The Downfall of the U.S. Healthcare System-- Is EMS To Blame

[bigj1130]

I just had a random 5am thought after no sleep tonight. Does EMS Directly or indirectly contribute to the shambles that is the U.S. healthcare system? I'm not gonna post this as a poll because I want to hear what everyone thinks. Personally I think that EMS as a whole contributes indirectly by being an enabler, so to speak, to the ER abuser and 911 abusers etc. Kinda the whole you call 911 we will send someone thing. Also, Why on earth are we taking a stubbed toe to an ER to tie up a bed or a waiting room chair when we end up with stretchers with acute injuries and medical conditions stacked in triage trying to get a bed. I am not trying to rant but I guess being an optimist I would like to try to fix this. what are your thoughts? Is there a fix or is the system broken beyond repair? Who is to blame and what can we do? Just want to see what everyone else thinks. Thanks for looking

[spenac]

Services that use the you call we haul system do contribute to the disaster that is USA healthcare. It is time more services start saying no to people. Get on scene and person can travel safely private car or bus etc then they are denied transport by ambulance. The ER by same token needs quick triage and if patient can go safely to a regular clinic they need to deny ER treatment.

It is time to stop fearing law suits and use some common sense.

[JakeEMTP]

I agree spenac. However, as usual we as a profession need to be educated enough to make a thorough assessment and then determination to transport or not. Until that happens we will continue to take people to the ED when they could easily be treated at their Primary Care Physician. Wait, the ED is their PCP.

[stcommodore]

Most systems can't afford to have a EMS based "refuse transport" protocol. Take for example this morning I transported a 30's male with a laceration to this finger, presented to us with the bleeding controlled with bandages and only needing a ride. He had insurance and would likely pay the bill for service. So if we were to refuse transportation we would not only miss making money, but lose money for generating a response with no income.

As much as we don't like things we need to look at them through the $ sometimes to.

Also don't forget most people don't have primary care and the ER is there source for medical care. As well as the fact that everyone knows that if "the cat gets out of the bag" and they call 911 somebody will show up and likely solve the problem for them. Basically the biggest and most successful government program ever put together, and in systems where 'call screening' from what seemed like 'minor' calls have only turned into major litigation nightmares.

[spenac]

Most systems can't afford to have a EMS based "refuse transport" protocol. Take for example this morning I transported a 30's male with a laceration to this finger, presented to us with the bleeding controlled with bandages and only needing a ride. He had insurance and would likely pay the bill for service. So if we were to refuse transportation we would not only miss making money, but lose money for generating a response with no income.

As much as we don't like things we need to look at them through the $ sometimes to.

Also don't forget most people don't have primary care and the ER is there source for medical care. As well as the fact that everyone knows that if "the cat gets out of the bag" and they call 911 somebody will show up and likely solve the problem for them. Basically the biggest and most successful government program ever put together, and in systems where 'call screening' from what seemed like 'minor' calls have only turned into major litigation nightmares.

But keep in mind most abusers are the ones with no means to pay. So now you are out supplys, time, fuel, not to mention more important you are wasting time that could be used for a person with a real need. By educating both by explaining when to call EMS and also educating by the fact you actually say no you stop the cycle of abuse.

And before someone brings it up I do understand if the abusers were not their many of us would lose our jobs. That means EMS healthcare professionals out of work as well as the support FF's that some have respond.

[WelshMedic]

And before someone brings it up I do understand if the abusers were not their many of us would lose our jobs. That means EMS healthcare professionals out of work as well as the support FF's that some have respond.

And there we have the answer in a nutshell. I don't deny anyone their right to make a living. However it is a fact that, certainly in urban EMS systems, there is a level of overkill. Look how many crews there are in any given city. Just to put this into perspective:

Putnam County has a population of 70,000. They utilize 10 ALS ambulances 24 hrs a day. My region has the same number of inhabitants and uses just 3 ambulances during the day and 1 at night. Why? Well we have well organized primary care and a no-send policy in dispatch. Should a "BS" rit still slip through, we would refuse to transport. That is why we can do the same job with less than a third of the vehicles.

I don't think EMS can be directly blamed, by the way. They are only operating under the first law of economics: supply and demand. The solution to this problem? Well, it's a complex one; investing in decent primary health care for all would be a good start. Prevention is always cheaper than cure at the end of the day. I don't hold my breath just yet though, not with all the healthcare insurance companies more interested in dividends than healthcare. It's a travesty that anyone in a first world country can be denied access to health insurance for whatever reason. Socialist medicine suddenly doesn't seem that much of a bad idea after all, does it?

Rant over.....

WM

[Richard B the EMT]

I would take it in a slightly different direction.

Perhaps as a contributing element, it is the universal 9-1-1 Emergency number.

9-1-1 is a victim of it's own success. Need help for anything, call it. Someone will respond to you, most times even if it is only an emergency for you.

That is why 9-1-1 systems get calls for broken pipes, both the water mains under the street with accompanying street collapse, and pipes in the ceiling of the old lady's apartment.

I could go on, but I won't.

[AZCEP]

Medical direction creates the protocols that EMS works under, and therefore creates the situation of requiring transport of patients that do not need it. Spenac may be on to something, but only a small part. EMS is not responsible for the situation, but does indirectly contribute to it only if you consider medical direction a part of the EMS system. If you don't consider medical direction part of the EMS system, then it would seem to be something larger.

[JaxonStreet]

Thankfully, I work for an EMS system that actually DENIES people rides to the hospital. And I don't mean us trying to talk people out of going to the hospital. I mean we would flat out tell people that they don't need an ambulance and we would leave their behinds on scene. And it's perfectly legal We have such a high call volume, mostly bogus calls, and so few ambulances that we can't afford to take everybody to the hospital, especially if the person doesn't need to go by us and if they don't have insurance. Don't get me wrong, just because a patient doesn't need an ambulance doesn't mean that they shouldn't go to the hospital, but that their condition doesn't require emergent transport.

When I first started working for this system, I had to get used to not taking everybody to the hospital because back at the system I used to work for, we took every kind of thing to the hospital and went lights and sirens to every call. For the system I work for now, we do most things under our discretion. We don't go lights and sirens to everything, we could cancel first responders, and we could use our judgment when it comes to protocol. Under this system, we are actually required to THINK and make the BEST decision for both us and the patient.

I just don't understand why all EMS agencies don't allow for denying transport. We are an EMERGENCY service, NOT a taxi. We have denied all types of people. If there's any doubt as to whether or not a patient should go to the hospital, we'll take them. But we do a lot of educating, explaining to people why they don't need an ambulance. And in my system, we always run out of ambulances whether or not we are transporting someone, so just think what would happen if we actually took EVERYBODY to the hospital. It'll be a mess here. And people go on and on about how we need more ambulances and so on. I say that more EMS agencies have to stop being afraid of litigation and be more concerned about the people's NEEDS.

But that's just my opinion

[Mediclcems]

Someone please tell the lawyers employed by our administration that we should be allowed to refuse to transport to certain people. We have a 10 point refusal documentation we have to write for EVERY "patient", whether or not they called.

On the other side...we do have some very lazy people who don't want to trasnport anyone, even if they really need to go, so I can see the cover your ass factor too.

It's that damned if you do, damned if you don't thing again.