Private ambulance companies are preferred over fire department ambulances by skilled nursing facilities because:

a) They don't like the drama of the fire truck showing up and the entire station tromping around the place.

Or:

b) They don't want the city seeing all the health code and safety violations.

I like option a, because I think it's funny in a "well, at least we do something better than you" sort of way. :)

(Your buses are definitely prettier. Because you know, my dream car is a bright red Ford F350. And that's what you drive. With an ambulance on back. Jealousy? I think so.)

But someone very tired and very grouchy at the end of a shift pointed out option b the other day.

Now, I've got my opinions regarding the many, many places I visit every day (see previous post). I have opinions about where I would send the people I care about, and my expectations of the staff and facilities for them. But I've never had an issue with the essential structures and mechanics of a facility. Maybe I didn't like the architecture, or the paint scheme, or the fact that they lock the front door to keep residents in. But most of my impressions of facilities were made up by the nursing staff. Even the most untrained lowly health aide can go a long, long way in my respect by caring about their patients. The more you care, the more you study. The more you study, the more employable you become (and the more money you earn).

You and your patients can have a mutually beneficial relationship. Remember, you signed up for this. Make the best of it.

I don't think I'll be outraged about option b until I run into a facility that doesn't have an AED on the floor where it's needed, or is incapable of treating a complicated case that they in fact said they were capable of treating (ie: patient with wound vacs transferred there from hospital, when the facility doesn't have any wound vacs or trained staff).

All of my issues with facilities come down to human error. Apathetic humans are one of the few things I cannotcannotcannot stand. I would never verbalize my opinion of you in front of a patient. There may be a lot of history involved that I'm not aware of during the ten or fifteen minutes that I'm on scene.

However, I can't promise I'll be able to control the need to frown meaningfully in your general direction. I might even go so far as to raise an eyebrow.

Though mostly I'm concentrating on smiling at my patient. Because even the worst dementia case will brighten up and smile back. It's human instinct. And sometimes the simplest forms of communicating are the best.

(No small non-verbal children were harmed in the development of this theory. Other than wetting their diapers from giggling. But they probably had to go anyways.)