Spin-off Thread from Off-loading at the ER

[EMS49393]

I've noticed it becoming harder to make a quick turn around this month in our ER's despite our "no diversion" policy. I see this as becoming much worse before it gets better as people continue to need medical care and are having increasing difficulty paying for the services. The ER isn't free, but they can't demand payment before exam. As more people are laid off, we will find ourselves running more calls and having a harder time turning patients with the over-crowding of the ER.

One of our area ER's is seeing 30-50 more patients a DAY than they were in January. Most of these patients are candidates for the PCP but simply can't afford the bill or copay because they are either uninsured or under-insured.

I can't be the only paramedic that is thinking about this. How can we work with the ER to facilitate a faster turn around? Can we start pushing for more ability to treat and release? Should there be more low-income clinics available? Socialized healthcare?

I'm curious if any of you are seeing the same volume increase. How do you think you would handle that type of increase every few months? Are your companies preparing themselves to function in a different capacity should your system become over-whelmed with people that simply can't afford a regular doctor anymore?

[Richard B the EMT]

1) As we hit the seasonal weather change, I unscientifically observe call volume of elderly people increases, mostly respiratory related.

2) Many of these persons are in a socioeconomic group that uses the hospital ER/ED as their "family doctor". They are open about it, you ask for the name of their doctor, they tell you "the ER at (insert name of hospital here)".

3) Due to geographic groupings of nursing homes, assisted living centers, and assorted levels of non-acute long term care elder residences, when these folks need the doctor, the facility staff sends them to be checked out at the nearest ER/ED, as ordered in by the doctor of record for the patient/resident. Transported by non 9-1-1 private ambulance services, community based Volunteer Ambulance Services, hospital based ambulance services, and, of course, FDNY EMS resources (You already know I am a member of that last one!).

4) When my ambulance arrives at either of the 2 hospitals in my service area, both have 6 bays. You can safely presume that there is going to be a wait for either the triage nurse to do their evaluation, or a wait for an examining bed, if there are 3 ambulances already in the bays.

5) If there is a code being worked up, in the ER/ED, you can safely presume the delay for triage or bed assignment will make the delay longer than as mentioned in item #4.

6) On other strings, I have mentioned that diverting patients away from a specific ER/ED for a part of a tour is a courtesy, not something carved in stone. FDNY EMS has groupings of hospitals in geographic "Pods", and if a certain number within a pod close to specific categories, all within the pod are reopened to "catchment", meaning, if the hospital is local to the pickup, they get the patient anyway. Even if the hospital is "on diversion", if a patient from nearby is "in extremis", the patient then goes to that nearest hospital.

[HellsBells]

Long hospital waits have been the norm, not the exception here in Calgary for quite some time. We have socialized health care, however it doesn't seem to have any effect on wait times. One of the larger problems, as I see it is that people don't use the emergency dept. properly. People who have colds, or the flu, stubbed toes, etc. seem to be calling 911 more and more often; its very frustrating to me, knowing they are going to be filling up the ER.

To answer your main question, yes I have noticed a sharp rise in call volume since Jan as well. However, it seems that most years Feb and March are the busiest months at my service, economic crisis or not.