The Downfall of the U.S. Healthcare System-- Is EMS To Blame

[latinaemt1300]

I tried searching for the actual picture of this bulletin board.. but i couldn't find it.. lake county , fl put out a outside bulletin board that said they were not a taxi ride.. i'm going to try and find it, i guess that's a start

[CBEMT]

I don't see myself as some sort of gatekeeper for the ED. That's what Triage nurses get paid to do. Not only is it beyond my current education to tell a patient that they don't need to be seen by a doctor, it's just not my place.

People call (either for themselves or someone else). I respond, I evaluate, treat if necessary, transport if necessary- OR REQUESTED- or document a refusal if the patient is capable, so desires, and understands all risks, etc. I don't make the patient's decisions for them.

Depending on the circumstances, at my POC gig I have the option of calling a private ambulance for transport in non-emergency cases (with the patient's permission) so as to keep my 911 unit available. But the patient still goes.

Triage can decide if they get a bed, or a chair out in Public Waiting. I don't get paid enough to do their job for them.

I will admit that was DOES get my goat is when Ambulance Triage is full of skells, and the nurses in Public Triage call a Medical Team to a Critical Care room for someone who walked in through the front door. There's someone who SHOULD have called 911, might have even benefited from pre-hospital intervention (rare, but it happens) but chose not to for whatever reason.

[spenac]

CBEMT how can you sell yourself so short? This goes back to denying transport to the guy that tells you he justs wants hospital lunch. I still can not believe how many said they would still transport. It takes zero education to know that is someone just wanting a free ride. Why tie up an ambulance that should be available in order someone really needs help?

I agree we all need more education.

This is not about clogging the ER with BS, this is about taking our ambulances out of service for those that need us. The ER can put people in waiting rooms. If we are transporting the guy to lunch and someone collapses next to the ambulance while we're at a stop light we can do nothing, we already have a patient so person dies for no reason while waiting for you to get back from dropping lunch guy off.

So while with our limited education we will have to take most callers we should be able to still say no to some types of callers.

[rgrisham1117]

I am an Emt in Alabama and as much as we would like to say no,it is against the law.If they call 911 I am required by law to transport that person to the hospitol,to not do so is abandonment.However ,noone said that once you get to the hospitol you can't put them out in triage where they will be seen according to their priority.The reason alot of people do not go POV is because they think if they come in by ambulance they will be seen faster.So the problem falls on legal systems and the receiving facility,you are obligated.

[spenac]

I am an Emt in Alabama and as much as we would like to say no,it is against the law.If they call 911 I am required by law to transport that person to the hospitol,to not do so is abandonment.However ,noone said that once you get to the hospitol you can't put them out in triage where they will be seen according to their priority.The reason alot of people do not go POV is because they think if they come in by ambulance they will be seen faster.So the problem falls on legal systems and the receiving facility,you are obligated.

UMMM You may want to research the laws a little more. Many throw that out that it is the law here in Texas also. But actually you have the right to deny and can even file charges of 911 abuse on callers that have no real emergency. I could be wrong about your state but I would actually bet there is a way to be able to legally deny.

In fact maybe...........well look for a new topic so I don't hijack this one.

[CBEMT]

CBEMT how can you sell yourself so short? This goes back to denying transport to the guy that tells you he justs wants hospital lunch.

You're changing the scenario. That's someone with no medical complaint. I have denied transport to someone who, while having a minor illness, wanted a ride over the state line for prescriptions because his daughter was too sick to take him (slightly worse cold than his).

"Rescue's available, needless call. Any more calls from this address, send the police first."

Now, had he said he wanted transport to the ER for said illness, I'd be obligated to either arrange for a private ambulance if he had insurance, or take him myself. Would he have needed actual care? No, and he wouldn't have gotten any. But I don't have the right to tell him that he doesn't need to go.

I've taken someone to the hospital whom I was absolutely convinced was using us to move apartments- she gave us a different mailing address than the one we responded to, and she wanted us to take 5 suitcases and 8 cardboard boxes worth of her crap with us! But, she had back pain from a previous slip and fall, so we had to take her (plus I worked for a private at the time, we'd get fired if we didn't). We let her take one bag in case she was admitted.

I got the last laugh though, even if I didn't try to- she couldn't remember the name of the hospital, so I took my best guess based on her description. And I was wrong!

[spenac]

I got the last laugh though, even if I didn't try to- she couldn't remember the name of the hospital, so I took my best guess based on her description. And I was wrong!

OOPS, I hate when memory goes bad like that.

[Ridryder 911]

Most systems can't afford to have a EMS based "refuse transport" protocol. Take for example this morning I transported a 30's male with a laceration to this finger, presented to us with the bleeding controlled with bandages and only needing a ride. He had insurance and would likely pay the bill for service. So if we were to refuse transportation we would not only miss making money, but lose money for generating a response with no income.

As much as we don't like things we need to look at them through the $ sometimes to.

Also don't forget most people don't have primary care and the ER is there source for medical care. As well as the fact that everyone knows that if "the cat gets out of the bag" and they call 911 somebody will show up and likely solve the problem for them. Basically the biggest and most successful government program ever put together, and in systems where 'call screening' from what seemed like 'minor' calls have only turned into major litigation nightmares.

If the insurance is paying for "BS" calls then someone is "doctoring" the documentation. Sorry, insurance companies do not pay for such. They usually require the same requirements that Medicare require the need of an emergency. By law, one is supposed to inform the patient prior to treatment and transport (including Medicare) that services may not be covered, and the patient maybe billed for such services with a signature from them.

It is such statements from medics that I question the integrity of the EMS. Personally, wish more Medicare and Insurance Fraud investigation would bust such EMS. This would help promote the need of being able to refuse service when not needed.

As well, once the ER has accepted the patient the patient is in equal or greater hands and abandonment would have not occurred.

R/r 911

[spenac]

Rid how true that is. I keep hearing about services getting paid for BS transports yet my services receive nothing. Why? Because I will not put anything that is not fact in my reports. I will not list them as ALS when BLS was a stretch. I will not say we lifted when patient walked to the ambulance. I will not say anything just for payment. It is a legal tight rope for services to specifically give you statements to use or not use for payment.

As to screening over the phone, I do not like that idea.

I am a firm believer in saying no to people that after an examine it is determined that they can safely go to hospital by other means. In fact at some point I expect insurance and medicaid/medicare will dictate changes that will make that the standard not the exception as it is today.

[Lone Star]

Unfortunately, it doesn't help matters when you have an employer that wants you to 'come up with a medical justification' for transport, so they can submit a bill to the state (Medicaid/Medicare) or to the insurance companies.

If a patient has tripped over his own shoes left laying out in the middle of the floor, and twisted their ankle; we would have to write a 'chief complaint' of R/O (Rule Out) possible ankle fx....

There should be some sort of 'reforms' in the insurance world that if a person calls for an ambulance and it's for something extremely minor (as in the cut finger previously listed), the caller is responsible for the entire bill for services (including just 'show up pay'). You'd be surprized at how fast alot of these 'frequent fliers' and system abusers would quit!