Deny Transport?

[Just Plain Ruff]

quick note, did this article say they were 9-1-1 services?

when i worked doing transport we can refuse to take any pt with elevated bp's unstable vitals etc.. UNLESS there destionation is an ER, but if we get called to pick up to go to a nursing home from a hospital floor and the pt needs o2 or bag or intubation etc... we can refuse the pt.

we can also refuse pt's if we deem it not safe for us ...

like 2 months ago i was rolling up to a hospital with my partner we get out the stretcher about to pick up a pt, security wouldnt let us in we asked why they said and i quote "psych pt got out" i was like alright, talked to dispatch said scene was unsafe send no more units to this location, the ER was on diversion no one was allowed in or out at all, in this case the call was offically put in as we refused to take the pt cuz we refused to wait at an "unsafe scene" ... its all political nonsense..

if its a 9-1-1 call we cannot refuse anyone period the end.

Does anyone else have a issue with this post???

you can refuse a patient who obviously needs ambulance transport the intubated patient or patient needing oxygen? Explain that please. Are you just a basic life support transport unit or do you work on a transfer van? I can see you refusing then but if you are an ambulance and you refuse that type of patient then I find issue with that.

So if you refuse a patient who has unstable vitals and such who do you call?

you can also refuse to transport patients you deem unsafe to you? ? ? Explain that too. Do you refer them to law enforcement or do you just leave the scene and let them fend for themselves.

If you are a service that has paramedics then I find your reasons to refuse to transport very very troubling.

[Ridryder 911]

I have a problem with the post, because it is talking out of both sides... refuse a hypertension if the destination was not an ER or if the patient required oxygen or a vent type patient they could not transport ?.. WTF You won't transport to SNF or rehab units ? .. Not all patients need an ER, but may require critical care transport or even BLS such as oxygen to even a residence.

As well refuse if the scene is not safe.. hmm.. sounds like an excuse, not to work. Sorry, you have to be careful it is true, but unless the "psych" patient is armed and dangerous, and the whole ER was on lock down I am sure it was relatively safe. If not, leave and have them call you when the situation was handled and return to transport the patient.

Like I said.. not very clear..

R/r 911

[Just Plain Ruff]

Yeah, my suspicion is that this isn't a 911 or a ALS Transfer service. Nor do I believe it's a bls transfer service, simply a wheelchair van or similar.

TSK, please clarify your post. It's quite alarming to me at least.

[Laura Anne]

Medical director allows use of common sense. If person say's sneezed last week and decided that because they can't sleep tonight that they want to go by ambulance, if all vitals are ok we can refuse. When have doubt and cannot get in contact with medical director we transport. But we are also 90 miles from hospital and the only ambulance so when we do transport the community is uncovered for at least 4 hours. Nearest mutual aid is an hour away assuming their one ambulance is available. I am curious to see others protocols that allow deny patients transport as we are about to redo our protocols.

Hmmm, well the common sense of the BLS volunteer crew in New Jersey that told my grandfather, "you're fine. You're just having an anxiety attack, so go to bed," and then recalled the medic unit coming in OBVIOUSLY LACKED COMMON SENSE. My grandfather was C/O abdominal pains and did suffer from anxiety, as well as an extensive cardiac history. They took it upon themselves to diagnose my grandfather and call off the ALS unit instead of letting them assess him. He's dead now. He died in his sleep that night. We got the call the next morning from another relative who found him on the ground next to the phone. She was there the night before when the ambulance arrived and she unfortunately took the crews word, just like my grandfather did. Hey....after all, we're the 'professional health care providers', right? Deny transport because of use of common sense? In this field?? With the type of EMS providers that are being produced??? NO thank you. You deny, you go to court for abandonment. PERIOD.

Please don't take this irritation as being directed at you, Spenac. I just do not believe it's a safe practice, especially from personal view. Also, where do you work as a provider? Just curious. thank you...

[JPINFV]

The only time I will ever "refuse" a patient that is not going to the ER is if the care required is out of my scope (of course we do have the ability to do RN or RT CCT units, so I will recommend that they contact for a follow up. Most of the time this happens is because of a communications mishap and the facility will cancel us (ex. Someone forgot to tell dispatch once that our discharge was a vent patient... they called back for a unit with an RT. They were only slightly amused when I offered to BVM the patient the 20 minutes to the destination ). Hospice DNR patients without proper DNR paperwork [yes, you need a physicians signature on that sheet. No, your face sheet that says DNR doesn't work. Hospice employees loves to take our DNRs with them or give it to the family] gets a stern warning that if ANYTHING changes, we will reroute to the nearest facility if needbe. This generally gets a copy the chart DNR real quickly.

There has been once call that I should have "refused." I had a discharge out of a hospital once that was on lockdown due to a "bomb threat." They were supposed to bring the patient out to us [patient being discharged, not evacuated], but someone forgot to tell security that our patient would be waiting down in the lobby and was going to be brought out to us. Security outside couldn't find out patient in the lobby so they cleared us to go inside. The ER charge nurse was not happy that we were going to be passing through during a lockdown till the security guy walked over and cleared us. We got up to the patient's room to find it empty with the staff telling us that the patient was down in the lobby. :roll: In the end, the threat was fake, but you never know.

[spenac]

Hmmm, well the common sense of the BLS volunteer crew in New Jersey that told my grandfather, "you're fine. You're just having an anxiety attack, so go to bed," and then recalled the medic unit coming in OBVIOUSLY LACKED COMMON SENSE. My grandfather was C/O abdominal pains and did suffer from anxiety, as well as an extensive cardiac history. They took it upon themselves to diagnose my grandfather and call off the ALS unit instead of letting them assess him. He's dead now. He died in his sleep that night. We got the call the next morning from another relative who found him on the ground next to the phone. She was there the night before when the ambulance arrived and she unfortunately took the crews word, just like my grandfather did. Hey....after all, we're the 'professional health care providers', right? Deny transport because of use of common sense? In this field?? With the type of EMS providers that are being produced??? NO thank you. You deny, you go to court for abandonment. PERIOD.

Please don't take this irritation as being directed at you, Spenac. I just do not believe it's a safe practice, especially from personal view. Also, where do you work as a provider? Just curious. thank you...

Sorry for your loss. With your grandfathers history and signs/symptoms we would have erred on the side of caution and transported. When I say we refuse we refuse the obvious such as the 911 call that I feel hot. We get there and the patients a/c is broken. No medical problems. Patient wants us to take them in ambulance to the hospital so they can be more comfortable. Had we transported and someone died in the 4 hours we were gone I would have felt horrible. No need for the ambulance your not going. We are strictly a 911 emergency service. Texas also licenses transport or combo services. We are not the taxi though we would make more money if we were. We still get abused because people learn what to say so we have to err on side of caution. Many of them end up being illegals using us to get passed the border patrol checkpoints. Get to the hospital and we see many miracles as people's pain goes away and they walk out the hospital doors w/o even seeing the doctors.

Again let me clarify to refuse has to be obvious bs. We transport lots of taxi rides just like the rest of you but we can use common sense and recommend a repair company or a hotel or for them to visit a friend for the person who's A/C broke. Just like the person who called that said they had heard one of their friends had some illness and they wanted to go get checked to make sure they did not have it. Not an emergency could safely travel pov.

Guess I should use term limited common sense allowed.

[Laura Anne]

Thank you Spenac for your kind words. I have felt the loss of a loved one who died alone, in the dark, afraid, and in pain because of this tragic err in judgement and blatant abandonment. It's this mentality that makes me worry about the right to refuse people care transport. It's like a lot of good ideas that was taken advantage of by the incompetent ones who blunder this profession with their laziness.

As far as the abuse in the terms of the illegals on the border, it's a horrible loop hole that happens all too often down on the border. I lived in Southern California and worked in a border town ER and on the ambulance. I saw this abuse every night I worked. Not only an abuse by the illegals, but also by the BPA who don't want the added paperwork of processing the aliens. When the rescue unit would go to a 911 call from BPA somewhere out on the border, they'd have someone C/O an injury/illness who, although persued, caught, and detained by them, would tell us the IA is not under arrest. We'd get them to the ER, check them out in the nice, clean, cool air conditioned ER, then they'd grab a bit to eat from the vending machines, watch them make a phone call or two on the phone, then walk out before discharge. We all eat the bill for this, too! I am not saying they're all bad, but many of them know the system all too well and abuse the HECK out of it.

[EMS49393]

Spenac, no offense, but I hope you're not a paramedic. The bottom line, they call, we haul, that's all. We do not have the power or privilege to determine a person is full of S%*^. Of all the 911 calls we receive, probably 80% of them do NOT need an ambulance. However, that 80% creates enough run numbers to allow us to continue to provide three ambulances in our county, with the recent consideration of adding another unit. Giving us three ambulances makes at least one of us available for the 20% of the patients that really need an ambulance.

Now, I realize you said you only have one ambulance. Imagine if you hauled every patient that had, what you consider, a "benign" complaint. You might generate enough revenue to have two staffed ambulances in your area, or at least be able to prove a need for more then one ambulance.

In this business it is not our right to tell a person they will "be okay" without being willing to stand up in court and suffer the consequences of our actions after that patient mysteriously dies. It's also poor form to bully a patient into thinking they are wasting your time and don't deserve the pleasure of riding in your ambulance for what you feel is a BS complaint. You need to understand, our definition of an emergency is far different then the lay publics definition. I think I'll stay out of Texas.

[spenac]

Thank you Spenac for your kind words. I have felt the loss of a loved one who died alone, in the dark, afraid, and in pain because of this tragic err in judgement and blatant abandonment. It's this mentality that makes me worry about the right to refuse people care transport. It's like a lot of good ideas that was taken advantage of by the incompetent ones who blunder this profession with their laziness.

As far as the abuse in the terms of the illegals on the border, it's a horrible loop hole that happens all too often down on the border. I lived in Southern California and worked in a border town ER and on the ambulance. I saw this abuse every night I worked. Not only an abuse by the illegals, but also by the BPA who don't want the added paperwork of processing the aliens. When the rescue unit would go to a 911 call from BPA somewhere out on the border, they'd have someone C/O an injury/illness who, although persued, caught, and detained by them, would tell us the IA is not under arrest. We'd get them to the ER, check them out in the nice, clean, cool air conditioned ER, then they'd grab a bit to eat from the vending machines, watch them make a phone call or two on the phone, then walk out before discharge. We all eat the bill for this, too! I am not saying they're all bad, but many of them know the system all too well and abuse the HECK out of it.

Something that really bothered me about your grandfather was a bals crew turning around als when they had signs/symptoms that really needed at least an ECG exam. I definitely would have rather traveled to the hospital than risk a life.

As far as illegals I've even asked the checkpoints to stop us but they won't as they don't want to assume reponsibility for the illegals. We have a rule that no one but the patient rides with us and no luggage. Years ago had people claiming to be family would ride to get past checkpoints or even smuggle drugs in luggage.

[spenac]

Spenac, no offense, but I hope you're not a paramedic. The bottom line, they call, we haul, that's all. We do not have the power or privilege to determine a person is full of S%*^. Of all the 911 calls we receive, probably 80% of them do NOT need an ambulance. However, that 80% creates enough run numbers to allow us to continue to provide three ambulances in our county, with the recent consideration of adding another unit. Giving us three ambulances makes at least one of us available for the 20% of the patients that really need an ambulance.

Now, I realize you said you only have one ambulance. Imagine if you hauled every patient that had, what you consider, a "benign" complaint. You might generate enough revenue to have two staffed ambulances in your area, or at least be able to prove a need for more then one ambulance.

In this business it is not our right to tell a person they will "be okay" without being willing to stand up in court and suffer the consequences of our actions after that patient mysteriously dies. It's also poor form to bully a patient into thinking they are wasting your time and don't deserve the pleasure of riding in your ambulance for what you feel is a BS complaint. You need to understand, our definition of an emergency is far different then the lay publics definition. I think I'll stay out of Texas.

We still transport 95% or more of the patients that want to go and more than 90% of them never pay a dime. Our discretion is limited but thankful that we have it. We use a billing service that applys for medicaid, medicare, insurance, illegal alien fund (forget correct name), and bills patients, but when given false names and addresses doesn't do much good, and even many that give you ID give a false ID, so no way to collect. We have the number of runs to justify more ambulances and the state even verbally recomended it but will not order it as then they would have to help support it.