Do you transport or not?

[lee357]

I work for a private service and the policy is if you call we hall. The company keeps track of dry runs and the only thing they look at in the dry runs is if we transported (non dry run) or not (dry run). The company will fire us if our dry run rate gets higher than 25%. Included in the dry runs are things like cancellations by fire, refusals, utl's, no medical need, or any of the varied reasons a pt. may not be transported. So I would have to say that in the system that I work in the person would most likely be transported no matter what the reason they called for.

[flight-lp]

I work for a private service and the policy is if you call we hall. The company keeps track of dry runs and the only thing they look at in the dry runs is if we transported (non dry run) or not (dry run). The company will fire us if our dry run rate gets higher than 25%. Included in the dry runs are things like cancellations by fire, refusals, utl's, no medical need, or any of the varied reasons a pt. may not be transported. So I would have to say that in the system that I work in the person would most likely be transported no matter what the reason they called for.

So the fate of your job is in the hands of patients essentially? To think an employer would fire someone because of refusals, no patients, and patient by law enforcement type calls is absurd. Not where I would want to be, especially since probabaly half of my pts. do not need nor get transported to an ER....................

[spenac]

So the fate of your job is in the hands of patients essentially? To think an employer would fire someone because of refusals, no patients, and patient by law enforcement type calls is absurd. Not where I would want to be, especially since probabaly half of my pts. do not need nor get transported to an ER....................

Flight see you on unemployment line. I would be fired from lee's service as looking at the log book the past 3 years almost half of our calls did not get transported. Before someone jumps on that saying we deny that many, no we do not deny that many. Most are people that either immediatly don't want transported or we reason with so they decide not to go with us. We only deny a small percentage of patients. Lee does your service have a definite amount that they will be paid by the hospital or other per patient transported regardless if patient, or patients insurance never pays? Makes no sense to transport everyone.

[mffrhorne]

My views on this.

1. I am not billing. I am employed to evaluate, treat, and transport as needed. The closest I care about billing is getting the person's RN to sign the physician's certificate of necessity paper for medicare.

2. My area has at 7 well established ambulance companies, at least one up and coming company, and several other companies just outside the area that can easily find their way down here. We aren't hurting for ambulances either for interfacility or for 911 transport. Transport times are short to the hospital in most cases. In the end, it would be much easier to just transport and get it done with.

THAT SAID, I've been on one call where we transported because fire refused to let the contracted 911 BLS crew transport a patient WITH a complaint (fall secondary to dizzyness if I remember correctly) to a hospital about 10 minutes farther away than the closest hospital (that was about 5 minutes away). They were told to call a private company. That gem occured at an assisted living place [no RNs] for Alzheimer's patients.

You seem to be criticizing the fire and rescue guys for enforcing there MANAGEMENT'S policy of transporting to the closest appropriate facility. Did it escape your attention that the policy also serves as job security for you as an employee of a private provider. The body politic makes a decision through it's elected representatives to provide only emergency service, Management formulates a policy to carry out that decision, the firefighters carry out that policy by declining to provide elective transportation in violation of that policy. Sounds like a well run organization to me!

--

MFF/R Tom Horne

[Dustdevil]

You seem to be criticizing the fire and rescue guys for enforcing there MANAGEMENT'S policy of transporting to the closest appropriate facility.

You seem to be jumping to a conclusion about exactly who JP is criticising.

And you also seem to be misspelling the word "their."

What is an "MFF/R"?

[mffrhorne]

As I indicated in my previous reply to an individuals post ten minutes additional transport time on a priority three patient is our magic number as well. To be clear that means we may transport to a more distant facility if it will not lengthen the transport time by more then ten minutes. What complicates that is that we respond mutual aid to an adjacent city that shall remain nameless because it is the capitol of an allegedly friendly nation. That cities policy is that their EMS units will transport to any hospital in the city that the patient wants to go to. They will not transport out of the city for anything short of a working code. If you are shot on "boundary" Avenue only five minutes from a trauma center you will be transported the twenty minutes to a trauma center in the city. The totally dependent portion of that cities population; every city has some folks that are totally dependent on government services; are used to the cities policies and have learned to manipulate them to their advantage.

In the middle of a major snow storm with six inches on the pavement and more coming down my unit is dispatched mutual aid to a transit station just across the cities boundary. We arrive to find an agitated adult female who is demanding to be taken clean across the city to a hospital that is literally situated on the city boundary on the other side of that burg. The trains are suffering major delays due to icing on the surface portion of the rial lines. The ambulance is chained up on it's rear tires because the installed on spot chains do not work in snow that deep. I explain that we can only take her to the closest hospital. She says I want to go to X hospital and you have to take me.

Since the transport station in question is an elevated above ground station I point out our unit in the parking lot below and ask the patient if she can read the name on the unit. She does. I say "That's not a city ambulance is it?" She says then call for a city ambulance I have to go to X hospital. I explain that if a city ambulance had been available we would not have been sent. A transit police officer steps forward and tells her that she can decline service or go with us to a hospital about one mile away for treatment. He also tells her that if she declines service and calls again she will be arrested for false emergency alarm. She sits down on the concrete bench and begins crying.

If you haven't figured it out yet this woman wants a ride home. She is poorer than a church mouse. Her coat is unsuitable for the deteriorating weather. She is stuck on an elevated transit platform in a brisk wind during a snow storm. She is only one bus into a three bus and two train trip home from her mandatory welfare to work job training and the overhead speakers are warning of prolonged delays due to icing on the rails. Her child care center will charge her one dollar per minute that she is late picking up her child. We are the only resource she can think off that mite get her out of her situation. Or as Dennis Smith put it in the book "Report from Engine Company 82" "When you pull the white hook in the little red box the firefighters always show up." The only service in this woman's life that always works is the Fire Department. So when nothing else is working that's who she calls. We have the transit officer witness her refusal and return to service. Yes it is system abuse but the question is whether the system is the victim or the perp/doer.

Tom Horne, Speaking only for himself.

[JPINFV]

You seem to be criticizing the fire and rescue guys for enforcing there MANAGEMENT'S policy of transporting to the closest appropriate facility. Did it escape your attention that the policy also serves as job security for you as an employee of a private provider. The body politic makes a decision through it's elected representatives to provide only emergency service, Management formulates a policy to carry out that decision, the firefighters carry out that policy by declining to provide elective transportation in violation of that policy. Sounds like a well run organization to me!

--

MFF/R Tom Horne

First off, the county medical director has stated several times that patients should be transported to their home hospital if it isn't too far out of the way (it was not in this case) and they were stable enough for the extra transport time (which, since they essentially refused to transport, this is a pretty good bet). The patient would have been transported by a private service anyways (most cities only provide ALS through the fire department and contact with a private company to provide the actual transport.).

Second, I could care less about so called job security for an interfacility transport company. If job security means screwing over patients, then sorry, I don't have the stomach for it. If job security means "don't do anything that makes SNFs mad, including calling medics and/or rerouting" like stories I've heard from other places, then sorry, I'm out. My values aren't for sale at 10/hr. If that means I lose business because the medics want to transfer my patient to the contracted company's gurney, then so be it [actual event] because I see no sense in getting into a fight on scene and delaying the patient's transport. Besides, I don't remember the last time I saw "County Medical Director" on a ballot.

[mffrhorne]

You seem to be jumping to a conclusion about exactly who JP is criticising.

I thought that using the language "You seem to be" was sufficient to indicate that I thought his post could be read as criticism of the fire department in question.

And you also seem to be misspelling the word "their."

He who lives by the spell check will be embarrassed by the spell check. In my dictionary the word is spelled "criticizing".

What is an "MFF/R"?

MFF/R = Master Fire Fighter / Rescuer. Some FDs call that position "Lead Fire Fighter" others "Fire Apparatus Engineer", still others call it "Chauffeur," and there is squad boss, crew chief and so on.

--

Tom Horne

[spenac]

As I indicated in my previous reply to an individuals post ten minutes additional transport time on a priority three patient is our magic number as well. To be clear that means we may transport to a more distant facility if it will not lengthen the transport time by more then ten minutes. What complicates that is that we respond mutual aid to an adjacent city that shall remain nameless because it is the capitol of an allegedly friendly nation. That cities policy is that their EMS units will transport to any hospital in the city that the patient wants to go to. They will not transport out of the city for anything short of a working code. If you are shot on "boundary" Avenue only five minutes from a trauma center you will be transported the twenty minutes to a trauma center in the city. The totally dependent portion of that cities population; every city has some folks that are totally dependent on government services; are used to the cities policies and have learned to manipulate them to their advantage.

In the middle of a major snow storm with six inches on the pavement and more coming down my unit is dispatched mutual aid to a transit station just across the cities boundary. We arrive to find an agitated adult female who is demanding to be taken clean across the city to a hospital that is literally situated on the city boundary on the other side of that burg. The trains are suffering major delays due to icing on the surface portion of the rial lines. The ambulance is chained up on it's rear tires because the installed on spot chains do not work in snow that deep. I explain that we can only take her to the closest hospital. She says I want to go to X hospital and you have to take me.

Since the transport station in question is an elevated above ground station I point out our unit in the parking lot below and ask the patient if she can read the name on the unit. She does. I say "That's not a city ambulance is it?" She says then call for a city ambulance I have to go to X hospital. I explain that if a city ambulance had been available we would not have been sent. A transit police officer steps forward and tells her that she can decline service or go with us to a hospital about one mile away for treatment. He also tells her that if she declines service and calls again she will be arrested for false emergency alarm. She sits down on the concrete bench and begins crying.

If you haven't figured it out yet this woman wants a ride home. She is poorer than a church mouse. Her coat is unsuitable for the deteriorating weather. She is stuck on an elevated transit platform in a brisk wind during a snow storm. She is only one bus into a three bus and two train trip home from her mandatory welfare to work job training and the overhead speakers are warning of prolonged delays due to icing on the rails. Her child care center will charge her one dollar per minute that she is late picking up her child. We are the only resource she can think off that mite get her out of her situation. Or as Dennis Smith put it in the book "Report from Engine Company 82" "When you pull the white hook in the little red box the firefighters always show up." The only service in this woman's life that always works is the Fire Department. So when nothing else is working that's who she calls. We have the transit officer witness her refusal and return to service. Yes it is system abuse but the question is whether the system is the victim or the perp/doer.

Tom Horne, Speaking only for himself.

Easy answer the system is the victim as are the real patients that die while your out with a person wanting a taxi ride.

The economic plight is a matter for politicians. I feel for the poor. I deal with the poor daily. But I am still here to help those with ambulance emergencys not people wanting taxi rides. The politicians should have emergency plans in place to help those stranded in disasters.

[mffrhorne]

First off, the county medical director has stated several times that patients should be transported to their home hospital if it isn't too far out of the way (it was not in this case) and they were stable enough for the extra transport time (which, since they essentially refused to transport, this is a pretty good bet). The patient would have been transported by a private service anyways (most cities only provide ALS through the fire department and contact with a private company to provide the actual transport.).

Second, I could care less about so called job security for an interfacility transport company. If job security means screwing over patients, then sorry, I don't have the stomach for it. If job security means "don't do anything that makes SNFs mad, including calling medics and/or rerouting" like stories I've heard from other places, then sorry, I'm out. My values aren't for sale at 10/hr. If that means I lose business because the medics want to transfer my patient to the contracted company's gurney, then so be it [actual event] because I see no sense in getting into a fight on scene and delaying the patient's transport. Besides, I don't remember the last time I saw "County Medical Director" on a ballot.

Does your medical director appoint his/herself or is he/she in fact a part of management. Why do we all assume that our situation is the same as everyone else's. You are adding facts not revealed in your first post. It's easy to sandbag anyone who's views you don't like but much like burning number one fuel oil you will generate far more heat then you do light.