frequent flyers and public relations

[firedoc5]

I'm just going to be blunt here: What a stupid idea!!! EMS is for emergency services (regardless rather we think they are truly having an emergency) It is not our job to go check up on patients. That's for home health care or social services. What is going to happen when you are at a frequent flyer's house doing your check up and emergency traffic comes out? Do you just say, " Well we have to go now because someone else is in need of our services?" I'm serious, what would you do? I say don't go to someone's house unless they have activated the 911 system.

Yep, that's what we did. But back then you didn't have home health nurses that made rounds, only specific patients. If one of our legitimate pts. had not been assigned home health or social service visits, then no one would check on them.

While we were out, whether checking on pts., getting something to eat, or just away from the station, we just responded from where we were. They would just radio us and we'd go. No problem.

[Arizonaffcep]

The way to do it is to stay "in-service" while doing the welfare checks (?). This way, you are available for 911 if need be, and you are working with the "frequent flyer" person. This provide what they need (some attention, which, just like a kid, if they can't get good attention, they will seek bad attention) and lower your call volume a little. After all, would you rather haul this person to the hospital for no reason, or see them at their home and have a conversation with them, then go? The conversation is usually a lot easier, and LESS PAPERWORK!

[firedoc5]

The way to do it is to stay "in-service" while doing the welfare checks (?). This way, you are available for 911 if need be, and you are working with the "frequent flyer" person. This provide what they need (some attention, which, just like a kid, if they can't get good attention, they will seek bad attention) and lower your call volume a little. After all, would you rather haul this person to the hospital for no reason, or see them at their home and have a conversation with them, then go? The conversation is usually a lot easier, and LESS PAPERWORK!

Excellent way of putting it.

[VentMedic]

Excellent way of putting it.

That would all depend on what the welfare check consists of. If they want you to do a few vitals or any of the things I mentioned previously, you may have to do extensive documentation to cover yourself. If the persons dies a couple hours after you check on them or if the hospital questions abuse or a severely malnourished state, you may have to provide good documentation as to why you thought the patient was fine earlier.

It also depends if your company is actually working through a formal contract with a governmental agency and what they are requiring and if there is some sort of fee your company is receiving from that agency for your service.

To some in EMS, a welfare check might be a wave from the door. Again, it will depend on what your company and an overseeing agency have decided on.

Of course, they shouldn't expect you to be a case manager since you have little education or training in this area but hopefully that is made very clear as to what your limitations are and what can be expected from Paramedics. That is another thing, don't overstate what you think you can do versus what you and your co-workers have a thorough knowledge of.

Another area of concern would be how much medical and personal information you will have about each person you are visiting. Where will that information be stored? How much of that information, if you now have knowledge of, are you going to responsible for (meds, nutrition, living conditions, financial etc)?

If there is not another agency involved, it may still not relieve you from thorough documentation since others may be watching how a program like this turns out. And, if something goes very wrong with the person you are checking in on, you may still have to answer who, what, when and why or how.

I think we've all seen cases where the person was supposed to be monitored by some agency only to find they didn't have all the proper training amongst the workers and the paperwork was not adequate to show how much was actually done or poorly reflected the actual situation.

[speedygodzilla]

Like I believe you are stating above in a sense I see this as a possible big legal mess. If I am ever involved in a program like this you better believe there will be some form of paperwork, CYOA. The chances off this coming back and biting you know where is going to be rare but when it does it will hurt. When I go into someone's house to check on them, they are a pt, 2 things have to happen, they have to either refuse services (of course assuming that they can), or accept services which including being handed off to the hospital therefore keeping me from legal abandonment. I'm am not getting into the whole thing of accepting only on scene tx and all but I think you should get the point.

Injury prevention programs are great as well as education of the 911 system. I don't believe this will be effective on an individual level in the way it is being presented here. However I can see a benefit to the program, it just seems that the risk out weight the benefit.

[cynical_as_hell]

I agree with the whole legality mess this would create. It's too much of a risk. If you want to get checked out, then go to the doctor's. If you have an emergency, or what you believe to be an emergency, then activate 911. But a patient dieing a few h ours after you checked on them, makes you look pretty bad to any attorney. I agree that one of two things will happen on scene: Accept treatment and go to the hospital or deny treatment and sign my paperwork stating so. Outside of that it's all a gamble. NO THANKS!!!

[Arizonaffcep]

That would all depend on what the welfare check consists of. If they want you to do a few vitals or any of the things I mentioned previously, you may have to do extensive documentation to cover yourself. If the persons dies a couple hours after you check on them or if the hospital questions abuse or a severely malnourished state, you may have to provide good documentation as to why you thought the patient was fine earlier.

First off, at least in Arizona, EMS is one of the mandated reporting agencies for abuse...no matter what the age. It is required by state law that EMS contacts 1. CPS if the patient is a child and the thought of abuse entered your mind (even if it was just a fleeting thought), 2. Law enforcement, and if the patient is an adult, we call 3. APS. We don't have a choice in the matter. This gets the ball rolling, and the "monkey" off our backs if we document who we talked to at every agency. For the patient to die from malnourishment...takes a while. You would expect that if you visited them even a DAY earlier, you'd notice the S/S...if you didn't...get out of the field and get a refund on the box of Cracker Jacks you got your cert/License from.

[VentMedic]

First off, at least in Arizona, EMS is one of the mandated reporting agencies for abuse...no matter what the age. It is required by state law that EMS contacts 1. CPS if the patient is a child and the thought of abuse entered your mind (even if it was just a fleeting thought), 2. Law enforcement, and if the patient is an adult, we call 3. APS. We don't have a choice in the matter. This gets the ball rolling, and the "monkey" off our backs if we document who we talked to at every agency. For the patient to die from malnourishment...takes a while. You would expect that if you visited them even a DAY earlier, you'd notice the S/S...if you didn't...get out of the field and get a refund on the box of Cracker Jacks you got your cert/License from.

Yes, every state has reporting laws for child abuse as well as many other forms of domestic violence. However very few states mandate additional training for it. Some may require only 1 CEU for 4 years. That is NOT enough unless it is in your face obvious. EMS is most familiar with what they have learned about BLATANT abuse discovered during a 911 call. I'm sure you probably have known co-workers who abused their spouses but have kept quiet about it. Or, they may have a drug and alcohol problem that you don't say anything about because "they can handle it". However, in the homes it might be as rosy as things appear to you on the outside.

Entering someone's home on a nonemergent bases is a very different ballgame. Also, you may not be the one who will always see the person and witness their behavior to establish a pattern. Malnourishment is not always that obvious. Many patients with chronic illnesses like COPD have albumin levels at 1. Often they are admitted to the hospital with a close watch on getting their nutritional status up as well as whatever inflammation they need to shake. Why do you think people on the street have wounds that won't heal?

[Arizonaffcep]

Yes, every state has reporting laws for child abuse as well as many other forms of domestic violence. However very few states mandate additional training for it. Some may require only 1 CEU for 4 years. That is NOT enough unless it is in your face obvious. EMS is most familiar with what they have learned about BLATANT abuse discovered during a 911 call. I'm sure you probably have known co-workers who abused their spouses but have kept quiet about it. Or, they may have a drug and alcohol problem that you don't say anything about because "they can handle it". However, in the homes it might be as rosy as things appear to you on the outside.

Entering someone's home on a nonemergent bases is a very different ballgame. Also, you may not be the one who will always see the person and witness their behavior to establish a pattern. Malnourishment is not always that obvious. Many patients with chronic illnesses like COPD have albumin levels at 1. Often they are admitted to the hospital with a close watch on getting their nutritional status up as well as whatever inflammation they need to shake. Why do you think people on the street have wounds that won't heal?

I agree with the fact that malnourishment is not always an easy thing to spot...but if a patient is SO MALNOURISHED that they DIE 2 HOURS LATTER, you'd think they'd be...unconscious/unresponsive? Altered mentation...all of which should spark a thorough assessment and transport.

As for the abuse thing...you can only do what you can do. What I mean is if the situation appears that it is NOT abuse, and or there is no reason to suspect it, the 2 hours latter the husband/significant other kills them...that's not your problem, especially if it's an unforeseeable event. Now, will you get sued...probably. But that's the nature of people...give me money because (insert favorite thought here).

The area that you'd probably MOST likely get into trouble with this is if you don't recognize a hypoglycemic event (or are unable to predict it), or if the person is SI and attempts suicide after you leave. But...it all boils down to the provider being able to competently assess their patient, even without laying a hand or instrument on them, and then taking the next step and turning the "welfare check" into a call if need be.

[VentMedic]

I agree with the fact that malnourishment is not always an easy thing to spot...but if a patient is SO MALNOURISHED that they DIE 2 HOURS LATTER, you'd think they'd be...unconscious/unresponsive? Altered mentation...all of which should spark a thorough assessment and transport.

If they get to that point it is probably too late. The idea is NOT tolet it get to that point. In some people it doesn't take much for out of whack electrolytes to stop the heart. If a person just gives you a wave each day but you don't know or care to know if that person is eating or taking their meds, how much good are you for their welfare. Essentially you are just a vulture circling while waiting for them to drop over and then you can take them to the hospital.

Again, the things you are writing are only what a Paramedic has been taught which is not wrong but not entirely complete for a "home visit" assessment. You are thinking from an EMS provider point of view and not in a preventitive plan of care.