Question from UK Paramedic about life as a US Paramedic

[ukparamedic]

Hey guys,

I've often been under the impression that in America, calling 911 for an ambulance always cost you money, so people never called for any BS such as homeless drunks or cut fingers and stubbed toes and stuff like that. However I was browsing YouTube and I see a lot of LAFD Paramedic callouts to homeless drunks and people going crazy / being high. And I'm basically here to ask, what gives?

I thought you could only call an ambulance if you had health insurance which I assume a majority of bums and wasters etc don't. Part of the reason I hate working in the UK as a Paramedic is that ALL healthcare in the UK is free, no insurance required. No nothing. So we get called to some absolute crap every day, like cut toes or homeless people being drunk etc. America sounded like some kind of paradise to me where people were scared to call 911 for an ambulance because they knew they'd be charged out of the ass end of their wallet for calling Paramedics. Am I wrong?

I was basically only browsing YouTube to find a ride along with LAFD (and you know what I mean, a REAL ride along that shows the BS. Not a heavily edited "look at us man we save lives!!!" ride along), because I wanted to see what it's like for you guys and whether you get treated like crap the same way we do over here.

Any responses from Paramedics working for a Fire Department would be greatly appreciated.

[Just Plain Ruff]

Paramedics from all walks of life here in the US get called to all sorts of calls. Having insurance doesn't mean a thing.

Where did you get the idea that 911 is only for those with insurance?

[paramedicmike]

Welcome to the City.

Hey guys,

I've often been under the impression that in America, calling 911 for an ambulance always cost you money, so people never called for any BS such as homeless drunks or cut fingers and stubbed toes and stuff like that. However I was browsing YouTube and I see a lot of LAFD Paramedic callouts to homeless drunks and people going crazy / being high. And I'm basically here to ask, what gives?

The costs associated with 911 calls are covered in a variety of ways depending on the structure of the system in question.

Some departments are tax base supported. These can be fire based or municipal third service. Any 911 call, transport or not, rich pillar of business or local homeless drunk, would be covered regardless of ability of the patient to pay.

Some departments are volunteer supported by donations.

Some departments are moving to a mixed system where taxpayer support is provided by local government and then patient is billed to help cover costs of services. In some cases people can, and do, pay. In some cases people can't, and don't, pay. Ability to pay does not in any way, shape or form affect the provision of services in a 911 environment.

So what gives? Whoever told you that EMS in the US was only for people with insurance and crews were never called out to "BS such as homeless drunks..." was woefully misinformed. We answer and respond to a wide variety of calls from an exceedingly diverse patient population.

I thought you could only call an ambulance if you had health insurance which I assume a majority of bums and wasters etc don't.

Bums and wasters, eh? I'll admit your chosen adjectives are a little concerning. Perhaps it's time for you to take a holiday and get away from the ambulance for a bit.

Don't assume anything.

You thought wrong.

Part of the reason I hate working in the UK as a Paramedic is that ALL healthcare in the UK is free, no insurance required. No nothing. So we get called to some absolute crap every day, like cut toes or homeless people being drunk etc. America sounded like some kind of paradise to me where people were scared to call 911 for an ambulance because they knew they'd be charged out of the ass end of their wallet for calling Paramedics. Am I wrong?

Yes. Your impression of EMS in the US is very, very, very wrong.

To be fair, I, and I imagine most of the others here, have encountered patients who didn't want to call 911 because they didn't want to pay the bill they thought (rightly or wrongly) they might receive. This is not the rule. Provision of EMS services dispatched by 911 in the US in given regardless of the individual's ability to pay.

I was basically only browsing YouTube to find a ride along with LAFD (and you know what I mean, a REAL ride along that shows the BS. Not a heavily edited "look at us man we save lives!!!" ride along), because I wanted to see what it's like for you guys and whether you get treated like crap the same way we do over here.

YouTube, like Wikipedia, is neither an accurate nor infallible resource for anything and everything you ever wanted to know.

I imagine treatment of EMS providers by the public at large is similar the world over with some people exceedingly grateful for the services received and some people who will never be happy with anything.

Any responses from Paramedics working for a Fire Department would be greatly appreciated.

Paramedics don't have to work for a fire department to be able to accurately and reasonably answer your inquiries. I've worked for fire based, municipal third service based, hospital based/air medical based EMS in a number of areas in the US. There is a much wider base of experience with a much wider and more varied employment history when you look at the many people who post here.

Fire based EMS is not the be all, end all of EMS especially here in the States. (In fact, many will argue that EMS should not be based in a fire department system anyway as the two are completely different jobs. That's another discussion altogether.)

[ukparamedic]

Well you can forgive me coming from a country where 'EMS' is a national service fully tax funded and yet even for those who don't pay taxes or have just come to the country on holiday can call as many times as they like for no penalty.

In the UK, people can and do call us up to 10 times a day, because it's free and because it's not a criminal offence to waste ambulance time. Only the police. Is it the same here?

You may think everything I've said so far is very wrong but a majority of people in the UK all think the same, and I also got this impression by talking to someone while I was in the US who told me it costs like $500 for an ambulance ride if you call 911, and I figured she was correct since she lives here.

What is the call rate like here in a big city? I work in London specifically, which is known to be the busiest free ambulance service in the world. We do not get meal breaks, and the idea of one would make any Paramedic laugh. We normally receive about 6000 calls a day, and considering the size of London it's complete insanity. This is mostly due to the triage system we have, AMPDS. The most awful, clinically inaccurate triage system anyone could have the misfortune of working under. It seems like everybody gets an emergency response for literally anything.

I may have a tad of cynicism, but it is because I have been to the states a few times and often see ambulance crews driving around not doing much, 2 people in the cab, and I think why aren't they on a job? Is it really that quiet here? In London we go from job to job to job to job from the start of the shift to finish, and as a result are always late off of a 12 hour shift and still expected to come in the next day and do it all over again. Guess I'm just a bit jealous of Paramedics who can actually go to work and sit on station or drive around, or actually go out and get lunch.

[triemal04]

Man I really can't tell if you're being serious, or just trolling to try and stir people up. I'm leaning towards the latter.

So for now I'm just going to sit back and enjoy the show.

[paramedicmike]

Man I really can't tell if you're being serious, or just trolling to try and stir people up. I'm leaning towards the latter.

So for now I'm just going to sit back and enjoy the show.

Everyone gets the benefit of the doubt once.

But that's about it. After that response I'm inclined to agree with you.

Edited June 20, 2014 by paramedicmike

[scott33]

Obviously a Troll. Not a word of what he says is true.

ALL healthcare in the UK is free, no insurance required. No nothing

Incorrect. The NHS costs the UK tax payer billions per year, regardless of whether they use the system or not. There is no option to opt out of paying into it, even if you use separate private healthcare services. If you have a job, you pay for it. Unlike with the US, there are no point of care fees which can give the illusion that you are getting something for nothing when you need it most. You will still find yourself out of pocket for dental and optical care as well as prescriptions.

We do not get meal breaks, and the idea of one would make any Paramedic laugh

I think it's a little short sighted of you to ignore the position that many UK ambulance staff have, in respect to their protected meal breaks. It would be completely unheard of in the US for someone to be 1 block away from a cardiac arrest or chocking child, and not get pulled from their break. Not so in the UK.

http://www.birminghammail.co.uk/news/local-news/west-midlands-ambulance-service-paramedics-405112

http://www.telegraph.co.uk/news/uknews/3060387/Paramedic-on-lunch-break-refused-to-help-dying-woman.html

http://www.dailymail.co.uk/news/article-2542782/Unacceptable-delays-led-death-man-despite-four-calls-999-wife-Paramedics-delayed-enforced-breaks-coroner-finds.html

http://www.dailymail.co.uk/news/article-1156762/Paramedic-refused-help-man-broken-lunch-break-let-off.html

It seems like everybody gets an emergency response for literally anything.

The NHS use a wide range of prehospital clinical providers, who in turn can provide a wide range of clinical pathways for the patient - at their discretion. Transport, treat and release, treat and refer etc etc. The UK do not have the 'you call we haul' mentality of the US. Why? because US EMS primarily only generate income when they transport.

Edited June 21, 2014 by scott33

[Just Plain Ruff]

Does he even work in London? He should know better in regards to his countries health insurance if he actually works in an EMS capacity.

[zippyRN]

I smell troll , i see Scott has posted and dispelled some ofthe guff posted .

an interesting side point about Prescription charges in the UK - a significant amount of NHS prescriptions are exempt from the charges (under 16, under 19 and still studying , pensioners, low income exemptions, chronic condition exemptions ,,, ) or paid for with a 'season ticket' ( the pre-payment scheme gives you unlimited prescriptiosn for a little over 100 gbp / year)

[mikeymedic1984]

In the hopes that this was a legitimate post, let me clarify for all parties. NO HEALTHCARE ANYWHERE IN THE WORLD IS "FREE". Someone either pays for it through high taxes (up to 40-50% of your income in some European models), through insurance company premiums, or you pay for elective care out of pocket. In the US, the haves pay for the have nots through taxes (medicaid) and increased insurance premiums because hospitals can not turn a patient away due to lack of funds (therefore, my BCBS insurance premiums are higher because hospitals charge an increased rate to insurance companies to make up the loss they incur from the uninsured).

As far as the affect on 911 call volume, those who are homeless/uninsured or are on Medicaid have no out of pocket expense for ambulance service, regardless of what we charge after the fact, so there is no reason not to call 10 times per day if you wish. Also note, that under the US EMS model, most services can only bill for an actual transport, not being called to the scene (although some have tried to charge a response fee); so you can call an ambulance to your home 20 times per day, but would not incur a charge unless you were actually transported to the hospital. But again that bill is sent to you days/weeks/months AFTER you are transported.

For all those who chide the American healthcare system, we sure see alot of Canadians who choose US Healthcare over their "free" national healthcare:

In 2013, 41,838 Canadians went outside the country to get medical treatment, down from 42,173 people leaving the country in 2012. This is interesting since wait times for patients who had consulted with a specialist till the time they got actual treatment increased from 9.3 weeks in 2012 to 9.6 weeks in 2013.

Read more: http://dailycaller.com/2014/01/16/report-tens-of-thousands-fled-socialized-canadian-medicine-in-2013/#ixzz37MF0rg4C