I think the Pt's are getting it in the...........

[letmesleep]

Here's the situation: We have a Level 3 Trauma center (lowest level in the state) that is our Med Control. The reason for this, to the best of my knowledge, is only because they are the largest in the county (of 2 hospitals), and the "good 'ol boy system" of years ago put this into play. Anyways, the situation is that they hate for us to use helicopters, stating that the cost can be a hardship for the PT and their family. On the other hand, I have recently taken in 2 Pt's who really didn't need an ER (let alone an ambulance to transport them) from a single vehicle MVC. upon arrival to the ER (med control) they had called a "trauma alert" without my request (obviously), and based only on MOI.

I spoke to my Med Director who happen to be working that day, and asked.......WHY? I was told that the reason is because the Trauma Surgeon wants the ALERTS called to help maintain their rating.

My questions are simple:

1) What are your thoughts about the Hospital making decisions based off of MOI in a radio report?

2) How do you feel (as a pt advocate) with the charges that the ER is costing these Pt's in order to maintain a certificate before they even see them?

3) Does it make any sense that we are allowing this ER to charge approx $5,000 for this ALERT instead of flying a pt to a Level 1 TC for approx $6,500?

[dahlio]

Your first point that you bring up, about the hospital calling a trauma alert on MOI, is rediculas. You have to talk to med control, and give them a report. The hospital should be determining whether or not they want to proceed with calling the trauma alert. As for number 2/3, I don't think it matters. All trauma centers should be equipped to handle just that, trauma. If they take the trip, however, you might as well, as trauma 1 centers handle these things a lot more. Just my opinion.

[mrmeaner]

My questions are simple:

1) What are your thoughts about the Hospital making decisions based off of MOI in a radio report?

2) How do you feel (as a pt advocate) with the charges that the ER is costing these Pt's in order to maintain a certificate before they even see them?

3) Does it make any sense that we are allowing this ER to charge approx $5,000 for this ALERT instead of flying a pt to a Level 1 TC for approx $6,500?

1) It looks like either the MOD isn't backing up the decisions/reports given by EMS or they are jumping at any chance to call a trauma code. Probably the latter.

2) If the pt. is being charged for the staff being called in, that is wrong. They should only be charged for services received.

3) Is the Level 1 TC a different medical group? If not, no if the patient is that serious, they should be flown from scene or hospital helipad.

I've heard arguments before about how flight transport is dangerous, is a waste of resources, makes our ER look bad, etc., yet, our area is adopting a protocol that sounds similar which has me concerned now. The flight teams encourage at least calling for a flying standby based on MOI. The difference is, if the flight doesn't touch down, no charge. Apparently this isn't the case with your hospital. I think your patients will come to the same opinion about how they're being billed and word usually travels fast.

[whit72]

1. They have to make decisions based on your radio patch. If you call in a code they should have a medical team standing by. If you call in significant trauma they should have a trauma team standing by. I would fly anything lifethreatning if they don't have the ability to treat it there. Cost does not factor into me calling a helicopter, injury does.

2. Thats political bullshit, you should probably stand clear of that. I don't care if the presidents standing by, what they do after the patient is off my stretcher is their business. Sounds a little hinky though. The Feds will catch up to them if in fact they are fraudulantly charging people for services not rendered. It might take a while.

3. The ER should not be your concern, if the receiving hospital does not have the ability to treat the patients injuries. They get flown, end of story. If they want to somehow discipline me for that, they have that prerogative. I also have the prerogative of singing like a 500lb canary to all the sketchy behavior it seems like this hospital is up too.

Just my opinion.

[StickEm]

I have no problem fling a Pt. based on MOI and injury, and I have no problem with a trauma center preparing a facility based on MOI either.

We took a guy to Grady who wrecked a 4-wheeler, and though he said he felt fine, and was indeed stable for the whole trip in, etc., he ended up a veg due to a basal fracture they found at the trauma center. What if he had gone to some podunk pretend hospital wo a trauma room?

I guess it's moot in this case, but what if his worsening condition was actually preventable?

Let them charge the PT. to be prepared for them.

[Dustdevil]

Minus 5 for a teaser subject line.

My questions are simple:

1) What are your thoughts about the Hospital making decisions based off of MOI in a radio report?

It is unfortunately necessary in much of American EMS simply because medics are inadequately educated to accurately assess their patients' conditions, resulting in misclassifications that delay definitive care. Yes, in a perfect world, MOI would be nothing more than a statistic. But with medics in this country sucking as badly as they currently do, it is understandable that some hospitals take such measures to ensure readiness for those patients that are under-triaged by EMS.

2) How do you feel (as a pt advocate) with the charges that the ER is costing these Pt's in order to maintain a certificate before they even see them?

3) Does it make any sense that we are allowing this ER to charge approx $5,000 for this ALERT instead of flying a pt to a Level 1 TC for approx $6,500?

These sound like pretty much the same question to me. I have no experience with this "alert" charge to patients. Never heard of it. Sounds semi-shady to me, but then it might be a pretty "reasonable and customary" (the standard by which insurance companies judge) thing in practice. I'd say that if insurance companies are paying it without a lot of squawking, then it is probably a widely accepted practice. And when you think about it, it is really no more unreasonable for insurance to pay for this than it is for them to pay for a helo flight that was based only on MOI. Consequently, I would be tentatively in favour of the practice, pending further evidence and discussion.

As for the "alert" vs. HEMS thing, I definitely see a benefit to it. The benefit of a Level I over a lower level is in the immediate availability of surgical specialties. If they can have those people standing by at the level III in the same or lesser time than it takes to fly to a Level I, then I'd say that benefit is, for the most part, negated. And when you consider the negatives involved in aeromedical transport, I'd say they are probably onto an innovative solution with this concept.

[medic001918]

1) What are your thoughts about the Hospital making decisions based off of MOI in a radio report?

Happens all the time. Just like you have an obligation to cover your bases, so does the hospital. If it sounded to them like it was a trauma activation, then let them activate it. It also depends on local protocol. We have a trauma guideline in our regional protocols. Just like EMS can request an activation from the hospital, the hospital can activate one on their own if they feel the mechanism warrants it. I know I've had some less than impressive calls get activated, and some really impressive one's not end up activated. It depends on the hospital, and who's on. It's not my place to get involved with hospital policy. My job is treatment and transport to a higher level of care. What they do from that point is on them. Obviously, if the patient really should end up in a trauma room and doesn't...I have to speak up and request that things happen. Also, being that they are only a Level III trauma center, they may activate more questionable MOI's to evaluate the need for a higher level of care. Not all prehospital providers are great at determining appropriate facilities. In fact, most aren't. The hospital is covering their liability.

2) How do you feel (as a pt advocate) with the charges that the ER is costing these Pt's in order to maintain a certificate before they even see them?

There shouldn't be a trauma activation charge as you describe. The patient should be charged for actual treatment's only. In many trauma's that I've done, the same treatment's end up being done that would be done anyway; they just happen faster. A needless charge is patient's that get flown when they shouldn't. But that's a separate issue.

3) Does it make any sense that we are allowing this ER to charge approx $5,000 for this ALERT instead of flying a pt to a Level 1 TC for approx $6,500?

Flying a patient is based on presentation, mechanism of injury and proximity to an appropriate receiving facility. Nothing else. It's NOT based on what the local hospital is going to charge the patient for a service. If they need a level I trauma center, they get one. It doesn't matter if it's by air or ground. Cost to the patient doesn't come into play in my decisions. Appropriate treatment does. If the patient gets charged too much for something or charged for something they didn't need then it's up to them to get it straightened out.

Shane

NREMT-P

[Just Plain Ruff]

Letmesleep - if the hospital wants to activate a trauma alert then let em. It costs you nothing to let them do that.

as for being a patient advocate, unfortunately you really do not have any standing to complain about hospital policy and the charges for the patient. Sure you can say something but when you start to complain about a procedure that directly affects the hospital's bottom line then you start to step on toes.

It's one thing to be the patients advocate on patient care but when it comes to costs charged by the hospital you quickly become someone that is considered a nuisance.

Look at it from your companies perspective.

You have a patient with chest pain. You start the MONA protocol, start one or two iv's, take one or two EKG's and transport lights and sirens to the hospital. It turns out that the patient just was having an anxiety attack. Do you complain about the costs of doing all that stuff to the patient when in reality it wasn't warranted by the end condition of the patient. I can attest to the cost of this when my father in law had this happen to him. the costs of the ambulance transport with all the bells and whistles was 2500.00(that's what he told me the cost was) The trauma center is really doing exactly what you did for the chest pain patient.

Take for another example - you have a minor mva. Pt complains of nothing other than their pride being injured but due to protocols you have to c-spine, backboard and all that. You might start an iv just to be safe. You might put em on oxygen. Get a quick pulse ox and the like. You find out later at the hospital that the patient was completely fine.

Each facility and ambulance service have protocols to follow and I'd be happy that the trauma facility is proactive and looking out for the patients, even the ones you don't think required a trauma activation. That one time that a trauma activation is not called might be the one where you are the trauma patient. Would you rather the hospital be completely consistent and activate for everyone or just activate willy nilly which some facilities I've taken patients to have been. I for one would like consistency if it's me on the cot. I'm sure you would like the same.

It's good that you are playing the role of patient advocate but this battle is better left unfought. Save your energy for something that you can really make a difference in.

[whit72]

Who the hell flies a patient based on mechanism alone? The introduction of seatbelt and airbags allows for the occupant to at times escape even the most serious of crashes. If you cant assess a patient as to injuries they have suffered and base a helicopter ride on MOI alone then thats a problem.

People are not severly injured without any signs at all. You may miss interpert them. Thats your fault. The signs do exist and its your job to be able to detect and differentiate them.

If your flying based solely on mechanism then you either lack the ability or confidence to be able to detect a life threatning emergency.

[Just Plain Ruff]

Whit, many of the services I worked for had protocols that require patients to go to a trauma center based on MOI. If they met the criteria for MOI then they went to a trauma center period. If the trauma center was greater than 30 minutes away then you used a helicopter. our closest trauma center was one hour by ground or 32 minutes by air.

If you did not send them to the trauma center then bend over and kiss your ankles. As you were gonna get reamed by the medical director and the boss too. I'm not saying it's right but that is how it is in some services.

Death of same car occupant

Passenger compartment intrusion of greater than 20 inches

and so forth and so on etc etc.

so do you follow your protocols or do you go against the protocols and risk getting fired for not following protocols?