Refusals. You're Opinion

[Nate]

I was just wondering, I know when I work at the city I will offer to call a private ambulance service to transport the patient if they are stable and the hospital is out of our district or their problem isn't a true emergency. (We wait with them until the ambulance shows up.)

Most usually say no and just get in their car and drive off. I've never told anyone "no I won't take you," most understand when I say this isn't a true emergency and will then ask me if it is okay for them to drive themselves or have a friend do it.

[medik8]

I've never "refused" to take anyone to the hospital for anything...regardless of how stupid. However, I'm not beyond scolding a little [-X and properly educating the "stupid" portion of the public on what a "true emergency" consists of.... :roll: and furthermore...quite possibly what could be happening at that very moment that cannot be taken care of because I'm dealing with their bruised finger. Most of the time...not always...you see that look of "awww crap" on their face as they are imagining my scenario of a baby not breathing, and subsequently dying because of their nonsense. For those that have no reaction...well....you can't fix stupid, or selfish for that matter.

[StreetDoc2426]

1st day of EMT class, you should learn that what constitutes an "emergency" to us and what constitutes an "emergency" to your patient may be two different things, regardless, your job is to take them to the hospital. We employ a strict "you call, we haul" policy and if a crew refused to take a pt to the hospital, they would be looking for another job. Aslo, you leave yourself wide open for lawsuits. That brings me to my second point, taking refusals. Personally, i try not to as much as humanly possible,,,i'll talk BS into going any day of the week,,,i just give the ride, dealing with it is the hospitals problem, and i've protected myself. Its all about CYA, The number 1 EMS related litigation involves crews taking refusals. I enjoy my house, my car and all the other neato chit i've accumulated over the years to just give it up to someone because i didnt do my job.

[Ridryder 911]

1st day of EMT class, you should learn that what constitutes an "emergency" to us and what constitutes an "emergency" to your patient may be two different things, regardless, your job is to take them to the hospital. We employ a strict "you call, we haul" policy and if a crew refused to take a pt to the hospital, they would be looking for another job. Also, you leave yourself wide open for lawsuits. That brings me to my second point, taking refusals. Personally, i try not to as much as humanly possible,,,I'll talk BS into going any day of the week,,,i just give the ride, dealing with it is the hospitals problem, and i've protected myself. Its all about CYA, The number 1 EMS related litigation involves crews taking refusals. I enjoy my house, my car and all the other neato chit i've accumulated over the years to just give it up to someone because i didnt do my job.

I disagree... actually, my job is not a taxi cab driver. . it is to assess and treat & stabilize patients for the transportation to the hospital. I agree, if the patient deeds transportation or certain circumstances .. yes transport. But the "U called..... We haul".. mentality is wrong.

Worried about litigation... just lie to the patient/client.. good or bad. One, you have just lost respect from them (especially when they receive that $800 EMS bill) and could be held liable or accountable if you did not warn them that insurance or medicare may not be responsible for the bill if not warranted as a deemed emergency.

Far AMA or refusals, yes one definitely needs to be careful and yes try to convince to seek medial help if they need to do so. But, if the client is alert, orientated of event and have no outstanding special circumstances ( i.e mental capability) they have a right to refuse treatment & transport. Be sure to advise of potential risks and dangers... simple "Death".

For as "hospitals problem".. hey!, do your job.. don't pawn it off on a health care professional. Want to know why there is so much over crowding and diversions ? ....

Your incorrect on the number one law suit .. it is not refusals.. it is "improper use of stretchers & injuries related to stretchers"..

Be safe,

R/R 911

[vs-eh?]

I agree with Rid on all points.

The whole blind "You call, we haul" policy is absolute BS. As is blindly convincing your perceived BS complaints they need to go. If people meet your service's refusal of treatment/transport criteria, and they don't wanna go? They don't go. The reverse applies too, pt. with a legit concern that refuses to go. Now you might go into more lengths (read supervisor) to get them to go, but in the end, it their choice.

Kidnapping? Assault anyone?

As I said, one of my greatest pet peeves in EMS is the person who never wanted to go to the hospital and called 911 simply for a "consult" or to have their BP taken.

That being said...I would be in some ummmm trouble if I outright refused to transport a patient. Unless it was some ridiculous driveway-of-the-hospital scenario.

Thankfully here, our province uses universal ACR documents along with universal patient refusal wording on the back off the document. I always repeat that wording to all my patients that refuse before they sign and get a witness if practical. I always say they are more than welcome to call 911 again, even if in 5 minutes if they change their mind. I have never had a patient do that (that I know of). They are sufficiently informed.

Things I say...

"Would you like to go to the hospital by other means?"

"All I will be doing is offering you a ride to the hospital."

But I always end these with "You are more than welcome to come with us." Or go with the 18 family members that all have cars and you live 5 mins from the hospital. :roll:

[Guest CHP medic]

Anyone ever seen this? When I worked in private (for profit) EMS, the company I worked for kept track of everyone's "dry run rate." If you had a high dry run % you got talked to, and were kind of put under the microscope. So just to keep everyone happy, I would transport everyone who wanted to go. I figured I had to do a PCR anyway, I might as well do it while riding to the hospital. If it was a totally bogus call, we could fill out a 911 abuse form, but I seriously doubt anything was done to the patient.

[Dustdevil]

So just to keep everyone happy, I would transport everyone who wanted to go. I figured I had to do a PCR anyway, I might as well do it while riding to the hospital.

That is pretty much what my personal policy has always been. And, except for one employer (a fire department, of course), it has always been policy that EVERY patient encountered gets transported if he or she wants transportation. Even if you are the last ambulance available in the county.

Now of course, I do agree with Rid that this is far from ideal. In fact, it makes about as much sense as immobilizing everybody who is an any MVA. But unfortunately, there is no nifty little algorithm backed by NAEMSP that purports to reliably and safely sort those in true need from those who do not need us at all. And with the sad state of EMS education in this country, I personally have no faith that every medic in my organization (if I had an organization) possesses the medical knowledge and critical judgment necessary to make that determination with one-hundred percent accuracy.

So, despite the fact that we all know there must be a better way, we have yet to find it. Therefore, you call, we haul.

[Nate]

Been tracked by % of billable runs and $ amount of runs. Kind of depressing when you see how much you've brought in and how much you get paid on the same page.

[StreetDoc2426]

I disagree... actually, my job is not a taxi cab driver

1. yes it is, the sooner you accept it, the better off you'll be. Its not all blood, guts and glory.

could be held liable or accountable if you did not warn them that insurance or medicare may not be responsible for the bill if not warranted as a deemed emergency.

2. Not really, (this may change state to state), but here, they get 2 bills and then the transport is written off. Every ambulance provider in this state has to certify that they will transport patients on emergency calls, regardless of thier ability to pay, in order to recieve their license. (even the privates)

Far AMA or refusals, yes one definitely needs to be careful and yes try to convince to seek medial help if they need to do so. But, if the client is alert, orientated of event and have no outstanding special circumstances ( i.e mental capability) they have a right to refuse treatment & transport. Be sure to advise of potential risks and dangers... simple "Death".

3. I will agree with you on this one, they do have the right to refuse, and, if oriented, I will allow them to do so after they have been fully advised and informed of the potential risks involved. Then i document accordingly.

For as "hospitals problem".. hey!, do your job.. don't pawn it off on a health care professional. Want to know why there is so much over crowding and diversions ? ....

4. Once again, not really, the abusers will be triaged and we will escort them to the waiting area where they will spend the better part of the day twiddling thier thumbs and watching CNN with the rest of BS that walks in. Most just get tired of waiting and leave.

As I said, one of my greatest pet peeves in EMS is the person who never wanted to go to the hospital and called 911 simply for a "consult" or to have their BP taken.

5. I've made too many of these to remember,,however, there have been runs like this that I've made where the b/p has been OMG/Holy Chit batman, and they have recieved rapid transport to the hospital. We also get alot of "i just need you to check my sugar".

I do get peeved when i have to drive across the county to get to a pt's house and there is a driveway full of cars, house full of family and they are a good golf swing away from the hospital.

I've also seen a percieved routine headache call result in an previously undiagnosed brain tumor, a toothache=MI (pt confused tooth pain with jaw pain), and waaaay too many FDGB's result in head bleeds. All were transported.

All im saying is dont get complacent, watch what take refusals on, document, document, document.

[Ridryder 911]

Actually, you may be a taxi cab driver or they may even call you an ambulance driver... but, I am a Paramedic & was one when you were still in diapers.. so, I don't have to worry about getting over it. I have way too many ... you call, we haul...ambulance drivers & yes those deserve minimum wage.

Actually, according to Medicare guidelines, you are to inform the patient if knowingly, that services are not to be covered. Hmmm.. I smell medicare fraud.... the same on taking granny to the dentist or shopping or even returning home from a ER or hospital, if they are ambulatory. Sure, you have to guarantee transports....as you state "Emergencies" in which case these are not & can not be classified as. Too many municipal uses policy to ensure the numbers look good.

Now on "dumping" on the ER, if you really did your job appropriately, you should 1) offer to seek other transportation if the client needs to be transported 2) Provide transportation, for them if they have no other means with them understanding that they will receive a bill and chances are insurance and M/C may not cover it. ... if that the case..why not take them to an urgent care center instead of an ER. ?...

Medicare is quite aware of EMS practices of "writing" things off.. for partial reimbursement. With good policies and active medical director, some of these transports can be eliminated. You will always have abusers of the system.

As part of the EMS profession and job, don't always take things as face value. If local policy dictates, fine.. then, you have to accept or change things.. With the increase aging population, decreased ER availability, new policies may have to be developed and looked at if this trend increases.

Be safe,

R/R 911