Petition to: Allow Ambulance crews to refuse transport

[scott33]

Are you sure that most in USA are volunteer? Also I am aware of many volunteer services that bill for all calls, just no labor charges, in fact never been around any service that does not bill. One paid service here charges about $750 for a transport. A volunteer service the same distance from hospital in another town charges $500. Only difference no labor hours billed. Not free but most people just don't pay and there is little that you can do to legally collect.

100% free in my part of the world (Rural NY) .

Different places have different systems. I have no problem with volly 911 systems billing insurance companies if their government funding is nominal. But insurance status should never be a consideration for treating / transporting those who genuinely need it. I do hope it never comes to that.

[HellsBells]

I have to agree that is a bad idea to have a policy that allows paramedics to outright deny patients transport. I think that if you're smart, and a half decent communicator you can usually convince your patient that its not in their best interests to be transported. If they still want to go, fine, our service has an agreement with the ER dept that allows stable pts to be downloaded to the waiting room, where they can wait for 12 hours for a doc to look at a sore toe.

I think that theotherphil is right about the changing role of paramedics in the field, with the increased pt load in ER depts, changes need to be made. I just heard about a native reservation service out hear in AB that allows their Medics to do suturing on scene for non-complicated lacs.

As far as the public treating us as an expensive taxi service, I think that a big part of the issue comes from a lack of knowledge as to what paramedics actually do. I find that particularly in elderly pts there is the expectation of the old school ambulance, where they just toss the pt in back and both attendants ride up front. There have actually been times where some older pts were suprised and even dismayed that I was assessing and treating them, "oh no son, I just want to talk to the doctor." It seems that for some reason we as a whole have done a poor job educating the public as to what an ALS ambulance can do and when its appropriate to call 911.

[aussiephil]

I can never agree wit hrefusing transport to someone, there are too many things that can go wrong.

I do however believe that as EMS is a MEDICAL service (as opposed to an appendage of fire) & we transport to a MEDICAL facitlity, if the person is deemed to have nothin wron, then hit them with a full fee. if they dont pay, chase them for the money.

People call because the have a percieved need, they may not have any physical S&S, buthow many of our elderly patients call because they are lonely? This is an opportunity for us to take a more holistic approach to pre hospital medicine & yr health depts (& mine too) should work towards an ems referal service. One that will in the long run reduce hospital presentations & provide the most appropriate care to your patients.

To refuse to transport is a legal & ethical minefield that I want no part of. At the end of the day ems is also a transport service. They ring, we transport.

Play safe

Phil

[craig]

I can never agree wit hrefusing transport to someone, there are too many things that can go wrong.

I do however believe that as EMS is a MEDICAL service (as opposed to an appendage of fire) & we transport to a MEDICAL facitlity, if the person is deemed to have nothin wron, then hit them with a full fee. if they dont pay, chase them for the money.

People call because the have a percieved need, they may not have any physical S&S, buthow many of our elderly patients call because they are lonely? This is an opportunity for us to take a more holistic approach to pre hospital medicine & yr health depts (& mine too) should work towards an ems referal service. One that will in the long run reduce hospital presentations & provide the most appropriate care to your patients.

To refuse to transport is a legal & ethical minefield that I want no part of. At the end of the day ems is also a transport service. They ring, we transport.

Play safe

Sorry dont agree

in some cases to refuse is theappropriate thing to do

phil tere have been times that you have refused to do a job...i've been there

stay safe

Phil

[katbemeEMT-B]

You must be from a rare part of the US. After recently attending a conference and talking with Steve Berry, most volunteer services DO charge for their service across the US. Some services, such as ours will also charge for certain supplies and meds used. The base charge for our service I believe is $475 and we also charge $8 per loaded mile. This means that if the patient is refusing to go to the closest facility and chooses to go to a Metro hospital instead, they will have a pretty hefty bill as the nearest Metro hospital is 60 miles away (an additional $480).

An easy way to rid yourself of that bother some chest pain guy is tell him you are going to give him Nitro so you need to know before you admin. it if he is truly having chest pain. If he isn't it will kill him. It's amazing how quickly that chest pain goes away. We ocassionally transport from the county jail and chest pain is always the c/c of the prisoners that want to get out.

[spenac]

An easy way to rid yourself of that bother some chest pain guy is tell him you are going to give him Nitro so you need to know before you admin. it if he is truly having chest pain. If he isn't it will kill him. It's amazing how quickly that chest pain goes away. We ocassionally transport from the county jail and chest pain is always the c/c of the prisoners that want to get out.

I like it, will have to try it next time.

[scott33]

You must be from a rare part of the US. After recently attending a conference and talking with Steve Berry, most volunteer services DO charge for their service across the US

Hmmm, perhaps my system and those like it, is soon to be in the minority.

It does beg the questions though, what is the point in having a volunteer system at all, if patient billing is in place? Traditionally, "volunteer" meant unpaid and free of charge. So where is the justification for also having state or township funding to operate these systems (if applicable) as well as funding for the upkeep of the buildings and maintenance of the vehicles and equipment? Lastly, what consolation is it to the public to have to pay for their "Volly" EMS stystem twice (state taxation and point of use billing)?

Or am I missing something?

[spenac]

Hmmm, perhaps my system and those like it, is soon to be in the minority.

It does beg the questions though, what is the point in having a volunteer system at all, if patient billing is in place? Traditionally, "volunteer" meant unpaid and free of charge. So where is the justification for also having state or township funding to operate these systems (if applicable) as well as funding for the upkeep of the buildings and maintenance of the vehicles and equipment? Lastly, what consolation is it to the public to have to pay for their "Volly" EMS stystem twice (state taxation and point of use billing)?

Or am I missing something?

Most volunteer services in my area receive limited funds from taxes. So they rely on payments and donations to maintain equipment and supplies. Thankfully not many volly services left in the area. Most are paid professional services now.

[spenac]

Since we're getting off topic let me get it back on track. We should be able to deny transport.

[katbemeEMT-B]

Hmmm, perhaps my system and those like it, is soon to be in the minority.

It does beg the questions though, what is the point in having a volunteer system at all, if patient billing is in place? Traditionally, "volunteer" meant unpaid and free of charge. So where is the justification for also having state or township funding to operate these systems (if applicable) as well as funding for the upkeep of the buildings and maintenance of the vehicles and equipment? Lastly, what consolation is it to the public to have to pay for their "Volly" EMS system twice (state taxation and point of use billing)?

Or am I missing something?

I would have to guess that if your service is totally dependent on state, city, or township funding then you are hurting badly. While we do get monies from the city which we service it is minimal. The money that we receive from the city actually comes from payments received for billing. We are allotted a certain budget each year for wages (we are considered a paid volunteer service), equipment and uniforms, and vehicle maintainance and are not allowed to go over that budget. We do however receive money from the two townships that we service and that money is used for education, additional uniforms, equipment not in the budget, and other expenses approved by those townships. An example is we did not have in our budget to replace our stair chair. One of the townships saw we had a real need for it and donated the money to us to get it. They actually treat us very well and realize that we provide an imperative service to the area. As far as the tax thing. We double pay on just about everything in the US. Think about the roads you drive on. We not only pay for those federally but also through the state through general funds made possible by our tax dollars. Then there's that wonderful gas tax. If you live in an area with toll roads you pay tolls too. There's also money that comes out of the City, County, and Township general funds that pays for those roads. We paid those taxes too. When one of these roads happen to run right in front of your house, guess what? You get to pay again. They assess you a certain amount to fix or improve that road (special road assessment). It's called the wonderful world of goverment and taxation. Ain't it great.

Anyway, back to the original post. What was that anyway? Does anyone remember? :-k :dontknow: