Inter-facility transports

[xgldcrossemt]

OKAY now put an ambulance at every house it's a preventative measure not much a husband, wife, child or other untrained person can do. :twisted: No it's a scam. It makes EMS nothing more than taxi drivers and low paid ones at that . If there is not an immediate emergency ambulances should not be used.

Did you put any thought into your reply? I'm not suggesting that ambulances be placed everywhere as a preventitive measure. You are comparing apples to oranges. This topic was focusing on patients coming from a hospital to a skilled nursing facility. Patients going from one healthcare setting to another may still be considered medically fragile, and ambulance transport seems feasible should an emergency arise. You sound bitter, and it kind of makes me wonder what sort of care the patients in your municipality recieve.

[spenac]

Did you put any thought into your reply? I'm not suggesting that ambulances be placed everywhere as a preventative measure. You are comparing apples to oranges. This topic was focusing on patients coming from a hospital to a skilled nursing facility. Patients going from one healthcare setting to another may still be considered medically fragile, and ambulance transport seems feasible should an emergency arise. You sound bitter, and it kind of makes me wonder what sort of care the patients in your municipality receive.

Welcome to the site.

Plenty of thought about this subject. My patients get the best care. Don't worry your little head about that.

Most patients released are just in need of a ride home, which may be the nursing home. There is no need for an ambulance. You said preventative measure in case they get sick, I used an extreme to illustrate how bad an idea it is to waste an ambulance on a taxi ride. There would be times, rare ones but times, when a person might justify an ambulance to return a patient home, but again very rare.

If you want to be a taxi driver be the best one you can be. For me I choose to be a healthcare Professional that will work to do away with wasted resources.

[brentoli]

So...

Wow....

Spenac has a point...

That really isn't apples vs. oranges. You said the ambulance driving miss daisy home is prevenitave care. So is the ambulance sitting outside my house.

Eh ok 3 911 calls later I lost track of my point.

But yea. Make a note. The dispatcher things Spenac is right.

[spenac]

So...

Wow....

Spenac has a point...

That really isn't apples vs. oranges. You said the ambulance driving miss daisy home is prevenitave care. So is the ambulance sitting outside my house.

Eh ok 3 911 calls later I lost track of my point.

But yea. Make a note. The dispatcher things Spenac is right.

Noted

[xgldcrossemt]

This whole discussion makes me realize why the "cabulance" was invented.

[ERDoc]

So, what was the BP?

Were there any other symptoms?

[VentMedic]

No it's a scam. It makes EMS nothing more than taxi drivers and low paid ones at that . If there is not an immediate emergency ambulances should not be used.

Most patients released are just in need of a ride home, which may be the nursing home. There is no need for an ambulance. You said preventative measure in case they get sick, I used an extreme to illustrate how bad an idea it is to waste an ambulance on a taxi ride. There would be times, rare ones but times, when a person might justify an ambulance to return a patient home, but again very rare.

If you want to be a taxi driver be the best one you can be. For me I choose to be a healthcare Professional that will work to do away with wasted resources.

(Sorry spenac, your posts are the easiest to quote)

NH pts are sometimes caught in a revolving door of healthcare. The physicians are being forced to move pts out of the acute areas faster, sometimes too fast. Broken hip pts are barely off the OR table when they are moved to a convalescent. NHs are expected to take care of higher acuity pts without additional help. So, if one RN is responsible for 30 pts they are still responsible for 30 pts but 10 of those might now have the same acuity as what 2 - 3 RNs might be covering in a hospital. We set the patients up for failure in a failing healthcare system.

No one has a crystal ball to accurately predict how soon the patient will be back or die from complications. But, those that are involved in the discharge of these patients do quietly place their bets on how soon they'll see the patient or read their obituary in the newspaper. And yes, sometimes we bet they won't survive the ambulance ride back to the NH. EMS people rarely are aware of the frustrations Doctors, nurses and other healthcare providers have with the system. Nor, do they see the end results of that pt's early discharge when another ambulance will bring the patient back a few hours later.

I could go on to tell you how many dialysis patients that have come in by either transport van or ambulance with EMTs or Paramedics that have coded (some dead before they are unloaded but not noticed because "they're just routine nobodys") when they enter the door.

I have intubated many of these "routine transports" that were presumed BS taxi rides a few minutes after their hospital arrival with the EMTs somewhere in the background doing their paperwork. Many of these EMTs have the skills but their attitudes now prevent them from doing a good job even at the basic level. Once they hear "routine" any assessment skills that have been taught to them are now replaced by "taxi run" mentality. Thus, important information is missed and appropriate questions are not asked.

Burnt out, or L/S jockeys or wannabe nothings have no business touching any patient. The elderly and handicapped have very little or no choice in how they are moved. Bekins Moving and Storage could probably do just as well as what we have in our healthcare system currently in some areas.

And believe me, after meeting the 2 jackarses of EMTs that transported my mother to Hospice with the iPOD earpieces stuck in their ears, if there was any way on this earth that I could have safely transported her in my car or by cab without causing her more pain, I would have!

I have offered to teach the next EMT recert class for that company. My plan is to have it in the day room of a nursing home and let the NH residents do the grading.

I'm sure it really makes the elderly and handicapped patients feel good to know they are inconveniencing such important EMTs because they are old and must depend on others for transportation because their body refuses to move like it used to. They should be ashamed of themselves for being such a burden.

Sick, handicapped and elderly patients deserve alot better than what the U.S. healthcare system has to offer them. Then we must further burden them with the identity crisis that EMS professionals are having and I'm amazed the elderly, handicapped, sick or injured manage to survive as long as they do.

Generalizations and hasty summations are part of the healthcare system's failure. People in State and Federal agencies who are thinking, just like a few people posting here, that it is okay to cut corners and quality. Those that placed the "length of stay" guidelines also assumed everyone was the same in their response to illness and injury.

And, there are ways to report fraud for any service involved. But you better be sure of your accusations and not just making an out of your arse statement because you hate routine calls. The training an EMT gets really does not prepare them to make that judgement or even understand what is on the physician's report. "They don't look sick" is only one part of the assessment.

Hospitals and physicians also have a legal responsibility to see that their patients get to whatever destination safely. If it is my loved one they are making that call for, I would rather them error on the higher side of care for transport.

So, when you can accurately predict which pt is going to go bad, when, where and how or doesn't deserve someone in that truck that can as the very least take a set of vitals, you'll have your alternative system.

[spenac]

Vent,

I see where you are coming from. But the routine patient that is a healthy release not needing medical care should be transported by family. There is no way of saying for sure I can complete this reply w/o coding. There is no way to say anybody is going to live. I am tired of comments such as "preventative measure" that others have used.

Now to your other point about the EMT's / paramedics that just don't pay attention. These idiots need to leave EMS/taxi driving/etc and should loose their certs. If you choose to work for a Taxi/ambulance you need to do so in a professional manner. You need to pay attention to the person even if nothings wrong with them because that is what you are payed to do. If you feel it is a waste of your time doing transfers home then quit. Even in 911 only services most transports are still taxi rides, but I assure you my patient gets great care.

So my position is still if not an emergency you do not need an ambulance, but if you do the job do it well.

[tinshee]

depends on the transport service you are with. i work for a service that transports from lower levels of care to higher levels. i have to intubate patients, administer drugs, start IV's, and stabilize patients.

[Just Plain Ruff]

the thing I want to ask is this in regards to nursing home calls or other bullshit calls and here is where my RANT starts

"How do you know it's not an emergency?" The physician knows certain things about their patient that you do not. The physician knows if a certain patient is a brittle diabetic who's sugar crashes at the least opportunity and wants the patient at the hospital to manage this.

Who are we, as medics and emt's to judge what the physician says about the patient. To do this don't we put ourselves on the same level of a physician?

I know that my grandmother has certain things that cause her to get pneumonia. Allergens, chemicals like soaps and such and then just not keeping covered. When she starts to have a fever and that's all it is right now but you just know that within a day or so she's gonna have pneumonia, so bad once it required intubation. Who are we to 2nd guess the physician who knows my grandmother better than you who have never seen her.

The arrogance of people in our profession who say that nursing home calls are bullshit and that the minor complaint doesn't warrant an ambulance. There are factors behind the scenes that you nor I know about.

This is what I consider to be one of the most pressing problems in our profession. The providers with 120 hours of class or the providers at the medic level who second guess physicians and say that all nursing home calls are bullshit. Sorry but I'll say it again and again, if you don't like running nursing home calls, if you don't like running bullshit calls for the drunk who fell or other calls like that need to SHUT UP and do your freaking job.

It's what you are paid to do, transport of the sick and injured and if someone calls for an ambulance and they request to go to the hospital, just put up with it and transport. If you don't like it then EMS is not for you. The problem will never go away, it will only get worse and to listen to this constant complaining makes me glad I don't work in ems as much as I did in the past.

I know that this may touch on some nerves here from some but so be it. To hear it all the time and the non-stop complaining of those at the companies I worked for and to here it here just makes me feel sorry for our profession.

I have no easy answers, I have no crystal ball nor am I as vested now as I have been in the past to fix the issues. At one time I would but my career now is away from EMS and frankly, I'm happier for it.

RANT off

so in conclusion, you can see where my opinion is at, agree or disagree with it but remember it's just my opinion and if you don't like it tough.

I've had a long day and this thread as well as the Hate thread has just about made me sick of this whole deal.

We aren't in high school anymore we are considered professionals here and to be professional we have to walk the walk and talk the talk and I can't imagine that posting what you hate and other negative comments make us professionals.

Be safe, god speed and adios.