Is there such a thing as Frequent Flyer Benefits? Yes there is, and I’m not just talking about flying across the country on the cheap either.
In this business, “Frequent Flyer” is a semi derogatory term given to those patients to whom we see often. They are the homeless alcoholics, the poorly managed type II diabetics, and the lonely widow. Anyone who has been in the field for a few months can tell you who their preferred customers are, and they know their address and chief complaint by heart.
These patient are not just the habitual 911 callers, but are also the weekly scheduled transfers like dialysis and chemo patients. I recently had a discussion about this with a good friend of mine. He is an administrator at a mid sized ambulance company specializing in inter facility transfers, and he has been dealing with a rather problematic trend amongst the field providers. He told me that many of his personal were not doing assessments on frequently transported patients.
When he would ask why they weren’t doing full assessments, he was met with poor excuses like “Mr Johnson has CHF, he’s always tired” or “Ms Conner is post CVA, she’s always altered.”
This is a very dangerous practice. I know at times it is tempting to think of our frequents as static characters that we give rides to. But that is just not the case . And it should be reiterated that for the time on scene and during transport, regardless of your level. You are the person that is most responsible for that patient. And not doing a full assessment is frankly irresponsible and could cause harm.
So you ask where’s the benefit’s? , why should I be happy to be transporting this patient for the third time this week? well because you are at a huge advantage to provide really good care. You’re even at a greater advantage then the patients primary physician.
If you transport Mr Fillips to and from dialysis three time a week, that means you do six assessments a week on the same patient. That’s twenty four assessments a month, and one hundred and forty four assessments every six months! Do you think his primary physician, let alone anyone assesses this man health twenty four time a month? Probably not. And if anything was out of the ordinary, who do you think would notice first? You would. That is of course if you did an assessment.
When treating a frequently seen patient, we should pretend that it is the first time we have seen them. Sure you know their name and medical history but that’s where the familiarity stops. Afterward ask yourself how what you found compares to what you know? Whats different or new about the patients presentation?
EMS, despite what it might claim is not an emergency service. At least not exclusively. Our place in medicine is quickly expanding in many ways. If we can lose the “trauma junky ” hero mentality, and embrace our true role as Health Care Professionals. Then we will not only benefit ourselves as providers and our industry, but also provide our patients with better care.
So the next time Mrs Miller starts singing “ca’mon ta my my house, ca’mon ta my house” Be true to your role. Be kind to your patients. And give them the respect and attention they deserve.
As usual, Jeramedic, you’ve hit the nail on the head! How very often we over look our Frequent Flyers and complained of their redundancy- when we forget that in our field that the human element is ever changing and ever special (especially Mrs. Miller). <3 I'm glad that someone has pointed out the opportunity to better our skills with these patients- everyone needs to go over basic assessment sometimes, right? You rock, Jer!
MsP
Very true. A routine patient is no excuse for sub par care or neglect. Take care of your self MsP, and your patients.
I think you’ve touched briefly on another important part of our role, that of patient advocate. We are the health care professionals who know these people best, and we are in a unique position to see that they get what they need. A routine VNA, office, or even ER visit may not discover conditions which we recognize. We see these patient’s homes and get to know their physical, mental, and social status very well. Sometimes we have to be the ones who stand up and see that they get proper medical and social care.
I don’t think the system deliberately neglects them, but we sometimes see more of the picture than anyone else.
Absolutely Mack, Patient advocacy runs deep with me. And knowing your patients well as well as what they need is a big part of the job that is sometimes overlooked.
i like that, Mac. We are the direct line for patient advocacy. We see how they live- whether it’s a dirty environemt with no apparent steady food source, to in a draft apartment filled with cats. That’s not something the triage nurse is going to be asking the patient- but it’s something that we can take note of and pull them aside to say- “Hey, look. He doesn’t have heat and he lives under a leaky roof, he’s complaining of toe pain. I know that’s annoying that he’s coming into the E.R. but it’s been in the ‘teens all week and we were worried about cold exposure and tissue damage.” That’s just a rough example, of course. (In Louisiana we see 30* and we’re scrambling for tropical settings on our thermostat) Anyways, my point is that you touched a great subject in our role as patient advocate… Sorry for butting in, Jer.
well said MsP, This is a discussion worth having.
The idea that we know a patient better than his/her PCP really made me pause. We really are on the front lines of patient care in these cases yet many (most?) of us slack off in this area. I’m a big CYAer and often do “too much” because I don’t want to be the one there when the “chest pain” frequent flyer is actually having an MI–because it WILL happen.
I also treat these folks with as much respect and compassion as any other patient which usually shocks them. That’s so sad to me. I worked in a city that had a particularly bad frequent flyer population and my coworkers and ER staff were so resentful of these folks that they treated them like crap. I actually had a nurse ask me why I brought the patient in on a stretcher, like he didn’t deserve to be treated like a “real” patient.
The general attitude of a squad/agency towards frequent flyers really affects and molds the way newer providers act. I’ve been through many different EMS settings, and it really is a monkey-see-monkey-do thing. So it’s extra important to set a good example in this area because that new EMT or medic just might be watching.
Non-emergent transports, like dialysis runs or discharges to nursing homes, were my favorite when I had a preceptee or student. You’ve got a stable patient with no acute complaints who’s used to being poked and prodded, often with special equipment like foleys, port-a-caths or fistulas and tend to be eager to help. Those are the ideal patients to practice assessments on and too many preceptors blow those great teaching opportunities.
We have a “frequent flyer” we pick up near HGH about 2 to 3 times a week. His chief complaint is always chest pain. He is an alcoholic, with diabetes that he does not manage well. Most of the time his chest pain is epigastric pain from the alcohol. About a month ago sure enough the call comes out at carson cross of vermont, and the crew responding knows its him and arrived before the fire dept. I later asked the crew how our frequent flyer was doing. The crew that did the assessment said something was different this time. Something didn’t seem quite right and his pain seem to present different. After all was said and done, he was transported to HGH code 3 with medics. Turns out the 12 lead showed a STEMI. He was having a full blown MI. The crew did the proper assessment and knew something was wrong. Kudos to them for doing to proper assessment, and kudos to you for writing this entry.