Every call to the ER?

[DSBrown84]

Looking for advice/suggestions/all the above: I work for a private ambulance service in Florida where the 911 service is fire-rescue. Often times my service is called to a residence where fire-rescue has already responded and deemed the patient non-urgent and in no need of ER care. So the patient calls us and even though we are under the same impression as fire-rescue we take the patient to the ER because that is what we are told to do. Upon arrival to the ER the staff usually shakes their heads and asks us why we thought the transport was necessary.

And of course I am not trying to dodge work....but I feel that through my training I can tell that a scratch and bump on the elbow does not require adding to the deluge of patients to the ER's in my city. I agree that most patients should go to the ER just to be sure there are no additional problems, i'm not a doctor just an EMT-B but shouldn't there be room for discretion?

[DartmouthDave]

Looking for advice/suggestions/all the above: I work for a private ambulance service in Florida where the 911 service is fire-rescue. Often times my service is called to a residence where fire-rescue has already responded and deemed the patient non-urgent and in no need of ER care. So the patient calls us and even though we are under the same impression as fire-rescue we take the patient to the ER because that is what we are told to do. Upon arrival to the ER the staff usually shakes their heads and asks us why we thought the transport was necessary.

And of course I am not trying to dodge work....but I feel that through my training I can tell that a scratch and bump on the elbow does not require adding to the deluge of patients to the ER's in my city. I agree that most patients should go to the ER just to be sure there are no additional problems, i'm not a doctor just an EMT-B but shouldn't there be room for discretion?

Hello,

Yes, there should be room for discretion. However, this is slippery slope. From the EMS side some people do not transport because they are slacking. I have seen some bad calls in regard to non-transport.

As for the ED attitude. Most ED that I have worked in are gong shows. You are up to your eye balls in patients ranging from the lame to the very ill. So, anybody who brings more patients may get attitude. Personally, these attitude stems from work load issue in the ED and EMS sometimes takes the flack for it. Along with the wards, ICU and detox et al.......

Cheers

[spenac]

Sadly many on here would transport a guy that just wants lunch at the hospital. Search my topics and you will see as I posted one about deny transport and only problem was he wanted lunch, even had a 100% guarantee there was nothing physical or mental wrong and the majority still said transport.

[Smitster_911]

The fire dept is on a very slippery slope. If someone calls 911, the conventional wisdom is that they want to go to the hospital, and you'll never be in any trouble by taking them there.

[Kaisu]

I feel that through my training I can tell that a scratch and bump on the elbow does not require adding to the deluge of patients to the ER's in my city.

You mean all 120 hours of the first aid course that constitutes EMTB in this country? If we want discretion to make transport decisions in the field then we need to commit to a proper education. And I don't mean a 7 month medic mill or even a 2 year associate degree.

[speedygodzilla]

They call we haul. Even if there "emergency" seems nonemergent or even nonurgent that is not our decision. It is better to legally and ethically to just take to patient as they wish no matter what we think. I never discourage a patient for transport.

The ER may say something to you which in my opinion is uncalled for. I always respond with "they call we haul" or "they ask for your facility by name." If needed I take the time to explain our role, but I have yet to find a nurse that doesn't understand it. They know we have no choice in the matter just sometimes feel the need to vent as we all do.

[spenac]

It is better to legally and ethically to just take to patient as they wish no matter what we think.

Actually no laws say we must transport all callers. Your protocol may say transport all callers but not a law.

[Kiwiology]

our Ambulance Officers have been leaving people at home for thirty years if they do not need to go to the hospital and it works well

[akflightmedic]

Two cities pilot efforts using EMS to curb ED visits

Two U.S. cities have implemented a new program intended to screen EMS calls to identify non-emergency cases and direct them away from hospitals to more appropriate health care providers, in an effort to alleviate non-urgent ED use, USA Today reports.

Advocates for the program—used in Louisville, Ky., and Richmond, Va.—tout its potential to ease the burden on hospital EDs that face high patient demand and to lower the number of non-emergency ambulance dispatches. Individuals calling 911 who are deemed at “lowest risk†are transferred to an RN or nurse practitioner who assesses the severity of a patient’s condition. Nurses also may direct a patient to a proper source of care, such as a primary care physician (PCP) or clinic, and help connect patients who do not have a PCP with clinics that are accepting new patients.

According to USA Today, 10 to 15 calls each day to ambulance dispatchers in the Louisville area can be identified as low risk. These low-risk calls often involved leg pain, abdominal pain and wound care. A Louisville EMS official said that saving a trip to the ED may result in better follow-up care and, ultimately, a better prognosis for patients, adding that the program will expand to offer “intensive follow-up†to ensure no patient “falls through the cracks,†USA Today reports.

The program costs about $100,000 to set up per city. An official from the National Academies of Emergency Dispatch said that such programs are widely used in Australia and the United Kingdom but that the programs in Louisville and Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

[Fox800]

Looking for advice/suggestions/all the above: I work for a private ambulance service in Florida where the 911 service is fire-rescue. Often times my service is called to a residence where fire-rescue has already responded and deemed the patient non-urgent and in no need of ER care. So the patient calls us and even though we are under the same impression as fire-rescue we take the patient to the ER because that is what we are told to do. Upon arrival to the ER the staff usually shakes their heads and asks us why we thought the transport was necessary.

And of course I am not trying to dodge work....but I feel that through my training I can tell that a scratch and bump on the elbow does not require adding to the deluge of patients to the ER's in my city. I agree that most patients should go to the ER just to be sure there are no additional problems, i'm not a doctor just an EMT-B but shouldn't there be room for discretion?

So, the patient calls your company on the phone directly? Is fire allowed to tell people they're not transporting them/deny transport, or are they obtaining legtimiate refusals of transport? If the patient has no legitimate medical complaints, I understand the frustration. If you are consistently getting bad attitudes from ER staff, it sounds like it's time for your supervisors/medical director to have a talk with hospital administration. It's not your fault that the ER is poorly staffed. They have an obligation to evaluate and treat your patients, no matter how minor the complaint.