There has been a spate of RSV going around, lately. RSV, or Respiratory Syncytial Virus, is contagious, via airborne droplets. In small children, it can lead to hospitalize-level-illness, whereas in adults it generally causes “a cold”. The reason younger children can get so ill, is that should the virus elicit swelling of the smaller airways, children, having narrower airways, cannot tolerate as much swelling as adults and older kids, before their ability to move air is compromised. We can test for RSV in the office.
So, from time to time parents bring in their kids, reporting cough, or lack of interest in feeding, or runny nose. Occasionally such a child will test positive for RSV. Occasionally such a child has alarming vital signs. One such child arrived, and the MA truncated her intake, once she noticed retractions and diminished oxygen level in this infant. She trotted out, figuratively grabbed me, and brought me in to see the child.
I saw, myself, the retractions. Retractions occur when the effort of breathing in, is increased to the point that the skin between the ribs, or below the ribs, draws in from that effort. NOT NORMAL!
We administered a nebulizer (“mist”) treatment of a bronchodilator. Subsequently, the retractions had not particularly improved, nor did the oxygenation of this child. I directed the mother that she needed to take her child to the emergency department. She responded that her ride was not present, and there would be a delay as the ride returned.
I recommended EMS at that point. The child appeared to be stable, presently, but I was uninterested in determining how long that would take to go downhill.
The mother responded, “No, I want to wait for my ride.”
It appeared that I had not successfully identified to her the ways that significant delay could make things go horribly wrong. And, waiting for her ride promised to present a significant delay.
Mother was not impressed. Her ride (eventually!) arrived, and everybody went to emergency. Finally.
Musings of A Stretcher Ape 
How do you not berate, yell, pummel, etc. these dunderheads? Other than through fear of being fired, that is.
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The Sunshine Rule: Everybody brings sunshine into my life. Some folks do so when they arrive…..
That’s how I maintain my tranquility.
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Ah. Thank you. I’m doin’ it wrong… 🙂
I disremember the quote, but it’s something like “Always treat people so they are glad to see you and not see you go”.
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Because it is not your call. Medical providers are not owed unchallenged obedience. They are consultants, not authoritarians. You have no clue what other factors are at play here; the parent may not be able to handle the cost of an ambulance ride. Unless you are willing to shell out the $ to pay for your recommendations, you need to back off. The parent is taking the responsibility, not the provider.
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Actually, it *is* my call. In addition, I suspect that I retain the right to be frustrated when folks, acting contrary to my appraisal, arguably place dependent third parties (such as a child) at risk. Now, I agree, I cannot figuratively drag anybody out and stuff them into an ambulance, but I am a “required reporter”, and am obligated to report actual OR SUSPECTED child abuse OR NEGLECT.
As regards the ambulance expense, in my not limited experience, EMS does not/will not turn a parent’s pockets out prior to transport for an emergent situation. Ya know like, oh, gosh, a child’s airway potentially being threatened, f’rinstance.
And, counselor, just how often have *you* “shell(ed) out the money to pay for your recommendations”?
I thought not.
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