Hearing Loss, a Possible Stroke, and 'I Don't Want a Big Bill'
07:50. A 78-year-old woman calls. She is hard of hearing, speaks with a heavy accent, and says her husband 'isn't right this morning.' He is 81 and sitting in his chair; she says his speech is 'like mush' and his left arm 'won't do what he says.' She repeatedly says she does not want 'a big bill' and wants to call her daughter first, and asks you to 'just tell me if I should wait.' Her address is rural: 'the white house past the Peterson barn on County Road 14.' CAD will not verify a house number on County Road 14, which runs six miles. A television is loud in the background and she keeps saying 'what?' She is the only person who can open the driveway gate.
1. How do you structure your questions and speech given the hearing loss, accent, and background noise?
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The problem is not volume, it is intelligibility and turn-taking.
- Slow down and lower your pitch rather than shouting. Shouting raises pitch and makes consonants harder to distinguish for a hearing-impaired listener.
- One question per turn, closed-form. 'Is he awake?' - pause - then 'Can he squeeze your hand?' Do not chain 'can he squeeze your hand and is his face drooping.'
- Use her words, not clinical ones. 'Smile for me' and 'hold both arms up' rather than 'facial droop' or 'unilateral weakness.'
- Ask her to turn the TV off and to use her better ear, or a speakerphone if she has one.
- Use teach-back to confirm critical facts: 'So the white house is the second driveway past the barn - is that right?'
- Ask her to keep the line open and set the phone down if she needs both hands, rather than hanging up and calling back.
- Avoid rephrasing the same question repeatedly - repeat the identical words; each new phrasing is a new sentence to decode.
2. She says she does not want 'a big bill' and asks you to tell her whether to wait. How do you respond?
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She has told you what she is actually afraid of: cost, and being talked into something. Argue with neither, and do not stall the response while you resolve it.
Dispatch first, then talk. The bill conversation happens in parallel with the call, not before it.
Do:
- Acknowledge it plainly: 'That's a fair worry, and I'm not going to guess at what anything costs - I can't promise you a number.'
- Reframe around her stated goal, which is keeping him home: 'The reason I'm sending them is that the things you're describing are the ones where waiting is what makes it bigger - treatment early is usually the smaller event.'
- Give her agency: the crew will check him and she can talk with them on the driveway; she can ask them anything before anyone moves him.
- Offer to have her daughter called so she is not deciding alone.
Do not: say it is free, quote a price, say 'you have to go to the hospital,' or imply she is being foolish. Also do not let the conversation run long enough to delay the ALS assignment - stroke symptoms are time-critical and the address is already the hard part.
3. How do you lock down the location?
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'Past the Peterson barn' is a landmark, not an address, and this is the failure point of the whole call.
- Anchor to the landmark: which direction on County Road 14, how far past the barn, what is across the street, what color is the mailbox, is there a number on the box or the house.
- Describe the driveway: gravel or paved, gate style and color, any signage, whether a vehicle is visible from the road.
- Nearest cross street or mile marker, and which side of the road.
- Phone location if your policy permits a location query on an open 911 line - this is exactly the case it exists for.
- Ask her to help you help her: leave the gate open if she can do it safely, turn on an outside light, or stand where she can be seen - only if that does not take her away from her husband.
- Broadcast the description, not just the address: 'white house, second driveway past the Peterson barn, north side, open gate' - the responding unit will search by description, not by number.
Repeat the description back to her before you release the line.