Regulars

   Like EMS systems, all coffee bars have "regulars"--customers who frequent them often or routinely. (Unlike EMS systems, coffee bars depend on their regulars.) You visit a coffee house in your neighborhood sometimes, and you've come to recognize their regulars.

   Today, there's a guy in the corner reading a two-inch hardbound volume titled Peter the Great, containing lots of small type and no pictures. Baristas call him a "camper," because he selects a seat, buys a single cup of coffee and nurses the drink for hours. (I'm one of those, actually; that's where all of these column articles come from.) Two other campers bring stacks of books and handwritten notes, and typically engage in lengthy discussions about minutiae they've found in the Bible. You can't help hearing everything they say, and that seems clearly intentional on their part.

   A lady you think of as Nails comes in to pick up her drink every morning from Monday through Friday, dressed in heels and conservative power suits and wearing three-inch shiny fingernails. She wears them in various colors (always garish), and you imagine she must be using carburetor cleaner to remove those colors--or the nails themselves. You're not sure what she does for a living, but she probably doesn't play a piano.

   A guy in a tired white Chevy pickup stops by at about the same time as Nails. He leaves his engine idling. He routinely walks in the front door, greets the staff and heads for the bathroom. He's always in there for five minutes, after which he emerges, wiping his hands on his jeans. He picks up a tall white cup of something with a lid on it, lays down cash, leaves the change and departs without adding condiments or saying good-bye.

   You have some regulars yourself: Connie, the old woman who can't keep her meds straight. Ted, the brittle diabetic who keeps getting in trouble with his insulin, then refuses transport and wants to fight after you awaken him with D50. You remember that last time his wife called, she had given him some juice that woke him up and he hid from you in the branches of his orange tree. And Angela, the 500-lb. lady with the monkey who calls you to help her to the bathroom. (Dang, monkeys are messy.)

Q. Some of those people are really a pain in the ass. It seems like their problems are more social than medical, and they're certainly not emergencies. Over and over, they call us back because they know we'll always come.

   A. I sympathize with you, really. But this is happening all over the world right now. So many social support systems either don't exist or are falling apart. A lot of people really are stressed, and they know that even in the face of predicaments most of us would consider minor, they really have no one else to lean on.

Q. Thanks for the sympathy, but what can we really do besides go through the motions, shift after shift? These are silly calls. They're not emergencies, and this is not fun.

   A. I promise, I'll be the last person who ever tries to convince you there's no such thing as a stupid call. There are calls you could use to define the term stupidity. But people always do what they do for a reason. In that regard, you're like a detective--the sole trained observer who ever gets to see a person's home environment. No social worker or prescribing physician would be welcome there, but you are personally invited to see their trip hazards, the lack of fresh fruit and vegetables in their refrigerators, their unyielding bathtubs and their burned-out lightbulbs or failing environmental controls.

Q. Fine, but where does it say that's part of an EMT's job? We can't possibly be responsible for every unfortunate human circumstance in the world. Besides, I still maintain that these are not medical emergencies.

   A. Many of them are worse than medical emergencies; they're unaddressed medical emergencies and are anything but silly calls. Legal agencies worldwide and in nearly every state designate EMS personnel and firefighters as mandated reporters of things like child or elder abuse or neglect. And even where they don't, somebody needs to take some responsibility for folks who simply can't manage their own lives.

   It's one of the reasons why you really need to like people in order to do this work.

   Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.

   EMS Reruns addresses dilemmas in EMS. If you think of an example, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail Nancy.Perry@cygnusb2b.com.