Petition to: Allow Ambulance crews to refuse transport

[Yummymedic05]

Wow Percocet for a sprained finger....

[theotherphil]

We already have the option to totally deny transport to patients who have no clinical need to go to the hospital. As long as we do a full examination and document the findings then there is no issue. It is done all the time where I work....if they don't need hospital treatment, we tell them so and refer them to their family Dr. If they still want to attend the hospital, we tell them that they are free to make their own way there as they don't require an emergency ambulance. 9/10 they don't bother. The trouble is, a lot of crews take the easy road and walk the patient on to the vehicle and off again at the ED, doing only minimal obs. They'd rather pass the book to the ED than use their clinical skills and judgment. If that is all they are going to do, then we may as well just employ taxi drivers to ferry these people to hospital and save a fortune. Let's be honest, we are pretty well paid nowadays earning a basic of £32,000 ($64,000 US) pa, let's start earning it!

I do agree that we should be able to levy a charge to the timewasters though.

[spenac]

We already have the option to totally deny transport to patients who have no clinical need to go to the hospital. As long as we do a full examination and document the findings then there is no issue. It is done all the time where I work....if they don't need hospital treatment, we tell them so and refer them to their family Dr. If they still want to attend the hospital, we tell them that they are free to make their own way there as they don't require an emergency ambulance. 9/10 they don't bother. The trouble is, a lot of crews take the easy road and walk the patient on to the vehicle and off again at the ED, doing only minimal obs. They'd rather pass the book to the ED than use their clinical skills and judgment. If that is all they are going to do, then we may as well just employ taxi drivers to ferry these people to hospital and save a fortune. Let's be honest, we are pretty well paid nowadays earning a basic of £32,000 ($64,000 US) pa, let's start earning it!

I do agree that we should be able to levy a charge to the timewasters though.

:headbang: :hello1: Yes, finally someone else that feels it is possible to think and deny transfer. I still feel that to be looked at as a Professional we have to be able to stop being taxi drivers. Thanks for great post. MY bothers and sisters in the USA about hung me for suggesting that we could deny transport, when I asked if they would transport someone wanting to go eat no medical problem many said yes. Different mind set I guess.

[WendyT]

Right on, so what relevence does this have to a canadian MFR who has no ambulance to refuse transport in anyway :shock:

If you look at the fact that it's based in the UK, maybe there will be a change like it here, or in the USA and maybe elsewhere.

Next time you get one of those kinds of ppl, ask them if they have their cards and if they dont then it's not their day to go.

If this doesnt appeal to you, who cares because I dont see an improvement here, it's always and I put it lightly ALWAYS going to be a problem and it's NEVER going to get better, so I guess you better get used to it as you have always done before.

I want to see to reason, but like these ppl, they are looking for someone to care for them or about them, or you wouldnt be in this business. I've read many a posting and to know where you ppl are coming from, it's a sad world out there and unless you can do away with homelessness, drugs/alcohol/abuse, its always going to be there.

God Bless the many talented men and woman who make it their calling to help in a time of need.

[scott33]

Let's be honest, we are pretty well paid nowadays earning a basic of £32,000 ($64,000 US) pa, let's start earning it!

Phil, educate me! Which particular service is it who pay their Paras a "basic" rate at the very top of band 6 ???. Let's not pull the wool over anyones eyes :wink: most Paramedics will be on Band 5 wages: £19, 166 - £24,803 for a 37.5 hour week. This will get you just as far in the UK, as being on the same figure in dollars in the US, irrespective of exchange rates.

[theotherphil]

Phil, educate me! Which particular service is it who pay their Paras a "basic" rate at the very top of band 6 ???. Let's not pull the wool over anyones eyes :wink: most Paramedics will be on Band 5 wages: £19, 166 - £24,803 for a 37.5 hour week. This will get you just as far in the UK, as being on the same figure in dollars in the US, irrespective of exchange rates.

I don't know where you work, but all our paras earn £32k....the new student para's are on less though but then they are training. There has been no para courses in our trust since A4C was implemented Aug 05 therefore all para's went accross at the top rate. Lets not split hairs on what is the basic rate though. All our para's/ EMT's get +25% unsocial hours allowance every month, even if we are off sick or on leave. It is not calculated on actual unsocial shifts worked. All our Para's/ EMT's get £1500pa to be available during breaks. This is also paid if we are on leave or sick. That's why I regard it as a basic rate....which is actually closer to £33k for a para.

I fear you have missed my point though :roll:.....we are pretty well paid for what we do and I believe we should put our training and skills to use and earn our cash. If you just want to take any old dross to the hospital and not use your training, experience and judgement, then you are in the wrong job.....you should be working for John's taxi cab co.

As you know, the NHS way of healthcare is totally different to the US model. We are putting in place measures to stop unnecassary admissions to the hospital and referring a lot of patients on different pathways to healthcare rather than transport everything. Treating in the home is a buzzword at the moment. Many of our regular Para's (not ECP's) are able to glue or suture lacerations at home to reduce the need for hospital admission. We are trained in advanced assessment skills. I can directly admit to coronary care or medical/ surgical wards. I can refer directly to a patients GP, District Nurse, Diabetic Nurse, mental health teams or social services etc. I've just got in from a 12 hour nightshift in which it was fairly quiet and had 9 callouts - none were transported to hospital. 2 were time wasters and I educated them in the error of their ways. The other 7 were suitable for treatment at home and referal to a GP/ District Nurse/ Social service.

The funding for the Ambulance service is ultimately via central government and therefore they want to save money. The EMS services in the US are, as far as I am aware, run as a business and seek to recoup the cost (or at least part of it) from the patient/ government. In this instance, it is only good business sense to transport everything to hospital. I am pretty sure if private healthcare insurance was introduced in the UK, then there would be no need to train paramedics to such high standard of clinical assessment and there'd be no need to be totally autonomous in our practice. Our referal pathways would go out of the window and we would be told to transport everything to the ED. The cash saved in this area would then be ploughed into the ED's. Hey, just call me cynical

[spenac]

[ If you just want to take any old dross to the hospital and not use your training, experience and judgement, then you are in the wrong job.....you should be working for John's taxi cab co.

As you know, the NHS way of healthcare is totally different to the US model. We are putting in place measures to stop unnecassary admissions to the hospital and referring a lot of patients on different pathways to healthcare rather than transport everything. Treating in the home is a buzzword at the moment. Many of our regular Para's (not ECP's) are able to glue or suture lacerations at home to reduce the need for hospital admission. We are trained in advanced assessment skills. I can directly admit to coronary care or medical/ surgical wards. I can refer directly to a patients GP, District Nurse, Diabetic Nurse, mental health teams or social services etc. I've just got in from a 12 hour nightshift in which it was fairly quiet and had 9 callouts - none were transported to hospital. 2 were time wasters and I educated them in the error of their ways. The other 7 were suitable for treatment at home and referal to a GP/ District Nurse/ Social service.

In our service in the USA this is what my director works to have us do. We are asked to use our education to tell people no you are not going any where in my ambulance. Many on this site got upset when I menyioned denying transport. Wish the laws would allow as much as you describe.

[scott33]

I fear you have missed my point though :roll:.....we are pretty well paid for what we do and I believe we should put our training and skills to use and earn our cash. If you just want to take any old dross to the hospital and not use your training, experience and judgement, then you are in the wrong job.....you should be working for John's taxi cab co.

It's a good idea in principle, but it opens the door for "trial by media" cases such as this one. Guilty or not, this poor guy has this on his record. Not good for PR, not good for career prospects. As for using good clinical experience and judgement, the "fitness to practice" section of the HCP web site shows that human error / negligence / malpractice etc will always be a potential problem.

The funding for the Ambulance service is ultimately via central government and therefore they want to save money. The EMS services in the US are, as far as I am aware, run as a business and seek to recoup the cost (or at least part of it) from the patient/ government. In this instance, it is only good business sense to transport everything to hospital.

PTS aside, I believe most 911 EMS systems in the US are run by volunteers, who get their funding from the state, donations, and their county. Nothing is billed in these systems (as with MRT, and RNLI etc) certainly not in my part of the world... It's free!

Like I said, what you are suggesting is a good idea in principle ( I know it would make sense for some chav-town on a Friday night) and I for one would never dream of transporting anyone just for a ride, it's not happening! I know of numerous instances where one particular time waster in our district gets transported by PD, once we have done our H&P. You do know however, that it won't take long for Joe public to catch onto the fake "chest pain" mantra, which will put the ball firmly in your court as to your transport descision. I am not siding with the LOB jobs, some of them are the scum of the earth, I know that. But as long as your job entails providing a service for the public, there will always be members of the public who will abuse this.

There is an other alternative to what could end up being "picky" on who NHS staff chose to transport. More servicable ambulances on the road, more paramedic crews, and less FRVs. It will always come down to the one thing the NHS does not have...money

[theotherphil]

Yes, I totally agree that the idea is good in priciple. Where it falls down is certain Crews don't want to take on the extra responsibilites that the role has evolved into. Many are long time paramedics and EMT's that joined the service when it was little more than a van, stretcher and first aid kit! This leaving patients at home lark goes totally against all they have done for the last 30 years and the safety net of the ED that they once had is gradually dissolving. Their mantra is "cover your ass!" - which translates as "pass the book and don't take responsibility".

This job is now as much about the paperwork as it is the examination and treatment options. To me, it is vitally important that I dot all the I's and cross all the T's. Every part of my examination is documented including the checks I have made where I've found nothing of interest....if it isn't documented, it didn't happen!

Looking at the HPC fitness to practice hearings (something I do on a regular basis), a lot of cases are down to incorrect documentation or failure to perform an adequate examination and formulate a proper treatment plan. The way I see it, if you do a full examination, document all your findings and provide treatment, transport or referral then all the bases are covered. If you do your job to the standards expected of any paramedic then you have nothing to fear. It's when you tell somebody they're a waste of space without an examination and leave without documenting your visit that you leave yourself open to critisism - and rightly so! Unfortunately, many crews will take the easy road once they've jumped to the conclusion that they are dealing with a timewaster and take them to the hospital thus passing on responsibility and extra workload to the hospital staff. They have a fear of losing their licence which they think goes away if they take everybody to hospital. Unfortunately, this is not the future of the Ambulance Service in the UK. If you can't embrace the changes and evolve with the role, then you cannot carry out your duties effectively and arguably, your fitness to practice is impaired.

It is envisioned that in the near future we'll be taking bloods, urine samples, prescribing anti-biotics and god knows what else. It is an exciting time for pre-hospital care in the UK and the role is evolving very rapidly. Entry requirement are going to be foundation degree with progression onto BSc (Hons). Unfortunately, it's sink or swim time for many staff over the next few years I believe :?

[spenac]

PTS aside, I believe most 911 EMS systems in the US are run by volunteers, who get their funding from the state, donations, and their county. Nothing is billed in these systems (as with MRT, and RNLI etc) certainly not in my part of the world... It's free!

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.