Nursing homes questioned about emergency calls

[abckidsmom]

Private/IFT ambulance companies release emergent calls to us all the time. If a nursing home calls them with something like difficulty breathing, they'll just call us (Fire/911 EMS) and give us the call. Anyone else heard of a policy such as this?

Oh, you reminded me. When I was a dispatcher, our company had the contract for all transports within the city limits. Plenty of times the nursing homes would call for non-emergency transports and we would upgrade them to an emergent response, even adding fire first response if our protocol called for it.

If a nursing home outside of the city called for non-emergent transport with symptoms that would upgrade the call, we turned it over to the county responsible.

 

[DrParasite]

Off-hours staff at nursing homes stink at making judgement calls. The trouble is in the staff deciding what is life-threatening and non-life-threatening.

I can't speak for others, but many SNF's here call the doctor with any issues, and he or she (the MD) determines if the transport company is called or 911. most staffers can't call 911 unless they get permission from someone higher up than them, for all calls except for a cardiac arrest.

Sometimes the transport company will request ALS based on the nature (before the transport unit gets on scene), but not always.

 

[Akulahawk]

That's what I like about Riverside's policy. It's not optional. If you call a non-911 provider for, say, low pulse ox or chest pain, it's not an option. That call has to be forwarded to the local 911 service. There's no (well, not supposed to be), "Well, just call another IFT" since all of the IFT service" since they all should be referring critical patients to the 911 service.




The problem is how often EMTs are dispatched when it shouldn't. I agree that if an EMT crew gets on scene and transport time is relatively equal or less than paramedic ETA (I'll argue that even if transport time is a few minutes longer than the ETA) that the EMT crew should transport. However, I find it hard to believe that the call-on scene time interval is normally shorter for IFT than it is for paramedics. An IFT EMT crew simply should never be dispatched to a chest pain or altered mental status, or difficulty breathing call if for no other reason than the 911 service should have a shorter response time.

If a patient needs paramedics, then they need them ASAP, not after an IFT unit clears, responds (non-emergently more often than not), assesses the patient (even if it's a 2 second doorway assessment), calls 911, and then wait for the paramedics to arrive. Everything before calling 911 is a waste of potentially valuable time.

Oh believe me, I've had many an occasion where I couldn't agree with you more... In one of the systems that I worked in, the SNF's were quite adept at specifically NOT wanting 911 while providing complaints that vaguely close to what the actual problem was but not so specific that it would throw up an immediate "Call 911, we won't do that" response out of our dispatchers. Consequently, the EMT's that I worked with ended up becoming VERY good at doing Emergency calls. They also got VERY good at reminding the Nurses that 911 should have been called instead without irritating them to the point that they'd cancel our usual transport contracts.

The upside is that our crews got VERY good at their jobs, to the point where they were the preferred crews if BLS had to run system calls, but the downside was that they shouldn't have gotten the experience because of the way the system had been gamed for so long...

 

[JPINFV]

If the nursing home is accepting extended ETA s and not providing any treatment then shame on them.

...and I've had nursing homes leave a patient in bed and wait an hour for a patient in acute pulmonary edema just because they knew that the fire department would only transport to the nearest facility. Unfortunately, this was in the county that doesn't allow private companies to run paramedics, so it was an hour wait for an EMT crew who, in the end, called paramedics and still transported to the nearest facility.

Then there's the nursing home who sees nothing wrong with a patient who has a pulse in the 30s with severely increased lethargy. Survey says, 3rd degree AV block. Same county, hence EMT transport.

 

[JPINFV]

Consequently, the EMT's that I worked with ended up becoming VERY good at doing Emergency calls.

This has nothing to do with the individual ability of EMTs. I used to be the great defender of the IFT faith because my Orange County rose tinted IFT glasses gave me plenty of SNF emergency calls of varying severity, and always without paramedics. There was plenty of people at my first company that I would have no concern putting up against 911 EMTs for medical patients. The problem, though, is not the individual IFT EMTs (however, to be fair, having worked in another state with EMTs who could count the number of emergency runs in a 3 month period on 1 hand, was a scary experience on those rare emergency calls), but the lack of scope of practice needed to treat. I don't care if someone is God's gift to EMTs, if the patient needs a paramedic level intervention (which is not always the case), then the EMT is not the appropriate responder.

 

[Akulahawk]

This has nothing to do with the individual ability of EMTs. I used to be the great defender of the IFT faith because my Orange County rose tinted IFT glasses gave me plenty of SNF emergency calls of varying severity, and always without paramedics. There was plenty of people at my first company that I would have no concern putting up against 911 EMTs for medical patients. The problem, though, is not the individual IFT EMTs (however, to be fair, having worked in another state with EMTs who could count the number of emergency runs in a 3 month period on 1 hand, was a scary experience on those rare emergency calls), but the lack of scope of practice needed to treat. I don't care if someone is God's gift to EMTs, if the patient needs a paramedic level intervention (which is not always the case), then the EMT is not the appropriate responder.

Please, don't think I'm at all disagreeing with you. Our system had been gamed for so long that the County EMSA couldn't conveniently ignore the problems, so they ended up re-writing the BLS utilization protocol so that about 95% of emergency calls out of SNF's that were improperly referred to BLS crews would (in the theoretical sense) be caught and referred to the 911 systems by the crews. Eventually the SNF's got the message and begrudgingly started calling 911 a lot more frequently. A couple years later they also allowed private ALS to operate in the County. They use the same protocols as the regular system units. I'd be completely surprised if the SNF's haven't caught on and started calling the private ALS companies instead of 911... knowing that the call won't be recorded as an emergency transfer out as a 911 call would, while the patient still gets run to the local ED...

Not a fan of that, but that's the way that particular system is set up to be gamed by the SNF's.

 

[JPINFV]

Don't get wrong, I don't think you're disagreeing with me. The problem with IFT EMTs is that the experience ranges from an emergency once every blue moon to one or more calls per shift, and the ability to handle due to experience becomes quite large, but one that can't be ignored.

 

[Bon-Tech]

I work PRN as a CNA, and as an EMT I do both 911 and IFT. The main issue, imo, with nursing homes is how understaffed they are. Secondary to that is a seemingly stagnant level of training with their personnel.

It's not uncommon to have 10 + residents to tend to, and it gets extremely chaotic. There might be LPN's available, but their skill set is usually not much higher and the RN's are either absent or too busy to come help.

The CNA course is extremely basic, I actually took at the same time as my EMT-B and can honestly say that it was far more of a challenge to get through that (which is not to say much). The sad thing is that being a CNA pays substantially more, but it does suck. My goal with getting it is hopefully landing a ER tech job, for which it is a requirement around here.

 

[johnrsemt]

Or the patient whose doctor wrote orders for patient to be transported to ED anytime her Pulse ox dropped below 97%: I live at 94% I would never get out of hospital. We would take her 2-3 times a day. And the nurses knew how stupid it was.

When I dispatched we had an ECF that would call us, for us to call 911. If they called they had a bunch of paperwork to do, per the state, but if we called 911 for them, NO paperwork.

 

[Jon]

Private/IFT ambulance companies release emergent calls to us all the time. If a nursing home calls them with something like difficulty breathing, they'll just call us (Fire/911 EMS) and give us the call. Anyone else heard of a policy such as this?

My private service will NOT give an ETA under 30 minutes... but if they accept our ETA, we will send a unit. Management says sometihng about "Medical staff onsite judging the patient is stable enough to wait for our ETA"

 

[Shishkabob]

1) Grr, I hate journalists.



2) When I worked for AMR in Dallas, we'd often get sent to "Priority 2's" (911-esque calls), however a lot of the time we'd be cancelled enroute due to dispatch contacting DFD instead.

I know of some agencies, and medics at those agencies, that get cardiac arrest fairly frequently doing these types of calls.



Honestly, though, you're almost better off getting a private ambulance Paramedic in Dallas than DFD...

 

[Akulahawk]

Don't get wrong, I don't think you're disagreeing with me. The problem with IFT EMTs is that the experience ranges from an emergency once every blue moon to one or more calls per shift, and the ability to handle due to experience becomes quite large, but one that can't be ignored.

Of this, we agree.