Air Miles

The term ‘frequent flyer’ is one that is used often in pre-hospital care to describe a patient who regularly accesses ambulance services. The term is often reserved for those people who paramedics believe are abusing their services by calling the emergency line weekly, daily or even, believe it or not, hourly requesting ambulance attendance.

For a long time I have been unsure how I feel about the use of this vaguely pejorative label. The term gains its meaning from the airline industry- a frequent flyer being someone who regularly engages with one particular airline often accruing points in a rewards per miles flown type system. So in defence of the term, when applied to those who regularly access ambulance services for whatever reason, there is a weak argument to be made that the label does not draw from any derogatory origin. Instead it is simply a humorous placeholder name for ‘regular caller’. Yet when we examine how paramedics use this term we can see quite clearly that it can led to blatant discrimination.

I will preface by saying that I would like to hope that no paramedics intentionally discriminate against any of our patients. We work long, emotionally-cognitively-physically draining hours with a diminishing sense of job satisfaction as your career progresses that can lead to frustration. When you are new to the job, your cup of experiences is empty and your cup of empathy is full. As the full cup slowly drips into the empty one, one of the first things you begin to understand is the difference between a ‘big-sick’ patient and a ‘little-sick’ patient. The former encompasses those with very real, immediate medical or traumatic life threats, and the latter groups almost everyone else. Most paramedics will agree that this perception takes somewhere in the order of one to two years to develop. And then, as you attend to more and more big-sick patients, your confidence grows and you begin to get a sense that you can handle almost anything that is thrown your way regardless of acuity or type of ailment. Most veteran paramedics will state that this happens somewhere between five and ten years on the job.

So imagine a paramedic who has been working at a busy station for ten years. They have likely seen far more than their fair share of death and disease in their community. They will have witnessed life, death, violence, compassion. Likely the entire spectrum of human emotion and disease states. You can certainly imagine the sense of frustration they must feel when they are called out at terrible o’clock in the morning of a grueling nightshift to old mate for the exact same thing they were discharged from the closest hospital for only hours previously. Frustration is a normal emotion to experience.

We spend so much time learning to manage those who are big-sick, devoting most of our tertiary education and professional training to it. Those who aren’t in the job think that we attend to these sorts of patients all the time, however the truth could not be further from this. At least in the Australian experience, we see one maybe two of these sorts of patients a week. Oftentimes less than this. You almost develop a sick, twisted desire for something bad to happen so you can be challenged cognitively at work, and use some of the training you have sacrificed so much of your life for.

The paramedic arrives at old mate’s house for the umpteenth time and they quite literally jump into the ambulance asking to be driven straight back to the hospital they just left a few hours ago. Because they cannot refuse to transport someone to hospital on the basis of ‘you were just there’, they start driving in the direction of the hospital. On the way there they hear chatter on the radio about some car accident, or medical resuscitation in their area that they would have been closest to had they not been picking up old mate instead. Even more frustrating is that the ambulance that has been tasked to the job is over twenty minutes away, so that person who is likely very unwell could suffer directly because old mate’s repeat calls.

The paramedic takes a deep breath in, bottles up the frustration, and puts on their customer service face. Because if they express any of their contempt toward the situation toward old mate, a complaint against their name may be placed, leading to more undue stress down the line. When other paramedics vent their frustrations about old mate someone casually states, “Yeah they really are becoming quite the frequent flyer aren’t they”, everyone nods in agreement, finding solace in the communal vexation, even those officers who have never met old mate before. And therein lies the problem. Should those officers who have never met old mate before then be called to attend to them from this point onward, they will already be primed to dismiss any complaint they have as time wasting nonsense. Boy oh boy is this a perilous path to walk down for a number of reasons.

The first and most obvious being that life isn’t like email accounts. Names are not unique. You may have two people with the exact same name living on the same street right next door to one another. So if you use someone’s name and label them as frequent flyer, paramedics who take this sentiment onboard without ever meeting the patient may attend a different patient with the same name and dismiss their complaints of pain as drug seeking for example. This is straight up neglectful care that can and will result in a professional misconduct issue.

The second reason being that we as paramedics do not have the tools or the training to completely dismiss someone’s complaints. Even if their issue is not with their health as such as is more of a social issue, who are we to say that the hospital is unable to find a solution to their complaint. By declining transport or withholding certain aspects of care, we move in the direction of discrimination.

And thirdly, it is not the patient’s fault that the system allows them to phone 000 whenever they want and request ambulance attendance for whatever reason. I believe this point really is key to processing some of our frustrations toward these patients. By redirecting our frustration away from the patient and toward the systems that are currently set up, we realise that the ball now falls into our court. We cannot as paramedics tell someone who has every right to attend the hospital as many times as they wish that they cannot come with us. We can however, suggest improvements to the system, and suggest management plans for frequent callers. And this shift in mindset really does begin with cessation of plastering regular callers with labels such as frequent flyer.