# How do/would you handle frequent flyer...



## RebelAngel (Sep 29, 2014)

To give some background, we are a very small rural, volunteer, fire department with emergency squad and BLS ambulance. 

This frequent flyer, whom I will refer to as Frank is an overweight, 70 year old sickly man with history of cardiovascular issues including heard surgery. He has open sores, at one point had MSRA, and he smells. He lives in a condemned house that we can not enter, in deplorable conditions, with his sister. He walks out to meet EMS or sits in his car and waits until we get there. His calls are always breathing related. He goes to triage when taken to the ED, whom doesn't really want him at all. I believe the hospital has interceded at some point because of the number of times he visits the ER. ALS and lift assist are always dispatched simultaneously. He doesn't pay out of pocket for anything, and even if he did we don't bill anyway. 

Even with a power stretcher it can be difficult to get him into and out of the ambulance. He does not help us at all, at any point. I have seen him talk a mile a minute, trying to interact with the members of our squad, but the second we ALS intercept and the Paramedic steps on board he shuts up and shuts down. 

On the most recent call the driver of the ambulance and the Paramedic were unloading him. Apparently the Paramedic stepped away from the stretcher because of Frank's smell and our ambulance driver hurt his back trying to keep control of the stretcher. 

Our squad Captain has tried to get in touch with DSS to see if there was something that could be done for him, including getting him a Medi-Van so he can stop wasting our time and ALS services' time. Frank does not want to help himself at all and is not receptive to any involvement. Our Captain feels torn. She knows he is "using" us and an unnecessary 911 call from him caused one of our drivers to get hurt but morally she feels we must answer his call.


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## OnceAnEMT (Sep 29, 2014)

Well to start, the unfortunate back injury is not the fault of the patient, but is instead the fault of lack of communication among the crew at that time. So hopefully that stays out of the equation.

My suggestion is to continue to do your job. In this case, I see 2 main points. First, run the call like any other call. That said, it is not the wrong thing to do to assess the patient, recognize the lack of an emergency situation, and refer him to his/a PCP. Second, you are supposedly seeing deplorable conditions, so report it to the state. I'm not sure how it works in NY, but in Texas it does not always suffice to tell someone at the hospital or your supervisor. Often we have to make personal contact with the state. That said, it is a simple process (well, our part is). 

Cases like this are why CHP is trending lately. It saves money on all aspects of the call.


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## RebelAngel (Sep 29, 2014)

I believe the Squad Captain has reported it (the wasting of our time and resources) and him (the condition he lives, his physical condition, etc.) to both the county and state. I know that she has also been in touch with the Department of Aging for out county to try to get him help. How can you help someone that does not want to help himself? You can't. 

The "This is not a situation for 911 but rather your PCP..." has been visited many times. 

I understand, and agree with you, about the back injury. It just throws gasoline on the fire because the back injury occurred during transportation of this man. 



Grimes said:


> Well to start, the unfortunate back injury is not the fault of the patient, but is instead the fault of lack of communication among the crew at that time. So hopefully that stays out of the equation.
> 
> My suggestion is to continue to do your job. In this case, I see 2 main points. First, run the call like any other call. That said, it is not the wrong thing to do to assess the patient, recognize the lack of an emergency situation, and refer him to his/a PCP. Second, you are supposedly seeing deplorable conditions, so report it to the state. I'm not sure how it works in NY, but in Texas it does not always suffice to tell someone at the hospital or your supervisor. Often we have to make personal contact with the state. That said, it is a simple process (well, our part is).
> 
> Cases like this are why CHP is trending lately. It saves money on all aspects of the call.


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## Angel (Sep 29, 2014)

^^ That and he is abusing the system which as some point he can be fined for.


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## RebelAngel (Sep 29, 2014)

Unfortunately for him, this could be one of those situation where he has cried wolf so many times that when something bad does happen to him he's not going to be taken seriously. We're not the only agency in the area that has fielded his calls. If for some reason, like our ambulance is out of service, other agencies get his call sometimes his calls get bounced around because of the inability to get a crew together.


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## irishboxer384 (Sep 29, 2014)

Lower your expectations not your standards
There are always people abusing any system, best way is to remain professional, do your job the same way as with any other patient and your conscience will be clear when he finally croaks it


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## EMDispatch (Sep 29, 2014)

Unfortunately it happens all too often across the US. Habitual patients use the system the way that they know. They need help and they will call for it, many times for things that we'd never consider to be an emergency. A lot of it is the result of  failures in our current healthcare and social care systems. It's frustrating, but it's what happens.

Reporting the issues to social services, and treating the patient with care and respect are all you can really do. As a volunteer, I understand it will continue to get harder and harder to get people out for these calls, but one day it maybe a major emergency...


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## Ewok Jerky (Sep 29, 2014)

Treat the guy with some respect and do your job. Letting the gurney go and causing an injury to a partner because the guy "smells" is unproffesional on a few levels.

We work in medicine.  We deal with gross people. We deal with people who don't know any better. We deal with people who have no one else to call.  We deal with people who have physical, emotional, psychological and social problems. It's our job, whether you are paid or volunteer.  If you can't handle it then get out.

OP I hear the frustration in your post, and what I interpret to be a struggle to understand your place in this mess.  The only thing you can do is continue to run the calls in a proffessional and ethical manner while personally filing reports to whatever agency you feel is appropriate for the situation.  Just remember, you are a patient advocate, and one day he will be actually having a legit medical problem.


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## wanderingmedic (Sep 30, 2014)

This is why EMS should be allowed to refuse to transport patients. A wheelchair van would be much more appropriate for this call...better yet, and assisted living facility.


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## TransportJockey (Sep 30, 2014)

Check with local PD and see if there's an 'abuse of 911' statute that the municipality PD can pursue. I would do that if it were my patient, along with report him to APS.


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## exodus (Sep 30, 2014)

TransportJockey said:


> Check with local PD and see if there's an 'abuse of 911' statute that the municipality PD can pursue. I would do that if it were my patient, along with report him to APS.



The issue is, it technically isn't abuse as he does have a valid medical complaint every time.  As irritating as it is that's how they can get away with doing this.

Edit: OP, what about a code 2 response, then a referral to a private company to transport?


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## JWalters (Sep 30, 2014)

TransportJockey said:


> Check with local PD and see if there's an 'abuse of 911' statute that the municipality PD can pursue. I would do that if it were my patient, along with report him to APS.



He can still simply call dispatch and request an ambulance, small rural departments don't only run off 911. And, he does have a medical complaint each time.



beano said:


> Treat the guy with some respect and do your job. Letting the gurney go and causing an injury to a partner because the guy "smells" is unproffesional on a few levels.
> 
> We work in medicine.  We deal with gross people. We deal with people who don't know any better. We deal with people who have no one else to call.  We deal with people who have physical, emotional, psychological and social problems. It's our job, whether you are paid or volunteer.  If you can't handle it then get out.
> 
> OP I hear the frustration in your post, and what I interpret to be a struggle to understand your place in this mess.  The only thing you can do is continue to run the calls in a proffessional and ethical manner while personally filing reports to whatever agency you feel is appropriate for the situation.  Just remember, you are a patient advocate, and one day he will be actually having a legit medical problem.



Yes.  Yes, yes, yes.


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## RebelAngel (Sep 30, 2014)

Yes I am frustrated.

When I first joined this EMS squad I remember them talking about him and how horrible he is and his calls are always a waste of time and resources. It put me in an awkward position right off the bat. It was the injury to the driver that brought the issue up again of "something needs to be done" about him. The first call I went on for him, as a student, I didn't think he was as bad as they made him out to be but then again I don't run calls to him three times a week or whatever either. I can see how taxing it is on the Squad Captain, among other EMTs, and sometimes yes it does show in how they react to him sometimes, and that they talk about him. The whole thing bothers me. I feel torn. Ethically they need treat this guy with respect and handle the call just as any other. BUT, ethically, this guy shouldn't be abusing the system either. 



beano said:


> Treat the guy with some respect and do your job. Letting the gurney go and causing an injury to a partner because the guy "smells" is unproffesional on a few levels.
> 
> We work in medicine.  We deal with gross people. We deal with people who don't know any better. We deal with people who have no one else to call.  We deal with people who have physical, emotional, psychological and social problems. It's our job, whether you are paid or volunteer.  If you can't handle it then get out.
> 
> OP I hear the frustration in your post, and what I interpret to be a struggle to understand your place in this mess.  The only thing you can do is continue to run the calls in a proffessional and ethical manner while personally filing reports to whatever agency you feel is appropriate for the situation.  Just remember, you are a patient advocate, and one day he will be actually having a legit medical problem.


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## DrankTheKoolaid (Sep 30, 2014)

Hi my name is so and so. What hospital are we going to today?


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## Rialaigh (Sep 30, 2014)

Two things 

1. We have patients in our small rural county system that we have transported 70+ times since Jan 1st, dozens of patients that we have transported 20+ times since then. 

2. This guy is 70, with a crappy medical history, poor living conditions, no PCP, medication non compliance (Im sure) ..etc..etc..
Treat him with some dignity and respect, transport him when he wants, and in 2 years when hes dead ...well...that is that. 

If this were a 35 year old I would be much more likely to pursue the Abuse of 911 route, we have several that have been jailed multiple times this year for it in our county, but usually only after becoming combative with crews after multiple transports in the same 24 hour period. 


3rd thing
3. Job security sir...job security...not saying it's good, but it's the truth


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## DesertMedic66 (Sep 30, 2014)

Rialaigh said:


> Two things
> 
> 1. We have patients in our small rural county system that we have transported 70+ times since Jan 1st, dozens of patients that we have transported 20+ times since then.
> 
> ...


This. Just treat them like a patient and move on after the call is done.


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## epipusher (Sep 30, 2014)

azemtb255 said:


> This is why EMS should be allowed to refuse to transport patients. A wheelchair van would be much more appropriate for this call...better yet, and assisted living facility.


This would be fantastic but too many lazy medics would abuse it.


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## Tigger (Sep 30, 2014)

RebelAngel said:


> Yes I am frustrated.
> 
> When I first joined this EMS squad I remember them talking about him and how horrible he is and his calls are always a waste of time and resources. It put me in an awkward position right off the bat. It was the injury to the driver that brought the issue up again of "something needs to be done" about him. The first call I went on for him, as a student, I didn't think he was as bad as they made him out to be but then again I don't run calls to him three times a week or whatever either. I can see how taxing it is on the Squad Captain, among other EMTs, and sometimes yes it does show in how they react to him sometimes, and that they talk about him. The whole thing bothers me. I feel torn. Ethically they need treat this guy with respect and handle the call just as any other. BUT, ethically, this guy shouldn't be abusing the system either.



The injury should not have been the sign that something needs to be done, and it cannot be used as justification for anything. 

If it's truly a case of someone that is unable to care for themselves, involve your department of human services or whatever NYS has. We have a similar patient and recently persuaded the state to manage his homecare, place him on long term hospice, and agree with us that transport is not warranted. Now when he calls we still respond and put him back and bed or whatnot, but we do not transport. We call home health and wait for them to respond, and then leave. If they can't come they get in big trouble with the state, so they come.


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## mike1390 (Oct 1, 2014)

DesertEMT66 said:


> This. Just treat them like a patient and move on after the call is done.



hey hows our Desert female Frequent? still see her in downtown stealing cop cars?


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## raieghn (Oct 1, 2014)

Unfortunately there are so many frequent flyers that don't need help, they do tend to abuse the system or are not responsible for the cost of the ambulance so they don't even think about the use of wasted resources. In my Fire Department we only have 1 medic unit and on rare occasions we can run our aid unit, plus it takes us 45 minutes to drive one way to the hospital.

But look at it this way.

He may be abusing the system, but he has real issues. Real problems that might one day lead to real life threatening situation that requires him to call 911. He is a patient, he is a person, he may not need emergency help but he does need help. Trust me, you would hate to be the one who treats his real ER call as nothing and then wind up with a dead patient on your hands.


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## DesertMedic66 (Oct 1, 2014)

mike1390 said:


> hey hows our Desert female Frequent? still see her in downtown stealing cop cars?


No man. She got locked up for about a year. She is a completely different person now. She calls 911 for her CHF/COPD now. I haven't ran on her in over a year.


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