mycrofft
Still crazy but elsewhere
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DrP has it. CLose the thread.
Dr. P,
Around here, that quick assessment and a transport for a those kinds of chief complaints often mean a 2-4 hour wait (as a range...it's often more and sometimes less). That's a lot of resources being moved around when you get a few of those. I might sometimes spend 8-10 hours out of a 24 hour shift standing/crouching/leaning against the ER hallway wall waiting for an available bed. After these days, I usually have back pain and spasms the next day. There's the very real issue of fatigue as well. Overall quality of medicine and customer service goes down sometimes unfortunately :-/ Sometimes society or local government might decide their resources are more important elsewhere and some part of the system suffers (be it EMT/Medics or critical patients or stable non-emergency patients).
Good read: - Los Angeles Times article on 911 abuse
http://articles.latimes.com/2012/may/14/local/la-me-911-changes-20120515
I agree that this form of EMS no longer works, but wondering why you think PSA's discouraging calls for non-emergency complaints does not work. It seems like it's a mindset that might be changed.
It would be different if people were calling the ambulance simply because of lack of options (which is a certain amount), but in my area for example, there are urgent cares and clinics left and right. Many patients have families with cars.
But I said patients directly tell me they choose the ambulance because taxis cost money and ambulance companies don't come after them for the bill (because they don't much), that they get into the ER faster (and that they know it's not true when we tell them it's the same wait), or that MediCare/MediCal pays for it, so why not use it?
Then there's another subpopulation that simply doesn't know what ambulances are for. It seems to almost be a cultural thing. She has the flu, well call an ambulance. Those are usually responsive to teaching moments...but dependent on the EMS personnel in charge to do so. In areas like many/most parts of LA, the FD contracts out private ambulances, so doesn't have to go along with BLS patients, so they actually encourage many patients to go (not all, but most).
I guess for all those reasons combined with limited resources local governments have (reference previous post), I think the PSA's are a reasonable idea. There are M.D.'s and public health personnel backing these PSA campaigns too, so I don't think they were rash decisions. The system might have simply decided to assume the very low risk of some people not calling when they need to call. But it was done consciously...just as every society chooses what health/safety checks they can take on...
You know, not for nothing, but I don't discourage ANYONE from not going to the hospital. I used to, but in my 2nd year of paid urban EMS, I found I could spend 20 minutes talking BS out of going to the hospital, or spend 10 minutes doing a quick assessment, walking the patient out to the ambulance, and transporting them to the local ER. It was just a time saving method on my part.
On the topic of frivolous calls, they keep us in business..... So with the decreased calls, I go from 8 BLS trucks during peak hours to 1 or 2. ALS goes from 5 during peak hours to 2 or 3 (since they cover three cities, not just the big one). Staffing numbers decrease, budgets are slashed, special operations funds vanish, and the department changes from 300 or so people to maybe 100. Jobs are lost, and we become outsourceable or even worse, expendable.
You call them frivolous calls, I call them easy job security.
Most PCPs want either copay or payment up front, which is a problem for most fixed income (retirement, disability, welfare). It is also a problem for people who live pay cheque to pay cheque.
The problem with making calling an ambulance socially unacceptable is that it doesn't work on a target population, it works on all populations.
Here in Aussie land low income earners are given 'health care cards' entitling them to no out of pocket expenses at many many PCP/GPs