Politely telling a patient "no"

[VentMedic]

For everyone else who is reading this: This was an opportunity to "touch" a life instead of "saving" a life. Why not let this taxpayor see a kind and compassionate EMS system, instead of an argumentative one ? This is one of those situations where you can choose to be NICE or choose to be right and piss everyone off.

For once I am in agreement with crotchity.

This may not seem like an emergency to those in EMS because it is usually assumed an "emergency" is someone dying right now or at least has some bleeding. The husband may know that whatever time he has left with his wife will be very much shortened by an infection or any complications that can occur when a person is immunocompromised from chemo. While you may not see this as an emergency, whatever is going on with the patient may cause death even if it is not right now. To the patient and her family this is an emergency. I can truly see a family member becoming frustrated when presented with an ambulance crew that doesn't want to transport "because it is not an emergency". The sooner she can get treatment, the more days, weeks or months she may have with her family.

This is not only the over reaction of the lay person. I have seen experienced EMS providers call their own ambulance services wanting immediate transport for their loved ones who had a chronic or terminal illness regardless of what trucks must taken out of service.

Why must all patients feel like they are being judged by some EMS providers? If the patient waits to see if they feel better and get worse instead, they get "the lecture". If they call before they are actually dying the get "the lecture". Heaven forbid the patient that calls with chest pain that might have any indication of it being reflux. They may wish they had the MI and died before the ambulance arrives so they don't get "the lecture". It is usually the well meaning citizens that want to do good and not be a bother that get "the lecture" from EMS providers about abusing them. Or at least those are the ones that care. Who really expects a catastrophic illness in their life? I would bet that the couple in the original post had never used an ambulance before the wife's illness.

While yes you can try to get into a pissing match with the family and tell them their loved one is not worthy of all the available care that an ALS truck has. The husband has also requested to go to a hospital that can provide more care for their loved than the basic local little general. Why do they want a Basic truck? In times like this, you will truly offend and come across as uncaring.

[spenac]

I disagree with Vent and Crotch. The minute I was told we would have to wait they are no longer emergent and we would have left and pressed charges if they dialed 911 again for this. This patient was stable enough to wait she was stable enough to travel in the family car. Even If I did transport she would go to the nearest hospital regardless of her preference. I am doing my job. If patient calls 911 at that point it is my patient and home health is booted. If patient and home health refuse then they do not need me. Just because patient history does not mean those items qualify her for 911 at that moment. I am not a taxi and refuse to allow people to treat me as such. I am as professional as any medical professional you have met and I do my job. Being a taxi is not my job.

[sirduke]

I've run into similar situations where I work, we are a small rural two truck service. Sometimes we have to refuse to transport to hospitals outside our county because we have both trucks out on calls, and the people get pissed, but our hands are tied. As a 911 service, we are obligated to keep on truck in the county at all times. Very often we get called and they request to be transported to a hospital 80 miles away, and we aren't able to comply. This always results in pissed off patients, family, etc, and the crew getting a ration of verbal abuse.

I've had calls where we get there and the reason they called doesn't justify an ambulance, or they expect us to wait till "so and so" gets there, and we explain why we can't wait, and transport, or if they refuse to go, we go back in service.

As for those nurses, they would definitly had a complaint against them.

Guess this will make me even more unprofessional is crotchrottey's opinion

[VentMedic]

I disagree with Vent and Crotch. The minute I was told we would have to wait they are no longer emergent and we would have left and pressed charges if they dialed 911 again for this. This patient was stable enough to wait she was stable enough to travel in the family car. Even If I did transport she would go to the nearest hospital regardless of her preference. I am doing my job. If patient calls 911 at that point it is my patient and home health is booted. If patient and home health refuse then they do not need me. Just because patient history does not mean those items qualify her for 911 at that moment. I am not a taxi and refuse to allow people to treat me as such. I am as professional as any medical professional you have met and I do my job. Being a taxi is not my job.

So you are punishing the patient because of the actions of the nurses?

Medical professionals also help patients in their time of need to find solutions for their medical problems regardless of whether it is ALS or BLS. It is just part of being in the field of medicine. Hospitals don't like being thought of as hotels either but each patient's case is taken into consideration and not a blanket approach to deny those that might fall through the cracks of care otherwise.

Have you not taken into consideration about a patient's treatment that is specialized and not just any local little general hospital will do? Not all hospitals are created equal and it is this patient's unfortunate luck that she had the misfortune of getting cancer while living in the boondocks with only some rinky dink hospital that can not provide the doctors or the care needed. It is also unfortunate that there may be limited ambulance services for that area and the family has not had time to research all the options. So again you are there only to dish out the punishment for their stupidity of bothering you instead of taking a taxi for 1 hour while risking more pain and suffering for the patient if not able to position properly.

The husband in all of his stupidity may only have wanted what is best for his wife. What a stupid fool he is for calling 911 when he thought something could happen to lose what time he has left with her!

It is a shame people can not move from these areas such as sirduke's that have no options for the patients who suffer a major illness in their lives. How horrible to suffer through an illness and then have to worry about finding transportation after being refused by argumentative EMT(P)s. It would be nice if one could know about their future illnesses so they could live closer to a major hosptial and not rely on the inadequacies of rural life when it comes to healthcare.

We also used to dump all traumas and AMIs at the nearest hospital. The local little general in this case could just start a medicated IV on the woman and request an ALS truck anyway. All you have done is just prolong her from getting the appropriate care she needs.

Gee, so glad to see such caring about the patients but only if it fits with your own needs. There are exceptions to the rules and not everyone is a drunk wanting a free ride across town. Maybe instead of bitching about things, you should get a list of agencies that can provide the services to patients in your area. Many are here today and gone tomorrow, as if we haven't seen that through the AMR era, so it is difficult to stay up with the most current agencies. You could even talk about changing the way trucks are dispatched. What about setting up information lines of communication for people? How about attending meetings in your area to improve where the tax dollars are spent? No, it is much easier and probably more fun to piss of patients by telling them they don't need transport.

[sirduke]

Now I know why they call you VENT.

The problem I described is caused by the people in the county who keep electing county commissioners who refuse to fund our service so we can have more than two trucks in operation. Not as you imply by heartless evil asinine paramedics who delight in refusing to transport. We are bound by the rules and policy established the same body of commissioners, and they tell us what we can and cannot do.

I try to honor any request made by a patient, but in order to keep my job, I have to obey the rules. Sorry if that makes me a bastard.

[spenac]

So you are punishing the patient because of the actions of the nurses?

Medical professionals also help patients in their time of need to find solutions for their medical problems regardless of whether it is ALS or BLS. It is just part of being in the field of medicine. Hospitals don't like being thought of as hotels either but each patient's case is taken into consideration and not a blanket approach to deny those that might fall through the cracks of care otherwise.

Have you not taken into consideration about a patient's treatment that is specialized and not just any local little general hospital will do? Not all hospitals are created equal and it is this patient's unfortunate luck that she had the misfortune of getting cancer while living in the boondocks with only some rinky dink hospital that can not provide the doctors or the care needed. It is also unfortunate that there may be limited ambulance services for that area and the family has not had time to research all the options. So again you are there only to dish out the punishment for their stupidity of bothering you instead of taking a taxi for 1 hour while risking more pain and suffering for the patient if not able to position properly.

The husband in all of his stupidity may only have wanted what is best for his wife. What a stupid fool he is for calling 911 when he thought something could happen to lose what time he has left with her!

It is a shame people can not move from these areas such as sirduke's that have no options for the patients who suffer a major illness in their lives. How horrible to suffer through an illness and then have to worry about finding transportation after being refused by argumentative EMT(P)s. It would be nice if one could know about their future illnesses so they could live closer to a major hosptial and not rely on the inadequacies of rural life when it comes to healthcare.

We also used to dump all traumas and AMIs at the nearest hospital. The local little general in this case could just start a medicated IV on the woman and request an ALS truck anyway. All you have done is just prolong her from getting the appropriate care she needs.

Gee, so glad to see such caring about the patients but only if it fits with your own needs. There are exceptions to the rules and not everyone is a drunk wanting a free ride across town. Maybe instead of bitching about things, you should get a list of agencies that can provide the services to patients in your area. Many are here today and gone tomorrow, as if we haven't seen that through the AMR era, so it is difficult to stay up with the most current agencies. You could even talk about changing the way trucks are dispatched. What about setting up information lines of communication for people? How about attending meetings in your area to improve where the tax dollars are spent? No, it is much easier and probably more fun to piss of patients by telling them they don't need transport.

I am not punishing anyone. I am making a professional medical decision based on real need. I refuse to be a taxi at the detriment of the greater number. I am the most caring provider you will meet but I also will not allow abuse. I attend county and city meetings demanding more funds. I educate the public as well. By saying no we educate patients that we are not the darn taxi. I refuse to take patients out of the way when they do not need it. Then my ambulance is available quicker for others that have a real need.

[VentMedic]

I am not punishing anyone. I am making a professional medical decision based on real need. I refuse to be a taxi at the detriment of the greater number. I am the most caring provider you will meet but I also will not allow abuse. I attend county and city meetings demanding more funds. I educate the public as well. By saying no we educate patients that we are not the darn taxi. I refuse to take patients out of the way when they do not need it. Then my ambulance is available quicker for others that have a real need.

So that one cancer patient who requires a different level of care than what her local hospital provides means nothing to you. They are essentially a detriment to the greater good. Whatever pain and suffering she is experiencing is her own tough luck and she should have known better than to call for an ambulance. That goes for the stupid husband who cares about her. Honestly, if she could have tolerated a POV or taxi, it probably would have been less trouble and cheaper. She also wouldn't have to listen to an EMT(P) complain about her abusing the system.

Are you really sure you know how sick some of the patients are that you pick up? Many on these forums complain about "BS" nursing home calls or dialysis runs and yet many do not know why the patient is actually on dialysis or what sepsis truly is. Many also don't fully understand pain, as we have seen by some threads, or chronic illnesses or cancer. Yet, those in EMS believe they know exactly if a patient is not worthy of their ambulance. Medical illnesses are not as simple as the scraped knee or broken finger.

[spenac]

So that one cancer patient who requires a different level of care than what her local hospital provides means nothing to you. They are essentially a detriment to the greater good. Whatever pain and suffering she is experiencing is her own tough luck and she should have known better than to call for an ambulance. That goes for the stupid husband who cares about her. Honestly, if she could have tolerated a POV or taxi, it probably would have been less trouble and cheaper. She also wouldn't have to listen to an EMT(P) complain about her abusing the system.

Are you really sure you know how sick some of the patients are that you pick up? Many on these forums complain about "BS" nursing home calls or dialysis runs and yet many do not know why the patient is actually on dialysis or what sepsis truly is. Many also don't fully understand pain, as we have seen by some threads, or chronic illnesses or cancer. Yet, those in EMS believe they know exactly if a patient is not worthy of their ambulance. Medical illnesses are not as simple as the scraped knee or broken finger.

Vent I resent that you would ever question my professional treatment and compassion for my patients. I know about the issues you bring up. If I do transport I do not complain, I treat professionally. I never neglect my patients. Despite all your attempts to make us out as backwoods, toothless, ignorant inbreds, some and actually many can and do have enough knowledge to properly say yes or no to ambulance transport. And yes most nursing home, dialysis, and even 911 calls do not really need an ambulance. You spoke of public education earlier, well the public has been educated that we are a free taxi by the you call we haul services. We need to re-educate the public to the fact that an ambulance is for emergencys not for a free ride. If a patient has just had dialysis honestly the center should observe them long enough to ensure they are not going to develope the electrolyte imbalance, etc.

Vent I appreciate you positive input on many subjects but I am personally sick of you verbally treating us as if we were too stupid to wipe our own butts. I assure you my patients even those I deny transport to are treated properly and respectfully. I do not abuse or mistreat anyone. I educate patients as to when to dial 911, when to go to the ER, and even when to just wait to go to their family doctor. For anyone that doesn't agree, tough. I will not apologize for being a Pre-Hospital Medical Professional rather than an underpaid taxi driver.

[VentMedic]

The problem I described is caused by the people in the county who keep electing county commissioners who refuse to fund our service so we can have more than two trucks in operation. Not as you imply by heartless evil asinine paramedics who delight in refusing to transport. We are bound by the rules and policy established the same body of commissioners, and they tell us what we can and cannot do.

I only stated paramedics who delight in refusing transport as one reason not to live in these areas.

Hence, people should be warned if they come down with a chronic or catastrophic illness in your area that there will be no way for them to get to a hospital if they can not tolerate a car. They definitely won't be able to get to the hospital where their specialists are. Hopefully their distraught loved one can drive them safely to the hospital if that is their choice. There probably aren't any taxis available in these areas either. I am not being sarcatistic and I often advise people who have medical needs children or adults to consider relocating for better healthcare. Pregnant women who know they may have a difficult birth, complications or anything abnormal with the fetus should also get closer to a hospital that can provide the care they need and NOT trust their local ambulances to get them to the appropriate facility directly or by transfer . To be a high risk delivery at the little general hospital may jeopardize both the life of the baby and the mother.

spenac,

You are taking this very personally. Look at a couple of posts before you. Would you call the cops on a cancer patient with a wound vac? Look at the many threads we have had on this subject. If you read position statements made by NPs and PAs by their professional organizations, they are attempting to find solutions for the patients that don't need this but could use that. So far all some have stated in EMS is about their own agenda as to what the patients should do for EMS.

If you are feeling I am intentionally picking on you so be it. I just considered your statements an opportunity to make more points about patient care.

I also want some to see the patient as an individual and not just as BLS or ALS but in medical terms. Blanket labels don't always apply for every situation.

[spenac]

spenac,

You are taking this very personally. Look at a couple of posts before you. Would you call the cops on a cancer patient with a wound vac? Look at the many threads we have had on this subject. If you read position statements made by NPs and PAs by their professional organizations, they are attempting to find solutions for the patients that don't need this but could use that. So far all some have stated in EMS is about their own agenda as to what the patients should do for EMS.

If you are feeling I am intentionally picking on you so be it. I just considered your statements an opportunity to make more points about patient care.

I also want some to see the patient as an individual and not just as BLS or ALS but in medical terms. Blanket labels don't always apply for every situation.

I will call the cops on anyone that chooses to abuse the 911 system. I sympathize with her problems but that does not justify abuse.

I see every person as an individual. I treat or transport based on that patients actual needs, not preferences, especially a preference that for no real valid reason takes an ambulance from my community. I will not transport just to transport. I am making statements on what EMS needs to do to improve so that we can serve our communitys better and next to more education is quit allowing the public to use us as taxis.

I agree we need to stop being BLS/ALS and just Pre Hospital Medical Professionals providing the actual care needed in the field based on each patient, and that includes saying no to those that can safely go by other means.