One afternoon, a nice 95-year-old man came in, referred by his physician, for new-onset A-fib. With him were two people: a neighbor and a coworker. Yes, this man was still working. At 95, he was working as a law consultant. He was very sweet and funny.
Through the course of the afternoon and evening it became apparent that he would be admitted to telemetry. Finally, at about ten pm, the two people at his bedside decided that they had to go home. I happened to be in the room at the time (thank goodness). The next-door neighbor said, "Don't worry, I'll look in on Vera for you."
"Who is Vera?" I asked. "Your cat?"
No. Vera was his slightly demented, frail, 97-year-old wife. She was okay to be left alone for a few hours during the day, but she tended to sundown at night.
I told the patient and his visitors that I didn't feel comfortable with leaving Vera alone all night by herself, even though the neighbor said that he would look in on her every hour during the night. I felt that Vera might even be alarmed if she saw a strange man in her apartment, or woke to find her husband not there, and that she might try to leave to look for him, or fall and break something, or otherwise injure herself. The couple had no children and no one who could come and stay with her.
I called the nursing supervisor and talked to the ER attending, and they agreed with me that we needed a social admit for Vera. She could even stay in her husband's room with him. I told the neighbor and coworker the plan, and that they needed to bring Vera back to the hospital.
About an hour and a half later, I got a frantic phone call from the coworker. She said that she had called EMS and that they were refusing to transport Vera; that one of the EMTs there said that they had no obligation to take Vera to our hospital, and that if he DID transport her it would be to Scary Ghetto Hospital a mile away. I told her to put him on the phone.
He SCREAMED at me about this being ambulance abuse. HOW DARE I tell this lady to call EMS for MERE TRANSPORT (which I didn't--I assumed she would call a car service or something). He DEMANDED the name of my supervisor and my name, which I cheerfully gave him, and said, "Are you refusing to transport? Will you transport her later when she falls and breaks her hip? I know for a fact that if you had been called to transport her husband [he was a walk-in] that you would have brought her along for the ride because she can't be left alone."
He hemmed and hawed and mumbled something about telling his supervisor, and then hung up.
I relayed the situation to the nursing supervisor and to our ER attending, who happens to be the director of our EMS training program. His eyes bugged out a little and he said, quietly, "Send him to me when they get here."
Minutes later, the ambulance showed up. They were walking in this little, tottering old lady. Even 17-year-old "I vomited once yesterday" cases get wheelchairs. Our attending leaped up, got a chair for the lady, and redirected the EMS guy while his partner wheeled her up to be triaged. He rolled his eyes and apologized for his partner.
The reunion of the couple was very sweet. "Vera!" said the elderly man. "I missed you! Now we can talk before we go to bed, just like every night!" She tottered over to his bedside and gave him a kiss. "I'm so happy to see you," she said.
So, did I do the right thing? Or am I a vicious EMS abuser?