# When is it appropriate to call an ambulance?



## ambulancequestion (Sep 26, 2006)

Hello everyone, I'm not in the medical field so I'm sorry if this is the wrong place to post, but this seemed like the best place to ask.

We had an email circulate around the office recently, a hilarious list  of frivolous complants people thought they needed an ambulance for, written by EMTs. That got us talking and long story short, some of my coworkers will call for a broken wrist and others will drive themselves to the hospital with a gushing head wound.

I've always thought that if you're on death's door you should call an ambulance, but you should take a cab if you're able. But what about the gray areas? For instance, if you're alone and you break an ankle badly, then you might not be able to hobble out and find a cab, but it doesn't seem serious enough for an ambulance. What about a broken arm with bones piercing the skin? 

What are your thoughts on the minimum requirements for an ambulance? By the way, we did google this but came up guidelines that were too general. Thanks for your time, you'll be educating a whole office of clueless IT people.


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## EMTalex (Sep 26, 2006)

you should call whenever you feel you need us. 24/7. Thats what we are here for.


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## Raf (Sep 27, 2006)

This is an excellent question that I've always wondered about myself as well. Personally if I ever got hurt I think I would go to the hospital myself.

There are some things that I know can't wait, in which case I would call an ambulance if something happened to someone I know. Amputation and cardiac arrest being two.

If I ever needed stitches or broken a bone, I would patch myself up and drive to the hospital or have someone drive me. 

You just have to remember that going to an ER means waiting for HOURS for treatment. If you take an ambulance, you get instant service...at a very large price! So moral is, if it's an injury that can wait, don't take an ambulance.


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## ffemt8978 (Sep 27, 2006)

Each situation is going to be dependent upon the totality of the circumstances including: nature/severity of injury/illness, general health of patient, distance to nearest treatment center (which may be your doctor's office), time of day, transportation availability and a host of others.

Ask yourself the following questions (if you answer yes to anyone, then call EMS)

1) Is there any possiblity that I could die or be permenantly disabled from this injury/illness?
2) Do I need to see a doctor now?
3) Will me driving myself to the doctor/ER place myself or anyone else at risk of injury?

If there is any doubt about whether or not you should call an ambulance, you've already answered your own question...YES, call an ambulance.

BTW, you and your IT friends should stick around here.  Who knows, you may find this to be the intersting field that we do and decide to find out more.


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## islandgal (Sep 27, 2006)

I agree call anytime you feel it is a true emergency.  However, remember (and depending on the resources where you live), when you dispatch out the aid unit you are tying up that unit from responding to other calls.  For example, I've been on a calls for someone with a possible ankle fracture (and a ride was available-they managed to get to the resort lobby), and another call goes out for chest pain.  I don't like when 911 is used as a taxi service to the doctor.  But I never would hesitate and never feel bad showing up and having it turn out fine (yeah!!) because people are scared or overwhelmed.


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## rescuecpt (Sep 27, 2006)

My general rule is if you are too sick to walk to the roadway to either get in a car or a cab, then call the ambulance.  If you are having difficulty breathing or chest pain, call the ambulance.  If you can't control the bleeding, call the ambulance.  If bones are sticking out of your skin (not good!) call the ambulance.  If a baby has it's head sticking out of you, call the ambulance.


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## SwissEMT (Sep 27, 2006)

EMTalex said:


> you should call whenever you feel you need us. 24/7. Thats what we are here for.



I can tell you haven't worked in EMS yet.


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## EMTalex (Sep 27, 2006)

yeah thats true, but im just goin of my experience back in england. my uncle was a ff and my cousin a paramedic


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## Jon (Sep 28, 2006)

Ok. IMHO, there aren't any "minimum guidelines" for when to call an ambulance. Yes, there is abuse of the 9-1-1 system. Yes, I've heard "I've got Medicaid.. that means I get to ride in the ambulance for free instead of taking a cab."

Are there patients who go by ambulance who don't "really" need it? Yes, there are - plenty of them. On the flip-side, though, there are many examples of people driving themselves to the hospital when they should call 9-1-1.

For example... when you are having a heart attack, if the "hosptial comes to you" by way of a _good _EMS program, you will get faster care, and faster care upon arrivial at the hospital. Paramedics often have protocols that often let them do much of their patient care without consulting a doctor first. They can give you asprin, oxygen, nitroglycerin, use a EKG machine to do a cardiogram of your heart and determine, to an extent, whether or not you are having a heart attack. Often, they can give you morphine to reduce the chest pain and reduce the stress on the weakening heart. If you drive yourself to the ER, you might get there before you would on the ambulance... but you won't have an IV started, a first cadiogram done, asprin, and your first dose or two of nitro and perhaps morphine. You will have to register, be seen by the triage nurse, then get taken back to a bed. When you come in by ambulance, if you are _*REALLY *_sick, you get to go right back into the treatment area... in fact, in some systems, if the pre-hospital cardiogram reveals that you are having an active MI (Miocardial infarction - Heart attack) ambulance crews are bringing patients straight to the cardiac cath lab. If you drove yourself in, it will take time to get the initial evaluation done... Part of this is load on ER staff vs. EMS staff... In the field, I usually only have 1 patient I am responsible for. I can't get my patients mixed up and cause a medication error. A paramedic in the field can give patients medication on "standing orders" and do it immediatly after they determine the need for the medication. In a hospital, a nurse is often responsible for 3-5 or more patients, and only physcians can order medications.


What I am trying to say is:

If you have a valid medical complaint, ANYTHING... a fracture, nausea, whatever... and you feel that you need to get to an ER, than feel FREE to call 911. As long as you don't say "I called 9-1-1 and you HAVE to take me to the hosptial for my clinic appointment," you shouldn't have any problems with the EMS crew... they should be caring and do their best to make you comfortable. Also, when you call 911, make sure that you answer the call-takers questions fully and honestly. Don't say you are having chestpain unless you are actually having chest pain... all systems prioritize calls to some extent. In some cases, you will only get a "basic life support" ambulance, staffed by EMT's... not an "advanced life support" ambulance staffed by Paramedics... Paramedics start as EMTs and have more training on managing serious medical emergencies... for the most part, if all you need is advanced first aid (fractures, etc), than an EMT is all you need.

To get back to the point about when to call 9-1-1 - When I am treating a patient and they say they don't want to go to the hospital by ambulance, they will get there on their own - I ask this question:
-Is there someone who can drive you? (If you are saying you feel weak, or perhaps you are bleeding profusely... what happens if you pass out while driving yourself to the ER? You could further injure or kill yourself or others)

In some cases, driving yourself, or being driven to a hospital is a reasonable alternative to ambualnce transport. I work as a Security Officer/EMT at an office complex that backs up against a hospital. My boss has told me that I should "discourage" the employees from going to the hospital "on their own." In our case, in reality, it DOES take longer for an ambualnce to arrive than for me to drive myself to the hosptial. Further, we are so close to the hospital that an ambualnce crew often doesn't have time to provide lots of care going to the hospital.

Ok... I've run the gamut back and forth... basically, it is your call... if you are close to a hospital, feel that you can safely get there, and you are only minorly/moderatly sick or injured, than you can probably do OK without going by ambulance... on the same token, if you call 9-1-1, EMS will come and take you to the hospital (as long as you have an actual medical complaint). - For example... if you need stiches, or something else that is urgent, but not emergent, you could probably drive yourself to the ER.

Oh.. and a caveat - this IS NOT medical advice, just what I've wittenseed as both a patient and provider.


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## Firechic (Sep 28, 2006)

Raf said:
			
		

> You just have to remember that going to an ER means waiting for HOURS for treatment. If you take an ambulance, you get instant service...at a very large price! So moral is, if it's an injury that can wait, don't take an ambulance.


Sorry Raf, I have to call you on this one. Just because you get to the hospital by MICU does not mean that you will automatically be seen ASAP by the hospital staff. The patient you are bringing is still triaged according to their complaint. There have been times where we wheeled the patient right into the waiting room because there were more critical patients waiting. So, MICU does not = no waiting in the ER.


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## rescuecpt (Sep 29, 2006)

I agree Firechic, I have taken many patients out to triage or even to chairs - the triage nurse signs for them and then they sit their butt down with the rest of the people who stubbed their toes.


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## wolfwyndd (Sep 29, 2006)

Raf said:


> You just have to remember that going to an ER means waiting for HOURS for treatment. If you take an ambulance, you get instant service...at a very large price! So moral is, if it's an injury that can wait, don't take an ambulance.


Well, that really depends on where you live.  I've taken patients to a couple of our local hospitals and if when we give a radio report the ER staff doesn't think it's serious, they'll have us drop the patient off in the waiting room and they'll wait just like everyone else.


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## Guardian (Sep 29, 2006)

EMTalex said:


> you should call whenever you feel you need us. 24/7. Thats what we are here for.



You all might be surprised to hear that I agree with this totally.  If you get a splinter in your hand and think it's an emergency, then you should call 911.  Who am I to say that's not an emergency.  If it's an emergency to the pt, then it's an emergency.  I only get upset when people knowingly call 911 for b.s. looking for a free ride to the hospital.


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## Celtictigeress (Sep 29, 2006)

MY Pet peeve

we in SC had a regular who called because they had a headache EVERYTIME Now this pt was a hypocondriac...

many of the points stated are on the Money....A Broken ankle is an emergency but not a sprain...

a Broken arm is an emergency but to me not a dislocation

Bleeding, vomiting...varies....

but if you calling because you have a cold, and dont want to wait in the ER so you call 911 imagine if at that moment a crew rolls to help you with the sniffles and theres a MVA and someone dies because w didnt get to them due to your sinus acting up and your nose is runny

Its on thing to have something with your body going on that you have never experianced before and it concerns you, or severe stomach cramps and you cant drive

but I will never forget, on call a woman called us saying she was having trouble breathing....w thought emergency and hauled *** there...upon arrival BP was 110/90, Pulse 80 Resp 22 Pulse Ox 99 no abnormalities found in assssment....She had the "sniffles" needed to see a doctor because she couldnt breathe through her nose considering she was being absolutely serious and wasting MY time I returned the favor... O2 Non rebreather (Why us a cannula she couldnt breathe through her nose right?)we made the PT quite uncomfortable within legal standards


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## ambulancequestion (Sep 30, 2006)

Wow, thanks to all of you for the great responses! I hadn't expected so many of you to reply or to be so thorough. Your views vary a bit, but this clarifies the issue a great deal. I think I've gotten a few people at work to at least think the situation through before calling 911. I can understand calling out of sheer panic, but it does make me angry to hear about people wasting a common resource, not to mention treating you guys (who are heros in my eyes) as a personal limo service. 

It's also comforting to know that I don't have to feel like a complete *** if have to call for broken bone. You're a lot more tolerant than I expected considering all the sniffle/clinic appointment/splinter calls you must get.

Speaking of splinters, Guardian, what you said about getting a splinter in the hand reminded me of my dad sailing 4 hours through a storm with a large splinter sticking out of his eye. When he finally got to his GP, the guy glanced at my dad and said, "Ok, drop your pants, let's see what the problem is." It was funny later.

Thanks again!


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## Tincanfireman (Sep 30, 2006)

Since you've already seen the reasons why ambulances are often tied up on the BS when others are in need, I'm wondering if this might be the time to suggest an employer-funded CPR class for your company's employees?    You might also want to consider getting a few people trained as first responders to know what to do until the cavalry arrives...


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## MMiz (Sep 30, 2006)

I work as a teacher with a public school, and have been with several different schools in the past.  Both as a remember of a school's formal response team, and also as a instructor, I've witnessed many medical conditions/emergencies, and calling 911/EMS is a tough issue when you're a school.

Our current policy states that 911 is to be called for any life-threatening emergency.  The problem is that "life threatening" isn't easy to define, and few teachers want to be the ones calling 911.  Even worse, the school doesnt want to call for an ambulance when they know parents will ultimately foot the bill.

It is my belief that 911 should be called in the following instances:

Difficulty breathing
Loss of consciousness, even if it is regained
Profuse bleeding
Otherwise I'm comfortable with the school declaring an emergency and deploying the school resource officer, EMT, and nurse to the scene.  

As an EMT/Teacher I have seen instances where EMS absolutely should have been called but wasn't.  I've also seen instances where a school errored on the side of safety, and in retrospect have *always* felt this to be the best option.

As a bystander it is your job to call 911, and they can then determine whether the call requires a police officer, BLS unit, or advanced life support.


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## Colorado Medic (Sep 30, 2006)

You all have some great points. I agree if someone wants to call 911 and come with us great 
I also have dropped off many people off in triage many times, but I have also treat and released many people that really didn't need togo. 
So if we give people guild lines when to call 911 and when not to.

Are they going to Die from the mass MI cause they drove them selves
Or the Stroke that thought it wasn't anything wrong. Time is muscle!!!!!!
I think if we are going to give guild lines it needs to be education and prevention.

I know we all have had that drunk at 3am. That the only C/C is that they are to drunk for detox. 
Is that just EMS>>>>>
suck but oh well


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## Jon (Oct 1, 2006)

MMiz said:


> I work as a teacher with a public school, and have been with several different schools in the past.  Both as a remember of a school's formal response team, and also as a instructor, I've witnessed many medical conditions/emergencies, and calling 911/EMS is a tough issue when you're a school.
> 
> Our current policy states that 911 is to be called for any life-threatening emergency.  The problem is that "life threatening" isn't easy to define, and few teachers want to be the ones calling 911.  Even worse, the school doesnt want to call for an ambulance when they know parents will ultimately foot the bill.
> 
> ...


We have a similar policy at work (slightly older population ). 9-911 is called if any of the following exist:
Chest Pain
Respiratory Distress
Loss of consciousness
uncontrolable bleeding
severe trauma
"When the caller specfically requests it"


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## ambulancequestion (Oct 1, 2006)

Tincanfireman said:


> Since you've already seen the reasons why ambulances are often tied up on the BS when others are in need, I'm wondering if this might be the time to suggest an employer-funded CPR class for your company's employees?    You might also want to consider getting a few people trained as first responders to know what to do until the cavalry arrives...



We actually have all of this. I work for a large paranoid corporation. In my opinion, the classes don't help much because we seem to have poor retention of the material. It's good to be reminded about chest compressions, mouth to mouth, etc. but I wouldn't say we're prepared. It's a little like giving an EMT a class on programing, then expecting him write code under pressure several months or years later.


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## rescuecpt (Oct 1, 2006)

My best advice for that is to sign up for the class at least every year, if it is available.  The more you practice, the more it get stored in the back of the brain, and recall will be automatic when it is needed.

When I was a lifeguard I took CPR every six months... I used to have several valid CPR cards at the same time because of this, but you know what, when I needed it, there it was, ready to go.

Good luck with all of this, it is great that your company has a program at all, most of my clients do not, but it could definitely make a difference.


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## Celtictigeress (Oct 1, 2006)

ambulance

you would be amazed at how quick people can retain the information.. If you guys are taught Guidelines it saves those of us running calls VALUABLE time and can save a life.. There are many that do in fact use us as a personal Limo. I wont forget this one call the second I ever had in my entire life...

We had an MVA we were called on which was common practice and fine Now upon arrival it was 2 vehicles in one passenger car it was a couple early 20s in the car that rear ended them A woman early thirties...Richland County FD as well as Sheriffs were on standby we arrive...

I unload the stretcher and begin to Wheel it over when the Para Im with finds out the Woman doesnt wanna be transported... we have her sign and we get ready to head to another call a bit more severe when we are flagged down Apparantly she found out she was getting a ticket and thought us taking her would get her out of it....

We head back, I get the stretcher out shs complaining of Severe pains and numbness down Left leg (there wasnt even a scratch on the car) THIS is a case of wasting an EMTs time we could have been at the serious of the two accidents...we had to send another unit I was Ticked....so gee "Trauma" cspine,collar board...and to better do it when I check breathing during assessment.....theres weezing..when she opened her mouth toe breathe as I asked.. Nada...amazing what threatening Intubation will do to a faker..

Cases like this where you say no then use us as an excuse to get out of tickets (I did tell richland where we were taking her to be courteous to them she did get her ticket)

Cases where you have a headache or are drunk call a taxi

Teaching a CPR course to an office and first aid will do wonders small things YOU can assess that will save us time or help you determine when its okay to call or not.....


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