# Cleveland EMS will reject some calls on minor ailments



## Tincanfireman (Jan 11, 2010)

CLEVELAND, Ohio -- The days of Cleveland paramedics hauling people to the hospital for minor ailments such as hemorrhoids and headaches are over. 

At 7 a.m. today, Cleveland Emergency Medical Services will no longer serve as a hospital taxi for problems such as toothaches, boils and similar illnesses. 
Callers with the most serious ailments, such as chest pains and trouble breathing, will still be treated before paramedics are dispatched on low-priority runs. Those lesser calls will not be dispatched until 10 ambulances become available and all life-threatening calls are finished. 

Read More...


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## firecoins (Jan 11, 2010)

Damn it! My hemorroids are acting up.


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## EMSLaw (Jan 11, 2010)

This article is a bit confusing, and I find it hard (maybe from lack of sleep) to figure out what their policy actually is.  Do they only have paramedic ambulances?  And so will they not be sending an ambulance /at all/?

I know that "back in the day", places like NYC allowed EMTs/Medics to tell people their ailments weren't serious enough to need hospital care.  That was stopped, and I would guess that EMS's general lack of ability to diagnose.  I'm even less sure about the ability of dispatchers who have the same or less training, and haven't seen the patient, to make that decision.


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## Aidey (Jan 11, 2010)

Wasn't there a thread on a system that is using RNs to triage calls? 911 receives the call, and if it sounds like it may be a non-emergent issue they forward it to the RN who would get further information and advise the patient on what to do. Does anyone remember where this was?


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## Veneficus (Jan 11, 2010)

*7 unfilled positions? You don't say...*

This was passed out at several of the local paramedic programs a couple years back. Not much has changed.


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## LondonMedic (Jan 11, 2010)

It's a great idea - until someone is left at home to die (invariably from something entirely unconnected).

Telephone diagnosis and management is fraught at the best of times. In my experience, they will end up overdiagnosing (like many of the AMPDS systems do) and sending as many trucks as they do now or underdiagnosing and leaving sick people at home.


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## Veneficus (Jan 11, 2010)

I wouldn't read too much into this article or expect too much change. There has a been a public outcry over 911 system abuse in the city since a series of inestigative reporting stories on the local news after a poor response time to a critical patient.

The system problems are considerably more profound than simple caller abuse. 

This past year the city has suffered from a major budget shortfall and the race is on to look like significant changes are in the works. (for a variety or reasons) 

Many of these resources, like Nurse on call have been in place for years. They are algorythms that end with "go to the ED." 

Piss and wind my friends.That's all this is.


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## Cory (Jan 11, 2010)

I always hated Cleveland, it's in my blood


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## Mountain Res-Q (Jan 11, 2010)

Veneficus said:


> I wouldn't read too much into this article or expect too much change. There has a been a public outcry over 911 system abuse in the city since a series of inestigative reporting stories on the local news after a poor response time to a critical patient.
> 
> The system problems are considerably more profound than simple caller abuse.
> 
> ...



Agreeded.  Actually, I would add one factor that I have personally observed at least in my neck of the woods that makes me doubt that any system would start rejecting "BS" 911 Medical Calls... and it all comes down to the almighty DOLLAR.  In my observations, Government Run Systems want the larger call volumes to justify the budget they recieve and then try and get a larger budget for new year; "Look at the 10,000 calls we ran this year compaired to the 8,000 we ran 5 years ago... we need more money to support this system that saves the lives of taxpayers"  On the other hand, Private Companies want the high call volumes even if they are BS calls because then they get to bill more people and insurance companies.  I have personally witnessed both money driven positions.  You can expect this attitude from the private companies, but it is really shocking in the government run agencies, especially those that are Fire-Based.  Locally the Fire Boys keep seeing a "need" to raise their budget based on the increased call volume; despite the fact that their increase in calls is not due to fires, hazmat, PSAs, or rescues... it is due to the slowly increasing number of non-emergent medical calls where Fire responds code 3 because someone says "My don't feel well, I need and ambulance", gets on scene, takes a set of incorrect vitals while trying to avoid obstructing the patients view of "All My Children", and then stand around the Engine waiting for the Ambulance to arrive in 30 seconds and provide a code 2 BLS trip to an overworked ER for a Rx refil or an ingrown toenail.  The people working the calls might think that these unemergent calls are a waste of time, energy, and money... but you better believe that the higher-ups love to see an increase in the yearly call volume and their budget/profits.  IMHO.


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## Veneficus (Jan 11, 2010)

It is not personal or hatred, simply a long time observation. 

The powers that influence the EMS system do not seem to be capable or have the desire to effect real and needed changes. 

Simply focusing on "911 abuse" to make it look like something is being changed or that the problems of the system will somehow be solved by it (or save a bunch of money) is simply an attempt to distract from the larger issues both in EMS and at the city government level.

Go strickly by the numbers: "we hope to reduce the 80,000 calls by ~3% this year?

There is ~80% transport rate. Reducing 3% of calls will save what percent of transports?

The article goes on to say they expect to reduce another 25,000 calls once they identify abusers. so 31% of callers abuse the system?

That seems like a very high number. Almost 1/3.

Is calling 911 for help with medical issues by a person who has limited alternative means of addressing it abuse or a safetynet? Where is the line drawn? Who decides? (I am still trying to figure out where to send my resume to get on the death panel) 

I wonder how that stacks up against the number of patients ED physicians feel could benefit from a visit to the ED. 

_"CLEVELAND, Ohio -- The days of Cleveland paramedics hauling people to the hospital for minor ailments such as hemorrhoids and headaches are over. 

At 7 a.m. today, Cleveland Emergency Medical Services will no longer serve as a hospital taxi for problems such as toothaches, boils and similar illnesses."_

It is also very poor reporting for attention grabing headlines. Am I to understand an EMS system whose leaders boast of driving at breakneck speeds through traffic and  administer medical attention under impossible field conditions are going to start fielding providers who decide not to transport headaches and hemorrhoids? Tooth aches? Maybe they are going to have dispatchers tell them to call somebody else?

Based on the pathologies, the risk of and severity of conditions from such things as untreated dental infectons, not to mention the costs of vegatative endocarditis or sepsis, I would be surprised if medical direction signed off on providers making these decisions. It seems more logical these are administrative changes that will have no bearing once a provider gets involved and will not produce the profound savings imagined. 

Deciding who gets a ride to the hospital and who doesn't is a very bold step. I think this reporter is grossly overstating what the actual changes are going to be. Probably to give the illusion of some major cost savings to help diffuse anger over the current financial situation in the city.


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## Veneficus (Jan 11, 2010)

Mountain Res-Q said:


> Agreeded.  Actually, I would add one factor that I have personally observed at least in my neck of the woods that makes me doubt that any system would start rejecting "BS" 911 Medical Calls... and it all comes down to the almighty DOLLAR.  In my observations, Government Run Systems want the larger call volumes to justify the budget they recieve and then try and get a larger budget for new year; "Look at the 10,000 calls we ran this year compaired to the 8,000 we ran 5 years ago... we need more money to support this system that saves the lives of taxpayers"  On the other hand, Private Companies want the high call volumes even if they are BS calls because then they get to bill more people and insurance companies.  I have personally witnessed both money driven positions.  You can expect this attitude from the private companies, but it is really shocking in the government run agencies, especially those that are Fire-Based.  Locally the Fire Boys keep seeing a "need" to raise their budget based on the increased call volume; despite the fact that their increase in calls is not due to fires, hazmat, PSAs, or rescues... it is due to the slowly increasing number of non-emergent medical calls where Fire responds code 3 because someone says "My don't feel well, I need and ambulance", gets on scene, takes a set of incorrect vitals while trying to avoid obstructing the patients view of "All My Children", and then stand around the Engine waiting for the Ambulance to arrive in 30 seconds and provide a code 2 BLS trip to an overworked ER for a Rx refil or an ingrown toenail.  The people working the calls might think that these unemergent calls are a waste of time, energy, and money... but you better believe that the higher-ups love to see an increase in the yearly call volume and their budget/profits.  IMHO.




I should just point out that Cleveland EMS is the only non fire based system in the entire region. This time the fire service has nothing to do with the issue at hand.


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## Mountain Res-Q (Jan 11, 2010)

Veneficus said:


> I should just point out that Cleveland EMS is the only non fire based system in the entire region. This time the fire service has nothing to do with the issue at hand.



Didn't say they were, nor does it have a bearing on the issue.  Fire based or not, my point stills stands that in addition to all the reasons you gave (all of which I agree with) MONEY is always a motivating factor for why and how things get done or do not get done.  EMS is a multibillion dollar business, whether we are talking private companies or government.  Every federal, state, and local agency wants their cut of the budget to be as big as possible; inflated numbers provide that for EMS, Fire, and LE.  As for privates... we all know the money to be had on picking up non emergent patients for taxi rides to and from home/hospital/SNF/etc...  Turn down calls?  Not likely!

The whole issue was something that can not be easily "fixed", nor do I believe (as you do) that anyone in a possition to make changes will honestly have the desire or true power to do so...


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## DrParasite (Jan 11, 2010)

I bet Cleveland's call volume of people with toe pain and resp distress skyrockets once this changes goes through.  

or even better, out of all their ALS dispatches, most end up being a taxi ride to the hospital


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## MedicSqrl (Jan 11, 2010)

I agree that people with get craftier in wording there C/C when calling. Abusers know the system and will not be easy to shake off with a different triage system. Just like nurses abuse medicare to get their pt out of the nursing home because they don't want to take care of them, to those same nurse that refuse to take the pt back so now they are stuck at the hospital. 

Why don't they just have BLS trucks go to those calls, if they have them. If its actually serious then call for intercept. I doubt they are going to be refusing calls for very long, if at all.


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## redcrossemt (Jan 11, 2010)

Aidey said:


> Wasn't there a thread on a system that is using RNs to triage calls? 911 receives the call, and if it sounds like it may be a non-emergent issue they forward it to the RN who would get further information and advise the patient on what to do. Does anyone remember where this was?



Huron Valley Ambulance, the secondary 911 call center for all medical calls in Washtenaw County, does this.

There was another article about another system posted recently as well. Acadian Ambulance and Wake County, NC do it as well I believe.


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## redcrossemt (Jan 11, 2010)

And regarding this whole issue, it doesn't seem like they're going to cancel any calls... just delay them until they have adequate coverage available. They're even going to call back and check on the patient every 10 minutes! I saw the comments about a nurse call line, but they can only do that if the patient is agreeable.


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## MedicSqrl (Jan 11, 2010)

Their going to have to hire more dispatchers to keep track of all that. Calling people back and asking "Do you really still need us to taxi you to the hospital?"


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## redcrossemt (Jan 11, 2010)

MedicSqrl said:


> Their going to have to hire more dispatchers to keep track of all that. Calling people back and asking "Do you really still need us to taxi you to the hospital?"



Because you know the Cleveland dispatch center isn't already overtaxed...


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## VentMedic (Jan 12, 2010)

MedicSqrl said:


> . Just like nurses abuse medicare to get their pt out of the nursing home because they don't want to take care of them, to those same nurse that refuse to take the pt back so now they are stuck at the hospital.


 
Wow!  That is a very stiff accusation.  Are you representing Florida Hospital when you make that statement?  Does Florida Hospital know you are making these accusations? 

What proof do you have?  Do you know the paper work that must be filled out for each transport and the auditing system that is done?  Do you think these nurses don't know this and that their license can be up for review if an audit or one piece of paperwork is out of place?  Do you think that the families won't start their own investigations if the nurses fail to send their loved ones to the hospital and the patient dies?    Do you understand any of the legalities that must be met for acceptance for a patient? Do you really understand the responsibility of be a nurse in these facilities?   Until you have actually experienced that type of responsibility resting on your own shoulders with every note you write scrutinized by physicians, administrators and Medicare, you might want to chill a bit on the accusations. 

However, if you have any proof of your accusations, you can easily summit a complaint provided you can back up everything you state.  But, the proof must be absolutely solid and not just an irrational opinion made out of a dislike for nurses or "BS" calls.    

You might also want to put a disclaimer that you are not expressing the opinions of Florida Hospital.    The administrators at this huge hospital system might get a little touchy if they are involved in unsubstantiated accusations.   You might also be surprised to know how many long term care centers the SDA owns.


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## MedicSqrl (Jan 12, 2010)

VentMedic said:


> Wow!  That is a very stiff accusation.  Are you representing Florida Hospital when you make that statement?  Does Florida Hospital know you are making these accusations?
> 
> What proof do you have?  Do you know the paper work that must be filled out for each transport and the auditing system that is done?  Do you think these nurses don't know this and that their license can be up for review if an audit or one piece of paperwork is out of place?  Do you think that the families won't start their own investigations if the nurses fail to send their loved ones to the hospital and the patient dies?    Do you understand any of the legalities that must be met for acceptance for a patient? Do you really understand the responsibility of be a nurse in these facilities?   Until you have actually experienced that type of responsibility resting on your own shoulders with every note you write scrutinized by physicians, administrators and Medicare, you might want to chill a bit on the accusations.
> 
> ...



I am referring to nursing homes for the most part, but there are some hospital that knowingly fraud medicare cause they are too lazy to find other means of transportation. To answer your question about reporting, I have not, only because the company I work for also (that isn't FL Hospital), would of found a way to fire me cause I am creating grief for them. 

I never stated that I was making these statements on behalf of the hospital as I am not on here in any official capacity. 

I know this from my own experience. Nurses do not care what they sign their names to anymore. I had a nurse tell me straight to my face that the paper was filled out wrong and to take the pt anyways cause there wasn't a valid reason to transport the pt. I've have had nursing homes send out pt's just so that they could refuse to take them back. On multiple occasions mind you. There are some places better than others, but there is a serious lack regulation IMHO.

Families do start their own investigations and I have been apart of that also. I don't think these nurses know the legalities of what they are doing. Or they just don't care. I am not discriminating on the need for transport. I am all willing to transport someone that needs to goto the hospital for whatever small reason. There is a serious disconnect in when you can and can't transfer someone by ambulance and when they need other means. There is also another issue when nursing homes should send the pt out 911, but don't want to get reported so they use Non-Emergency IFT. 

Nurses are not the only culprits, doctors have some of the blame too. Its a whole system of waste. It just frustrates me because I care. Both for the pt that should get definitive care sooner cause they really need it and for taxpayers that shouldn't be paying for people being lazy.


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## MedicSqrl (Jan 12, 2010)

Oh I would like to add most of this is with the company that is not FL hospital. All the transports for FL Hospital are usually paid by FL hospital and rarely use medicare.


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## Jon (Jan 12, 2010)

I question how much effect this will really have. Some of the investigative reports have discussed that folks with minor complaints have "gotten smart" and will complain of chest pain or SOB when calling 911 to get a faster response.

How long until the callbacks turn into "Are you having chest pain? No? OK... gonna be a while for an ambulance"... Oh... wait... you just started having chest pain? An ambulance will be there soon after all.


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## Jeffrey_169 (Jan 12, 2010)

I have mixed emotions about this. How is a dispatcher supposed to know what is life threatening or not? Take the headache for example. My wife is now blind in one eye, and lost half her sight in the other because the...Dr's diagnosed her with migraines after five minutes and no diagnostics. I took her in there 5 times in 2 weeks, and it wasn't until I lost my temper and and almost decked a cop that they agreed to do something. When they finally did the MRI they realized, "Well damn, maybe the stupid Paramedic Student knows something about A&P". 

I see the point they are getting at, I do. Too many medics get tied up with non emergency calls to respond to the more pressing ones, I get that, but how does a dispatcher know the difference? 

For example; I was dispatched to a call of a car vs. kid on a bike in the middle of no where in NM. I ran L/S all the way there, as I was the first projected unit to arrive on scene. I get there only to find a women who slightly overshot a turn and was now stuck in a ditch. After searching and searching, and the State Police confirming these were the coordinance, I pulled her out and we went on our way. I am not bad mouthing a dispatcher, but it happens. All I am saying is all too often a calls comes across as one thing, but when we arrive it is something totally and completely different. 

 I sincerely hope it works.


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