivot her hips onto her bed.
The more energy she exerts, the more she starts coughing… not just a polite dainty cough, no, she sounds like a mix between a walrus and a dog barking. I turn my head to try to escape the violence of this cough of hers.
Yes, I’m vaccinated, proudly. And, yes, I at least have a surgical mask on.
We get her sitting on the side of the bed and help her with her legs and feet to a supine position. She continues to hack and gasp for her.
“This damn Covid is going to kill me,” she reports. Thanks dispatch… Thanks for the heads up.
She says she just got out of the hospital. “How long were you there,” I asked. She replies, “Three weeks. And my husband is still in there.”
There is a CPAP machine at her bedside, and my partner asks if she wants to put it on. In between red-faced coughing into the open atmosphere, she says, “No, I’ll put it on later.”
So, we check her vitals, and I’m fully regretting even coming in to work today.
BP checks out okay, a little high. Respirations are around 22, to be expected in this case. Pulse normal. Oxygen saturation is 81%.
So, your oxygen saturation normal levels (normally healthy individual) should run between 94–100%.
If we get you in the back of the ambulance, we will titrate oxygen through the nasal cannula at 2 to 6 liters per minute (LPM) to get you to a minimum 94%. If this level of oxygen flow doesn’t cut it, we move up to the non-rebreather mask with a higher concentration of oxygen, and push up to 15 LPM through the mask that is sealed to your face.
At 75% O2 saturation, you have a sense of impending doom… that feeling that you are going to die… that feeling as though you are drowning because of lack of oxygen. She was at 81%.
“Ma’am, would you like to go to the hospital?” my partner asks, bypassing our normal response of “sign hear for refusal of transport to the hospital.”
“No, they sent me home, and there’s nothing else they can do for me,” she says.
We are out of the house after getting her signature, and I’m pissed.
Pissed at dispatch for not screening. Pissed at this woman for not even attempting to cover her face prior to or during our arrival. Pissed at myself for not putting on the N95 mask instead of that surgical mask.
I’d rather not get a COVID-cough-to-the-face if I can help it.
These people, I swear, have no sense of protecting themselves or others.
