What kind of calls do you feel DON'T require a trip to ER

[Trauma_Junkie]

I was working with an EMT that's been on the job for 16 years, we had a call last night on a lady that had a liposuction proceedure 2 days ago and was c/o waekness and nausea x 3 hours. My partner asked questions about the new pain meds she was taking and follow up questions about her current complaints ... to make a long story short ... we ended up signing an RMA and recommending that she see her doctor on monday for a post op evaluation. She was stable with good vitals, no dizziness, some vomiting.

I didn't feel inorrect about not taking her to the hospital but she clearly was not emergent at that moment ... but it got me thinking ... and made me question as to how others judge what conditions require a trip to the ER and what is better off staying at home.

Please give some examples.

[vs-eh?]

What kind of calls do you feel DON'T require a trip to ER?

By ambulance? The majority...

I didn't feel inorrect about not taking her to the hospital but she clearly was not emergent at that moment ... but it got me thinking ... and made me question as to how others judge what conditions require a trip to the ER and what is better off staying at home.

How does an EMT with under 200 hours of education judge who requires a trip to the ER and who stays home? They don't.

Someone who calls 911, the assumption is that they wish to go to the hospital. You must always offer transport, but also give other options that they and you feel comfortable with. But, in the end, it is the patient's decision. Personally, I don't like transporting certain types of patients or feel that 911 should not have been called for this, but hey if they want to go with us, they go.

Post liposuction with N+V and weakness? I don't know about you or your EMT partner (or any other advanced EMS provider), but post liposuction complications aren't covered in much depth where I was educated. Simply elucidating "what is wrong with them" based on their "pain meds" knowing nothing about the patho/surgical procedure in question? Nor having the ability of advanced assessment? I would offer them transport to the hospital and suggest they go...

[Redcell19512]

Nursing home has a patient that needs a G tube replaced or a Picc line replaced. It's 2 am on Sunday night. We know from past experience that the ER won't deat with these problems but the nursing home insists we send them out. What happens? we arrive at the ER, charge nurse says hang on. ER doc looks at patitent and note from the nursing home. Pt is registered and discharged with instruction to call IR in the morning for an appt. Pt never leaves our litter. Round trip transport is $1,150, not including what the ER charges.

Here's how we handle it now. If it sounds like a BS run for a BS tube change we call in to speak with one of the command doctors at the recieving facility. We give him/her the run down...doc asks to speak to nursing home staff. If it is a service the ER doesn't provide and there are no additional medical concerns...the transportation is canceled.

We don't make the decision...we merely find the appropriate people to make them for us.

[becksdad]

I don't think there are many cut and dried answers to the question of what calls should not be transported. A guy working in his garage who lacerates his hand on a razor knife, his wife panics, calls 911. He's cool, you bandage his hand, he just wants his wife to drive him to the ER or a walk-in for the stitches he needs. OK, no big deal, I wouldn't mind signing him off. A little old lady who lives alone lacerates her hand while working in the kitchen. She's kind of upset, she's by herself, if you don't take her for the stitches she needs, how will she get there? Drive herself shaky and upset? Maybe call a friend? I don't know, but I wouldn't be comfortable signing her off. Same injury to 2 different people, 2 different circumstances, 2 different responses.

Refusals can be a double edged sword that can come back and bite you. It is a common paradox that some people who really need to go to the hospital will be the ones most adamantly refusing, and many that don't need a hospital will be the most insistent on going. You are always safest transporting a patient who calls you. Of course there are the completely ridiculous calls like splinters or pinched fingers, stuff like that. Then there are the calls that would benefit from some sort of social services referral. Did you know that if someone calls 211 on the phone it rings to the United Way, who can refer to literally thousands of agencies of specialized assistance? All it takes is a patients consent and willingness.

I would be extremely careful with RMA's - especially if you are new. It takes more than just an idea of what types of illness or injury are better served by alternatives to EMS.

[emtkelley]

Perhaps you should look up lipo surgery and see what you find. Pay close attention to the post surgical complications and then ask yourself the same question as to whether you should have transported. People have died from this surgery.

I don't judge who goes to the ER and who doesn't. I get toned out, I go to the call, perform patient care, deliver them to the facility, do my paperwork and wait for the next call. I personally don't get into refusals and it is becoming too commonplace to use them. Does no one want to do their job anymore?? Sheesh.......

[JPINFV]

Simple, most nursing home patients. In my experience, most nursing home patients who actually need a hospital should be a direct admit and only see the ER as they are being rolled from the ambulance bay to the door to the hallway.

[becksdad]

Oh, by the way, I agree completely with vs-eh? about the liposuction patient. Hopefully, there's a whole lot of info you didn't tell us about that. I don't know much about liposuction either. At any rate, any post surgical patient who is fine at discharge and deteriorates 2 days later warrants a much closer look than just a few questions.

[Andrewtx]

Post liposuction with N+V and weakness? I don't know about you or your EMT partner (or any other advanced EMS provider), but post liposuction complications aren't covered in much depth where I was educated. Simply elucidating "what is wrong with them" based on their "pain meds" knowing nothing about the patho/surgical procedure in question? Nor having the ability of advanced assessment? I would offer them transport to the hospital and suggest they go...

I wouldn't be very comfortable with the situation either.

[Asysin2leads]

A post-op patient c/o nausea and weakness is actually a better candidate for the ER than many of the patients I treat.

[alpha23958]

You suggested she not go to the ER, and made her refuse?

Or

She didn't want to go, you didn't talk her into it, and she signed off anyway?