other people's emergencies: random thoughts of an urban paramedic

For more than twenty years I've worked as a paramedic for the city of Boston, Massachusetts. The opinions expressed in this diary are mine alone, and do not represent the views of Boston EMS. Names, dates, locations, and physical characteristics have been changed to ensure patient confidentiality.

Monday, May 25, 2009

If You Can't Do the Time...

Often you can tell what's happening at the scene of an emergency even before you begin your response. When someone reports an "unconscious man in an ATM machine," for example, you know that you will arrive to find a homeless man taking a nap. That's what it aways turns out to be.

So, when we saw on the ambulance's computer screen that we were responding to a "thirty-five-year-old male, unconscious after shoplifting," we knew that he wasn't unconscious at all. He was hoping to land in a hospital instead of in jail.

We weren't the only ones to pick up on this. We arrived at the department store to find a bunch of firefighters and a trio of security guards staring at a man on the floor. None of them seemed to be particularly concerned, because they all knew what was really happening.

"He stole a bunch of sunglasses," the fire lieutenant reported to me. "The security guard grabbed him as he was going out the door, and he started to have this kind of seizure thing."

The man was awake, but when I asked how he was feeling, he made only a groaning sound. I could have assessed him further, but there wasn't any point. He would continue the charade as long as necessary to avoid being arrested.

Instead, we lifted him onto the stretcher and wheeled him to the ambulance. "Is he under arrest?" I asked the security guards. "Does anybody want to accompany him to the hospital?"

The guards shook their heads. It wasn't worth their while to guard him over twenty dollars' worth of merchandise. We put him inside the truck and closed the doors.

I knew how this call would turn out. We'd bring him to the hospital, and when nobody was looking, he'd run away. This kind of thing happens all the time. I saw it first when I was still working as an EMT. We picked up a woman who'd been arrested on a similar charge, and who, like this man, was pretending to have a seizure. We brought her to the Massachusetts General Hospital, and as I opened the ambulance door, she shoved her way past me and ran up the street. I wasn't going to chase her, because there wasn't any point. What would I do if I caught her? Force her to stay in the hospital, to be treated for a condition she didn't have?

I wasn't going to go through that again. Instead, It made sense to get right to the point. "Here's the situation," I said to the man, who was still groaning. "The store doesn't want to press charges. The security guards are gone. You're free to leave if that's what you want to do."

The man lifted his head. He looked around the ambulance. "My God," he moaned. "Where am I?" He knew perfectly well where he was. It wasn't exactly an Oscar-winning performance.

"Listen to me," I said. "You're free to leave. Nobody's going to stop you."

Hearing this, he jumped up from the stretcher. He looked out the back window, and then out the side window. "I can't leave!" he said in a panic-stricken voice. "The police will get me!"

"There are no police," I told him. "Only security guards. And they're all gone. You can leave. Nobody's going to stop you."

"My bike!" the man shouted, looking out the window with greater urgency now. "Where's my bike? I left it right there by that streetlight!"

That would have been a bit of ironic justice, I thought--for the thief to have his bike stolen while committing his crime. But then the man sighed with relief. He'd spotted his bike. It was right where he'd left it.

Slowly he opened the ambulance door. He stepped out cautiously, obviously concerned that we'd set some kind of trap for him. When he saw that there really weren't any police officers out there, he straightened up, hopped on his bike, and pedaled furiously away to freedom.

I don't like the way this call ended. As trivial as the theft may have been, it's wrong to let shoplifters get away with their crimes. Retailers lose millions of dollars to petty criminals each year, and we certainly don't want to send the message to shoplifters that they can evade prosecution simply by faking an illness.

But what choice is there? Denying care to a patient who appears to be faking could prove disastrous. Those are the calls that turn into lawsuits.

At the same time, though, it makes no sense to tie up the ambulance with an unnecessary transport, when everyone knows that the guy will flee the moment he lands at the emergency department.

The least bad option, as I see it, is simply to play the game.

20 Comments:

Anonymous Anonymous said...

I agree with you about tying up an ambulance for nonsense, and also about letting them get away. It's you and me who pay the increased retail prices for shoplifting! What really irks me? When you respond to the police station and they do the same. They let the person "go" with EMS, instead of keeping the person under arrest...way to reward them and spread the word...easier to go to the hospital....most likely they'll let you go! Ach...nothing to do about it!

11:11 AM  
Blogger Gábor said...

I guess this is simply the case of choosing the lesser of two evils; he'll escape sooner or later anyway, might as well free up the ambulance to be able to take the next call even if it seems like you're giving out the wrong message to shoplifters and other criminals.

1:16 PM  
Anonymous Joy said...

What choices! I think you are correct, totally. What a shame. At least we can see that not all people are this way. A few bad apples though...

Joy

1:42 PM  
Anonymous JAM said...

Same thing in my community with patients involved in a MVC and OUI. Go to the hospital with EMS or to the police station

3:16 PM  
Anonymous Anonymous said...

And is why I love your blog...for real life stories like this one. I always learn something new after reading one of your posts.

Unrelated...here are two similar stories. One from the US and one from China. In my opinion, the guy from China had the right idea.

http://www.boston.com/news/local/massachusetts/articles/2009/05/25/2_on_roof_pull_distraught_man_to_safety/

http://news.bbc.co.uk/1/hi/world/asia-pacific/8064867.stm

Thoughts???

4:09 PM  
Anonymous Anonymous said...

It seems one of the links got cut off.

http://www.boston.com/news/local/massachusetts/articles/2009/05/25/2_on_roof_pull_distraught_man_to_safety/

4:11 PM  
Blogger Overmatter said...

I am learning so much from this blog!

6:23 PM  
Blogger TS said...

Anonymous:

I saw that story about the guy in China. I think it rates a post of its own.

10:33 PM  
Anonymous scannerbuff1 said...

I know many police officers who avoid making arrests for petty shoplifting on a first offense. As long as the store gets the merchandise back, and a no-trespass order is given, it makes more sense to send them on their way than to tie up a cruiser, two patrolmen and a holding cell. If the person goes back to that same store, they have violated the trespass order and are arrested for trespassing, and if an officer recognizes the person shoplifting again, they usually arrest them that time. And the person is almost always arrested if the store doesn't get the merchandise back or if it's damaged.
But, otherwise, if the merch is recovered and its a first offense, it's a pretty minor crime to tie up police resources for.

It's funny that the man chose to fake having a seizure. In the town where I live, most of our seizure calls are for the same patient. He has multiple seizures every week. Firemen and EMTs actally know him by name, and dispatchers will say "it's [name] having a seizure again". I think there are also some mental health issues, though, as this man is also well known to local police for disturbance calls.
(just for the record, I'm only a scanner monitor, not a public safety employee, so nothing here violates HIPPA, as I have no prof. capacity in this situation).

11:00 PM  
Anonymous Anonymous said...

"this kind of seizure thing"?

Are Boston firefighters not at least EMT-B's?

12:36 AM  
Blogger brendan said...

Its posts like this that must absolutely blow the minds of (some) rural/slow service EMS people. I know there must be a couple of them out there absolutely batshit over the fact that you didn't transport him ALS.

"this kind of seizure thing"?

Are Boston firefighters not at least EMT-B's?
Yeah... and?

1:14 AM  
Blogger Mr. 618 said...

This syndrome has its own name: incarceritis. It is closely related to JACOB Syndrome, which affects many folks accused of DWI; it stands for "Just A Couple Of Beers." 14 years as a cop and I NEVER dealt with anybody -- no matter how obliterated -- who ever admitted to more than just two beers.

9:28 AM  
Blogger TS said...

Anonymous:

That wasn't the firefighter's fault. Essentially, the man had faked a seizure. "Kind of a seizure thing" was a pretty good way of describing what had happened. At the time, I knew exactly what he meant.

Some, but not all, Boston firefighters are EMTs. But even as a paramedic, I think I would have described the man's behavior in much the same way.

4:14 PM  
Blogger TS said...

Mr 618:

You're right--every person in America, when asked how much he's had to drink, seems to use precisely the same phrase: "A couple of beers."

I sometimes wonder: How did all of these people come to use exactly the same words?

4:17 PM  
Blogger TS said...

Brendan:

If they were to ask, I'd say this: There aren't enough ALS ambulances in the world to work up every person in Boston who is less than fully oriented because of intoxicated or has had an alcohol withdrawal seizure.

In order to help people with more serious emergencies, we sometimes have to treat them for what we actually believe is wrong with them, and not for something they could conceivably have.

4:23 PM  
Blogger TS said...

Scannerbuff1:

We know many, many people--most of them homeless, and nearly all of them alcoholics by their first names. We see these people just as often as the firefighters in your town see the guy with the seizures. Some things are the same all over, I suppose.

4:26 PM  
Anonymous Beverly said...

I hate to say this but with some people faking unconsciousness, don't you just LOVE to give them a good, deep sternal rub??? Sigh...I dream about this sometimes.

9:14 PM  
Blogger TS said...

Beverly:

Or starting an IV on them? :)

9:43 PM  
Anonymous Anonymous said...

great choice, the way I think of it is which oath will I pick: waste my time, nurses and doctors or turn my back to a minor theft on a major company that would not even alter anything?

11:47 AM  
Anonymous laxrn75 said...

His choice tied up a limited resource, a good act always beats a pair of felony flyers.

10:41 PM  

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