Fifteen Minutes Later, the Husband Calls to Cancel
At 06:40 the husband of an 82-year-old woman calls. She slipped getting out of the shower and is on the bathroom floor on her right side; she cannot get up. She says her right hip hurts badly and she cannot put weight on that leg. She is awake, answers questions appropriately and is breathing normally. There is no bleeding and she did not hit her head. She takes a blood thinner for atrial fibrillation. The husband wants to lift her under the arms and drive her to hospital himself, saying, 'I've done it before, she's not that heavy.' The bathroom door is narrow and she is wedged against the bath. A unit has been dispatched.
1. What post-dispatch instructions should be given while waiting, and why does each one matter?
Read the worked answer
PDIs and their rationale:
- Do not move her, and do not try to lift her. A fractured hip or pelvis can be displaced by lifting, and turning a stable injury into a vascular one is a real risk.
- Do not let her try to stand, even if she insists she is fine now.
- Keep her still, in the position she is in, with a pillow or a rolled towel between her knees and under her head if he can reach one without moving her.
- Cover her with a blanket or towels. She is on a bathroom floor, wet, elderly, and at risk of hypothermia within the response interval.
- Nothing by mouth - no food, no drink, no painkillers. Possible surgery and possible anaesthesia.
- Watch for a change in her alertness, breathing, or pain, and call back immediately if anything worsens. An anticoagulated head strike would also change everything - she reported no head strike, but a change in alertness means call back at once.
- Scene preparation: unlock the front door, turn on the outside light, put the dog out or in another room, gather her medications, ID and insurance card, and have a phone within reach.
Rationale in one line: the PDIs prevent the injury worsening and remove every avoidable minute from the crew's arrival.
2. The husband says he will just carry her to the car because it will be faster. How should the EMD respond?
Read the worked answer
Acknowledge the intent, then be firm - he is trying to help, not obstruct.
I understand you want this over quickly, and so do I. Please don't lift her. The crew has a stretcher and the training for exactly this, and carrying her through a narrow door could make her hip much worse or end with both of you on the floor.
Then substitute a task - a person who is told not to do something needs something else to do:
- Stay with her and hold her hand.
- Bring a pillow and a blanket.
- Unlock the door and turn on the light.
- Get her medications together.
Do not: scold him, threaten him, or explain the differential diagnosis. One clear reason, one firm instruction, one replacement task.
Exception: if the scene becomes unsafe - fire, gas, structural danger - the balance changes and moving her becomes the lesser risk. Absent that, he does not move her.
3. Twenty minutes later a man calls back on a different line saying his wife is fine and he wants to cancel the ambulance. How should this be handled and closed?
Read the worked answer
The EMD cannot cancel on a third party's word.
Steps:
- Verify - name and address, and confirm this is the same incident. A second call from a different number is not automatically the same caller.
- Establish who is asking. The husband is not the patient. Ask to speak to the patient herself and confirm directly that she is alert, oriented, and wants no help.
- Do not cancel; update. Pass to dispatch that the caller reports improvement and wants to cancel, so the crew knows. Whether the response is cancelled, and whether a refusal is accepted, is decided with the patient by the responding crew under local policy - not by the call-taker, and not by a family member.
- Do not simply agree and hang up. If it is agreed with a supervisor the response will be cancelled, close it properly.
Closing the call either way:
- Confirm address and callback number back to the caller.
- If she tries to get up, gets drowsy or confused, or the pain gets worse, call us straight back.
- Do not promise a time of arrival; give what local policy permits and no more.
- Document verbatim who requested the cancellation, at what time, and what was said.
The failure mode this case tests is the call-taker who wants to be agreeable: a pleasant 'okay, cancelled' can end with an untreated hip fracture, or with an injured woman on a bathroom floor and no one coming.