Deny Transport?

[CBEMT]

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.

Hospice patient going to Hospice inpatient unit- they are alive until we get there.

[EMS49393]

How does your service survive at all if 90% of runs billed are never collected? It seems a little high to me, but I'll give you the benefit of the doubt as I've never lived in a "boarder city."

I've been in EMS for a long time, run a lot of calls, and worked in five or so different cities. I've always treated every patient the same way, regardless of who they were, if they could pay, or if they were just using the service. People abuse 911, that's a fact. I feel a great deal of loathing in your posts. You don't sound as though you like your service, area, patients, or job. If you're butting your head against a wall attempting to effect a change, I can understand your frustration. If you're just one of those EMT's that wants to sit in the chair all day, watch cable, eat ice cream and bully patients out of going to the hospital because they're just another non-paying illegal, then perhaps, it's time you seek another line of work.

Do you have legitimate stats to back your claims of non-payment? Do you have all of this need documented on paper? Have you tried to appeal to your tax paying base? Have you pleaded your case with anyone, even the state, with any sort of passion? Have you tried, or are you just sitting here, spewing off incredible numbers and complaining about your patient base instead of using your energy for the good of the people you are supposed to be serving?

You've managed to skirt around a few questions already asked of you. I'm interested to see how you skirt around the difficult ones I've posted.

[JPINFV]

Hospice patient going to Hospice inpatient unit- they are alive until we get there.

Err, what happens in your ambulance if the hospitce patient with a valid DNR crashes in route ?

[CBEMT]

Err, what happens in your ambulance if the hospitce patient with a valid DNR crashes in route ?

I believe what you are asking is what happens if the hospice patient dies enroute to hospice?

Answer- nothing. They are alive until I get to hospice.

Having a family member working at hospice changes your outlook on care of the terminal patient, ESPECIALLY if said patient is enroute to a hospice unit. Transporting to the local ED is not the answer.

[Just Plain Ruff]

I believe what you are asking is what happens if the hospice patient dies enroute to hospice?

Answer- nothing. They are alive until I get to hospice.

Having a family member working at hospice changes your outlook on care of the terminal patient, ESPECIALLY if said patient is enroute to a hospice unit. Transporting to the local ED is not the answer.

so let's say that you are 25 minutes from hospice, and the patient dies. how can you justifiably say they were alive until they got to hospice? Do you falsify your run report and say they died when they got to hopsice or what do you do?

I'm curious - the patient is dead in your ambulance for 20 minutes yet they didn't die until they got to hospice???? explain please

[spenac]

How does your service survive at all if 90% of runs billed are never collected? It seems a little high to me, but I'll give you the benefit of the doubt as I've never lived in a "boarder city."

City and county fund us. No funds no ambulance. Thats why we're not able to be properly staffed.

[spenac]

How does your service survive at all if 90% of runs billed are never collected? It seems a little high to me, but I'll give you the benefit of the doubt as I've never lived in a "boarder city."

I've been in EMS for a long time, run a lot of calls, and worked in five or so different cities. I've always treated every patient the same way, regardless of who they were, if they could pay, or if they were just using the service. People abuse 911, that's a fact. I feel a great deal of loathing in your posts. You don't sound as though you like your service, area, patients, or job. If you're butting your head against a wall attempting to effect a change, I can understand your frustration. If you're just one of those EMT's that wants to sit in the chair all day, watch cable, eat ice cream and bully patients out of going to the hospital because they're just another non-paying illegal, then perhaps, it's time you seek another line of work.

Do you have legitimate stats to back your claims of non-payment? Do you have all of this need documented on paper? Have you tried to appeal to your tax paying base? Have you pleaded your case with anyone, even the state, with any sort of passion? Have you tried, or are you just sitting here, spewing off incredible numbers and complaining about your patient base instead of using your energy for the good of the people you are supposed to be serving?

You've managed to skirt around a few questions already asked of you. I'm interested to see how you skirt around the difficult ones I've posted.

I see the red on the budget , I get the complaints from the officials. I see all the stacks of bills that are returned no one by that name at this address. I work the 7 24's straight, In fact starting next week I have to work 13 24's straight so I can get some days off that I need. Yes I have the facts.

I don't ask any patient for there paperwork to prove they're legal. If you call for ambulance we come we treat and yes we transport almost all that ask to go to hospital.

I will never bully a patient, that statement pisses me off and shows your lack of professionalism.

You may not agree with frontier medicine and the things we have to do but those of us that survive it do so because we care about those we serve. Its not just a paycheck. We have worked fund raisers, we have asked people to even send $5 month towards the bill, we've offered free first aid,cpr,eca,emt education. Again I am always proffesional with my patients hell a lot of them are my friends by the end of our trip to the hospital even the illegals. I have people come to my house that know me from the ambulance and don't have money to go see doctor to get blood pressure checked or have me explain what the medicine is that the DR sent them home with, yes I said my house not the station. Do you allow people to stop by your house or call it day or night with questions. I don't ask them to call me or come by but I don't refuse them. If they need more than that I help them contact their Doctor or call 911 for them. We have extreme poverty here and you know the best pay I get are the hugs and handshakes of people that appreciate my efforts taking care of them or a family member. If it seems I have skirted any ? sorry did not do it on purpose unless it required me giving to much personal or patient info. As previous we survive on city and county funds and occasional grants. Even the state had to bail us out so we could get an ambulance recently as we were all but walking.

I have not attacked practices on any posts that I disagree with or don't understand because I realize everyone has different circumstances and I haven't walked in their shoes. I ask that you do the same.

[CBEMT]

so let's say that you are 25 minutes from hospice, and the patient dies. how can you justifiably say they were alive until they got to hospice? Do you falsify your run report and say they died when they got to hopsice or what do you do?

I'm curious - the patient is dead in your ambulance for 20 minutes yet they didn't die until they got to hospice???? explain please

Document accurately, absolutely. But I will complete the transport as if nothing happened. Local EDs are not experienced or equipped to deal with the families of these patients. Instead of being placed gently into bed as if asleep, with plenty of time for the family to spend time and say goodbye, they will be tagged, bagged, and shoved in the cooler until at least the next day, instead of picked up by the family's funeral home within a few hours.

The "alive till we get there" is in situations where Hospice, in their infinite wisdom, took the DNR with them to the inpatient unit prior to our arrival. In these cases I know the DNR exists and is valid because of how often we work with them, I just don't HAVE it. I refuse to code a terminally ill patient with less than 2 months to live because the hospice home nurse took a piece of paper with her 10 minutes before I got there.

If that means, once out of 10,000 times, I may have to put "transport completed without incident or change" on my run form when in fact there was a change, I will, and not lose a wink of sleep or anything else over it. The patient and their family are more important to me than a protocol violation that I would never be convicted of in a trillion years, even in the US.

Worst case scenario- my partner's wigging out, screaming about lawsuits and licenses and generally acting like a moron. So to make him/her happy I call the closest ER's med control number, explain what's up, and be told to complete my transport. Exactly what a coworker did a few years back when she had a guy croak enroute on her (minus the hysterical partner).

[tskstorm]

okay its taken me a bit to get back to this thread, okay to clarify,

1st note is i didnt give FULL details on company policies but will attept to clarify and still keep details to a minimum

it is a bls unit, full on part 800 doh unit, to clarify,

if a pt is on the 7th floor of a hospital on his way to a nursing home, after being admitted for xyz has an elevated bp, we are REQUIRED to deny the transport, simply because the NH wont accept the pt.

ill pose you this.. what sense does it make for the company to take an unstable pt out of the hospital ? how can that help the pt ?

now if we reverse the situation and the pt is in a nursing home scheduled to go for dialysis, and we find they are unstable elevated bp bla bla, then we refuse txp to the dialysis center and go to the nearest ER.

Ruffems- does that clarify it enough for you ? who would i call for the pt ? the DR on the floor or the ER and get the pt down there.

Do you refer them to law enforcement or do you just leave the scene and let them fend for themselves.

WE do not except them from the hospital, fend for them selves? nope the rn's and dr's on the floor help them.

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

we do have als txp units but if the pt needs ALS i still REFUSE the call and the appropriate unit will be notified.

Ridryder 911

Not all patients need an ER, but may require critical care transport

we dont have CC, and again i will say the same thing why would i take a pt outta the hospital in an unstable condition

BLS such as oxygen to even a residence. when i said o2 the first time i meant o2 with a vent, of course we dont refuse pt's who are on o2 all the time.

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.

okay 1 im a Marine, i dont flake out on work, nor am i worried about psych pt or otherwise, i havent EVER denied txp for that reason personally, doesnt mean it isnt done.

okay and then back to ruff, like i said it is isnt 9-1-1 it isnt ALS it was BLS TXP not an ambulette or "wheel chair van"

i think that clarifys it for the most part .. any other thoughts or anything else need explanation ?

[FormerEMSLT297]

New York City 9-1-1 units can refuse transports, the procedure is as follows:

The NYC-EMS system (Pre-merger) had a procedure (still in place with the great fire monkeys) called a 10-95 (triaged out thru medical control). After a unit BLS or ALS arrives at the scene and completes a full patient assessment (2 sets of V/S) and determines in the crews mind that the patient does not need transport, they can call a medical control physician, and present their case, if the MD agrees he will speak with the patient on a taped phone line and basically tell the patient "you're not going" and then we give the patient a copy of the PCR and leave.

In 10 years full time I saw the need for it to be done 3 times.... and all 3 times it was successful. One patient that stands out is as follows:

30 something male found at the MTS Police station, prisoner, complaining of non traumatic back pain, onset 8 hours ago. He claims the cause of his pain was "sleeping all night on this hard jail cell bench.

No evidence of trauma, v/s WNL, put him on the phone with the doc, he repeated that his back only started hurting after trying to sleep on the jail cell bench.,,, denies trauma, no fight during arrest, no medical Hx. etc.

After speaking with the MD he was REFUSED.

Talked to the cops later in the week, he made it to court and was released on bail. his "back pain " never came up again after we refused him.

Now this is just one of the 3 examples i have,, all are basically the same,,,, This protocol is still in place,, I think it specifies, that under 5 or over 70 you can't refuse,, etc.

But in this case it is good. I have heard of some systems doing similar stuff, like after assessment if you just need a ride to the hospital because you have a clinic appointment or like a minor laceration needing a few stitches, but can wait, they give you a taxi voucher, bus ticket, or in some cases send an ambulette or van to run around and pickup all the minor cases within like an hour or 2 and the 9-1-1 unit goes in service....

Anyone do stuff like that it would be interesting to hear about.

Stay safe

Former