101 Ways to Tell a Patient You Don't Need an Ambulance, Without Actually Saying so..

MrBrown said:
Looks like EMS in California all right :D

While one should not discount a mechanism of injury, it cannot be used in isolation from sound clinical judgement to determine treatment

Should we give some bloke a CT just because he was in a road traffic accident? No. Should we strap everybody to a long spine board just because they hit their head? No.
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Didn't watch that link, but I'm assuming it's that animated video about everyone freaking out about moi? Haha awesome video.

And yes, Brown, I agree. I just think it should be the difference between being "yea, it's not a big deal, just sign this refusal," vs "I can't make you go, but I'd highly suggest you get checked out, even if you drive yourself to the hospital."


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mikie said:
The plethora tactic around here seems to be telling patients which hospitals are "busy" thus we'll have to take you to XXX hospital (which has a poor reputation)...REFUSAL signed!
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Yup... Most of them want to go out of county to some hospital in N. Baltimore or DC.

My partner uses this one a lot

"I'm sorry ma'am but county protocols state that we take you to the closest appropriate facility, and we unfortunately can't take you 45 minutes north just because you don't like the doctors here"
 
Bon Secours, anyone? ;-)

MedicBender said:
Yup... Most of them want to go out of county to some hospital in N. Baltimore or DC.

My partner uses this one a lot

"I'm sorry ma'am but county protocols state that we take you to the closest appropriate facility, and we unfortunately can't take you 45 minutes north just because you don't like the doctors here"
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Yes! I hate this! "Our protocols says..." -but there is some truth to the 'closest medical facility crap' when patients really want to go to their covered hospital, which typically isn't more than a few more miles down the road (cause we ain't short hospitals around here...). I hate hate hate it.

edit: i'm not talking about bypassing a level 2 to go to a level 1 or other Specialty Referral Center, this is more for the casual medical, if you will
 
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mikie said:
Yes! I hate this! "Our protocols says..." -but there is some truth to the 'closest medical facility crap' when patients really want to go to their covered hospital, which typically isn't more than a few more miles down the road (cause we ain't short hospitals around here...). I hate hate hate it.

edit: i'm not talking about bypassing a level 2 to go to a level 1 or other Specialty Referral Center, this is more for the casual medical, if you will
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We usually pull the closest facility thing when they request a hospital that requires us to pass 5 other hospitals on the way there.

The only time I've gone to a level 2 vs. a level 1 is when we are close to PG Trauma then to STC. Even though I HATE going to PG...
 
mikie said:
Yes! I hate this! "Our protocols says..." -but there is some truth to the 'closest medical facility crap' when patients really want to go to their covered hospital, which typically isn't more than a few more miles down the road (cause we ain't short hospitals around here...). I hate hate hate it.
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We will happily take people to any hospital they wish within county, and although there is one hospital that has a somewhat worsened reputation, it is requested more than the others (for who knows what reason). We can also go to neighboring counties if requested or for closest appropriate facility, but "I want to go to UNC" isn't accepted by all medics as a legitimate reason, and I have heard the phrase "choose again" uttered when the patient requested such a transport.
 
MedicBender said:
Yup... Most of them want to go out of county to some hospital in N. Baltimore or DC.

My partner uses this one a lot

"I'm sorry ma'am but county protocols state that we take you to the closest appropriate facility, and we unfortunately can't take you 45 minutes north just because you don't like the doctors here"
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Where are you? Judging by this comment and the later one about PG vs. STC, it seems pretty obvious you're somewhere between Baltimore and DC, probably in PG or AA. Howard is always closer to STC than PG Trauma.

(I'm in Howard County, by the way. :))
 
I arrived on scene at the greyhound station, and a transient male got into my truck. I asked him what the problem was he says " my knee hurts real bad". I asked him how long ago it started and he replied, " oh about 30 maybe 35 years ago". In a stunned voice/look I asked him if anything had changed or if the pain was worse in some way? He replied " nope, figured I'm not really sure where I am in town, or what's close to me, and I don't have anything else to do so I figured now was as good a time as any to go get it checked". With the most shocked look on my face I told the MSN," this is the most blatantly abuse of an ambulances I have ever seen, I will take you to the ER, but if someone dies on this side of town while I'm transporting you I want you to know it is your fault. " I then told him to buckle hus seat belt and not to talk to me during my map to the ER.
 
Say "yeah you can come with us to the hospital but first you have to help us dump these bodies in the back into that ditch."
 
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"She's an adult, it's her decision if she wants to go or not, not yours. If she doesn't want to go, that's fine by us"


"So, do you want us to take you?"
 
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You can walk can't you?
 
Is that your car? Does it run?
 
Sure we will take you!! Is this your first time in an ambulance? No, well it is my first time with a PT and I have been playing around with these paddle thingies making grilled cheese and I have been dying to try them on a PT and today is my.... I mean your lucky day!!!!
 
I had a call where someone got hit by a lightbulb in the hand. It was one of those small energy saving ones that go in lamps. He had a very MINOR abrasion, if that, that didn't even break the skin. He was worried about possibly getting mercury poison and wanted to get checked out. I said hop in. Wish I could have said call a taxi.
 
firefite said:
We can't say that a patient doesn't need to be transported by an ambulance. If they want to go for the smallest reason then well they are going. If they don't want to go even for the smallest thing we have a whole 12 step process for signing AMA :wacko:
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This, but no 12 step process needed. It is tough to explain what could happen if you don't go get this paper cut looked at that didn't break the skin.
 
I personally use the honest route;

We had a call for a girl who had blisters and such all over her body, we got there and when we go there the blisters/spots had gone from "all over" to "only a here and there" so I told her honestly, I can take you to hospital, but you'll probably only get seen tomorrow morning - and by the time they (the doctors) see you, your spots would've gone away and then you're going to be so angry at "ME" because I bought you here. LOL.

See how it is in the morning, if it hasn't gone away completely, go to the doctor/hospital - or, call a ambulance again.
 
We get a lot of "Do you think I/He/She should go to the hospital" basically we just say if they don't have to go "We are an ambulance company legally we have to recommend you go but we can't force you to. It's up to you."
 
firefite said:
We can't say that a patient doesn't need to be transported by an ambulance. If they want to go for the smallest reason then well they are going. If they don't want to go even for the smallest thing we have a whole 12 step process for signing AMA :wacko:
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in la county?
 
So here's the deal, everything that we can do from our side checks out: your heart looks great, your blood pressure is fine, and you're getting good oxygen to your body. Based on your complaint, its not necessarily an emergency that requires something to be done at this exact time, we can take you to the hospital if you want, but rest assured that you will not get seen any faster as you may have heard from people. Usually for your situation, you'll be waiting for at least 6 or so hours before you get checked out, and even then its only to take your blood pressure and ask you what your name is. Also, the ambulance ride that you could've avoided by having you brother right there drive you will also cost you about 1300 dollars.
 
This one is the worst...true story.

I was on the ambulance and responded to a woman who had a seizure while she was waiting in line for her check at the social security office.
The fire department was on scene checking her out and bystanders were saying they watched her have a "full body seizure".
While she was still lying on the floor, the captain asked her if she drove herself. She said yes. Then he asked her if there was anyone who could take her to the hospital. She said no. Then he asked if she had any family. She said she had a son but before he could say anything else she said that she hadn't seen him in over 20 years. I couldn't believe it when he said, "that's ok m'am, if you have his number I can call him for you, he can take you to the hospital, you can see your son" I couldn't believe how lazy these guys were. I felt so sorry for her and told her not to worry, we were going to take her. Once fire department saw that we were an ALS unit they were gone so fast and left us with the patient.
 
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