EMS or taxi service?

[BCEMSmedic87]

I'm sure everyone has run those calls with patients that are calling 911 for an expedited trip straight into the ED. I responded to a call the other day to a patient that was requesting EMS transport so that she could get into the ED quicker. My partner and I were absolutely infuriated. I was working a 24 hr shift, and the county was falling apart around us, wrecks, 33 sick calls, and 33 transfers out of town. How do you deal with these type calls, and how do you explain to a patient that EMS is not for taxi transports?

[paramedicmike]

[Happiness]

I agree

[paramedicmike]

Another forum I frequent has an emoticon tossing popcorn into its mouth. I thought that might've been more appropriate but it isn't an option here. This was the best alternative available.

[DwayneEMTP]

I'm sure everyone has run those calls with patients that are calling 911 for an expedited trip straight into the ED. I responded to a call the other day to a patient that was requesting EMS transport so that she could get into the ED quicker. My partner and I were absolutely infuriated. I was working a 24 hr shift, and the county was falling apart around us, wrecks, 33 sick calls, and 33 transfers out of town. How do you deal with these type calls, and how do you explain to a patient that EMS is not for taxi transports?

You do so carefully and kindly. Does it make you angry? Sometimes. Should it? No man...that's the system. It's how it's set up and how it works. You really, really need to get good with it. You chose this gig, and you have to take it all...not just the good.

I will admit though that those patients get a pretty thorough exam, (No, not punishment) as well, they will likely only do it once as I will call ahead, give the results of my assessment, and that person will almost certainly sit in the waiting room for days before being seen. Of course this assumes that they had no valid reason for calling.

If you treat them poorly, or harshly lecture them on the proper use of the system then you take a chance on giving them the power to claim that you tried to forcefully refuse them. And refusing patients against their will is a super quick, fairly certain way to lose your cert.

Be happy, do a good assessment, find a way to turn their bullshit to your advantage by learning something new from them, give them a ride and triage them to waiting room hell forever. Don't hate the patient for using the system the way that it's been created, hate those that have retarded the EMS learning curve and prevented us from achieving a place where we have right of refusal.

Dwayne

Another forum I frequent has an emoticon tossing popcorn into its mouth. I thought that might've been more appropriate but it isn't an option here. This was the best alternative available.

The man has 4 posts...that was a better alternative than answering the question?

Dwayne

[medicgirl05]

I know how frustrating such a situation is...

I get very agitated when a patient has the nerve to say "I only called y'all so I don't have to wait to be seen". I, however, don't change my treatment of said patient other than when we get to the ER I may kindly inform the nursing staff the patient could be triaged before room assignment...They usually get the hint that the patient isn't "emergent" but that lets them make the final determination if the patient can be sent to the waiting room. Most of the nurses we deal with on a regular basis will proceed to tell the patient the purpose of 911 and EMS, clearing us from getting dinged with "refusing to transport."

The bad part-patients who do not need ambulances are the majority of our calls, so I've pretty much just learned to deal with it. Only time it really sucks is when both of our ambulances are on BS calls and something serious gets toned out. It takes an hour for mutual aid to respond to our county; and a typical call for us, with transport times, takes 2 hours...

[Katiebug]

The bad part-patients who do not need ambulances are the majority of our calls, so I've pretty much just learned to deal with it.

And there it is in a nutshell. This is how the bills get paid. No BS patients = unemployed EMTs. Consider them customers.

On the flip side, I have been miffed at times for missing interesting calls while tending to some crybaby, but you have to get used to that. You can't pick your calls.

I have helped guide a few to triage hell myself. That usually stops them from trying again. You'd just better be damn sure you know what you're doing. You will never have any credibility again if you pull that stunt and you're wrong. Plus you'll have to live with yourself after.

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[medicgirl05]

You'd just better be damn sure you know what you're doing. You will never have any credibility again if you pull that stunt and you're wrong. Plus you'll have to live with yourself after.

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Exactly! That's why I can't do it as often as I'd like! :-)

[ShockDoctor]

^ Ditto, they're pretty much paying our bills.

I find there are two types of B.S. patients: Lazy ones and ignorant ones.

The ignorant ones honestly don't know when to call 911 and what's considered a medical emergency. For example, if a kid dislocates something and starts freaking out, I'd say most of the population would rather just hit 911 and let somebody else deal with it instead of thinking logically, realize that it's not life threatening, and figure they can just drive the kid to the hospital themselves. These people have very little or no first aid training, and they truly don't know what to do. So they call somebody who does. These are the ignorant ones, and I'm fine with them.

The lazy ones are the ones who want to get into a room right away, and they know that if they go by bus they'll get there faster. I also include in here the ones who want to make a "point". They get into a little fender bender, and instead of taking themselves to get a quick checkup, they demand the flashing lights and sirens come. These people also routinely refer to me as an "ambulance driver", which pisses me off.

[DwayneEMTP]

...I have helped guide a few to triage hell myself. That usually stops them from trying again. You'd just better be damn sure you know what you're doing. You will never have any credibility again if you pull that stunt and you're wrong. Plus you'll have to live with yourself after. ..

Yeah, I should have been more clear about that.

I was talking about a radio report such as, (True call), "When questioned as to the reason for EMS activation pt states that she needs her prescription refilled and that her husband refused to drive her to the pharmacy. Pt has no other complaints at this time, no significant issues discovered by medic." Hospital responds, "Copy Dwayne, we'll meet you in triage." When we rolled up on this call an apparently well female ran up to the side of the ambulance, very indignant, and pounded on the side with her fist complaining about our response time.

Now, please understand that has this women been symptomatic, in any way, even if I believed that the symptoms came from PO narc withdrawals for her chronic 'bad back', that I would have considered this a valid call and moved forward like any other call. This woman was simply spoiled, fighting with her husband, wanted to get baked on Vicodin and intended to show him that she would have her way with or without him. (No license due to DUIs)

I don't want to leave anyone with the impression that this is a common practice..I've seen several thousand patients now yet I believe I've done the 'triage hell' maybe three or four times. Another was for a spoiled, rich, 'overdose' chick. Her parents were going crazy, she had her moms narc prescription that she was pouring out of the pill bottle into her mouth and chewing! I grabbed the bottle and immediately smelled M&Ms, looked in the bottle and found it to be full of M&Ms that she was using to freak her parents out with. She claims that she ate all of the narcs that morning (12hrs past), but had gotten some more!, and had 'just' put the candy in there a second ago! Screaming the whole time that "I'm really going to die! that's drugs, not candy!" I actually love psych calls, I love the mentally infirm. This was neither. She was just a spoiled little bitch.

40 minute transport time, no symptoms at any time during the transport...so I made the triage hell call...grin.

EMS is what it is folks until we change it. Punishing patients, treating them poorly, forcefully refusing them...that's just bad form. Leave that kind of behavior to the wankers.

Dwayne