Homepage / Administration & Leadership / Bernie, Erma's Brother
Off-duty: Intervene or Be a Witness? Mass Shootings in a Small Town: What are Your Resources? #TapTapTime: The Latest Trending Topic Police Responsible for Ambulance Bills on College Campus? The Spooktacular Episode “I’m out of ideas” Advanced Airway Seminar HM on Medic 2 Medic Podcast Respond to the Rollover – Tales from the Interwebs Hazards we can most certainly remove Witty Banter with the Unaware – Volume 3324 the Crossover Ep 125 – Who Gives Two Sh*ts Why Giving Two Shits About a Patient is Not a Bad Thing the Crossover Episode 122 – Annual Kilted Show! Things keep getting worse for Cop who likes arresting Nurses My Beautiful Blue Eyes The Seizure Patient 500 – An EMS Race Crossover Podcast – Ep 116 – That’s Not Why we Have Cameras, Gary …for the head injury, PD on scene Crossover Podcast ep 113 – Middletown Ohio or Deathville USA? the Crossover Ep 112 – Are you a good hair boss or a bad hair boss? Stop Responding for Overdoses? Sign Me Up! Yup. Still Barfing I Heard You, She Heard You, the Baby Heard You Is there a Doctor on board? the Crossover Podcast – Ep 111 – Paramedic Perv Reporter Unclear of Aircraft EMS Operations The new rigs are here! the Crossover Show – Ep 110 – Do You Poop Where You Eat? What to do for an allergic reaction…or not The Last Shift of the Lost Cause The Crossover Show – ep 109 – Is that Cocaine or Anthrax? How to respond when your spouse tells you to be safe at work Always, In Service – EMS Week 2017 Lost Cause gets cocky FDIC 2017 – Structural Response to Aviation Incidents: Engine Company Operations I Got Lost Going to a Call – So I made sure everyone knew about it Crossover Podcast Ep 102 Mrs Happy Medic and Mike the Cop Arby’s Roast Beef Ad angers EMTs, not sure why Strippers and Cocaine watch – 2017 Seizures! Seizures Everywhere! Nothing is certain except death and taxes. I can help you with both What to do when the powers that be – just can’t. Episode 99 the Crossover Ep 98 – Off Duty and Fancy Free NO is Never Easy to Hear Ohio Cop vs Ambulance Crew Member on Video – Crossover Show Investigates! An MCI With Wings: Aviation Incidents EMS Today 2017 First in Ambulance MCI at EMS Today 2017 Crossover Show Learns How to Take a Joke To Haul or Not to Haul – Should the Complexity of a Refusal Influence Transport? Crossover Show – Ep 91 – ACLU cameras Tip of the Helmet – Bj’s Brewhouse the Crossover Show – Episode Eighty Eight Eminence Based Medicine If You Don’t Give Him Insulin He’s Going to Die Lost Cause Strikes Again the Crossover Podcast – Ep 85 – Florida Cry Baby “I Can’t Breathe!” you keep using those words… the Crossover Show – 84 – TN Bus Crash Happy 150th Anniversary San Francisco Fire Department! Thank You For Your Service? A Complete Secondary Assessment the Crossover Episode 81 – Let’s Talk Politics! Aircraft skids off runway, rescue task force ill equipped Crossover Show – Ep 79 – Do we need so much active shooter training? How to Ignore Everyone in the Room: Be an Intern Your Meme is Bad and You’re Not One of Us Anymore Goodbye tarps, I never loved you The Crossover Episode 76 – Flashback to the Beginning You found me how? Less CSI, More Columbo EMS Festival Standby – You can’t just park a car there the Crossover Show Ep 72 – Florida EMT photo game A&O vs able to make decisions Kilted to Kick Cancer Cops vs Firemen Writer calls for Medics to risk more in shootings, misses the target What’s with the French? the Crossover – Ep 69 – Twelve Ninety Désolé the Crossover Show – Ep 67 – Traffic Stops and Profiling Actually, Officer, No. It Really isn’t that hard to try When Patients Don’t Play by the Old Rules Letters in the File – Oklaloosa Selfies the Crossover Podcast – Ep 64 – Turning Passion into Retirement Why Pokemon GO is so much like EMS Us Against Us Apathy is worse than absence So Now I’m Back! Changes are a-comin’ The Sounds of Silence I know that feel, Bro TCS – Ep 59 – SHOOT HIM! CISD with OK GO part VI the Crossover – Ep 56 – Rooms for Shooting the Ballad of Big Dave the Crossover Episode 55 – Text me Bro Why vs How and Book vs Street A Mother’s Day Crossover Show Dear Valencia County Fire Chiefs Dear Random Township Fire Department at FDIC

We all have those addresses that get our blood boiling.  The one you know by heart.  When the address comes over the radio we can recite the person’s name, social security number and even their first 4 medications.

For me the new address, since there are folks like this in every area, is causing me more headaches than it should.

The first time I met Bernie (Bernie is Erma Fishbiscuit’s brother. Yes, I’ve added to the Glossary of Terms! Found under the Who is HM tab) he was sitting in bed, unbathed for weeks, arguing with his home health care worker about how short of breath he was and that she can’t leave him yet.  Bernie didn’t want his daily companion to leave.

Unfortunately Bernie didn’t let the care taker do anything much for him when she is there.

He won’t let her change the bedding.

He won’t let her cook him food, he’d rather snack all day.

He won’t let her clean up the room he is in for fear she will steal something.

The poor care taker sits and watches him slowly dying simply because he won’t let her help.

So here we are on a code 3 dispatch, ambulance trailing because Bernie won’t let anyone under the rank of MD help him.  But what can we as Paramedics and EMTs do?

When Bernie and I start to have an honest discussion about quitting smoking, or at least agreeing to walk the length of the apartment to get his smokes each day, he demands transport, spinning yarns about how long they will keep him there.

We all know he’ll be home tonight, if not this afternoon, right back where he started.

The care giver knows she should be doing more, but is a frail thing and if she and Bernie got into a shoving match, we’ll be here for her instead of him.

Bernie refuses to listen to reason.

“I have asthma” he tells me.

“You smoke too much” I tell him noting the stench from the nearby overflowing ashtray sitting on the oxygen machine.

“You’re no doctor, what do you know?” I’m challenged.

“No, not a Doctor, but I don’t need to be one to see what you’re doing to yourself” he hears.

The private ambulance company is more than happy to take him in since he has private insurance and I am once again reminded why my premiums keep going up.

The health care practitioners at the scene, the ones most experienced to make a determination of most appropriate resources for this person, are powerless to effect change in this situation.

We could call his insurance company and ask them to send more people.

We could ask them to send a counselor to discuss with Bernie the importance of taking their advice.

Calling Adult Protective Services might bring a case worker out in a few weeks, but we’ll have been there dozens of times by then.

Bernie doesn’t want our help, just a ride.

On our most recent visit, I moved his pack of cigarettes to the other side of the room and reminded him of the real possibility that he will kill himself AND others while smoking on oxygen.

Then I helped him to the cot and along to the ambulance for yet another treat and release at a not so local ER.

What can we do unless the system adjusts to let us assess, refer and release Bernie?  The insurance company, fire department and ambulance company could save 10s of thousands of dollars on one person each year.  And that’s just one person.

They need savings, I can offer tons.  So long as Bernie realizes that when the Paramedic arrives without an ambulance he isn’t getting an automatic taxi ride, then listens to what we have to say and becomes an active participant in his own health we all win, especially Bernie.

And Bernie is not one of the uneducated poor often blamed for EMS abuse, but one of the growing trouble spots in EMS.

Bernie is a baby boomer.

Related posts:

0 Comments

  1. Pingback: Tweets that mention Bernie, Erma’s Brother | The Happy Medic -- Topsy.com

  2. 510medic July 12, 2010 3:05 am

    Definitely a common occurrence. Seems to me that the problem here results from patients being encouraged and feeling empowered to dictate their own care without any formal training. Fear of litigation on every level means that all a patient has to do is hint at a lawsuit and we in EMS as well as those in the hospitals, clinics and private physicians offices do whatever it takes to appease these patients. That unnecessary care ranges from pain meds to expensive lab tests.

    At the end of the day, if the government and insurance companies want savings, they have to let us say “no”. Care providers across the board need to be trusted to tell patients that they don’t need every test and treatment under the sun. There are simply some times that patients can wait for a clinic appointment. Now there’s obviously training involved with that responsibility , but if we’re willing to undertake that, give us the chance to cut healthcare costs. Encourage patients to put faith back in the trained providers. Or else get out the checkbook!

  3. 510medic July 12, 2010 3:05 am

    Definitely a common occurrence. Seems to me that the problem here results from patients being encouraged and feeling empowered to dictate their own care without any formal training. Fear of litigation on every level means that all a patient has to do is hint at a lawsuit and we in EMS as well as those in the hospitals, clinics and private physicians offices do whatever it takes to appease these patients. That unnecessary care ranges from pain meds to expensive lab tests.

    At the end of the day, if the government and insurance companies want savings, they have to let us say “no”. Care providers across the board need to be trusted to tell patients that they don't need every test and treatment under the sun. There are simply some times that patients can wait for a clinic appointment. Now there's obviously training involved with that responsibility , but if we're willing to undertake that, give us the chance to cut healthcare costs. Encourage patients to put faith back in the trained providers. Or else get out the checkbook!

  4. Jake Bigelow July 12, 2010 2:33 pm

    Being able to say “no” is a grand idea. However, it will take that one lazy Paramedic who doesn’t want to transport that last patient in before his/her shift ends that will result in something being missed, a patient dying, an agency getting sued for millions, and the system going back to the way it is now. As it stands now, even the most trusting medical director (most), aren’t willing to take that liability. How many sub par medics do you know? I agree with being able to refer patients and refuse transport, but the bottom line is, we aren’t in a position professionally to “diagnose” and refer a patient elsewhere, even if you are capable of doing so.

    We aren’t definitive care, regardless of how stupid the complain, or ignorant the patient is. It’s sad, but it’s true.

    • Thehappymedic July 12, 2010 4:52 pm

      But Jake, that is happening now. And it is happening because that burnt medic on his 14th job in 10 hours has not been allowed to do what their patient’s NEED, but instead what they WANT.
      Powers of refusal of service will not start at the ground level, but first with supervisors, you know, the folks already entrusted with additional training and responsibility. that burnt medic will be able to call out a supervisor who can accept responsibility.
      We are already killing people because of our laziness and inattention to patient care. Adding the ability to refuse service with a lawyer who will welcome Erma coming to court to complain we didn’t open her windows at 4 AM could change this industry forever.
      Luckily I am meeting young professionals getting into these fields who are ready to make a stand and change things for the better.

    • 510medic July 12, 2010 6:48 pm

      I definitely agree with HM. In all honesty, there need to be consequences (educational first!) for those paramedics who misuse, whether intentionally or unintentionally, the ability to say “no”. Sadly I do know some subpar medics and they make poor treatment decisions now. I really don’t think that should decrease my ability to treat my patients in the way that is medically indicated.

      We have to take a stand against lazy paramedics. If that involves taking people aside who are staying up to speed, then so be it. At the end of the day, we have to be willing to lead by example.

  5. Tigermom3 July 12, 2010 2:54 pm

    seems untreated mental illness plays a big part here~not letting someone change the sheets nor clean his room for fear she might “steal” something~not making the connection bwt needing oxygen to breathe and the smoking that is chocking his already damaged lungs~knowing the dangers of keeping anything aflame near an oxygen tank~sounds like a 72hold and forced assessment/treatment for mental illness would do him far more good~

  6. Tigermom3 July 12, 2010 2:57 pm

    on facebook, i am ann noviello email im tigermom3@yahoo.com, my daughter has been a paramedic for years and my son (private pilot) just received his emt certification~i ran your happy medic column by some friends on the farm (summertown tn) who were emts & instructors in the bronx back in the 70s, this was the consensus op that mental health was the real issue here and that while you were out on that call, someone with a true breathing emergency was likely somewhere waiting for an ambulance that was otherwise engaged.

  7. Jake Bigelow July 12, 2010 2:33 pm

    Being able to say “no” is a grand idea. However, it will take that one lazy Paramedic who doesn't want to transport that last patient in before his/her shift ends that will result in something being missed, a patient dying, an agency getting sued for millions, and the system going back to the way it is now. As it stands now, even the most trusting medical director (most), aren't willing to take that liability. How many sub par medics do you know? I agree with being able to refer patients and refuse transport, but the bottom line is, we aren't in a position professionally to “diagnose” and refer a patient elsewhere, even if you are capable of doing so.

    We aren't definitive care, regardless of how stupid the complain, or ignorant the patient is. It's sad, but it's true.

  8. Tigermom3 July 12, 2010 2:54 pm

    seems untreated mental illness plays a big part here~not letting someone change the sheets nor clean his room for fear she might “steal” something~not making the connection bwt needing oxygen to breathe and the smoking that is chocking his already damaged lungs~knowing the dangers of keeping anything aflame near an oxygen tank~sounds like a 72hold and forced assessment/treatment for mental illness would do him far more good~

  9. Tigermom3 July 12, 2010 2:57 pm

    on facebook, i am ann noviello email im tigermom3@yahoo.com, my daughter has been a paramedic for years and my son (private pilot) just received his emt certification~i ran your happy medic column by some friends on the farm (summertown tn) who were emts & instructors in the bronx back in the 70s, this was the consensus op that mental health was the real issue here and that while you were out on that call, someone with a true breathing emergency was likely somewhere waiting for an ambulance that was otherwise engaged.

  10. Thehappymedic July 12, 2010 4:52 pm

    But Jake, that is happening now. And it is happening because that burnt medic on his 14th job in 10 hours has not been allowed to do what their patient's NEED, but instead what they WANT.
    Powers of refusal of service will not start at the ground level, but first with supervisors, you know, the folks already entrusted with additional training and responsibility. that burnt medic will be able to call out a supervisor who can accept responsibility.
    We are already killing people because of our laziness and inattention to patient care. Adding the ability to refuse service with a lawyer who will welcome Erma coming to court to complain we didn't open her windows at 4 AM could change this industry forever.
    Luckily I am meeting young professionals getting into these fields who are ready to make a stand and change things for the better.

  11. 510medic July 12, 2010 6:48 pm

    I definitely agree with HM. In all honesty, there need to be consequences (educational first!) for those paramedics who misuse, whether intentionally or unintentionally, the ability to say “no”. Sadly I do know some subpar medics and they make poor treatment decisions now. I really don't think that should decrease my ability to treat my patients in the way that is medically indicated.

    We have to take a stand against lazy paramedics. If that involves taking people aside who are staying up to speed, then so be it. At the end of the day, we have to be willing to lead by example.

  12. Anonymous July 13, 2010 12:46 pm

    Ahh… the Baby Boomers. If ever there were a demographic ready to destroy EMS they would be it. The possibilities are frightening, they mostly came of age in the sixties, expect government services, and haven’t been living exactly healthy lifestyles and grew up watching personal injury lawyers make a killing suing people for negligence.-

  13. mmorsepfd July 13, 2010 12:46 pm

    Ahh… the Baby Boomers. If ever there were a demographic ready to destroy EMS they would be it. The possibilities are frightening, they mostly came of age in the sixties, expect government services, and haven't been living exactly healthy lifestyles and grew up watching personal injury lawyers make a killing suing people for negligence.-

Post a Comment

Your email address will not be published. Required fields are marked *

*