Deny Transport?

[spenac]

New York City 9-1-1 units can refuse transports, the procedure is as follows:

The NYC-EMS system (Pre-merger) had a procedure (still in place with the great fire monkeys) called a 10-95 (triaged out thru medical control). After a unit BLS or ALS arrives at the scene and completes a full patient assessment (2 sets of V/S) and determines in the crews mind that the patient does not need transport, they can call a medical control physician, and present their case, if the MD agrees he will speak with the patient on a taped phone line and basically tell the patient "you're not going" and then we give the patient a copy of the PCR and leave.

In 10 years full time I saw the need for it to be done 3 times.... and all 3 times it was successful. One patient that stands out is as follows:

30 something male found at the MTS Police station, prisoner, complaining of non traumatic back pain, onset 8 hours ago. He claims the cause of his pain was "sleeping all night on this hard jail cell bench.

No evidence of trauma, v/s WNL, put him on the phone with the doc, he repeated that his back only started hurting after trying to sleep on the jail cell bench.,,, denies trauma, no fight during arrest, no medical Hx. etc.

After speaking with the MD he was REFUSED.

Talked to the cops later in the week, he made it to court and was released on bail. his "back pain " never came up again after we refused him.

Now this is just one of the 3 examples i have,, all are basically the same,,,, This protocol is still in place,, I think it specifies, that under 5 or over 70 you can't refuse,, etc.

But in this case it is good. I have heard of some systems doing similar stuff, like after assessment if you just need a ride to the hospital because you have a clinic appointment or like a minor laceration needing a few stitches, but can wait, they give you a taxi voucher, bus ticket, or in some cases send an ambulette or van to run around and pickup all the minor cases within like an hour or 2 and the 9-1-1 unit goes in service....

Anyone do stuff like that it would be interesting to hear about.

Stay safe

Former

Thanks for explaining how your service deny's transport. It is interesting to hear how it's done in the big city.

It is funny how many people in custody decide they're sick or hurt. We get some that are caught smuggling dope into the country. We get called out and while we are checking them we explain to them that they will still be under arrest, they will be cuffed, they will be accompianed by an officer, and this will delay how soon they can see their lawyer or get bailed out. If vitals are good we then ask if they want to go to hospital, most decide they would rather have the officers take them to the jail so they can work on getting out. I guess some of them think that if the ambulance takes them they're free. If anything is questionable or obviuosly wrong we recommend that they be taken by ambulance.

We can as previously stated at times refuse transport w/o calling Dr. But we also if we can reach a Dr on the phone can call give them the info and let the Dr decide whether we transport or refuse. But again as previously posted like all services we still transport the majority that ask to go.

I like the idea of providing a voucher, I'll have to look into it,discuss with medical director and discuss it with the city as it would keep us in service and plus cost less than us transporting a patient that is just looking for ride to Dr appointments.

I hope more that have the right to deny transport will post the procedures they use.

[zippyRN]

refusing or delaying transport requires approrpaitely educated providers

in the Uk one of the main benefits of the ECP role is that inapprorpaitetransports can be minimised , andsome services are now extending this to paramedics and event QATs, the important thing to remember is that Uk paramedics are 'proper' Health professionals , ECPs anre generally either RNs or Paramedics and even the UK tech has a hell of a lot more training and education than US EMTs...

i am involved with a town centre project on friday and saturday evenings - two pronged strategy

1. provide emergency care quickely

2. minimise inapprorpaite ambulance and ED use ...

refusing or delaying transport is again down to a n RN , Paramedic or Doctor to decide ( depending which health priofessionals are available to the scheme )

[elvismedic]

Yes we can refuse transport....Oops I just woke up must have been dreaming. No way not in MA.

[flopeyeman]

In the system that I worked in you could refuse transport if you absolutely knew that it was absolutely BS but if you screwed up it was on you no one else so it was very rarely used

[pinymayu]

quick note, did this article say they were 9-1-1 services?

when i worked doing transport we can refuse to take any pt with elevated bp's unstable vitals etc.. UNLESS there destionation is an ER, but if we get called to pick up to go to a nursing home from a hospital floor and the pt needs o2 or bag or intubation etc... we can refuse the pt.

we can also refuse pt's if we deem it not safe for us ...

like 2 months ago i was rolling up to a hospital with my partner we get out the stretcher about to pick up a pt, security wouldnt let us in we asked why they said and i quote "psych pt got out" i was like alright, talked to dispatch said scene was unsafe send no more units to this location, the ER was on diversion no one was allowed in or out at all, in this case the call was offically put in as we refused to take the pt cuz we refused to wait at an "unsafe scene" ... its all political nonsense..

if its a 9-1-1 call we cannot refuse anyone period the end.

You should not have an EMT ticket. Your so WRONG and negligent in the instances you mentioned above I don't even know wheren to begin. Do your patients a favor amd apply as a janitor to work at McDonadls where you will hurt none except yourself.

pinymyachia?

[flopeyeman]

You should not have an EMT ticket. Your so WRONG and negligent in the instances you mentioned above I don't even know wheren to begin. Do your patients a favor amd apply as a janitor to work at McDonadls where you will hurt none except yourself.

pinymyachia?

you should have seen the clarifacation post that was made before you jumped on your high horse!

[pinymayu]

Double Post..DELETED

[pinymayu]

okay its taken me a bit to get back to this thread, okay to clarify,

1st note is i didnt give FULL details on company policies but will attept to clarify and still keep details to a minimum

it is a bls unit, full on part 800 doh unit, to clarify,

if a pt is on the 7th floor of a hospital on his way to a nursing home, after being admitted for xyz has an elevated bp, we are REQUIRED to deny the transport, simply because the NH wont accept the pt.

ill pose you this.. what sense does it make for the company to take an unstable pt out of the hospital ? how can that help the pt ?

Your duty bound to treat the emergent presenting condition which you find and be sure that the patient recieves adequate care and get acess to continuing advanced care. PERIOD refusing to transport and leaving..that abandonment pure and simple as once you assume care you can't just say no way and walk away unless there are safety issues. Irregadless of company policies. FURTHERMORE, thoise same policies will not protect you from failure to follow the standard of care. They will just gain the plaintiff more money and make the Co, a co-defendent. Next you give no context as to what 'high' is and whether you truely have the intelligence, capability or clinical knowledge to determine whether thatn is a 'critical' or 'concerning' value for that patient. Especially when your first post put your competence in question.

now if we reverse the situation and the pt is in a nursing home scheduled to go for dialysis, and we find they are unstable elevated bp bla bla, then we refuse txp to the dialysis center and go to the nearest ER.

You have no choice, also, you must provide appropriate care as well as transport...PERIOD..

Ruffems- does that clarify it enough for you ? who would i call for the pt ? the DR on the floor or the ER and get the pt down there.

Why are you asking a question you should be answering?

Do you refer them to law enforcement or do you just leave the scene and let them fend for themselves.

WE do not except them from the hospital, fend for them selves? nope the rn's and dr's on the floor help them.

More than likely the Dr's and nurse take cover and run and the patients fend for themselves. This statement shows you are ignorant to the realities of ER care and policies...

Ridryder 911

Not all patients need an ER, but may require critical care transport

we dont have CC, and again i will say the same thing why would i take a pt outta the hospital in an unstable condition.

ALOT of CCT transfers go via the ER and are done only after an ER doc has been consulted with and agrees. Your staement is thusly false and misleading.

BLS such as oxygen to even a residence. when i said o2 the first time i meant o2 with a vent, of course we dont refuse pt's who are on o2 all the time.

It's good to know you don't refuse to do everything you should.

okay 1 im a Marine, i dont flake out on work, nor am i worried about psych pt or otherwise, i havent EVER denied txp for that reason personally, doesnt mean it isnt done.

Kindly clarify this statement..Also explain what being a marine has to do with refusing to do psych calls? Unless of course your a marine psych pt?

okay and then back to ruff, like i said it is isnt 9-1-1 it isnt ALS it was BLS TXP not an ambulette or "wheel chair van"

i think that clarifys it for the most part .. any other thoughts or anything else need explanation ?

No it begs mnore questions than it answers. These two astuite and highly capable and experienced individuals were just being nice and trying to politely tell you that you're wrong. They believe in being PC, I am not going to coddle you like they do on Parris island with stress cards and counseling and such. I'm kinda like the clue bat that you so obviously need to get educated about EMS care.

In closing I will refer you to this graphic.

Out Here,

Pinymayu

[flopeyeman]

getting a little touchy are we?

[pinymayu]

you should have seen the clarifacation post that was made before you jumped on your high horse!

I saw it just fine thank you, and it clarified nothing..If anything it begot more questions than it answered. Thanks for the unhelpful insight, and non-productive comment.

pinymayu.

If I am infuriating it's because I'm right..