Beyond the Threshold
Any situation that requires an ER physician to go outside and retrieve a patient is usually going to be complicated and time-consuming, and I would wager that it is also more likely to end badly. Here are some examples with which I am personally familiar:
1) Two police officers unload an agitated psychotic crackhead on the ramp. Naked, sweating, yelling and struggling violently, he is a handful to say the least. Make that 10 handfuls: a beefy male ER tech is restraining each leg, the two officers are securing the torso and neck, and a male nurse has the pelvis when I finally go outside to see what I can do. This guy has five strong men on him and he's still bucking and kicking. Suddenly, he stops fighting. Is he playing possum? I check for his pulse, finding nothing. We carry him into the ER and begin CPR. He remains in asystole and fails to respond to any interventions. Another patient struck down by a "rare and controversial condition."
2) I hear a commotion at the ambulance ramp and run down the hall to see what's up. Lots of yelling and chaos. A young woman is in the back of a private auto surrounded by a small group of onlookers. Is she delivering a baby perhaps? Unfortunately not. She's been shot in the chest and dies despite our aggressive efforts to save her.
3) A woman is brought in for altered mental status, and that assessment seems to be on the money. A quick chart review shows a recent admission for cocaine overdose. While we are trying to verbally calm her down and assess her, she says she needs to pee. Good, we need a urine sample anyway. As the nurse is walking her to the bathroom, she breaks away and runs right out of the ER, across the parking lot, and faceplants into the bushes. A tech and I drag her back inside.
4) A psychotic suicidal young man is being transferred to a psychiatric facility. The EMS team arrives to transport him, but they seem uncomfortable and clueless. The patient has been calm the entire time he has been with us, but you can tell he is boiling inside and ready to blow. The ambulance crew mess around for quite a while, asking too many questions and stalling with paperwork and phone calls. When they are finally ready to transfer the patient to the EMS stretcher, he instead runs out of the ER and climbs up on the roof of a nearby parking garage, his elderly father following him. The police finally subdue him, red lasers illuminating his chest. He is transported by the police to the psych facility.
5) Shift change, 7:15 am. One of our ER nurses is walking out the door of the ER after a busy nightshift and is run over by an intoxicated driver who is backing up way too fast, in a hurry to be triaged for his low back pain. Our nurse thought she was done for the night, but she ended up staying in the hospital far longer than she had planned. A**hole patient-wannabe was triaged to jail.