Oh the Humanity...Hauling the Homeless

Each patient, whether you work in a 911 system and encounter repeat callers or you work in a non-emergency transport system where you routinely ferry patients to and from nursing homes, requires your utmost attention. Be ever diligent. Anyone can be a good paramedic on the good days. You need to be a great paramedic every time you begin a new patient encounter, regardless of the number of patients you have already seen in the shift, regardless of the number of meals you have skipped, regardless of the time of day or your fatigue level.  Never forget the person in front of you is much more than just a patient. They are someones mother, father, sister, or brother. There is someone in the world who loves them very dearly, with all of their heart, and you should imagine that person is looking over your shoulder demanding your best at every turn. Treat every patient as if they were one of your own family members.  Remember the little things. Sometimes a smile or simply being treated like a human being is the greatest and most important treatment the patient can receive. This is the philosophy I use to stay focused and try to give everyone I encounter everything I have to offer.  Sometimes it's not easy, but you have been called to a vocation that is best developed with humanity, intelligence, compassion, and respect for our fellow man. With this in mind I would like to describe a patient population in the City of Fairfax I encounter on a regular basis which is a good example, the homeless.

The City of Fairfax and Fairfax County, Virginia collectively have the second highest homeless population in the National Capital Region second only to the District of Columbia.  A large number of the Fairfax County homeless population are arrested at one time or another and charged with some sort of misdemeanor alcohol related offense.  They are taken to the Fairfax County Jail by their arresting officer.  After spending a warm night in jail they find themselves walking out to a bright and sunny morning smack dab in the middle of the City of Fairfax. They discover two major issues at that particular time in their lives.  They are hungry and they are shockingly sober.  In their minds these two situations require immediate attention.  So what to do? Hit up one of the many 7-11 convenience stores for problem number one.  But what to do about food? If they pay for food then they won't have enough money later for another trip to 7-11. Either by experience or by talking to one of their peers they learn of an establishment that feeds the homeless during the day.  This establishment is actually providing an amazing service to the community. They are a church based group that has daytime hours.  They offer food, showers, christian counseling, and help to get a man, down on his luck, back on the right path. They discourage drunkenness and offer a helping hand to any in need. God Bless them. A byproduct of this service, however, is after the doors shut and the sun goes down where does a guy get his next meal? Best bet is to just wait until morning for breakfast when the doors open up again. This behavior has created transient pockets of homeless tent communities throughout the city. Not everyone who frequents this establishment meets the description above, but I wanted to give a good descriptive example of one possibility as to why a small city in the suburbs of Washington D.C. could have such a high homeless population. 

Inevitably the fire department becomes involved in the lives of the homeless when they become too inebriated to walk or go to jail.  They may trip over a curb, discovered sleeping in the park in a near comatose state, or worse, involved in a traumatic accident.  When this occurs in rush the firemen and paramedics who encounter a great number of different homeless personalities on a regular basis. Sometimes the same personality two or three times a day every day for several weeks or months. As a paramedic you often get to meet people on the worst day of their lives. The homeless population seem to have these days on a regular basis.  


Regardless of their present physical condition, the fact they are alcoholics or mentally ill, homeless people are patients too, but above all else they are human beings and should be treated as such. They have all the same medical issues any other human being may have except all the signs and symptoms are clouded by alcohol and poor hygiene. Their lifestyle places them in a much higher risk category for all the major illnesses.  What I hate to see is a paramedic becoming complacent with the local drunk and overlooking a major medical emergency.  Paramedics dealing with a homeless population need to be ever diligent all the time. Regardless of the number of times you may have transported Otis to the hospital he requires, no he demands, your full attention because without another full patient assessment you have no idea what is transpiring with his current medical condition. 

The astute homeless immediately complain of chest pain when aroused by local police. Many times this pain is non-existent or actually upper abdominal pain from an overworked liver or pancreas, but it is not our place to assume this is the case. I have discovered more than one case of V-Tach and more than one acute MI from just such a situation. If I had just assumed Otis was drunk again and trying to avoid arrest I would have missed a serious emergency and provided a horrible service to the public. 

It's easy to be a good paramedic on a bright sunny spring day when all of your patients are pleasant and personable. The best paramedics are great all the time regardless. The next time you feel the pangs of burnout as you dread the next call or a certain type of patient remember what I have said and be a great paramedic, one that your mother would be proud of.