Administration and Leadership, Patient Care, Training

Treating Hypochondriacs

Issue 7 and Volume 35.

Anyone who flies regularly along the front range of Colorado quickly learns to adapt to the turbulent nature of the altitude gods who love to fling unwary souls within the confines of a compressed, metallic cylinder traveling at speeds eight times faster than you can drive an ex-lax overdose code 3 to the hospital. Inevitably, despite the pilot’s hopeless attempt to find thin pockets of smooth air for the 30-minute voyage, kidney stones will be jolted free, and the sounds of eustachian tubes imploding are heard throughout the passenger cabin.

During one of these flights, I immediately plugged in my headphones to send a clear message to anyone next to me that I had put myself in time out and was not to be disturbed. Then, I heard a voice above the ruckus of passengers trying to force their carry-on luggage into the overhead compartments. The passenger wanted everyone on board to know that the turbulence was so bad on the previous flight that all the passengers had been throwing up. As I turned the volume up to drown her out, “Highway to Hell” began blasting through my headset. It was an ominous sign of what was soon to follow.

Just after the flight attendant completed her safety address, I again heard that same whiny voice from several rows back. “Are there enough airsickness bags on this plane for everyone?” With our wheels now up, the voice began to tell other passengers that they didn’t look too well. Yep, you guessed it. Within 10 minutes of reaching a cruising altitude of 15,000 feet, that familiar sound and smell I’ve come to know all too well in the back of my ambulance began permeating my senses. The flight attendant was now rapidly racing up and down the aisle replacing airsickness bags—for a small fee of course.

And here’s the deal folks: There was no turbulence during the entire flight. Zip! Nada! In fact, it was probably one of the smoothest flights I had ever been on.
Did I feel guilty for not assisting the overextended flight attendant during this gala barf festival? No! Did I not have a duty to act, at least on an ethical level? Maybe, but I didn’t. So sue me. My mission was to find the idiot who triggered this gastric frenzy free-for-all MPI (mass psychogenic illness).

An MPI is when a group of people start feeling sick at the same time even though there’s no physical or environmental reason for them to be sick. One of the first rules of working an MPI is to quarantine the melodramatic instigator away from the situation. Unfortunately, the “voice” couldn’t be persuaded to depart through the emergency exit window in a timely manner.

The old protocols for treating MPI victims used to be quite simple—stupid, but simple:

  • Line up all MPI patients in single file;
  • Grab them by the shoulders and shake them back and forth;
  • Slap them once across the face while yelling, “Snap out of it;” and
  • Repeat as necessary.

We now know that these MPI symptoms are genuinely real to the patients and that headaches, dizziness, faintness, rapid heart rate, breathing difficulty, vomiting/diarrhea, and/or weakness are indeed a result from the mind convincing the body that it’s sick. “Adrenaline Psych!”

We in EMS have no choice but to initially assume all MPIs are the real deal until proven otherwise. EMS and fire services are obligated to provide a thorough physical and environmental examination to rule out toxic contamination.

Although, I have to admit, there was one call I was dispatched to some years back where I broke proper protocol. A compact mace canister was found on the floor of an elementary school boys bathroom. Although there was no evidence the mace had been used, the student who found the mace began coughing. Shortly thereafter, several more students around him began to cough and complain of shortness of breath and nausea.

To make a long story short, the fire alarm was pulled, and within minutes, the entire school was evacuated. More students soon joined in the fray of hacking and throat clearing. Rather than being separated from the “healthy” students, everyone was placed together on buses for the arriving paramedics to triage. My bus had 30 students who said they all felt ill, yet most were giggling following initial assessments.

Leaving the bus to pick an assessment supply tool, I returned with a 50cc syringe with a 2.5″ 10 gauge angio attached to the end of it. Holding the syringe for all to see, I asked, “Now, again tell me, who’s feeling sick?” Strange … my bus was the only one full of students who weren’t transported to the hospital.

Until next time, pass the Halls cough lozenges. JEMS

This article originally appeared in July 2010 JEMS as “Mind over Healthy Matter.”