911 non-emergencies a growing problem nationwide

[RavEMTGun]

http://www.denverpost.com/commented/ci_14084125?source=commented-

The 911 call came in as "ankle pain."

So Denver paramedics headed out onto frozen streets and brought Debra Neaves to the hospital.

With that trip, those emergency providers became makeshift patches in the frayed health care safety net, providing services they were never intended to provide — at enormous cost to health systems, taxpayers and everybody with health insurance.

[HERBIE1]

http://www.denverpos...urce=commented-

As we all know-not exactly news.

We've been down this road many times and this horse has been beaten to a bloody pulp, but...

The question I don't recall anyone really addressing is: Why has it gotten to the point where people can (ab)use the system in this way?

We can talk all day about how we can assist with social service interventions, how expensive health care has become, how some people need a safety net, and now Health Care Reform is supposed to solve all our problems, but I think this is a chicken and the egg thing.

When did people decide that an emergency service is appropriate for things like ankle pain, or a sore throat? WHat did people do before EMS was instituted or became so accessible for so many people? Depending on where I am, I still encounter people who simply cannot fathom using EMS for anything. They even apologize for calling for nonemergent things like CHF and MI's. I don't think that even the best reform bill can address the reasons why so many people have become completely incapable of taking care of themselves.

I think that over the last couple generations, we have become far less self sufficient in so many areas of our lives. I'm thinking this is not necessarily a good thing. The government has become the great benefactor for so many people, for so long, that they have forgotten how to forge their own path in life.

Just musing...

[Dustdevil]

The question I don't recall anyone really addressing is: Why has it gotten to the point where people can (ab)use the system in this way?

Oh trust me, it's been addressed plenty by the Republicans. The Democrats, however, will have nothing to do with fixing it.

I'll sum it up in two words: Bloodsucking Lawyers

[HERBIE1]

Oh trust me, it's been addressed plenty by the Republicans. The Democrats, however, will have nothing to do with fixing it.

I'll sum it up in two words: Bloodsucking Lawyers

I'm with you, Dust. Believe me. It seems painfully obvious to me, but as long as Democrats have trial lawyers in their back pockets, there will be no such things as tort reform or personal responsibility.

[VentMedic]

The example this article provided is not necessarily a 911 EMS abuse but rather a health care system failure. Also with this person's history, this could easily have become a medical emergency.

Sitting in a wheelchair inside Denver Health Medical Center's emergency room, Neaves teared up as she recited a list of the health problems that tumble through her life: diabetes, sleep apnea, high cholesterol, a crushed ankle. A doctor visit was weeks away, and the pain was worse every day. On this morning, "I stepped out of bed, and it was just so bad, I couldn't walk."

Neaves is on Medicaid, the taxpayer-funded medical coverage that in Colorado assists poor children and disabled adults. The program provides transportation, but Neaves said, "You need three days' notice for a taxi to take you to a doctor."

Right now those of us who work in the hospital are seeing sicker patients because they can not get in to a doctor's office and the community as well as the state services don't always have available alternative transport. A taxi ride may cost $30 to $75 dollars cash which may seem like nothing to some here but to someone on a fixed income that might as well be a month's worth of groceries. The patients may also have put off calling 911 because the do know what 911 abuse is and used it as a last resort which did article did say the woman explored her available options so let's not label her as an EMS call sucking villian. It is sad when some get old, ill and have no close family members to take care of them.

However, once they do get to the hospital, they may be admitted to the hospital for a lengthy stay which may even be in the ICU. Thus, that ties up critical care beds. The hospital may have to go on diversion for some patients and that is also sure to piss off EMT(P)s. It is a no win situation for anyone involved in any aspect of healthcre in this country. If there was a way for these patients to get access to early care, it may only be an office visit. This lady with her medical problems may spend at least a week in the hospital as the article did not say what her treatment or diagnosis actually was.

Unfortunately, the community health Paramedic also has its draw backs in programs that have been attempted throughout the years. Some agencies used this position for those on light duty or when someone was removed from the 911 trucks for some screwup. While it can work, it has a stigma to it and not many Paramedics want to do the job of home visits any more than they want to do dialyis calls.

Overall right now, the Paramedic is not in the best position to offer a solution as this profession still has to define itself. However, NPs, PAs, RNs and all the allied heath professions have been working through their own state and national organizations as well as collectively to bring about some change. If they hadn't been working on this for the past 20 years, EMS would definitely have seen more calls and there would be much more overcrowding in the facilities.

A couple of recent articles:

Researchers Study Whether U.S. Medics Can Make Transport Decisions

Keith Wesley, MD, FACEP, Marshall J. Washick, BS, NREMT-P

http://www.jems.com/news_and_articles/columns/Wesley/can_medics_make_transport_decisions.html

Paramedic Determinations of Medical Necessity: A Meta-Analysis

http://www.informaworld.com/smpp/content~db=all~content=a914292045

Edited December 30, 2009 by VentMedic

[chbare]

I'm with you, Dust. Believe me. It seems painfully obvious to me, but as long as Democrats have trial lawyers in their back pockets, there will be no such things as tort reform or personal responsibility.

You need to get with the times dude. Trial lawyers are so passe. Why go through the trouble of messing with the lawyers when you can just as easily get a judge to push your agenda foreword.

Take care,

chbare.

[Kaisu]

I would so love the job of home visit Paramedic. I could do health checks, have time to talk to the patient, really practice medicine. I am so over the blood and guts of 911. Does anyone know if that kind of opportunity exists anywhere is this country? or how to go about creating this kind of position?

[JakeEMTP]

I would so love the job of home visit Paramedic. I could do health checks, have time to talk to the patient, really practice medicine. I am so over the blood and guts of 911. Does anyone know if that kind of opportunity exists anywhere is this country? or how to go about creating this kind of position?

This is the only one I know of Kaisu. Wake EMS has what they call an Advanced Practice Paramedic. I have heard through the grapevine that the programme is dong well and the medic's who do this love it.

http://www.wakegov.com/ems/staff/app.htm

[VentMedic]

This is the only one I know of Kaisu. Wake EMS has what they call an Advanced Practice Paramedic. I have heard through the grapevine that the programme is dong well and the medic's who do this love it.

http://www.wakegov.com/ems/staff/app.htm

Wake County has a good idea but there are some from that area that complain they are tied up doing "social services" when they should be rushing over to help intubate a patient.

Washington D.C. has tried to start something like that after their PR scandals.

These programs should not of coures relieve the hospitals of their responsibility to referring the patients to the appropriate counseling especially for those with diabetes, asthma/COPD and cardiac problems. Every health care practitiioner knows their limitations when it comes to teaching complex care and a bandaid to prevent a couple of ambulance calls should stop the over deterioration of the patient if proper counseling is not instituted.

[Kaisu]

Wake County has a good idea but there are some from that area that complain they are tied up doing "social services" when they should be rushing over to help intubate a patient.

It's taken about 1500 calls in a year and a half for me to figure out that this 911 paramedic stuff AS CURRENTLY DONE is not rocket science. It's great to understand the physiology of what is going on, but most of the time, on a call, what I am required to do is pretty limited. I try and go above and beyond, figuring out what is really going on with the patient vis-a-vis physiologically, socially, economically, psychologically etc. Is any of that necessary? Not really. There are hundreds of eager young things in the pipeline that want to go tube somebody. I am interchangeable with any one of them.

I want to use my brain and knowledge to really make a difference, in a position where what I have to offer is necessary and required. I really like the idea of community based prevention and the opportunity to provide some answers to the situation as it stands. Let fire do the EMS thing - let those of us that want to do more find ways to do it.