An EMS crew responded to a middle-aged man who felt week.  When the crew arrived, the patient reported he had the sensation of the room spinning and was requesting assessment for this.  The patient explained that these symptoms had already improved.  The patient reported he only wanted an EMS assessment and did not want to be transported to the hospital.  The crew found the patient to be in atrial fibrillation but was not tachycardic.  The patient reports this is a chronic problem for him.  The patient also has chronic left sided weakness from a previous stroke.  The crew obtained a complete set of vitals as below:

Vitals: BP 112/82,  HR 98,  RR 168,  Sat 98%,  glucose 112

The crew expressed concern that the patient could be having a stroke or another serious problem, and after a lengthy discussion with the patient, the crew was able to convince the patient to be transported for further evaluation in the hospital. 

As the crew was wheeling the patient into the hospital, he had another episode where he reported the room was spinning.  The crew immediately notified the emergency physician, and the patient was brought to a room.  At this time the patient was still in atrial fibrillation with a rate >180 BPM, and became unresponsive.  The emergency department cardioverted the patient as well as intubated him since he remained unresponsive after cardioversion and improvement of his hemodynamics.  The patient was admitted to the intensive care unit for further evaluation and care.

 Highlights of the case:

EMS providers should advocate for patients if they are concerned about them.

This case shows why it is so important for EMS providers to advocate for their patients.  This patient called EMS but was refusing transport to the hospital even though that was what he really needed.  The EMS crew identified that the patient had medical decision-making capacity and that the patient was allowed to refuse care if he wanted.  It would have been very easy for the crew to leave the patient at his home, but they instead expressed their concern to the patient.  By taking the extra time to have an informed discussion with the patient, they were able to help him make the decision that was in his best interest, which was to seek further medical care at the hospital.  On top of this, the crew notified the emergency department team that the patient had a sudden decline as they arrived so that the emergency department staff were able to provide the needed resuscitation.  By advocating for a patient they were concerned about, the crew prevented the patient from being at home alone when he suddenly decompensated.