# 2014 = ems hell



## cspinebrah (Feb 4, 2014)

It seems like as soon as the new year started the call volume has been outrageously high. Non stop in my area. I don't know what it is. My company has been breaking our highest call volume record constantly this past month. 

My question is, is it just us orrrrrrrrrrrr is all of EMS blowing up? :blink::mellow:


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## mycrofft (Feb 4, 2014)

Are you losing resources so much the same work falls on fewer shoulders?


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## takl23 (Feb 4, 2014)

Ours are on par with yearly I believe. About 8,000/month.


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## unleashedfury (Feb 4, 2014)

cspinebrah said:


> It seems like as soon as the new year started the call volume has been outrageously high. Non stop in my area. I don't know what it is. My company has been breaking our highest call volume record constantly this past month.
> 
> My question is, is it just us orrrrrrrrrrrr is all of EMS blowing up? :blink::mellow:



Like Mycrofft said, is there a change in resources vs. the norm. 

Also take in consideration the baby boomers are getting older with health problems and the like. An increase of elderly patients is more likely going to increase your call volume. 

We been on par with our numbers for the last few years. A small increase but nothing drastic


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## CentralCalEMT (Feb 4, 2014)

I do not know what it is in CA, but up here in Central CA, our call volume has increased significantly. We have the same staffing as last year, but units are running many more calls per unit. ERs have also seen a surge in patients, some of the ERs have patient volumes 25% above normal as well. Quite frankly, it is scary. We have been hearing for years how the system was stretched too thin and one has to wonder, at least in parts of CA, if its at the breaking point.


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## RebelAngel (Feb 4, 2014)

We are slow, so far. Figures. I'm ready to ride as Observer and my district has gotten like no EMS calls. 

I'm actually trying to push my Chief  to set up things with another EMS company, one with much higher call volume, so I can Observe and eventually do my Clinicals there for part of the time, the rest of the time I hope to be able to do it in my own district. Can't learn anything if I'm not out there watching and eventually doing.

ETA: Maybe I'll get ready to go, head to the FD meeting and drop the Q word, hahaha.


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## Jim37F (Feb 4, 2014)

If anything we're a little slower here I'd say. Yesterday I had one cancelation on scene and that was it, otherwise sat around at post all day. And that was with fewer units available than normal too. Today is just as bad, just over halfway through shift, yet to catch a single call.

My single busiest day of the new year so far was actually the day before yesterday, had three ALS transports in our 12 hour shift on Super Bowl Sunday


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## Jim37F (Feb 4, 2014)

RebelAngel said:


> Maybe I'll get ready to go, head to the FD meeting and drop the Q word, hahaha.



I'm already doing that today lol no luck haha


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## RebelAngel (Feb 4, 2014)

Jim37F said:


> I'm already doing that today lol no luck haha



Well, I hope you continue to have quiet, boring, and slow days ahead! 

-----
(Did it work?)


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## mycrofft (Feb 4, 2014)

OK, absolute numbers are higher some places.

How about per capita for the _*catchment area*_? (If calls are up 12%, is population up 12%?).

Are there changing trends detectable in age of pt or % of primary ℅ (or Dx)? (How about average per capita age and age cohorts; are you being invaded by Boomers, is the birthrate up=>more neonates, what?).

Are more of these rides rather than emergencies?

Is ratios of causes of mortality changing? (Coroner or medical examiners' pie chart).
=============
Our big local FD is looking to cut staffing because of "disappointing income" from EMS calls"(??).


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## Anjel (Feb 4, 2014)

We have increased about 300-400 more calls a month. But the severity I guess you can say has gotten worse.


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## 46Young (Feb 4, 2014)

It's been slower here. If someone sneezes of farts they close the schools, so we don't get the injuries and allergic reactions, and people are going out much less due to the cold, so there's been less sick/feel-me-bads type taxi rides. The BS sick jobs typically make up the bulk of our calls in the winter.


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## Tigger (Feb 4, 2014)

Flu season has been worse this year than usual I guess and we've had more calls as a result. Not that much but apparently more than a typical winter.


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## Lorianne2010 (Feb 4, 2014)

A short list of reasons for a higher call volume in 2014.....OBAMA CARE......FLU SEASON....A lot of the country is in a deep freeze ( more homeless people calls).....You can't fix stupid when it comes to those who call EMS for silly reasons like "i have a headache" ......


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## CentralCalEMT (Feb 4, 2014)

mycrofft said:


> OK, absolute numbers are higher some places.
> 
> How about per capita for the _*catchment area*_? (If calls are up 12%, is population up 12%?).
> 
> ...



Me, personally, I have a huge increase in super critically ill or injured patients that seem to be on death's door. However, I am a black cloud.  And yes, the flu season up here is also particularly bad for some reason. 

System wide, we have seen an increase on those calls who are just for rides. Not to turn this into a political discussion but many people think that now that they have insurance, everything is free. Unfortunately most insurance providers in their haste to sign up people seem to have inadequately explained the concepts of deductibles, co-pay and fees for services. I see some people have a shocked expression on their face when the ER asks them for a co-pay upon discharge and they are like "It's free, I gave you my insurance card." Sadly, once again, lack of public education is straining the EMS system.


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## onrope (Feb 5, 2014)

mycrofft said:


> OK, absolute numbers are higher some places.
> 
> How about per capita for the _*catchment area*_? (If calls are up 12%, is population up 12%?).
> 
> ...



Same area served, 8% increase in call volume last year. Number of sick pt around the same, increase in rides and misunderstanding of the ems system. "You can't take me 40 miles to the VA?" No sir we can't drive past 10 receiving hospitals on the way.

Your comment about FD staffing being cut is indicative of the problem that FD's face when they get into transport. The only reason private companies make money is because of the barely minimum wage pay and minimal benefits and SSM. As soon as you get employees making a decent wage the whole ambo thing starts to look like a giant black hole. They somehow find analysts and companies that do studies and promise all sorts of increased revenue with transportation when in reality that simply is not the case.


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## mycrofft (Feb 5, 2014)

onrope said:


> Same area served, 8% increase in call volume last year. Number of sick pt around the same, increase in rides and misunderstanding of the ems system. "You can't take me 40 miles to the VA?" No sir we can't drive past 10 receiving hospitals on the way.
> 
> Your comment about FD staffing being cut is indicative of the problem that FD's face when they get into transport. The only reason private companies make money is because of the barely minimum wage pay and minimal benefits and SSM. As soon as you get employees making a decent wage the whole ambo thing starts to look like a giant black hole. They somehow find analysts and companies that do studies and promise all sorts of increased revenue with transportation when in reality that simply is not the case.


Sort of like hosting the Olympics.


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## emt11 (Feb 6, 2014)

We're already at a little over 14,000 calls this year.


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## HunterAsesino (Feb 16, 2014)

At work calls have been steady. At the volly squad, it's actually been kind of qui- i mean, "uneventful"


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## mycrofft (Feb 16, 2014)

Lorianne2010 said:


> A short list of reasons for a higher call volume in 2014.....OBAMA CARE......FLU SEASON....A lot of the country is in a deep freeze ( more homeless people calls).....You can't fix stupid when it comes to those who call EMS for silly reasons like "i have a headache" ......



Why Obamacare? Actual observation, not a generalization. Seeing more factitious calls where the pt says "I'm going with you because Barack's paying' " ?.


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## Handsome Robb (Feb 16, 2014)

Lorianne2010 said:


> A short list of reasons for a higher call volume in 2014.....OBAMA CARE......FLU SEASON....A lot of the country is in a deep freeze ( more homeless people calls).....You can't fix stupid when it comes to those who call EMS for silly reasons like "i have a headache" ......



Unless that headache is a bleed. Not a silly reason now...


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## 9D4 (Feb 16, 2014)

What Robb said. Got told a story by one of our instructors about the lady that runs our cadaver labs. She was acting really interested in our classes and wanted to watch some drills. Instructor finally asked why and she stated that "she had lost faith in EMS, because her husband had a sub-arachnoid hemorrhage that the FD passed off as a normal headache that wouldn't require him to go to the hospital at all". 
You may think it's silly, but :censored::censored::censored::censored: happens. As the saying goes "you may think of horses when you hear hooves, but it could very well be a zebra".


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## NomadicMedic (Feb 16, 2014)

That's just a poor assessment. Certainly not a zebra.


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## 9D4 (Feb 16, 2014)

DEmedic said:


> That's just a poor assessment. Certainly not a zebra.


I would argue that for both ways. I wouldnt typically expect a subarahnoid hemmorrhage with a headache. My 2 cents.


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## chaz90 (Feb 16, 2014)

Proper assessment of any patient will include more than a simple complaint of "headache" (or anything else for that matter). It may be a zebra in the sense that it's not the most common cause of a headache, but it had better be on your differential list until proven otherwise.


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## mycrofft (Feb 16, 2014)

Hence why dispatch doesn't diagnose.


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## emt11 (Feb 17, 2014)

mycrofft said:


> Hence why dispatch doesn't diagnose.



As far as I'm concerned, dispatch gives me an address and a made up reason as to why I'm going there in the first place until proven otherwise. Had entirely too many times where we get complaint "A" upon being dispatched and on the MDT and show up and it's actually complaint "M"(no where near what we were told".


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## Tigger (Feb 17, 2014)

9D4 said:


> What Robb said. Got told a story by one of our instructors about the lady that runs our cadaver labs. She was acting really interested in our classes and wanted to watch some drills. Instructor finally asked why and she stated that "she had lost faith in EMS, because her husband had a sub-arachnoid hemorrhage that the FD passed off as a normal headache that wouldn't require him to go to the hospital at all".
> You may think it's silly, but :censored::censored::censored::censored: happens. As the saying goes "you may think of horses when you hear hooves, but it could very well be a zebra".



Actually the quote is ""When you hear hoofbeats, think of horses not zebras." 

That said, a sub-arachnoid bleed is probably not going to present the same as a garden variety headache.


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## usalsfyre (Feb 17, 2014)

9D4 said:


> I would argue that for both ways. I wouldnt typically expect a subarahnoid hemmorrhage with a headache. My 2 cents.



You sir, have not been bitten in the @ss badly enough to do a thorough assessment on every patient . 

Remember the words "thunderclap headache"


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## NomadicMedic (Feb 17, 2014)

I'm going to be honest, when someone calls 911 for a headache, my index of suspicion goes up. Now, obviously this is not the case in an urban 911 system where everybody and their brother calls just for transport. But it's pretty obvious to me that something is going on when a patient is dialing 911 for something seemingly innocuous… unless you're totally burnt out or at the end of your shift and in the "I'm getting out of here in a couple of minutes" mode. It is my opinion that the paramedic should be working them up and most likely doing some pain management and anti-emetics. Now, also having said that… If all the vital signs are stable, it's not a thunderclap headache or "the worst headache they've ever had" and I don't see anything immediately ALS specific, there's nothing wrong with sending a headache in BLS.


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## mycrofft (Feb 17, 2014)

Had a neighbor's daughter sent home from the hospital ED with a bleed and died overnight. She had Battle signs, both anterior(raccoon eyes) and bilateral (ecchymoses behind the ears), ℅ nausea/vertigo and HA (headache, sorry).


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## unleashedfury (Feb 17, 2014)

usalsfyre said:


> You sir, have not been bitten in the @ss badly enough to do a thorough assessment on every patient .
> 
> Remember the words "thunderclap headache"



We don't carry CT machines in our trucks,, nor do I have a radiologist on speed dial to tell me that "that's just a headache" 

OTOH, Whether my patient states he/she has a headache, or is having a MI I wouldn't know unless I do a solid assessment. 

Generally my headache assessment generally spiels into a few questions. 

What made you call 911 today? 
A - I have a headache. 

Ok, well if you had headaches before whats the difference between today and other headaches? 

A- Well this one is a lot worse, or I have other things going on with it. Like blurred vision, nausea vomiting, etc. etc., 

OF course I keep questioning patient as the assessment continues, looking for root causes (Oh I fell and hit my head, Or hx, of Migraines I have a hangover) etc. etc. 

And I keep going with it. Some days your going to just transport a run of the mill headache, some days your going to be transporting a bleed. Most ED Docs that I have met will do a CT scan if a patient complains of a headache 

Theres nothing wrong with a assessment that proves normal and appears as a run of the mill headache going in BLS.


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## usalsfyre (Feb 17, 2014)

unleashedfury said:


> We don't carry CT machines in our trucks


Cop out. CT has only been in common use since the mid to late 1980s. They could tell bleeds from "run of the mill headache" prior to that. 



unleashedfury said:


> nor do I have a radiologist on speed dial to tell me that "that's just a headache"


You DO have assessment skills. 



unleashedfury said:


> OTOH, Whether my patient states he/she has a headache, or is having a MI I wouldn't know unless I do a solid assessment.


Very true 



unleashedfury said:


> Generally my headache assessment generally spiels into a few questions.
> 
> What made you call 911 today?
> A - I have a headache.
> ...



So what's your deciding factor between ALS and BLS? What makes it a "run of the mill" headache?


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## abuan (Feb 19, 2014)

Our call volume in Honolulu has increased significantly especially with AMR not taking cold calls (Deemed BLS by proQA) as of late.


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## Restless (Feb 23, 2014)

CentralCalEMT said:


> System wide, we have seen an increase on those calls who are just for rides. Not to turn this into a political discussion but many people think that now that they have insurance, everything is free. Unfortunately most insurance providers in their haste to sign up people seem to have inadequately explained the concepts of deductibles, co-pay and fees for services. I see some people have a shocked expression on their face when the ER asks them for a co-pay upon discharge and they are like "It's free, I gave you my insurance card." Sadly, once again, lack of public education is straining the EMS system.


>snipped<
_*
...and these are the same people who will be calling their Insurance Companies complaining about the bills they're going to be receiving.  Once they get the bill they call  and complain and force an Insurance to open an investigation into either the hospital or Ambulance for billing for service not rendered.  I see this all the time in my line of work unfortunately.

Have a good nights guys-n-n gals*_


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## Handsome Robb (Feb 23, 2014)

Tigger said:


> That said, a sub-arachnoid bleed is probably not going to present the same as a garden variety headache.




That's what I was thinking. Headache doesn't mean ALS but I'm with DEmedic. I get suspicious of headache patients.


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