Head on -vs- Grampas Dementia

Not long before my shift ended yesterday I heard a tone out for one of the neighboring towns ambulance crew for a head on collision. I think their ambulance is mostly EMT's so as I expected our medics were toned shortly after.

Just before that I had a patient triaged into trauma. 90 year old guy with a history of dementia, lived with his family and had gotten up several times the night before and tried to make his bed because he thought it was morning. I worked in a nursing home as a CNA years ago and we called that 'Sundowning' then. Grampa was a little more disoriented throughout the day and at 1800 on a Tuesday night it was an emergency.

I went into the trauma room and found a very pleasant gentleman sitting and reading the evening paper with his son and daughter in law. He was A&O x3, but some labs and a CT were ordered 'just to be on the safe side'. One of the medics joked that 'the families vacation must start tomorrow and they want Grampa in the hospital for a few days'. It wouldn't be the first time. I was pretty sure the tests would be unremarkable and the patient would be sent home to follow up with his PCP.

The night shift was just arriving as the ambulances started pulling up from the head-on. Apparently a young lady in a SUV was on the cell phone and crossed the center line striking another car head on at the top of a hill, dragging the other car 60 feet back down the hill.

We had four patients with multiple fractures and one with head trauma, as well as a person not involved in the MVA who had an asthma attack come in all at once. In the middle of this Grampa's son, who is one curtain over from a girl who is boarded and collared and screaming in fright and pain despite 10mg MSO4 and 100mg Fentanyl, lets us know that Grandpa hasn't had dinner yet.

I'm sorry, excuse me? I'm no longer surprised about what some people will consider emergencies, but it never ceases to amaze me when people will be oblivious to the actual emergencies around them and expect us to interrupt what we are doing to tend to them.