Emergency Social Services

It’s almost five when your tones go off, and you’ve just about reached your maximum fun level. But when you hear that address again—for the second time tonight—you’re sure. Something needs to be done for this guy. You can’t stand this for one more shift.

550 East Browning is the address of Paul Stevens, a 50-year-old invalid who’s gradually deteriorating with multiple sclerosis. He falls on his way to the bathroom; and when he does, he can’t get up. During the day he has a caretaker who helps him, but at night, you’re it. You change his diaper, clean him up and put fresh linen on his bed. Your crew has done that for him more than 60 times in the past year, usually between 10 p.m. and 6 a.m.

Nor is it just for falls. Paul chokes on his food, and sometimes he has trouble even managing his oral secretions. He also has a transient visual impairment. And sometimes his lack of neuromuscular coordination makes it simply impossible for him to conduct his most basic life functions. On top of it all, his symptoms are completely unpredictable. He can wake up feeling OK, and an hour later be relegated to bed.

Q. What can we possibly do for this guy? Most of the time, we help him up and he’s as good as he gets. He’s nice, and he always thanks us. But we’re a small agency with 50,000 residents to take care of. He’s one person. He accounts for 1% of our annual 9-1-1 responses, and he’s getting worse. We’ve explained his circumstances to our director more than once and nothing ever gets done.

A. I feel your pain. I do. We’re responsible for what we know about people, aren’t we? Our little system is struggling too, with folks whose most critical need for support is not medical, but social. When they call us, very often they know they don’t specifically need us. But they need somebody, and they just don’t know whom else to call. Fortunately, there are some things you can do, and they depend on the answers to two questions: Is this occurrence an emergency? And are there family members who could become advocates?

Q. What do you mean, an emergency? They’ve called us; of course it’s an emergency. No matter how hard we try to educate them, callers will always define their own emergencies.

A. I mean, if you resolve a caller’s problem and then leave them home alone, will their situation probably get worse, or won’t it? If it will, you need to immediately involve your area’s adult (or child) protective services agency, and possibly law enforcement. If their situation will probably remain stable or get better, I think a better goal is to harness the family.

Q. Yeah, well...a lot of families are either too stupid to help anybody, or they really don’t care. Or, they live 2,000 miles away. How does any of that help?

A. In those cases it doesn’t, of course. But you have to try. If a patient has a home, one family advocate can make it possible for them to stay there. Their situation may not be ideal, but sometimes it’s a lot better than being institutionalized. And if the family is not a viable resource, you can usually detect the clues in a few minutes. Any outside resource will want that information as part of your first conversation with them.

Q. What outside resource? The problem here is, there are no outside resources.

A. Actually, there are many. There’s a terrible shortage of public services, but there’s a long list of independent nonprofit ones. That list is different in every community, and the best time to familiarize yourself with them is between calls, when you’re not frantically grappling with somebody’s emergency. Our agency’s crews have been facing these kinds of problems for years, because the community we serve was a poor one even before the recession. We maintain a list of local, county, state and national resources, and we keep it up to date.

If you’re new to this stuff, no matter where you live, there are three options you can try right away. One is the social services coordinator at a hospital in or near your service area. The second is the community resource officer at your local police or sheriff’s department. And the third is your local adult (or child) protective services agency. They all tend to be very nice and very knowledgeable. They’re all likely to understand just about any situation you can describe to them.

There’s one more thing. Be patient; these things can take time to fix. But you’re not alone. EMS agencies are struggling with them everywhere.

Thom Dick has been involved in EMS for 41 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 the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.