Deny Patients a Ride In the Ambulance - What Laws?

[Arizonaffcep]

You do not collect from the majority of 911 callers so in theory you make more money saying no to those that do not really need an ambulance.

Actually, at the FD I worked at, our EMS collection rate was right around 80%.

[spenac]

Actually, at the FD I worked at, our EMS collection rate was right around 80%.

Thats much better than in my part of the world. But I think under new guidelines EMS is going to see more insurance/medicaid/medicare denial of payments when it is determined that the patient could have safely gone by other means.

[ambodriver]

In Chicago if they call ,we haul.

Not sure about the rest of the state though.

[spenac]

In Chicago if they call ,we haul.

Not sure about the rest of the state though.

Thats a policy not a state law.

[Doug]

According to the Massachusetts Emergency Medical Services System Regulations, 105 CMR 170.355(A), Responsibility to Dispatch, Treat and Transport:

No ambulance service or agent thereof shall refuse, in the case of an emergency, to dispatch an

available ambulance, to provide life support at the scene or to transport a patient to an appropriate

health care facility within its regular operating area.

Now, I understand that this law may be interpreted 2 ways A: you need to transport a pt with life threatening injury/issue or B: technically speaking everything we do is "life support" broadly interpreted as "quality of life support" (as explained to me by one of our medical control who is both a lawyer and an MD, go figure.) I tried argueing with him and he simply asked "What level was the pt you just brought in?" as soon as I said BLS I knew where he was going...then he said "And THAT is how we have to view it until stated other wise." When I said to him the law says "emergency" he said "Who defines the emergency?"

[Doug]

http://64.233.169.104/search?q=cache:9275B...;cd=1&gl=us

Full link, copy and paste. I don't know how to make it a link.

[crotchitymedic1986]

I had no doubt that you would transport those with lifethreatening symptoms, what i meant was that i would transport with a minimal illness or injury (flu or simple laceration) if they demanded transport. Because I have seen what happens when you dont and the patient files a complaint stating you didnt take them because you were racist or because they didnt have insurance ---blah, blah, blah. I found that i could either not transport 16 patients during my 24 hour shift, or i could transport 6-8. It was easier to just drive them the 8 miles to the hospital and be done with it, rather than argueing with them on the scene, having them call back later, then have them file a complaint.

But i feel your pain -- we had a drugseeker who called 8-10/week, we would transport him to the ER, they wouldnt give him the narcs he wanted, he would get a friend to drive him home, and he would call 911 again to go to a different hospital. PD wouldnt touch it (as an abuse issue), so we had our medical director make an order that if he called 911, we would only transport to the hospital in our county, and he worked with that ER to insure they wouldnt prescribe him any pain meds -- so he started taking his own car to more distant places, and stopped calling 911.

[spenac]

But when we cave in and transport the sick but non emergent patients we become no more than a taxi. Educate the public that Paramedics will examine then if not deemed emergent will not transport. We are medical professionals, not taxi drivers.

Doug your law quote does show we must show up, treat or transport if needed, so there is still an out. I do not see the law saying you must transport all callers.

It is time that as PreHospital Medical Professionals we start acting as such. When, IF, we ever get our act together we need laws and protocols clearly stating that we can say no. It is wrong that we continue to help the abuse of the emergency system.

[crotchitymedic1986]

I feel your frustration -- but the problem comes in "where do you draw the line". You could make a legitimate arguement that over 90% of the people who call 911 are not experiencing a life-threatening emergency and would survive a trip to the ER or doctor in their car. But lets just wave the magic wand for a much smaller percentage than that ---If your services call-volume dropped by 20-30% (once everyone is educated to only call for emergencies) over the next year, do you honestly believe you would not feel some cuts in service. Look around at fire departments that have done such a good job in code enforcement and education, that they had to close fire stations due to lack of fires.

Where would you draw the lines --- kids with fever, isolated upper extremity fractures, cold/flu, chronic illnesses/pain, abdominal pain, UTIs, Migraine HAs --- who would you refuse to transport ----- and would it matter if you were a taxpayor funded system and the person had no transportation (assume its rural and there is no transit system). Not argueing with you, just wondering how you are gonna implement your plan ?

[spenac]

If improved patient care happens then fine if some cuts to number of ambulances out there. I do not think it is right that tax payers are supporting taxis. I agree that 90%+ of EMS transports could be done by other means safely. But as we are going to err on the side of caution, we would have to presume that we still will transport 75% of callers as we do not have x-rays, etc ( now when we get ultrasounds, etc that may drop more ) to rule out everything. Just as ER docs even when they know it is nothing will still err on the side of caution on some patients that really should be kicked out and sent to local doc. In my area we are severely understaffed and no work force to replenish with so actually no cut backs. But in areas that have ambulances and fire trucks on every corner there should be cut backs. It is wrong to justify fire numbers with ambulance runs, and it is wrong to justify ambulances with BS transports. Educate your Paramedics, develope a check list, etc, and only transport serious illness or injuries.