Deny Transport?

[CBEMT]

"So, let me just make sure I'm hearing you correctly- you want me to transport you to (city across the state line, about 10 miles) to get your prescriptions because your daughter has a cold and can't drive you?"

"Yeah!"

"So you don't want to go to a hospital?"

"Nope."

"Sign here."

[whit72]

We never deny transport, you call you go. Its pretty simple. They pay taxes, well some of them do

To many meatheads in this field to allow crews to decide what is a true medical emergency and what isn't.

How is it your problem if the insurance decides not to pay? That isn't my responsibility. I know and understand the facets of my job description deciphering what an insurance company will pay for isn't one of them. I have enough on my plate.

If you use the excuse that you will take an ambulance away from a truly sick patient. Thats bullshit, we know the percentages of 911 calls that are trule emergencies. If you only staffed ambulances to handle truly sick patients you would have to drop half your trucks and lay off 75 percent of your field personnel. Its understood that half your calls you wont be reimbursed for, thats the nature of the beast.

Educating the public as to what is an acceptable reason to initiate emergency medical services is what is needed if you believe your area has a problem. However that could persuade others that are truly sick not call because they don't believe they fit the criteria. Its a slippery slope. Be careful what you wish for because if only the truly sick called 911 half of us probably wouldn't have a job anymore.

[spenac]

We never deny transport, you call you go. Its pretty simple. They pay taxes, well some of them do

To many meatheads in this field to allow crews to decide what is a true medical emergency and what isn't.

How is it your problem if the insurance decides not to pay? That isn't my responsibility. I know and understand the facets of my job description deciphering what an insurance company will pay for isn't one of them. I have enough on my plate.

If you use the excuse that you will take an ambulance away from a truly sick patient. Thats bullshit, we know the percentages of 911 calls that are trule emergencies. If you only staffed ambulances to handle truly sick patients you would have to drop half your trucks and lay off 75 percent of your field personnel. Its understood that half your calls you wont be reimbursed for, thats the nature of the beast.

Educating the public as to what is an acceptable reason to initiate emergency medical services is what is needed if you believe your area has a problem. However that could persuade others that are truly sick not call because they don't believe they fit the criteria. Its a slippery slope. Be careful what you wish for because if only the truly sick called 911 half of us probably wouldn't have a job anymore.

Well lets cut the work force in half. Only the most educated need apply. Yes many of us out of a job. Me keeping my job is never an excuse for allowing abuse of the system. You say it is not your problem to worry about if they pay. Remember those days your overworked exhausted. If you denied transport to people that do not need an ambulance, number 1 you would have more time available to catch your breath. #2 if your service still stayed busy only transporting real emergencys which are easier to get funding from your service could afford more people and trucks again keeping you from exhaustion. Also taxes end up paying most of our checks so you are paying higher taxes when you transport BS that does not qualify for reimbursement.

Do you want an easy way to know if insurance, medicaid, medicare will pay? Probably not but here it is anyway. If the patient could reasonably have gone by any other means your service will not be paid unless you commit fraud in how you write the report, not having access to another means of transport is not an acceptable reason for ambulance transport. To simplify it further will they die or become permanently worse if not taken by ambulance? Easily 90% if all paper work is done truthfully would be disqualified.

Now I do agee though this will not happen wide scale because as you say there are way to many "meatheads" in our profession.

[whit72]

Spenac wrote:

Me keeping my job is never an excuse for allowing abuse of the system. You say it is not your problem to worry about if they pay.

Well thats a pretty noble statement. So you never transported anyone that didn't require transport? Does your system allow you to deny transport? Whats the criteria or is just your opinion? I am sure you are quite capable but is every one you work with?

Spenac wrote:

if your service still stayed busy only transporting real emergencys which are easier to get funding from your service could afford more people and trucks again keeping you from exhaustion.

We wouldn't, no system would without losing half your personnel. If your system does 100,000 calls annually, half of them require an ambulance, they don't staff on for only the ones that require it. They have to staff for everyone that calls. Thats the way it goes. Even if you don't transport you still have to go assess the patient and clear up, that takes time.

Spenac wrote:

To simplify it further will they die or become permanently worse if not taken by ambulance? Easily 90% if all paper work is done truthfully would be disqualified.

So how many of your patients fit that criteria last week. Not many of mine did. So your service could still function with all its staff at ten percent of its volume?

Thats why we run a tiered system, the ALS trucks are available for true emergencies while the BLS trucks handle everything else. It isn't a solution but its a start. We can gaurantee when your truly sick you receive the care you require.

[captainstandup]

I wonder of any of the services represented on this thread utilize full EMD with the "Omega" option?

[paraloco]

Let me clarify. A person who accidently kicks a chair and stub his little toe, then calls 911 has a complaint, however minor. A person who calls for transport to fill prescriptions, for help doing ADL's (can you help him to the bathroom, and then back to bed?), or because he was stupid enough to take a nap in full view of passersby (who call 911) does not have a complaint, and is not considered a patient. gotta take kids to school, to be continued.

[Dustdevil]

That is just SO wrong. :shock: The "mother may I's" are in charge. :?

When I was an urban firemonkey, we were "mother may I" for IV and O[sub:94873ba753]2[/sub:94873ba753], but we could no-ride anybody at our discretion. Go figure. "Wrong" doesn't even begin to describe that situation. It seems to be most common in urban firemonkey systems though. That's why everytime you hear about legal action from one of these, it's always Detroit or DC or Detroit FD. I've haven't seen a private EMS provider allowing it since the mid-eighties.

[ambulancechick]

NO! I don't think it should be. Because at some point it was important to the patient even if you think it was bull. Or should I say know it was bull.

[Dustdevil]

So what if a patient feels like they need treatment that you don't think they need? Can and/or will you deny them? I'm not talking about treatment that would be medically contraindicated or would harm them. Say they want Morphine and you don't think they need it.

The reason I ask is, if you have medical discretion -- that is, your system trusts you do decide who needs what care -- it just seems a little archaic that you would not also have transportation discretion.

While I don't like this nonsense of not having discretion on who to transport and who not to, I certainly understand why it is that way. And, until a truly educated professional is the norm in the field, it will never be safe to give that kind of responsibility out. Way too many idiots out there these days.

[drichards275]

Deny transport to an ER? No. Deny transport to a prompt med facility or a hospital other than our own Regional hospital? Absolutely. We have 3 Helicopters within a three county area, no more than 25 miles apart so transport to a trauma facility is usually done by them. But here is the question. What if, hypothetically speaking you and your partner (same gender) are sent to a patient (opposite gender) claiming abuse. Do you transport or call for another crew with that same gender. If you call for someone else isn't that denying transport, (by you). Me and my buddy were discussing this very thing today.