My work in the Emergency Department involves meeting and interacting with many ‘Ambulance Doctors’ on a daily basis who come to transfer patients from some medical facility to our tertiary care hospital. Here is a report of my observation over the years. (Trust me every word of it is true and from real life scenarios)
1) Most ambulances always drive with their sirens on even if there is no patient inside. You will seldom come across an ambulance moving at a normal driving speed. While few motorists use this opportunity to drive bumper to bumper with the ambulance to beat the traffic (I do that often :p), I’ve seen young crack heads trying a stint of street racing with the ambulance too.
2) MOST doctors that are hired in this ‘money minting’ ambulance business are BUMS, BAMS and BHMS ie. Ayurvedic and Homeopathy ‘Doctors’ who have no/very little knowledge of modern medicines they use during the journey.
Note: There are centers across the country running a 6 month PGDEMS (Post Graduate Diploma in Emergency Medical Services) course that makes it easier for them to get jobs in such ambulances and a license to kill (Wow…they become qualified Emergency Physicians…why will MBBS people persue a 3 year MD/DNB Emergency Medicine degree then ?)
5) The oxygen mask used for patients during transit is reused for an unlimited time till the elastic straps on the side of the mask become loose or break. Even if they bring a patient with TB or pneumonia, they always want the mask back, as it’s the only one they have. (My hospital infection control nurse would surely kill them!!)
6) With the dressing sense and grooming of a few ambulance doctors, it can at times become difficult for us to recognize the doctor among the 3 people who wheel the patient in (the ambulance driver, the attendant and the real ‘fake’ doctor) until we see a stethoscope hanging in 1 someone’s neck.
7) The accompanying doctor’s are exceptionally good with ONLY 2 drugs.a) Dopamine – to increase the blood pressure. b) Nitroglycerine (NTG) to make the blood pressure fall.
Depending on what the reading shows on the monitor in the moving ambulance, they don’t even bother to manually check the BP and play with the infusion rates as they like.
8) Any patient who is irritated, non cooperative, moving about, there is a high probability that he/she will be injected with Midazolam/ Fortwin and Phenagan which puts the patient to a good sleep. The relatives feel that the doctor has done something, the doctor feel that the journey will now be uneventful. But the catch here is that with a wrong extra dosing, the patient can go into respiratory arrest developing hypoxia and carbon dioxide narcosis. Next step: Intubation in a moving ambulance — damaged vocal cords — a bathroom singer for life, if the patient survives.
9) Rarely does an ambulance doctor declare a patient dead at home and are more than happy to rush a patient who has been dead for more than 1-2 hours on AMBU (even a layman can tell that when the body is cold, pupils completely dilated, body is stiff- rigor mortis that the person is a goner) giving false hopes to the family of a miraculous recovery or securing a Death Certificate from the hospital the patient is taken to (both of which never happen).
My motive of the above article was not to disrespect any of my fellow medico colleagues, but was to highlight the plight of a very essential and ‘life altering’ (I say altering as it really can change the outcome of the patient, the future of the family members) service – The Ambulance.
It really is disappointing to see such practice and I really wish we could have better standards of care one day and may be an EMS services like 911 in our country too.