# Three things that I dislike to do as a Paramedic



## bushinspector (Dec 17, 2014)

Most EMT'S look up to Paramedics without looking at the downfalls. Every job has it negatives aspects to it. Would like to see if they are a common thread between Paramedics.


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## Angel (Dec 18, 2014)

The paper work
Still having to back board patients who don't need it (ie all of them)
Not having a general pain protocol (so I can give more narcs)
Am I doing this right?


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## gotbeerz001 (Dec 18, 2014)

The way some EMTs voice their opinion as to the acuity of a pt when they have nothing on the line if they are wrong (e.g. "This is BS")

Pressure from supervisors to provide thorough care and documentation yet still clear hospitals within 20 minutes of arrival. 

I'm pretty good with everything else.


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## Angel (Dec 18, 2014)

20?! We get 5 minutes and have to have a draft pcr (the basics: demographics any interventions and objective info) done in 30


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## gotbeerz001 (Dec 18, 2014)

We have to print a complete PCR prior to leaving.


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## Clare (Dec 18, 2014)

Shift work
Hours 
Pay


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## chaz90 (Dec 18, 2014)

I know this thread isn't about the positive side, but I'm pretty content at the moment! I can see the shift work/hours becoming a problem eventually as I get older or start a family though. 

I guess I could add the common EMS gripes. 

1. Low education standards

2. Dinosaur providers stuck in the past and unwilling to change with the times

3. Reliance on history or tradition over new information


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## Outbac1 (Dec 18, 2014)

I greatly dislike being wrong. I hate making mistakes. ( I am human, it happens.  I don't have to like it, I have to accept it.)
Paperwork
Working with incompetent people. I don't mind new and inexperienced, we were all new once.  But people who can't get their act together drive me nuts.


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## STXmedic (Dec 18, 2014)

Outbac1 said:


> I greatly dislike being wrong. I hate making mistakes. ( I am human, it happens.  I don't have to like it, I have to accept it.)
> Paperwork
> Working with incompetent people. I don't mind new and inexperienced, we were all new once.  But people who can't get their act together drive me nuts.


This. Exactly this.


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## teedubbyaw (Dec 18, 2014)

I dislike it when STXmedic doesn't like my posts.


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## STXmedic (Dec 18, 2014)

teedubbyaw said:


> I dislike it when STXmedic doesn't like my posts.


I can't tell if you're being sarcastic or not....


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## Burritomedic1127 (Dec 18, 2014)

I dislike trying to find the cleanest most appropriate bathroom when posted in between calls

Everyone has that one go to clean bathroom don't lie


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## Angel (Dec 18, 2014)

Haha I usually hold it. Try a 48 hour shift and not going poo...uncomfortable!!


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## chaz90 (Dec 18, 2014)

Angel said:


> Haha I usually hold it. Try a 48 hour shift and not going poo...uncomfortable!!




You run a 48 hour shift without a station????? Unimaginable!


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## Angel (Dec 19, 2014)

No we had a station but I am so uncomfortable going number dos around coworkers (boys). I know it's dumb but...


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## NomadicMedic (Dec 19, 2014)

Night shifts. 

Petty bickering by coworkers. 

Management by fear or threat of discipline.


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## DrParasite (Dec 19, 2014)

being trained to treat the sick and dying, knowing all about drugs and medical interventions, and dealing with mostly stable patients who simply need a comfortable ride to the ER (or could take a taxi to their PMD)

being stuck in a truck for 12 hours, posted on a street corner, in the sketchiest parts of the city,  in all walks of weather.

being forced to deal with dinosaurs.


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## bushinspector (Dec 19, 2014)

I am surprised that no Paramedics listed, getting involved in a BLS call and not having a Paramedic available if needed. In our service (at this time,) Paramedics transports everything that comes in. Granted our call volume is 1.5 calls per 24 hours on average. But it can take our only Paramedic unavailable for at least three hours.


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## cruiseforever (Dec 19, 2014)

Co-workers that come in late.

Left a dirty ambulance.

Fire standbys


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## Angel (Dec 19, 2014)

Our EMTS tech bls calls, including transfers...
Some things I dislike are not helping the new guy...we were all there once, and even just some words of wisdom can go a long way. With that patience as well. 

The low education  standards, I think in general you will get a bit more professional and mature staff. It kind of forces you to be in this field because you like it, not just a place holder for something else (eventually hopefully pay rate and respect amongst our peers will come)

Laziness and a bad attitude. Yes we all want to go home on time but to come to work and expect to run no calls is just setting yourself up for a bad day. Be a team player and help with the rig checks, I usually restock the rig because I know what I used, but everything else is fair game. I also will not pick up anyone's trash, so check out your mess before you clock out. 

Paperwork, but I said that already.


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## Jason (Dec 19, 2014)

Paperwork.
Incompetent coworkers. 
Ungrateful people we respond to for "help".


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## emschick1985 (Dec 20, 2014)

Haha I


Angel said:


> No we had a station but I am so uncomfortable going number dos around coworkers (boys). I know it's dumb but...


Haha I announce when I'm gonna poo to go ahead and just get it out in the open


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## DesertMedic66 (Dec 20, 2014)

Paperwork

Allowing anyone with a C/C to go to the hospital by ambulance even if it's total BS. You have had that cough for a month now and have not done anything for it. Use one of your 4 running cars and drive your d*** self to the ED or urgent care. 

Allowing every patient to pick the hospital they want to go to. I do not want to transport you to a hospital 30 miles away because it's closer to your wife who just got out of jail and bypass 6 hospitals in the process for a BS complaint. If you have an actual reason for not wanting to go to a certain hospital then cool, no issue.


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## Angel (Dec 20, 2014)

haha, my preceptor would pull the internal disaster card for people who wanted to go WAAAY out of our area (for things like a prescription refill)


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## DesertMedic66 (Dec 20, 2014)

Angel said:


> haha, my preceptor would pull the internal disaster card for people who wanted to go WAAAY out of our area (for things like a prescription refill)


I contacted the hospital he wanted to go to and informed them that there were 6 hospitals closer. The MICN and Doc had me put the phone on speaker mode and they told the patient he was going to the closest facility or not going at all.


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## gotbeerz001 (Dec 20, 2014)

DesertEMT66 said:


> Paperwork
> 
> Allowing anyone with a C/C to go to the hospital by ambulance even if it's total BS. You have had that cough for a month now and have not done anything for it. Use one of your 4 running cars and drive your d*** self to the ED or urgent care.
> 
> Allowing every patient to pick the hospital they want to go to. I do not want to transport you to a hospital 30 miles away because it's closer to your wife who just got out of jail and bypass 6 hospitals in the process for a BS complaint. If you have an actual reason for not wanting to go to a certain hospital then cool, no issue.


In my area, the bottom 65% of the seniority list has jobs basically due to "BS calls".... BS does not bother me.

If things were truly efficient, we might just find ourselves out of a job.


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## DesertMedic66 (Dec 20, 2014)

gotshirtz001 said:


> In my area, the bottom 65% of the seniority list has jobs basically due to "BS calls".... BS does not bother me.
> 
> If things were truly efficient, we might just find ourselves out of a job.


I'm fine with some BS calls but there are other BS calls that get on my nerves. It may not be as bad now for me since I don't have to deal with bed delays anymore. 

Having a patient on your gurney with a total BS complaint for 4 hours holding the wall of the ED is enough to make anyone crazy.


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## Tigger (Dec 20, 2014)

Holding the wall for four hours is downright crazy, regardless of the patient.


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## Angel (Dec 21, 2014)

No...BS calls do not save jobs because insurance companies will not pay for them. Not that they pay a whole lot in the first place but no money is made from someone going to the ER when there is no medical necessity.

@DesertEMT66 kudos to that doc.


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## emschick1985 (Dec 21, 2014)

Well just snatched another one from the jaws of death. 
Wait for it...... Diarrhea at 2 am he's had since yesterday. Vitals were good. I doubt insurance will pay this


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## emschick1985 (Dec 21, 2014)

We make our money on the IFT mostly they are a pain but pay the bills


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## gotbeerz001 (Dec 21, 2014)

Angel said:


> No...BS calls do not save jobs because insurance companies will not pay for them. Not that they pay a whole lot in the first place but no money is made from someone going to the ER when there is no medical necessity.
> 
> @DesertEMT66 kudos to that doc.


I am speaking more to call volume... If we didn't run so many non-acute calls, we could probably cover the county with 15 cars instead of 45.

We do not run IFT; 911 only.


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## Angel (Dec 21, 2014)

Well there's that lol
That's an insane amount of ambulances


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## wanderingmedic (Dec 21, 2014)

1) Having to transport everyone who wants to go, even when a taxi or wheelchair van would be more appropriate.
2) As others have said, the paperwork. 
3) The low standards and expectations for providers that are perpetuated by poor educational requirements.


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## okiemedic (Dec 24, 2014)

Burritomedic1127 said:


> I dislike trying to find the cleanest most appropriate bathroom when posted in between calls
> 
> Everyone has that one go to clean bathroom don't lie



I had designated places near post locations when I worked in Dallas fort worth.... it kind of helped that my house was across the street from our station. But, we were never allowed to post at the station...

Quick trip, and racetrac were the only gas stations I would use the bathrooms. lol....


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## H33 (Jan 3, 2015)

Angel said:


> The paper work
> Still having to back board patients who don't need it (ie all of them)
> Not having a general pain protocol (so I can give more narcs)
> Am I doing this right?



Concur


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## FltMedicRob (Jan 6, 2015)

Maybe my glasses are bit rose colored. I actually like helping the new kids learn to be better. I don't really mind BS calls, but we are only 15-20 minutes out from the hospitals. 

The only thing that really gets me is the out of town transfer that hits 45 minutes before the end of a 24hr shift.


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## Apple Bill (Jan 6, 2015)

Burritomedic1127 said:


> Everyone has that one go to clean bathroom don't lie



It's called the Eagle's Nest.


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## Burritomedic1127 (Jan 6, 2015)

Apple Bill said:


> It's called the Eagle's Nest.


That's a good one. Using that one next time I have a "business meeting" ha


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## 46Young (Jan 6, 2015)

I dislike having only the emergency room as a transport destination. I would like to have the authority to refer to urgent care or their PMD, whether or not I transport them there or leave them onscene. The ER is like bringing a cannon to a knife fight for most of these patients.

Like others have said, I'd like the authority to choose the closest appropriate facility for transport. The patient would need a really good reason why they can't go there, such as a family member dying there, or something like that. That would curtail the drug seeker calls - they wear out their welcome at one facility, then request txp across town where the staff doesn't know them.


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## JPINFV (Jan 7, 2015)

Just curious, how many people here would be willing to refuse transport to a patient where they would be personally named in the malpractice suit if an adverse event occurred? (and please don't get into a technical "according to the law, it doesn't matter" because emotions often override the law when it comes to malpractice).


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## PotatoMedic (Jan 7, 2015)

9 times out of 10 I go to the closest hospital.  Usually only go to the patients choice if they have a specialist there.  Ie cancer treatment or cardiac care.


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## bushinspector (Jan 7, 2015)

We are NOT going to refuse transport..The system is broke but one alone is not going to fix it. We can be on our way and transfer the patient over to the hospital much quicker and less liability than to stay and discuss why we will not take them.


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## STXmedic (Jan 7, 2015)

I refuse transport probably once a shift. A few of the perks of where I'm at: No-load (refuse transport), taxi vouchers, and the ability to go to the closest hospital instead of bypassing 15 of them. I do wish we could have alternate facilities. We can get PD to take patients to in-patient psych facilities, but we still can only go to the ED.


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## Vegeta182 (Feb 24, 2015)

20 year olds on Medicare that use us as a taxi. Had one call got there. Cheif complaint was that she needed a ride to the bank. 

Running calls at the state prison where I pay them to pay me to take them to the er


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## medicaltransient (Feb 24, 2015)

lack of cohesion within the service
paperwork 
being awake a solid 24 hrs


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## Ensihoitaja (Feb 24, 2015)

Changing house oxygen tanks.


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## PotatoMedic (Feb 24, 2015)

Vegeta182 said:


> 20 year olds on Medicare that use us as a taxi. Had one call got there. Cheif complaint was that she needed a ride to the bank.
> 
> Running calls at the state prison where I pay them to pay me to take them to the er


Did you take then to the bank?  Or the er?


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## TheLocalMedic (Feb 25, 2015)

System abusers that know all the right things to say to guarantee they get transported.
Anyone who has more than one bag with them (or, God help me, a bike that can't be left behind)
Fire "medics" who think they actually know what's going on.  How about you just carry my bags and let me take care of the patient, okay?


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## MackTheKnife (Feb 25, 2015)

JPINFV said:


> Just curious, how many people here would be willing to refuse transport to a patient where they would be personally named in the malpractice suit if an adverse event occurred? (and please don't get into a technical "according to the law, it doesn't matter" because emotions often override the law when it comes to malpractice).


My service gave PMs the authority to pronounce death and refuse transport.  The usual refusals were on the "I'm bad off sick and I needs you to take me to the hospital" complaints. No, I don't was my reply. Then came the "I gots Medicaid. You gotta to take me". Again, I told them no. I filled out a run sheet and they got billed for a BLS call. Medicaid supposedly won't pay these.


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## EpiEMS (Feb 25, 2015)

MackTheKnife said:


> The usual refusals were on the "I'm bad off sick and I needs you to take me to the hospital" complaints. No, I don't was my reply. Then came the "I gots Medicaid. You gotta to take me". Again, I told them no. I filled out a run sheet and they got billed for a BLS call. Medicaid supposedly won't pay these.



Do you mean that the patient was subsequently transported by a BLS unit? If so, how is this distinct from triaging a patient to a BLS unit?


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## MackTheKnife (Feb 25, 2015)

We turned them over to a private service if they wanted or told them to call a cab.


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## RocketMedic (Feb 26, 2015)

STXmedic said:


> I refuse transport probably once a shift. A few of the perks of where I'm at: No-load (refuse transport), taxi vouchers, and the ability to go to the closest hospital instead of bypassing 15 of them. I do wish we could have alternate facilities. We can get PD to take patients to in-patient psych facilities, but we still can only go to the ED.


How does SAFD no-load work? Do you call a private ambulance and be on your way or ?


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## STXmedic (Feb 26, 2015)

RocketMedic said:


> How does SAFD no-load work? Do you call a private ambulance and be on your way or ?


A quick call to med control (not med direction, there's a difference for us) for approval, then they get told they're not an appropriate candidate for the ED and they need to follow up with their PCP. No calling for a private or anything. A second option is a taxi voucher; we'll call a taxi for them, give them a taxi pass, then leave.


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## TRSpeed (Feb 26, 2015)

That's badass lol


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## Angel (Mar 4, 2015)

Why can't more places be like that


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## Handsome Robb (Mar 4, 2015)

We can't refuse but we triage to multiple Urgent Care style practices. Unfortunately it's not something we can "force" on someone, if they're dead set on the ER that's where they go.


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## TheLocalMedic (Mar 4, 2015)

I just wish we could take psych patients directly to PES rather than to the ED.  


STXmedic said:


> A quick call to med control (not med direction, there's a difference for us) for approval, then they get told they're not an appropriate candidate for the ED and they need to follow up with their PCP. No calling for a private or anything. A second option is a taxi voucher; we'll call a taxi for them, give them a taxi pass, then leave.


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## Ewok Jerky (Mar 4, 2015)

TheLocalMedic said:


> I just wish we could take psych patients directly to PES rather than to the ED.


Because there might not be a medical problem leading to their behavior problem?


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## Anjel (Mar 4, 2015)

Having to write reports and get creative to get them paid. Even if it is a BS call, when need to find some reason they need an ambulance.

Lack of uniformed practice  when it comes to training, protocols, and medications available. 

Out of town transports. I do 1-2 a shift.


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## DesertMedic66 (Mar 4, 2015)

Anjel said:


> Having to write reports and get creative to get them paid. Even if it is a BS call, when need to find some reason they need an ambulance.


That is something that I have not had to do. We have only ever been told to be truthful with our reports. If the patient could have been transported by wheelchair then we say that.


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## Anjel (Mar 4, 2015)

DesertEMT66 said:


> That is something that I have not had to do. We have only ever been told to be truthful with our reports. If the patient could have been transported by wheelchair then we say that.



I don't lie, but things get worded a certain way. 

For the I've been sick with a cough for 9 days. 

"Pt required transport and monitoring due to possibility of respiratory compromise". 

If I don't put that; report gets kicked back, and I have to do it again.


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## DesertMedic66 (Mar 4, 2015)

Anjel said:


> I don't lie, but things get worded a certain way.
> 
> For the I've been sick with a cough for 9 days.
> 
> ...


No thanks haha. I'll just stick to "patient has had cough for 9 days and is requesting transport to the ED"


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## PotatoMedic (Mar 5, 2015)

Anjel said:


> I don't lie, but things get worded a certain way.
> 
> For the I've been sick with a cough for 9 days.
> 
> ...


Ever thought about reporting your employer for insurance fraud?


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## TheLocalMedic (Mar 5, 2015)

Ewok Jerky said:


> Because there might not be a medical problem leading to their behavior problem?



Because there often isn't a "medical" problem that the ER can solve.  If they're combative or there is any reason to doubt that there is only a psych crisis going on, sure, take them to the ED.  But how about all the people who call us because they know they're having a psych problem, are cooperative and medically check out?  Do you know how many times I've had schizophrenic people call for a ride to PES only to be told we can only take them to the ED?  Or people in the throes of a manic or depressive episode who have nothing to gain from sitting in the ED for hours on end before a transfer is approved?


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## systemet (Mar 5, 2015)

TheLocalMedic said:


> Because there often isn't a "medical" problem that the ER can solve.



We've just started directing this to community mental health, instead of transporting. An RPN from the team responds to the call with a Community Paramedic. The transport rate is very low.


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## JPINFV (Mar 6, 2015)

STXmedic said:


> A quick call to med control (not med direction, there's a difference for us) for approval, then they get told they're not an appropriate candidate for the ED and they need to follow up with their PCP. No calling for a private or anything. A second option is a taxi voucher; we'll call a taxi for them, give them a taxi pass, then leave.


Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?


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## STXmedic (Mar 6, 2015)

JPINFV said:


> Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?


That's a good question. I see our head research guy today, so I'll ask him.


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## STXmedic (Mar 6, 2015)

JPINFV said:


> Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?


Answer: Not at the moment, but not from a lack of trying. The hospitals are apparently not cooperating in the acquisition of admission data. It is one of the projects he's working on, though.


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## NYBLS (Mar 26, 2015)

systemet said:


> We've just started directing this to community mental health, instead of transporting. An RPN from the team responds to the call with a Community Paramedic. The transport rate is very low.



What if a medical problem is causing their psychiatric behaviors?


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## TheLocalMedic (Mar 26, 2015)

NYBLS said:


> What if a medical problem is causing their psychiatric behaviors?



Again, that's one of those things where if there is any doubt, transport them to the ED.  But many many many times we encounter problems that are entirely and obviously only psychiatric in nature that would be better treated by PES rather than sitting in the ED for hours before being transferred.  

And I (prophylactically) beg you not to take the "well you never know" attitude about these things.  We are trained and expected to be able to differentiate between a possible medical problem and a clear cut psych problem, and your assessment should tell you which you are dealing with.


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## systemet (Mar 28, 2015)

NYBLS said:


> What if a medical problem is causing their psychiatric behaviors?



Well, my assumption is that any new-onset event would probably get transported to the ER for more thorough evaluation. There are plenty of people with mental health diagnoses living in the community who access health care via ambulatory clinics, family medicine clinics or outpatient psychiatry or psychology services.  There are also plenty of teams that predate EMS operating in the community that assess these patients on a daily basis.

While the group of patients that contact 911 are probably more high risk as a cohort than those using other services, it doesn't mean that all members of this cohort are high risk.


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## Tigger (Mar 30, 2015)

TheLocalMedic said:


> Again, that's one of those things where if there is any doubt, transport them to the ED.  But many many many times we encounter problems that are entirely and obviously only psychiatric in nature that would be better treated by PES rather than sitting in the ED for hours before being transferred.
> 
> And I (prophylactically) beg you not to take the "well you never know" attitude about these things.  We are trained and expected to be able to differentiate between a possible medical problem and a clear cut psych problem, and your assessment should tell you which you are dealing with.


We have a single paramedic transporting most of psych patients to a crisis stabilization unit. So far we have had very few issues with patients being directed to the wrong place.


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## RedAirplane (Apr 1, 2015)

DesertEMT66 said:


> Paperwork
> 
> Allowing anyone with a C/C to go to the hospital by ambulance even if it's total BS. You have had that cough for a month now and have not done anything for it. Use one of your 4 running cars and drive your d*** self to the ED or urgent care.
> 
> Allowing every patient to pick the hospital they want to go to. I do not want to transport you to a hospital 30 miles away because it's closer to your wife who just got out of jail and bypass 6 hospitals in the process for a BS complaint. If you have an actual reason for not wanting to go to a certain hospital then cool, no issue.



Sorry, I'm a BLS provider hanging out in the wrong forum. But recently at a special event we had ambulances for a few patients and the medics always suggested the furthest hospital they were allowed to transport to without special approval. Seems different than your opinion, but I noticed it in multiple medics at different times. Any thoughts why that might be?


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## Handsome Robb (Apr 1, 2015)

We can triage medically stable psychiatric patients to our private and state run mental health facilities. If they have insurance they go to the private one, if not they go to the state one. The attending provider at the facility we are triaging to has the ultimate say on if they will accept the patient after our report or if they want them taken to the ER for medical clearance. It's the same way our triage system works for Urgent Cares and the detox center. 



Ishan said:


> Sorry, I'm a BLS provider hanging out in the wrong forum. But recently at a special event we had ambulances for a few patients and the medics always suggested the furthest hospital they were allowed to transport to without special approval. Seems different than your opinion, but I noticed it in multiple medics at different times. Any thoughts why that might be?



Trying to lengthen to run. Longer run means more time to do your paperwork and less time available for more runs. Keeps you from getting backed up on paper and from being run into the ground. We have people that do that. I don't think it's appropriate but not everyone agrees with me. Personally if I need time to cut paper to try and catch up I call and ask and rarely am told no. Usually it's "sure just keep your radio on med X and we'll only pull you if we need your or you're right on top of a P1 call."



Anjel said:


> I don't lie, but things get worded a certain way.
> 
> For the I've been sick with a cough for 9 days.
> 
> ...



How's being an accessory to insurance fraud treating you? If there's no medical necessity and you create one that's exactly what you're doing. I do exactly what @DesertEMT66  does. "PT complains of a (productive/non-productive) cough x9 days. They deny any other associated symptoms. They request transport to xx ER for further evaluation and treatment." If they ambulate the the gurney it's "PT ambulates to the gurney with minimal (or minor) assistance to the gurney (or bench seat in many of these cases), is seated in their POC and transported without change in assessment or complaint."


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