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Top Ten Questions You’re Better Off Not Asking

EMS1.com News

December 26, 2008


The Ambulance Driver's Perspective
by Kelly Grayson

Top Ten Questions You’re Better Off Not Asking

By Kelly Grayson

It happened again yesterday. My partner, a relatively inexperienced EMT, asked the question we’ve all asked at one point or another: “So, if you’ve had this for a week, what made it an emergency at 3 a.m.?

Bless his sparky little rookie heart. He still actually believes that ambulances are for, well you know, emergency calls. He wanted to know why our 50-year-old patient had been self-medicating her sore ankle with booze and Lortab for the past six days, instead of going to the ER when the injury happened. He was understandably curious as to why someone would call an ambulance for chronic gout, especially when we had to maneuver our stretcher past four perfectly functioning cars in the driveway and a handful of able-bodied relatives in the living room to even reach the patient. I knew why.

Because they were all blooming idiots, that’s why.

But my poor partner, still clinging to the faint shred of hope that at least some of our patients may actually be, well … sick, just had to know. Call it morbid curiosity. Call it misplaced optimism. Call it whatever you like; but if you don’t think you’re going to like the answer, it’s probably best not to even ask the question. That’s a lesson my rookie friend has yet to learn.

When the patient told us that she was running low on her Lortab, and had been out of her gout medicine for a week, and that ambulance rides and narcotics administered in the ER were free, I think I saw the last shred of his idealism boil out of his ears like indignant steam from a teakettle. It was actually kind of cute, in an “Aaaawwww, they grow up so fast!” kind of way.

My reaction? I just shrugged and spoke the words I always do in such situations: “Watch your head when you climb in the truck, Ma’am. And what hospital are we going to this evening?”

I’ll also confess that I breathed a quick prayer of thanks that, in our system, such calls can be turfed to the EMT-B partner on the crew. It’s nice being an ambulance driver occasionally. And while I was providing her a safe and sedate $800 ride to the ER so she could save the $8 price tag for a month’s supply of allopurinol and colchicine — I was struck by the idea of other questions that we really shouldn’t ask (unless we’re really ready to hear the answer):

''Have you given him any Tylenol?'' Of course they haven't given him any Tylenol. If they had given him any Tylenol by the time the ambulance arrived, the patient may no longer have a fever, and then what use would an ambulance be? Don't even ask the question and you'll never have to ponder the merits of forced sterilization, or wonder how some nursing home personnel ever made it out of school.
''How much have you had to drink?'' You know darned well how much they had to drink — two beers. I mean, take a good look. I know the reek of ketoaldehydes on his breath, the vomit stain on his shirt front and the fact that he's wearing Burger King ''Home of the Whopper'' boxers — outside his pants - might lead you to believe he's perhaps imbibed ''tee many martoonis,'' but doesn't he have an honest face? Who are we to disbelieve? Two beers can do that to a person … if each of them came in a keg.
''How fast are we going?'' Honestly, do you really want to know? Suffice it to say that if a) you are over 40, and b) your partner is younger than 25, and c) said partner plans his vacation around Speed Week in Daytona, the answer is not one you want to hear. I asked this question once, in an old gas-burner Ford ambulance on a dark country road. My partner looked down at the speedometer, shrugged and said, ''Beats me. The speedo goes to 85 and I've got it wrapped all the way back around to 10.''
In those situations, it's best to just close your eyes, tighten your seatbelt, and pray that your service implements an Allsafe program soon. And perhaps ask your partner to rock you a bit when you get to the call, to break the suction on the seat.
''So, how many of these did you take?'' Well, doesn't it say right there on the bottle? I know that, objectively, the fact that you find the patient licking the dust from inside their Vicodin bottle, even though the prescription was refilled less than a week ago, should have lasted them roughly until the implosion of our sun. But surely there must be some other explanation. If you can wake them up from their stupor long enough to hold a conversation, they'll tell you they're still in extreme pain. Or that their pain specialist doesn't understand them. Or their shiftless nephew stole them all. Or the evil Vicodin Fairy came and took them all back. But they certainly wouldn't take more than 1 tablet, q 12 hours, PRN for pain. That would be unethical, immoral and maybe even fattening.
''So, what did the poop look like?'' Yeah, I know this is a germane question. You want to know if it was melena, or hematochezia or just plain old bloody-streaked poop from chronic hemorrhoids. But invariably, they'll apologetically tell you they already flushed the toilet, and if they don't, do you really want to open the Cool Whip container they so helpfully provided? Better to just get some orthostatic vital signs and let the ER doctor find out what's behind Lid #3. Or if you must know, have your partner open it.
''Do you feel anything out of the ordinary down there?'' Yes, I suppose if the guy complains of groin pain, we'd need to know if the patient has an incarcerated inguinal hernia, if for no other reason than to recognize the need for pain relief and the need for a surgeon. But what do you do if they tell you they're not sure? Because then, you're honor-bound to examine the area in question, and possibly even palpate it. Aside from directly violating EMS Rule #1 (Handle no one's junk but your own), it can also lead to a number of nasty surprises, like the aforementioned hernia, or testicular torsions, or genital warts. Or maybe even the partially absorbed skeleton of his unborn twin. Ignorance is bliss, folks.
''How do you spell that?'' Better to just get a first name, then copy the rest from the face sheet after the ER clerk signs ‘em in. That way, you never have to endure the exasperated eye roll because you didn't know that Chopaquelethia Da'Nae Desdemonaretha Smithe has a silent ''e'' at the end.
''Does anyone have a handcuff key?'' Context is everything here. If it's the prisoner who desperately needs IV access, by all means ask the cop to release the cuffs. But if it's an unconscious man wearing nipple clamps and a leather corset, still handcuffed to the frightened hooker who called 911, some cop is going to have just the type of key needed to free them both. And when that happens, it ruins a perfectly good war story.
''Can you show me your teeth?'' If you're checking for facial droop in a potential CVA patient, a better way is to simply ask the patient to smile. Otherwise, you'll forever be the butt of jokes when the elderly patient obediently points to the bedside table where she keeps her dentures soaking in a water glass.
And the number one question you're better off not asking:

''How did that get in there?'' While I understand that we all possess a certain curiosity as to how a Fabergé egg can wind up stuck in someone's rectum, is it worth the mental picture that the truth will conjure, or the aggravation of being lied to? Just accept at face value that some people paint their houses in the nude, leave paintbrushes sticking out of paint cans, and then fall backwards off the stepladder onto that can. Seriously, it could happen to anybody.


Ever asked a question that you wished you hadn't heard the answer to? Chime in with your comments! I'd hate to know I'm the only one in the market for brain bleach!

About the author


Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (www.facebook.com/theambulancedriverfiles), or email him at kelly.grayson@ems1.com.

Comments
The comments below are member-generated and do not necessarily reflect the opinions of EMS1.com or its staff.
Paul Carroll Paul Carroll Saturday, March 03, 2012 8:10:00 PM When a known brittle diabetic is unresponsive in a bar, and you can't stop yourself from asking his life partner what he is doing here. Of course he loaded up on his insulin while planning to do some serious drinking, then forgot eat a decent meal as he screamed past the point of no return.
Kim Callahan Kim Callahan Saturday, March 03, 2012 8:30:47 PM As a former Paramedic and ER nurse....this was great! LOL
Cory Mason Cory Mason Saturday, March 03, 2012 8:41:55 PM I always like when my partner asks a female pt how far along are you? Then the blank stare the pt gives..... Then the IM NOT PREGNANT!! Whoops!'. Makes me laugh every time.!
Todd Kuzma Todd Kuzma Sat Mar 3 21:01:49 PST 2012 The next questions should be, "exactly how high is your blood pressure, and do you take insulin?"
B.a. Liberski B.a. Liberski Sat Mar 31 05:20:44 PDT 2012 Todd Kuzma Follow that up with "are you diabetic?"
Beverly Allen Beverly Allen Saturday, March 03, 2012 8:46:06 PM This is hysterical! Thanks, I really needed this!
Gene Tourangeau Gene Tourangeau Sat Mar 3 21:00:17 PST 2012 But... how DID that get in there???
Beverly Allen Beverly Allen Sat Mar 3 21:04:33 PST 2012 Gene Tourangeau you REALLY don't want to know!!
Jeff Fowler Jeff Fowler Saturday, March 03, 2012 8:57:26 PM wow made my weekend! thanks..
Marc DeKlotz Marc DeKlotz Saturday, March 03, 2012 10:12:35 PM "So you say the toilet seat fell and that is how you suffered the traumatic penis injury".
Marc DeKlotz Marc DeKlotz Sun Mar 4 19:00:27 PST 2012 I'm still in therapy... My mind cannot stop trying to figure out just how this could happen. Truth I had to come to is It couldn't, and I REALLY DO NOT WANNA KNOW HOW IT HAPPENED.
Marc DeKlotz Marc DeKlotz Saturday, March 03, 2012 10:14:21 PM "Ma'am. Are you sure the patients temperature is 109.0?"
Marc DeKlotz Marc DeKlotz Sun Mar 4 19:02:20 PST 2012 I'm guessing she was holding the thermometer next to her crack spoon.
Jeffrey D Ellis Jeffrey D Ellis Saturday, March 03, 2012 10:42:49 PM Nursing home: futile question I still find myself asking, probably just to make sure the standard answer hasn't changed..."So when did this all start?"...Response, " I don't know, I don't normally work on this hall, I just came in and found him like this."
Nathan Kingsbury Nathan Kingsbury Sun Mar 4 06:43:15 PST 2012 or "I don't know, and (Moron) who called 911 went home already. I'll call the RN!!!"
Sarah Layne Sarah Layne Saturday, March 03, 2012 11:03:01 PM Oh man I could go on for days but one of my favs is.....where does it hurt? They never really seem to know;/.
Nathan Kingsbury Nathan Kingsbury Fri Mar 9 05:05:09 PST 2012 "My chest hurts!" -Ok point to where it hurts...ma'am....that's your knee-
Sarah Layne Sarah Layne Fri Mar 9 23:26:34 PST 2012 Nathan Kingsbury hahah ma'am can you point to where the pain is please?Can you show me or describe it? ...."You don't know?" Hmmmm that makes my job so much easier! lol
Veronica Brilhart Van Dyke Veronica Brilhart Van Dyke Saturday, March 03, 2012 11:30:16 PM Love it! I have lived all of these!
Karen Baer English Karen Baer English Sun Mar 4 09:08:17 PST 2012 Ha ha! When I worked call at a rual hospital, I asked several of these questions at 0300! Seriously, why come into the ER in the middle of the night, as I am trying to finish up important work like crossmatches from a car accident, because your throat hurts!! It hurt the day before too, so why is 0300 the breaking point that makes it an emergency?
Aimee Craig Aimee Craig Sunday, March 04, 2012 12:06:13 AM ha! sounds like a day in the life of a san joaquin county ammalance driver.
Jaime Cowie Jaime Cowie Sunday, March 04, 2012 3:32:26 AM The elevated temp. Call at a snf at 0300... Never want to ask what thd temp. Is if u dont want to know the answer because the answer is usually 99.1
Denise Aksoy Denise Aksoy Sun Mar 4 03:35:05 PST 2012 They actually did vitals? THIS week??!
Jane Cummings Jane Cummings Sunday, March 04, 2012 4:03:52 AM You made my Night doable! Thanks sunshine!
B.a. Liberski B.a. Liberski Sunday, March 04, 2012 4:34:13 AM A heavy set patient trots out to the ambulance. Patient has a full black curly beard. Claims to have green vaginal discharge. Q: You sure your're female?
Paul Carroll Paul Carroll Fri Mar 30 21:41:43 PDT 2012 Whoa! That's one I haven't heard.
B.a. Liberski B.a. Liberski Sat Mar 31 05:18:37 PDT 2012 Paul Carroll I took the patients word for it and transported. Pt could have taken a bus
Paul Carroll Paul Carroll Sat Mar 31 05:37:07 PDT 2012 B.a. Liberski Well, it certainly didn't sound immediately life threatening, so I would say you made the right call. :)
B.a. Liberski B.a. Liberski Sunday, March 04, 2012 4:35:02 AM Q: Are you Diabetic? A: No, I'm Baptist.
Angie Price Angie Price Sun Mar 4 19:35:58 PST 2012 This belongs with "Are you COPD?' "No, I'm NDP" (political party in Canada)
Becky Harvey McCallister Becky Harvey McCallister Tue Apr 24 18:44:55 PDT 2012 Are you a diabetic? No.. Ok then what is this medicine for? Oh, that is for my sugar....
Patrick Marshall Patrick Marshall Sunday, March 04, 2012 6:23:08 AM When was the last time you talked to him? About 45 minutes ago. Really? He's colder than room temp.
Jake Bierbrodt Jake Bierbrodt Sun Mar 4 07:34:07 PST 2012 so then you ask and when was the last time he responded to your talking
Patrick Marshall Patrick Marshall Sun Mar 4 09:01:54 PST 2012 That was an assisted living facility
Tavoccous Montra Elliott Tavoccous Montra Elliott Sunday, March 04, 2012 10:15:12 AM Awsome! Sad but so true.
Scott Powers Scott Powers Sunday, March 04, 2012 10:48:13 AM this is good.
Summer White Summer White Sunday, March 04, 2012 12:18:23 PM OMG! Soooo funny!
Jenn Coffey Jenn Coffey Sunday, March 04, 2012 2:04:01 PM Q Do you have any medical history I should be aware of? A No Q I see a med bottle for HTCZ is this your medication for high blood pressure? A Yes, but I don't have high blood pressure now that I take that pill. Q Is there any other history I should know? A No Q What is this scare from? A oh, I had surgery. EMT (facepalm) and we all know how long this can go on for......
Wayne D. Carroll Jr Wayne D. Carroll Jr Sunday, March 04, 2012 4:21:39 PM How did this Bite happen? I was on the top bunk bed and my roommates girlfriend was doing Oral on me and the bunkbed broke and fell to the lower bunkbed. Medic to pt, Hold this tight around the wound! We have to work on your roommate first, He has 2 broken legs and head trama from the weight of the 2 of you in the top bunk landing on him! Washington Mo. Mid 1980's
Linda Bolzenius Linda Bolzenius Sun Mar 4 16:25:26 PST 2012 Wow
Christy Ann Willoughan Christy Ann Willoughan Monday, March 05, 2012 5:00:11 PM One of my stupid questions to a pt with head injury during pupil assessment "Can you see the light?" "What? am I dying?" YIKES! never asked that one again lol.
Matt Jackson Matt Jackson Monday, March 05, 2012 6:45:57 PM So true!
Alex Ol Red Garmon Alex Ol Red Garmon Monday, March 05, 2012 8:11:41 PM Nursing home call : Dispatch : How long has the patient not been breathing? Nurse : I don't know... Dispatch : Is she dead? Nurse : I don't think so. Dispatch : So is she breathing or not. Nurse : I don't know. Dispatch.....FIND OUT
Tuesday, March 06, 2012 7:53:57 PM 2 of my worst ones is, asking the drug seeker where it hurts. It always results in a detailed explanation of ALL the places they hurt, right down to their toenails. Also asking the drug user if he uses recreational drugs (after he punched me in the face) he went into a huge story of how he doesn't drink or use drugs because mom was a drunk and dad was a druggie and all his aunt, uncles, 16th cousins ect used drugs, and he hates drugs. It was much easier to just find the meth in his socks while I did my detailed exam.
Chris Howley Chris Howley Wednesday, March 07, 2012 6:47:39 AM Priceless and so true.. These idiots contribute nothing all they do is take whatever they can get. EBT cards, welfare, free housing, free medical.. They don't pay a dime and they act so entitled for people that have never done anything..
Connie Dahlmann Connie Dahlmann Wednesday, March 07, 2012 10:19:37 AM When I was working in the CSICU we never excepted, patients from outside our unit with the expectation that's the unit would remain "clean". One evening the ER was completely packed and they had two patients we could . The first one was a 56 year old female with multiple lacarations in her vagina...the story had to do with spicing up her love life....the use of a pickle and the need to use a fork as a backup plan......use your imagination...hence the wounds. That's same night we also took in a patient had a bowel obstruction; foreign body. Because I was a critical care tech on the unit I got the pleasure of taking this patient down to x-ray, where it's was very easily seen what the obstructing item was. When my young mouth blurted out "I guess you didn't get a chance to turned it's off before your recutum sucked it's up?" I realized immediately that's those words should never have been uttered. I especially knew it when I was called into my director's office....she's had the intention of writing me up for my loose lips.....but given the circumstances of the night I got off with a verbal warning
James Robert Long James Robert Long Friday, March 09, 2012 10:58:30 AM are you sure your blood pressure is is 60 / 80? maybe we should check your dollar store machine?
Barbara J Power Barbara J Power Saturday, March 10, 2012 9:00:13 AM I knew when I heard the title, this was a Kelly Grayson special. Enjoyed reading every line and have experienced almost all of the 10. Thanks Kelly for making the exasperation bearable.
Susan Semonchick Anthony Susan Semonchick Anthony Sunday, March 11, 2012 4:59:08 PM Called to nursing home for "change in responsiveness". Me to person dressed like a nurse - What's her normal orientation? Person dressed like a nurse.....blank starte. Me to person dressed like a nurse - Is she normally A&Ox3? Person dressed like a nurse - "oh! no, she's right there in bed". Me............Face palm.
Susan Semonchick Anthony Susan Semonchick Anthony Sunday, March 11, 2012 5:58:10 PM And who was my partner? Eric Sacks
Mike Traher Mike Traher Friday, March 16, 2012 1:56:12 PM EMT: What is the patient's weight? Nursing hone: She weighs 350lbs. EMT: Which leg?
Becky Harvey McCallister Becky Harvey McCallister Tue Apr 24 18:37:29 PDT 2012 Is that lbs or kg. ?
Mike Traher Mike Traher Tue Apr 24 20:29:50 PDT 2012 Ask the nurse,he/ she will have no clue. Ask the the CNA he/she may have a clue. But if all else fails pray that you don't hurt yourself when the nursing home staff refuses to help you lift the patient.
Dan Mahlmann Dan Mahlmann Friday, March 16, 2012 7:34:46 PM EMT: So you're sure BP doesn't matter at all when taking vital signs? ER Doc: No. I've been practicing for 40 years and I've never taken or used a BP when evaluating a pt. o.0?
Paul Carroll Paul Carroll Fri Mar 30 21:45:11 PDT 2012 Scary, very scary.
Circus Tls Circus Tls Thu May 10 06:10:39 PDT 2012 hhhhhhhhhhhhhhhhhhhhhhhhhhh
Jon Puryear Jon Puryear Thursday, March 29, 2012 5:46:31 PM Kelly this is by far the best read for me in a long time. I laughed outloud in my chair and laughter is the best medicine. Thank you!
Scott Mosher Scott Mosher Tuesday, May 08, 2012 6:30:11 PM CC: patient is "spotting". Q: Is there any chance you could be pregnant? A: No (of course!) Q: Are you sexually active? A: Yes Q: Are you on birth control? A: No Q: When was your last menstrual period? A: About three months ago... Q: What makes you think you couldn't be pregnant? A: My boyfriend said I couldn't be!
Stacey Atwood-Bandell Stacey Atwood-Bandell Tue May 8 18:59:18 PDT 2012 *facepalm*
John Buckner John Buckner Wednesday, May 09, 2012 6:22:57 AM Good story! I laughed all the way through reading. And I can relate to about 99% of this. Don't forget genital fractures and sprained whatchamacallits. EMS is not for the idealist or the curious as you learn the longer you are in it. I carry a set of cuff keys by the way for that isolated "I accidentally dropped them and they locked me to the headboard". Oh, and I never use the ring cutter to remove tangled body jewelry from the nether regions. Life is a, ah, is circus a good word?
Amy Stamper Amy Stamper Friday, May 11, 2012 8:33:14 PM Always love going to Nursing homes and finding the pt on a NRB on 2lpm ripping the mask off and putting the pt on 15 lpm on the NRB. No wonder why the pt was having difficulty breathing.

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