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

[vs-eh?]

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?

I have a sneaking suspicion that due to the mention of "My partner asked questions about the new pain meds she was taking and follow up questions about her current complaints..." that this partner (overtly or not) implied to the patient that their current complaints perhaps related to normal side effects of these "new pain meds" and downplayed the post surgical signs and symptoms.

I hope however there was no gross suggestion not to go to the hospital.

[Timmy]

I think if someone wants to go to hospital its up to them. We don’t refuse to take people to hospital; everyone has the right to proper quality health care. So what if you don’t think they need to go to hospital, it’s not up to us to make that call. Either way you still get paid.

[strippel]

I can honestly only think of one time (recently) where I induced a refusal.

In this case, it was the 3rd 911 call to the residence in 24 hours. My partner was on one of them, and the previous crew told us about theirs at shift change. Bottom line, a female family member unwilling to properly take care of an older male with dementia. He was at the ER x2, and given prescriptions, which she refused to fill and give him. Also, the patient was to go to the county ECF, and administrators even arrived to pick him up. She refused, even though she set it up in the first place. Bottom line, she wouldn't get his money any more.

It is easier for me to transport, than not. I have to explain more (we have a long list of risks), and document more. I know a large number of calls are BS, and don't need an ER. I did not stay at a Holiday Inn Express. Hell, I'm only half way through Medic school.

[Just Plain Ruff]

I also hope you did not induce the refusal for the liposuction patient.

Any time we as medics or emt's begin to play doctor and say oh it's only your pain meds causing this or something along that line we get on a true slippery slope.

post surgery, liposuction patient, nausea and vomiting - can you or your partner diagnose what is going on in that patients body?

I do not think so.

Any time we start to pressure someone to not go with us then we begin to be our own worst enemies.

Can anyone here tell us what many women with MI's present with as initial symptoms????? I belive that n&v is one of those classic signs in a woman.

Not saying this was the case but go by this rule and you will never fail - if the patient wants to go take them - simple as that.

Who are we to go around telling patients or pushing them to refuse. If they want to go take em. What harm is there in taking these people?

Remember - many medics have been bit in the ASS by refusals and this lady had she have deteriorated you would have been more than likely found negligent or liable for her demise.

I like to look at it this way - it isnt' gonna take all day to get her to the ER and get your truck back in service. If you get angry at the patient because you miss the big call because you are taking care of the little call then you are in the wrong business.

Their complaint is important to them and they don't call 911 with the expectation that they are not going to be taken to the ER, they call us because in their eyes and mindset, they needed an ambulance.

It only takes one patient to refuse on you and then crash before your career is over.

[deacon]

Adult residential facility, staff have "standing orders" to transport a patient if BG drops below a certain threshold. By the time we get there, the patient has had a glass of OJ (all it takes) and his BG is now back in his acceptable range. Staff insists we transport patient, they follow us in their wheel chair equipped van while we drive the patient to the hospital.

We have talked to the MD that wries these orders and she maintains that she does not want the staff making subjective decisions...

[melangel16]

What about the regular patient that calls at least 4-5 times a week (always at 5am) with her chronic back pain? Pt is in NO distress and ambulatory around her house with NO problems. Nothing has changed - no recent falls, twists, turns, hits etc (she sits around the house all day doing nothing). She says she has taken her meds but they don't help (usually a bunch missing). You ask - what do they do for you at the hosp? Her response - nothing - she's seen by the doc - says see your family doc and released - everytime. (Must also mention she is on welfare and doesn't pay for the ambulance)

I'm all for someone not having to live in pain - but when the ER never does anything (no extra pain meds etc) and always says go see your family doc and she refuses to follow through, but keeps calling an ambulance even though she lives 3 blocks from the hospital.

My opinion - waste of resources.

[Ridryder 911]

Very soon we will be faced with the dilemma of those that will get to go by EMS instead of those that do not. With the increase in baby boomer and no ER rooms, as well as Medicare and private insurances not wanting to pay several hundred dollars a day for a taxi cab ride.. we should in medicine, have to justify transport as much as not transporting.

Like not all patients require spine boards on falls, not all medical patients need EMS for transports.

Is this patient in need of continuous monitoring, and medications?

Does this patient on-going medical assessment.. and continuous monitoring of v.s, repeat neuro.. etc.

Does this patient require a stretcher for transport or can the patient sit in a wheelchair?

Does the EMT feel it would be in the best interest for the patient to be evaluated because of the scenario, situation of social and psychological reasons?

Yes, EMS needs to be careful not to prejudice and make irrational decisions, that is why it is so essential more education is needed for EMS, as well as always error on the patent's behalf. However; there are many that are not in need of emergency care.

R/r 911

[JPINFV]

Adult residential facility, staff have "standing orders" to transport a patient if BG drops below a certain threshold. By the time we get there, the patient has had a glass of OJ (all it takes) and his BG is now back in his acceptable range. Staff insists we transport patient, they follow us in their wheel chair equipped van while we drive the patient to the hospital.

We have talked to the MD that wries these orders and she maintains that she does not want the staff making subjective decisions...

Why not just write a standing order for D50? (I actually had a discharge to a SNF where they didn't remove the saline lock because of such an order. I was honestly shocked).

[amartin]

I think two of the most redicilous runs that i've seen in the past year was this summer...A patient called an ambulance for a mild sunburn and insisted for them to bring him in...we were bustin out laughing on the phone when they called in the report...

the next one would have to be patient waits in the er for fifteen minutes for weld burns to the eyes and yes i understand it's painful,but chest pain and TMI's come first...patient gets all pissed off at us...has the spouse drive them down the road a few blocks then calls an ambulance to come get him....the ambulance brings him in, the er staff sees who the person is when they come in the back doors, and they sit him right back out in the waiting room

[zippyRN]

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.

there is an arguement that neither need a emergency ambulance trip, but then again to take the devil's advocate role there's an arguement that many emergency ambulances in the USA would not count as emergency ambulances elsewhere in the civilised world ...

intellignet transport policies is whatitls aobut - what can be transported by the single responder or Emergency Care Practitioner in a car / people carrier/ SUV , what can be transported by PTS or middle tier what requires transport by a 'full' emergency ambulance ...

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.

alternative pathways are best designed on a system wide basis with the knowledgeand consent of medical direction, other stakeholders in thehealth secotr ( hospitals, primary care etc ) and theorganisatiosn you will be referring to ...