We have initiated two distinct and different policies. The first is a Paramedic Refferal Program and the second is a Paramedic Inititiated Refferal. The first can be done by all of our medics. It is a mechanism that allows us to contact medical control and refer the patient to a facility other than the ED. This may be their PCP, an after hours clinic, or a non-emergent or semi-emergent clinic. The medic simply asseses the patient and contacts medical control. The med control physician either agrees with the paramedics assesment or doesn't. If he agrees we leave the patient with directions to follow-up with the appropriate level of care. All of these reports go through our QI process and each medic is responsible for his decisions. If a question arises and the program has been used inappropriately that individual is no lponger able to use the program. The second level is the Paramedic Initiated Refferal. This is reserved for our street managers. We have 4 assigned per shift. There are generally 3 working on units and 1 roving in a supervisory capacity. These individuals can, without med control, tell an individual that we will not be transporting them for a very specific group of complaints. They are:
#1 "Patient's without complaint or mechanism of injury." (These could be the "I am out of my pain meds" patients or somone who just wants to be checked out (i.e. BP check, Glucose check)
#2 "Animal Bite" Obviously this is left to the discretion of the Unit Commander involved. If someone was attacked by a dog and has serious injuries we will transport. If someone has a minor bite to an extremity with controlled bleeding they certainly fit.
#3 "Lice infestation" Again obviously not an emergency situation. Most reasonable people would not call an ambulance for this but folks here have done so and will continue to do so.
#4 "Foreign object in ear/nose" Again our unit commanders make the call here.
#5 Minor bruise, laceration, abrasion. Non-specific extremity pain/minor swelling due to trauma."
#7 Sutures
#8 Isolated toothache
If you have any questions I would be happy to answer them.
