The Message

“OK, Ma’am, we’ll get someone right over there.”

Dispatcher Buddy hung up the phone and swore in my general direction. “That was Local Nursing Facility. They have a code, and I have no-one to send. What do I do?”

I don’t remember why I was alone, but I had no partner until the next shift change. LNF was clear on the other side of Neighboring City, too far for a Priority 1 response even if I had been available. We didn’t even have a free BLS unit in the area.

“DB, you’ve got no choice,” I said. “Call the locals.”

“Yeah, I know.” Three words of resignation spoken even as his finger reached for the speed dial button. “Hi NCPD, this is the dispatcher at Local Private Ambulance Company. We have a reported full code at Local Nursing Facility, and I have no units available. Can you handle it? Thanks.”

As we listened to NCPD sending police, fire, and ambulance, something clicked in my brain. A lump began to form in my stomach, and ice ran in my veins.

“DB, did she use the exact words full code?”

He had the same thought a split second after I did. “Oh God, no,” he muttered, stabbing at the playback button on the recorder.

• —“Local Private Ambulance, this line is recorded.”
• —“Hi, this is Local Nursing Facility. We have a full code patient who needs transport to Local Suburban Hospital. . .”

DB’s head sank into his hands. The NCFD units signed on scene. “No, no, no, no. . .” DB began to mutter.

In our corner of medicine, we sometimes speak of a Code 99. The term has been around forever.  It’s origins are lost in the mists of time.  Hospitals have code carts and code teams, all dedicated to patients in cardiac arrest.

In long term care, however, patients are assigned a Code Status, denoting whether they should be resuscitated if their hearts stop. A patient with a Full Code Status is one who gets the full CPR/ACLS workup if needed. It’s the polar opposite of a Do Not Resuscitate order.

I don’t know why the caller led with the words ‘full code.’ The patient had a minor complaint; his code status was not relevant at all. This small piece of useless information sent three emergency units blasting across the city for no valid reason.

It also sent DB into a lot of paperwork.

All because the caller thought the patient’s DNR status was more important than his chief complaint.