Unconventional EMS-abuse solution

[Michael]

[web:e45fc638b3]http://www.lewrockwell.com/orig9/hand1.html[/web:e45fc638b3]

[mshow00]

A part of me likes what is being said... but I do not want to be the one to make that call of wether I believe someone deserves my care. Call me young, nieve, and/or idealistic, but I whole wholeheartedly believe in in 'Primum non nocere'. I fear not going to a legit emergency because someone has decided that a pt has "abused" the system in the past. Just because we(EMS/ERs) do not deem a call an emergency does not mean the pt feels the same. We would have to educate the entire public on a true emergency, these being the same people who can't figure out to pull to the right and stop when an ambulance is running code behind them. Just my thoughts.

[Michael]

I do not want to be the one to make that call of wether I believe someone deserves my care

Nothing in the article contradicts the clear reasoning you've expressed in support of the sound ethical principles you espouse. The author is not proposing that caregivers triage over the telephone, much less that anyone decide that a past abuser will never experience a true emergency and merit care. Rather, he's suggesting that some individuals who command something for nothing will devalue what they receive and treat their benefactors, and their benefactors' resources, with wasteful contempt, to everyone's detriment.

We would have to educate the entire public on a true emergency

The author of the article holds that such education includes allotting the costs less tyrannically. If someone knows that other people are obliged to pay for his mistakes and misdeeds, he will have less incentive to act ethically and prudently, whether that wisdom means saving money for old age, eating healthily, driving carefully, or avoiding fistfights. The article does not seek to discourage caregivers from approaching every call as potentially grave; it seeks to remove the incentive of exploiters who habitually demand services to rescue them from preventable traumas or trivial inconveniences. Its solution is to assign the costs to those who are willing to bear them (including charitable people who don't benefit from the services) rather than forcing sponsors through taxation to pay for rescuing others for "free". The notion here is that good ideas - such as ems - will attract voluntary supporters, both contractors and donors, but that good ideas that conscript those who pay for them cultivate bad practices, such as ems-abuse.

I confess that the prospect of private initiatives replacing most or all government initiatives runs so contrary to what I'm used to taking for granted that I can't always envision how it would work. As a thought-experiment, though, it wakes me up to realize that what I've taken for granted may not be the only or best way, and if the thought-experiment fails, it helps me think through why the accepted way is better. Thus far I've found the kind of site from which this article was taken addictively thought-provoking. But my addiction is my own damn fault, and I ask no one to rescue me from it except those who wish.

[Dustdevil]

The problem is that government at all levels is terrified of private enterprise because it represents a threat to their strangle hold on power. Consequently, in many case they simply don't allow it to succeed, if they allow it a chance at all. They set them up for failure just so they can point to that failure and say, "See! We need to do this job ourselves because private enterprise can't handle it!" Now think about it; how do we usually view "scientific studies" on products that are sponsored and funded by the product manufacturers? We tend to doubt their validity and take it with a grain of salt at best. So when government starts telling you that only they can provide you with quality EMS, that is exactly how you should look at that proclamation. You certainly won't find any independent think-tanks claiming that the government is the answer to our EMS problems. And no, the IAFC is not an independent think tank.

[Richard B the EMT]

I fear not going to a legit emergency because someone has decided that a pt has "abused" the system in the past. Just because we(EMS/ERs) do not deem a call an emergency does not mean the pt feels the same. We would have to educate the entire public on a true emergency, these being the same people who can't figure out to pull to the right and stop when an ambulance is running code behind them. Just my thoughts.

Good thoughts, indeed, but we, the long-timers of EMS, have been trying to succeed at that for years. We try making our system idiot-proof, but someone keeps improving the idiots.

Admittedly, after a while, the triage nurses and doctors take the chance that the "frequent flyer program" member is NOT an actual emergency, and will have the crew deposit the person in the waiting area, anyway.

I saw one of our frequent flyers on a hospital stretcher one time in an ER, brought in by another crew. He had an ETOH abuse problem, and brought in due to being initially unconscious due to the addiction. He passed me going to, and returning from, the men's room, and we exchanged "Hola's" as he did (I think he was from Honduras). The triage nurse had signed the ambulance call report, but never did an in-hospital evaluation.

Sometime after the tour change in the hospital, the oncoming triage nurse realized no evaluation had been done, went to the patient, and found him to now be stone-cold dead! The first triage nurse was summarily fired, but fought for her job back, won it, but was demoted to "just" a floor nurse, never to be either a "Charge" or "Triage" nurse again.

I feel that the 9-1-1 system is a victim of it's own success, to the point that, some years ago, NYC created a nice commercial.

In the commercial, it showed a somewhat loud 1930s party in a ballroom, with the voice-over saying, "save 9-1-1 for a real emergency". Then, the commercial shows Fay Wray, King Kong, and the Empire State Building, with military biplanes flying around, again with the voice-over saying "save 9-1-1 for a real emergency" again. This was more than 30 years ago, so you see, the message stuck with me.

I hope that when we have such calls, we maintain a high level of calmness and professionalism that, even while in our minds, we are screaming "You called us for THAT!!!???"They don't know, so to them it IS an emergency, until we calmly inform them of the real level of the emergency. Some here, I know, feel that a large part of what we do is "hand-holding". So be it. We treat the patient, and a lot of times, the patient's family.

It's just what we do, and save the gripes for later.

[Michael]

Fay Wray, King Kong, and the Empire State Building, with military biplanes flying around, again with the voice-over saying "save 9-1-1 for a real emergency" again. This was more than 30 years ago, so you see, the message stuck with me.

You're supposed to call 911 for help when Fay Wray resists your advances?

[Richard B the EMT]

You're supposed to call 911 for help when Fay Wray resists your advances?

No, you call 9-1-1 when you see her resisting the advances of a 60 foot tall gorilla that is carrying her up to the top of the Empire State Building, from the outside. Only the window washers are supposed to go up to the top from the outside, so Fay and Kong are risking their lives while trespassing!

My point is, it is an emergency when either lives or property are in what may be immediate danger. Other than that, don't call 9-1-1, call the precinct.

[Michael]

Oh.

So long as we know that Mr. Kong isn't the guy dispatched by 911.

I guess.

[spenac]

Just say no!!!!!!!!!!!! There is no reason any fifth grader with no medical education could not decide BS on many calls. Come on people it is crap to say I do not feel comfortable saying no.

[knhollenbeck]

Ok everyone needs to stop and think for a second, I work for a private Ambulance company in Detroit, yes we do get alot of calls from people that abuse the system, but you never know when something is going to be a true emergency, you have to treat everything like it is an emergency, if you cant handle that then you need to change jobs. That one time you THINK it is a non-emergency or stupid person with stomach pain and treat it like nothing and the person dies then you give all the rest of us who care about every patient and bad name, go work at Burger King