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

[Doczilla]

I think that some of this question can be broken down like this:

Who needs to go to the ED?

Who needs to go there by ambulance?

It's one thing to get someone to avoid going altogether and follow up with their primary care physician. Apart from the obvious (DOA, competent patient refusing), this is shaky legal ground. I would encourage EMS to contact the patient's primary care physician in the presence of the patient and touch base if possible. You can get some advice from the doc who knows them best, as well as ensure some follow-up care. Medical control can help you out here to a limited extent.

It's another thing to say they don't need an ambulance ride, but ensuring transport to the ED. There are patients that certainly require care but don't need it by the ambulance (like the patients with the lacerations), or those who called 911 because that's the only ride to the hospital they have. With the case of the lacerations just brought up, you may be able to ensure transport with family or through a taxicab voucher program. This way the patient gets the care they need but isn't socked with a $400 ambulance bill. The EMS crew clears the scene and is available sooner for transports, reducing burden on the 911 system. The potential downside here is with those patients who are inappropriately released who have a life-threatening problem that will require monitoring on transport.

What needs to go by ambulance? That list is long and distinguished, but basically comes down to those patients who require:

Monitoring because they are at risk to rapidly decompensate

Oxygen above what they normally take

Immobilization of anything but an upper extremity

Medications, including pain medicine

Restraint

Someone to make sure they get there because they are not mentating correctly

Someone to make sure they get there because they have extremely poor follow-up care or compliance, and you really can't guarantee they will get to the ED or doctor's office if you don't take them.

'zilla

[Dustdevil]

That list is long and distinguished...

LMAO!!

I ain't touching that one!

[beckoncall62]

DOAs with rigor O:)

[NREMT-Basic]

Doczilla-

you mention getting the patients primary care doc on the phone as if it were as easy as dialing for a pizza. I assume that you may be a physician, but around here in my area, you couldnt get your doc on the phone if your hair was on fire. And if you did this at, say, 0300 and managed to actually talk to him because he happened to be on call, dont you imagine he would be a little irked by a medic or basic calling him and asking him about whether or not he wants his patient to go to the ED?

A question about other areas: Here we have to take all AMS patients to the hospital if we are responding to a 911 call. Whats it like in other places?

[paraloco]

Had a near-miss recently. We got called for a fall, an elderly gentleman who fell while walking from his bed to the bathroom. A distance of about 8 feet. In his 80's, appropriate mentally, a retired prominent local businessman. All he wanted was assistance up, and he would be fine, he insisted. He denied injury, had no obvious injuries, was AAOx4, capable of self-evaluation, no alcohol or illicit substances. We helped him to his bed, and again asked him if he hurt. He finally admitted some lower back pain, which he had PRIOR to the fall. He allowed vitals, after his wife cajoled him. No radial pulses. weak carotid pulses. pulsating mass in the abdomen. " Oh yeah, I have an abdominal aneurysm, but just a small one." B*ll Sh*t ! It took 10 minutes of pleading to get him to consent to transport. Had a supervisor on the way, cuz I wasn't gonna go down alone if he crashed later. We grabbed him and scooted out fast, low & sideways. His aneurysm had grown up to be a big one, and had extended a fistula in to his vena cava. Don't know the final outcome. Oh, and he was also in a-fib with rapid vent. response. Good thing I stayed away from the diltiazem, the docs said I would have come in pumping on his chest if I had given that.