Abuse of the 911 System

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mmorsepfd

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Maya

Maya

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Wow, it's a fantastic article. It seems like there are a lot of problems both on on the Fire side of EMS and in private-run EMS. I think 46Young mentioned something in another thread about Unions in the FD in your region. Surely, other firemedics must feel the same way as you do. I know that budget is always an issue, but is the Department making any attempt to improve these conditions?
 
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46Young

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On numerous occasions I've had pts call for txp, nothing life threatening, and had the family following us in their POV. Numerous calls for a CC of "I just want to be checked out". Plenty of sick jobs for pts looking to avoid the waiting room. Why pay for a taxi when medicaid will pay 100% for an ambulance? Cops turfing drunks to EMS on numerous occasions. Whenever possible, I'll try to convince the triage nurse to banish the pt to the waiting room for an extended period if it's appropriate to their "emergency". Some have figured out that if they call EMS at about 0400-0500 they'll be treated quicker at the ED! (Less crowds)

It sounds to me like you're edging toward burnout, like many more before you. If this is true, then a change of venue might not be such a bad idea. You'll know when it's time to quit because your pt care will suffer noticeably.

I've identified the high incidence of medicaid/911 abuse early in my career, with many using the ED as their PCP. I made peace with that, as it's unfortunately standard for the business.

It wouldn't suprise me if your dept begins talking of crosstraining suppression and EMS, maybe for new recruits, for more versatile staffing.
 
karaya

karaya

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46Young

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Maya said:
Wow, it's a fantastic article. It seems like there are a lot of problems both on on the Fire side of EMS and in private-run EMS. I think 46Young mentioned something in another thread about Unions in the FD in your region. Surely, other firemedics must feel the same way as you do. I know that budget is always an issue, but is the Department making any attempt to improve these conditions?
Click to expand...

911 abuse goes on no matter what type of agency runs it. In Charleston County EMS there is a "no need for EMS" disposition for nonsense. Few used it, however, for fear of liability. CC also had medic fly cars that would triage onscene(pt could be made to wait quite some time if it's BS), and secure refusals, allowing other units to stay in service.

Richmond Va has(had?) a program that involved RN's in 911 dispatch that would evaluate a pt as well as they could over the phone, and attempt to both educate and persuade the caller to utilize other avenues for tx/txp. Apparently it's been working well, and worth a look at.

Both FDNY EMS and suppression unions would never allow crosstraining and merging of the ranks. Maybe the union that covers the OP can put a stop to cannabalizing suppression personnel for EMS reassignment.
 
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46Young

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Double-E

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"Our society once prided itself on rugged individualism, fairness and the ability to take care of ourselves, and our own. The tide has turned. People now expect to be taken care of."

who wrote this crap? :glare: it's one thing to discuss abuse of the 911 system, another entirely to start fantasizing about american ideology...next thing you know he's going to start telling us about washington and the cherry tree:rolleyes:

as for his gripes about the "free rides", seems like this guy doesn't understand the consequences of not having a health care system in his country. if poor people cant afford private healthcare, why are we surprised that they're calling ems and grasping for whatever free treatment and services they can get? yes its a waste, yes it's dangerous but blaming an individual for a social problem is just ridiculous.

anyone else notice the hilarity in this article lamenting how lazy americans have become being framed by these mcdonalds adds? :lol:

42671336.jpg
 
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46Young

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My mistake, your other thread advised that your dept's EMS is fire based.
I'm assuming your personnel are largely dual role already.
 
Maya

Maya

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Sorry Double-E, but I think you have no idea what you're talking about. I have little experience myself, but we should show a little more respect.

I agree with you about the Medical System, but that is a governmental issue. When one is overworked to the point of considering switching jobs, it is a personal issue. People do abuse the 911 system. It's a problem we have to face, particularly in lower-income and highly-populated urban areas, and we need to try to find solutions to fix the problem, as it affects all of us. Whatever that is -- joining unions, writing to congress, educating the public -- I don't know yet.
 
Aidey

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911 abuse is a huge problem, and being upset about it doesn't make a person burned out. For me it's not that I think the person doesn't "deserve" help, or isn't "worthy", but an issue of proper resource allocation. I wouldn't see a neurologist for a stomach problem, so why call 911 for a non-emergency?

One of my questions I ask soem non-emergent calls is "What is it that you're hoping the ER can do for you?". In some cases I don't have to ask anything beyond that, and the person is able to think it through for themselves and realize that calling their primary doctor in the morning is a better option.
 
terrible one

terrible one

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Aidey said:
One of my questions I ask soem non-emergent calls is "What is it that you're hoping the ER can do for you?".
Click to expand...

That is a really good question to ask. From what I have seen (in my limited EMS career) are paramedics that do NOT educate the public while on scene. (of course this could be do to area at the time) But a lot of times we are short and angry at a patient for waking us up at 3AM because they/their loved one isnt feeling well. A 3min conversation with them about what truely consitutes a 911 call can make a world of difference.

Again that is not always the case but a lot of times Ive seen EMS workers lash out at someone who simply was never told "you know this really isnt your best option"

I wont play the denial game either, there have been plenty of times when I felt this way as well and it takes a lot of patience and practice to fight that urge
 
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DWemt28

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mmorsepfd

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"Our society once prided itself on rugged individualism, fairness and the ability to take care of ourselves, and our own. The tide has turned. People now expect to be taken care of."

who wrote this crap? it's one thing to discuss abuse of the 911 system, another entirely to start fantasizing about american ideology...next thing you know he's going to start telling us about washington and the cherry tree

as for his gripes about the "free rides", seems like this guy doesn't understand the consequences of not having a health care system in his country. if poor people cant afford private healthcare, why are we surprised that they're calling ems and grasping for whatever free treatment and services they can get? yes its a waste, yes it's dangerous but blaming an individual for a social problem is just ridiculous.

anyone else notice the hilarity in this article lamenting how lazy americans have become being framed by these mcdonalds adds? "

Either you are not aware that "the writer of this crap" started the thread hoping to start some good discussion, or you simply have a lot to learn. If you didn't like the article, thats fine, a lot of people didn't like it, but insulting a person as if he weren't there is unnecessary.

Thanks Maya.
 
Mishka

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Sorry guys im a certified technology retard, i didnt know how tolink it for something.

HOSP-ITALITY ABU$E
2009 JULY 12
tags: ER, healthcare, Medicaid benefits, taxpayers
by Paul Monti
Monti Says: You want national healthcare? Take a look at a preview below.

New York Post

July 12, 2009

By GINGER ADAMS OTIS and MELISSA KLEIN

These bums are costing you a fortune.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.

For a chronic caller like Alardo — who phones 911 four or five times a week — the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years — and taxpayers pick up his tab, too.

Ricky and Robert are among the dozens of “frequent fliers†who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money.

An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop, according to estimates from medical experts.
Click to expand...

http://www.nypost.com/seven/07122009/news/regionalnews/hosp_itality_abue_178789.htm
 
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VentMedic

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http://www.kcbs.com/pages/194580.php

Paramedic's H.O.M.E. Team Reaches Out to Homeless
(San Francisco)

A paramedic for 15 years, Niels grew frustrated seeing the same faces again and again. So he envisioned a program where paramedics would partner with social service agencies, keeping the chronically homeless off the streets and getting them out of the emergency room.

"I realized you can sit and complain about it or really do something about it!" says Niels.

So in 2004, Niels founded HOME - the Homeless Outreach and Medical Emergency team. He recruited social workers to ride with paramedics and together, they began to coordinate different city services for the homeless. Two years later, there are only a third as many chronic callers to 9-1-1.
Click to expand...
 
EMTinNEPA

EMTinNEPA

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So they're moving resources and money from fire suppression to EMS, increasing EMS coverage at the expense of the Fire Department? The guys with the Bugles don't have a problem with the reverse situation. I don't see a problem with this one. And there's nothing we can do about 911 abuse. These idiots are just going to keep calling.
 
Maya

Maya

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VentMedic, that's a fantastic article. This is exactly why I'm in EMS. People working in EMS get to see people's lives the way they really are, when most people would sooner turn their backs to these problems. We're in a position to make a very positive change in our communities. I live very close to San Francisco and I would really like to get involved with this program or one similar to it in my area. Thank you for posting this!
 
djmedic913

djmedic913

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well as I have attempted to embed a soundfile and unable...here is a link to it.

Quote from Emergency


I believe this sums up a lot our collective frustration to the abuse of 911. I have made comments on other threads calling our ambulances, either cabulance or wambulance.

I understand the reasons for the abuse. And I know the Medicaid system NEEDS to be fixed. but how? I am for universal health care. I have seen it work when I used to live in Canada (contrary to popular American belief, Universal Health Care in Canada DOES work). But, alas, since lobbyists in DC out representatives and have a lot more money to throw at our politicians, than myself, I don't see a change anytime soon.
 
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4

46Young

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Mishka said:
Sorry guys im a certified technology retard, i didnt know how tolink it for something.

HOSP-ITALITY ABU$E
2009 JULY 12
tags: ER, healthcare, Medicaid benefits, taxpayers
by Paul Monti
Monti Says: You want national healthcare? Take a look at a preview below.

New York Post

July 12, 2009

By GINGER ADAMS OTIS and MELISSA KLEIN

These bums are costing you a fortune.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.

For a chronic caller like Alardo — who phones 911 four or five times a week — the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years — and taxpayers pick up his tab, too.

Ricky and Robert are among the dozens of “frequent fliers†who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money.

An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop, according to estimates from medical experts.

City officials don’t track frequent fliers or the costs associated with their transport and hospital care, but anecdotal numbers from ER and EMS workers suggest there are dozens throughout the city.

“We have a system that is extremely dysfunctional. We have no place to put these people,†an EMS medic said.

A paramedic working downtown said some frequent fliers think they’ll get faster treatment if they arrive at an ER by ambulance, rather than walk in.

“They know what to say to our call takers,†he said.

Or they’ll tell a bystander, “Oh, I have chest pains,†the medic said.

Alardo, 53, phones 911 so regularly, medics know which calls are likely his.

“When Ricky passes on, I’ll probably even go to his funeral,†said one medic who works in Washington Heights. “I’ve seen him almost every day for the last 13 years.â€

An inebriated Alardo lauded the medics last week, saying they “treat me like a king.â€

A few hours later, he called for an ambulance to pick him up on Bennett Avenue. He went into the hospital at about 4 p.m. and slept for hours.

His fellow frequent flier Robert said he has called 911 as many as 50 times since becoming homeless three years ago.

He said he would tell the 911 operator he had chest pains or was suicidal.

But, he confessed last week, “I’m not really suicidal.â€

Robert, 40, said he was looking for a place to sleep, get a meal and get the medications he takes for depression.

He said he stopped his 911 habit after an ambulance driver “chewed him out.â€

“I haven’t called an ambulance for about a month,†Robert said.

By law, EMS workers cannot refuse to treat or transport any patient. And ERs have to at least evaluate and stabilize homeless patients.

The drain on the city’s strapped medical system is huge. Medicaid reimbursements don’t come close to covering the costs of frequent-flier visits.

Medicaid pays just $175 for a basic ER visit and only $186 for the cost of an $800 advanced-care ambulance.

At a minimum, ERs give vitamins, showers, hot food and a bed to their homeless patients. But those who come in with underlying medical conditions require X-rays, cardiograms and medicines that can push the cost of an ER visit well above the average $400.

“They take space. They take nursing resources. They’re a drain on the staff’s energy level and emotions,†said Dr. Jeffrey Brenner, of Camden, NJ, who has studied the issue. “They’re costing the system in both direct and hidden ways.â€

Brenner’s research found Medicaid paid $46 million for the top 1 percent of Camden’s frequent fliers, or 1,035 patients, during a five-year period.

A pilot program at Bellevue Hospital has cut ER visits by 67 percent among “high-cost†Medicaid patients by finding them their own doctors, housing and even cellphones to keep in touch with their doctors, according to a recent report by the United Hospital Fund.

But it will be hard to break the habit of vagrants who view the ER as their personal retreat.

“It’s not always easy to pick up these guys and take them in,†one medic said. “But our policy is: ‘You call, we haul.’ We have no other choice.â€

P.S. 46Y is not going to let me lie here, he picked up the same drunks in his day that i am picking now. Sometimes 4 to 5 a night. Look at the $$$ numbers, probably one of the reasons our city is in huge financial ... right now.
Click to expand...

The way I link an article is to rt click on the address at top, then press cut. Then go to your post, rt click where you want, and select paste.

The article seems pretty dead on based on my experiences. I can understand to an extent how some use the ER as their PCP if they're uninsured and have no other options. I've transported numerous homeless, or "undomiciled" for the sensitive PC pukes, to the ED for an obvious free meal/shower/bed. If I were homeless, and were either mentally ill or not motivated in the least to better myself, I would do the same thing. It's too easy.

Something needs to be done, as Mary Innacurate, St. John's and the like closing due to uncompensated cases, will be only the first wave of closures. The remaining ED's, FH, Jamaica, Flushing, Elmhurst and such will eventually go down the same path. My father in law was treated in Booth last week, and he said that the crowds were ridiculous, the worst he's seen.

You're probably picking up the same regulars that I did. I don't want to name names(the HIPAA police will tune me up), but I've taken the approx. 40 y.o. Indian dude with the turban for ETOH, found at the park at QB and Yellowstone typically. He would sing to us outside FH ED after discharge, and chase us around the bus for fun. There's the old white guy who falls down drunk outside the bar on B'way and 75th, I think. I was waiting for his liver to explode one day. His friends at the bar are regulars, as well. There are others, too many to mention here.

I don't know if you worked Wed night, but my cousin Tara was working 46Young with Ivan. Ask anyone in dispatch, most should remember me. Send my regards.
 
J

JimStallings

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Nurseline Triage

karaya said:
Sounds like you need to look into the same program that Houston, Richmond and Philadelphia are using. We've covered this topic here in other threads, but here is a link to the story:

http://abcnews.go.com/Health/Story?id=5008343&page=1
Click to expand...

Philadelphia is not yet using a tele-nurse program, but their city controller recently recommended they adopt one:

http://http://www.philly.com/dailynews/local/20090422_Butkovitz__City_could_save___with__tele-nurse_.html

Houston and Richmond's are both in place.

Here in King County, WA, we have had a Telephone Referral Program/Nurseline (TRP/NL) in place since 2000. It has been effective in reducing BLS responses to non-emergent, low-acuity 911 requests for medical help. 911 call receivers, using criteria-based dispatch protocols, may transfer appropriate callers to nurses employed by Evergreen Healthline in Kirkland, WA. King County EMS maintains a contract to reimburse Evergreen for each call transferred. The nurses use standardized protocols to offer medical advice, home care instructions, or referral options to each patient. They may also transfer the patient back to 911 if they determine BLS response is needed (Sendbacks). In our case, Sendbacks are less than 10% of all calls transferred. In our area, Thurston County and Snohomish County have also contracted with Evergreen to provide nurseline services to their citizens as well.

If managed well, nurselines can provide an important and useful option for citizens and EMS providers.

Jim
 
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