Ambulance Abuse?

[tniuqs]

Liar. Everyone knows healthcare is free in Canadia.

Firstly Spelling FAIL no I in Canada Dust.

Second FAIL ... this phish ain't taking that baited line.

Nice Try though.

Quoting Vent:

Sickle cell is no joke and several patients have already been on ventilators. Each time they get that feeling of shortness of breath they may remember their last ICU stay. Granted many do just need their labs monitored and medications adjusted but I would hate to tell the one that is developing acute chest syndrome to call a cab.

I have been fortunate I have had only one exposure to a Child Ventilated with Sickle cell, propofol drip if I remember correctly.

Any advice since we have touched on that topic ... and am I correct that Pa02s need to fall below 50 mmhg before sickling, if so besides 02 and analgesia any other words of advice in treating in the field?

Is Entonox during transport for pain relief on the EMT level helpful ?

cheers

[VentMedic]

Any advice since we have touched on that topic ... and am I correct that Pa02s need to fall below 50 mmhg before sickling, if so besides 02 and analgesia any other words of advice in treating in the field?

Some sources have the increased Polymerization of HbS at a PaO2 < 75 mmHg.

One should consider the accuracy of SpO2 in sickle cell anemia. The pulse oximeter can over estimate or under estimate arterial oxygenation. Various factors contribute to this variability. The analyzer calculates the saturation value based on data from individuals with normal Hb. Most of the blood gas analysis equipment calculates oxyhemoglobin saturation by measuring arterial oxygen tension (PaO2) and applying a standard oxyhemoglobin dissociation curve. Patients with sickle cell anemia present a oxyhemoglobin dissociation curve shifted to the right. Hemoglobin is 50% saturated (P50) at a PaO2 of 42-56 mmHg in patients with sickle cell anemia, compared with a mean of 26.5 mmHg in the general population. Therefore, patients with sickle cell anemia can present an SpO2 < 90% and, nevertheless, present a PaO2 > 80 mmHg. In other words, using the oxyhemoglobin dissociation curve to calculate SpO2 in patients with sickle cell anemia generates misleading data. But hopefully in many cases the SpO2 "might" be lower than what a measured PaO2 might be measured as. The PaO2 measurement provides a more precise evaluation of arterial oxygenation in sickle cell anemia. PaO2 is therefore the best indicator of the risk of vaso-occlusive crises.

[Richard B the EMT]

Almost all patients with sickle cell anemia have painful episodes (crises), which can last from hours to days. ... Some patients have one episode every few years. Others have many episodes per year. The crises can be severe enough to require a hospital stay.

I have transported one sufferer several times a month. For him, the pain was so intense, 10 on a scale of 10, he was actually in tears.

[WorkinTheStreets]

Our system usually runs Sickle Cell Crisis as BLS jobs. I generally see the same patients for the same reason...no money to buy meds. I read up on the pathophysiology of the infliction and spoke with several higher level medical providers to better understand the issue. Based on the physiological conditions of the red blood cells during crisis, there is not much to be done on a BLS unit. What I did get a lot of positive feedback on was the use of high flow oxygen. Most patients have told me that while it does not relieve the problem, it does take the edge off the pain slightly.

And on the main topic, people know they we never say no and they take advantage of that. We transport some people like clockwork...You can always tell a new ER nurse because of their reaction to some of the folks that we bring in.

We have elected people into positions who are willing to give away the store in an effort to remain in office...When we stop doing that, we will solve some of the problems. Medicaid co-pays or limits would be a start.....

Edited August 4, 2009 by WorkinTheStreets

[tniuqs]

We have elected people into positions who are willing to give away the store in an effort to remain in office...When we stop doing that, we will solve some of the problems. Medicaid co-pays or limits would be a start.....

Have you transported many Sickle Cell sufferers that have a good enough paying job or they are hired by a company that helps pay their insurance, yah know a blend of systems of health care delivery would lower overall costs and provide for those that are too poor to live in comfort and dignity.

cheers

You will never get away from the true abusers of the system ... what about the routine dialysis patient that is 400 + lbs ... so who keeps feeding them deep fried twinkies if they are bed ridden anyway.

[VentMedic]

You will never get away from the true abusers of the system ... what about the routine dialysis patient that is 400 + lbs ... so who keeps feeding them deep fried twinkies if they are bed ridden anyway.

If I was on dialysis 3x/week, I don't know how I would behave. I honestly can't say if I would try to eat lettuce all the time or enjoy the foods I have deprived myself of all for staying healthy. Many gain the weight after the dx of an illness because of depression and immobility. Unfortunately we don't see these patients on their good days but only on their bad ones. For some, everyday is a bad day. COPD pts constantly attached to an O2 tank are also considered abusers of the system but yet few know what their lives are really like until they themselves are in that situation. And yes, they do call everytime the weather changes but their bodies can no longer adjust like it used to before they had any need for 911.

However, it is unfortunate that some in EMS are also becoming a permanent part of the health care system due to their own health habits. Smoking and obesity are taking its toll and there are now many articles as well as deaths to document it. There is not an EMS job description that says you must smoke and eat fries or donuts everyday. I recently go bashed on this forum for pointing out that there are now numerous EMT(P)s collecting and trying to collect workmen's comp for their health problems which can be largely attributed to lifestyle. That also sucks up a lot of insurance and healthcare funds as well as missed work days. Yes, it is a serious healthcare expenditure that affects many areas. Some of them are also the "frequent fliers" in the EDs and hospitals. They are actually a bigger problem because they use their medical knowledge to play the system. However, some believe those in EMS are exempt from the same issues they complain about concerning others.

Edited August 4, 2009 by VentMedic

[WorkinTheStreets]

Have you transported many Sickle Cell sufferers that have a good enough paying job or they are hired by a company that helps pay their insurance, yah know a blend of systems of health care delivery would lower overall costs and provide for those that are too poor to live in comfort and dignity.

Most all of the ones I pick up are in Section 8 housing...no job/medicaid/blah, blah, blah.... I don't fault them on that. The disease sucks. I try to review with them some of the things that would help them, like only take the prescribed dosage of meds, not more so you don't run out at the end of the month and stay hydrated. I think medicaid only refills prescriptions once a month. Some are in too much pain to listen, some are surprised I have so much info on the subject.

I avoid Deep Fried Twinkies because I'm afraid it would be like that first shot of H....

I think some one in Public Housing Administration School is teaching folks to put the biggest people in the system on the top floors

[VentMedic]

Most all of the ones I pick up are in Section 8 housing...no job/medicaid/blah, blah, blah.... I don't fault them on that. The disease sucks.

If the authors of this article wanted to make a point they could have chosen a better example than someone with sickle cell disease. It is predominantly a trait in African Americans here in the U.S. and often they are not able to work near the end of their life expectancy which is 42 for men and 48 for women with sickle cell anemia. However, with another variant of the disease they might live until 60. It would be like saying someone with Cystic Fibrosis is always calling for an ambulance everytime they can't breathe at they are nearing the end of their life expectancy.

Believe it or not the statistics do have a bearing on how some view their disease and choose to take care of themselves. We see those with CF from the ages of 16 - 24 most often in the hospital because it hits them that they are now adults and the future kinda sucks with the medications and lung transplants even if they can maintain a decent quality of life. We also see the same age group frequently for sickle cell. Those that have sickle cell may also know that no matter how well they take care of themselves it just takes one serious event to diminish their quality of life further. Treating the chronically ill is almost a specialty in itself. There is usually no miraculous cure even with the blood transfusions or transplants. I see this all too often with I test the lung function of an 18 y/o whose CF is progressing rapidly and their lungs are crap. While you try to be upbeat and encourage compliance, you just look at their breathing on a good day for them and can't help but see where their own attitude is coming from. Many become non-compliant but then become our frequent fliers when they realize that their body doesn't do well without proper care or they realize the end might actually be near.

Ambulances actually only see a very small percentage of those who come into the clinics and hospitals for a wide variety of reasons. It is like when some complain about "all those dialysis runs". What many don't realize is that ambulances again only transport a very small percentage of those on dialysis but since it is your truck, you might think 2 transports a shift is a huge percentage of your calls. One has to step back and look at the makeup of the healthcare system as a whole and essentially that is what the associations for NPs and PAs have done. Through their understanding of issues they have gained support and strength. Right now prehospital medicine is too narrowly focusly on just the emergent conditions and are not ready to dictate the care for patients with complex medical needs. Even the NPs and PAs realize that they also must ramp up their educational requirements to Masters and Doctorate to keep up with the demands of healthcare and the medical needs of the patient. Meanwhile, EMS is still debating the next cert or patch to obtain.

Edited August 4, 2009 by VentMedic

[Just Plain Ruff]

you know after many ruminations and random thoughts, I have come to this conclusion. I'll transport anyone and everyone. It is only an hour at most out of my day. I get paid to transport or not transport. If they want to go they get to go. If they don't then they don't unless I think they need to go and then I'll try to talk em into goin.

It cost me NOTHING to smile and be nice for an hour or less.

I used to get bent out of shape on these people but I realized that it's not my problem if they want to be transported or not. I get paid the same either or.

Surely everyone on this forum can act nice for an hour or so, or can they???????

[spenac]

you know after many ruminations and random thoughts, I have come to this conclusion. I'll transport anyone and everyone. It is only an hour at most out of my day. I get paid to transport or not transport. If they want to go they get to go. If they don't then they don't unless I think they need to go and then I'll try to talk em into goin.

It cost me NOTHING to smile and be nice for an hour or less.

I used to get bent out of shape on these people but I realized that it's not my problem if they want to be transported or not. I get paid the same either or.

Surely everyone on this forum can act nice for an hour or so, or can they???????

But Ruff why are you taking the easy way out? If we educate people about the need for ambulance and even ER we can help curb the delays in emergency care that take place because EMS is used as a taxi and ER's as a clinic.

I don't get bent out of shape as like you say I get paid either way. It actually takes me longer to do a refusal/denial than it does to transport. I take time to help patients contact appropriate agency's for what they need. By doing this it saves abuse of systems.