Another what would you do question...

[ffemt8978]

We have a local medical clinic in town that is causing us some problems.

Basically, they are waiting until they close for the day (1800) to page us out for a non-emergent transport for direct admit to a hospital that is an hour away. I would say that approximately 75% of these transports do not require an ambulance, and the patient could go via POV.

First of all, let it be known that I have no problems doing a transport for a patient that needs it (for whatever valid medical reason). Secondly, we are the only ambulance service within an hour of where we are. This leaves us in a situation of having one (and sometimes two) crews tied up on routine transfers when an actual emergency comes in. Also, by state guidelines, we are not a transfer service but are an emergent ambulance service. Basically, we are not allowed to do inter-facility transfers.

We've tried talking to the clinic on several occassions, and even have had our medical director talk to them, but this continues to be a problem. It has gotten so bad, we are having a hard time to get a crew to respond to the clinic for these types of calls.

We used to have the same problem with the other medical clinic in town, but they got burned by it. We were on two B/S transfers (one from each clinic), when a subject presented at the clinic and had a full blown AMI right there. There was no ambulance available for 30 minutes (time to get the helicopter there), so the clinic was stuck trying to save this guy. After that, they tried to blame us for the lack of ambulances until we pointed out it was their routine transfers that put them in this situation. We haven't had a problem with the second clinic since.

My question is what can we do to get the other clinic not to call us for people that do not need to go via ambulance before we have another person die from it?

 

[rescuecpt]

We have a nursing home in the Corp's district. After years of problems similar to what you describe (although not as long of a transport time) we established a contract with them which outlined the types of situations we would respond to. Obviously medical emergencies requiring immediate hospitalization, fires, generator failures, gas leaks, etc. All EMERGENCY situations. They don't call us for BS anymore, because they would be breaking the contract.

In theory, you are not required to transfer every patient, right? They could refuse medical assistance... maybe if you explain to the patient that you are a one-way trip - once you get them an hour away, they will be left there with no way home, and that since their condition is not an emergency, it would make more sense for them to go there in their car or with their family, etc...

 

[Luno]

FFEMT, all I can say about this is to know your protocols, that's the one thing King Co. has going for it, it has protocols (not that they are necessarily followed) but you can deny transport based on your protocols. i.e. if the pt meets the protocols for non-emergent transport by POV, send them that way. However, if the MD decides that they need transport by BLS/ALS, have them arrange it that way. The screening starts with your dispatch service, provided they haven't called 911. If they do call 911, take it up with your chief, who in turn should take it up with city council, and start billing them accordingly for abuse of resources. However, it caught my eye, that your agency "can't" do facility transports? Is this in your agency by-laws, or city ordinances, because all EMS can do facility runs as far as I am aware by state law, inc. Medic One, it's just most don't.

 

[rescuecpt]

We "can't" do NON EMERGENT inter-facilities - that's not our job. We only do EMERGENT transports. Doing non emergent inter-facilities takes emergency resources away from the community and leaves us vulnerable to not having the crew/equipment/etc to handle real emergencies. I could get in trouble for something like that.

 

[Luno]

RescueLT, I can't comment for your protocols or SOP, or how you would "get into trouble" but I would assume on a local level, as case law has stipulated that we cannot be held liable for not responding to a call, if we are otherwise engaged, i.e. on another call, etc... This principle also holds true, under I believe sovereign law, and that as we are not causing further harm to the patient by not responding, but rather we may improve their condition by responding. This principle also holds true for your firefighting activities, by case law. I hope this helps.
Luke

 

[PArescueEMT]

Originally posted by ffemt8978@Aug 19 2004, 11:54 PM
Also, by state guidelines, we are not a transfer service but are an emergent ambulance service. Basically, we are not allowed to do inter-facility transfers.

We've tried talking to the clinic on several occassions, and even have had our medical director talk to them, but this continues to be a problem. It has gotten so bad, we are having a hard time to get a crew to respond to the clinic for these types of calls.

:huh: have you had PD respond with you to explain that what they are doing is abuse of emergency services? in my area, I know that that's against the law and carries a $5000.00 fine.
I think that your service should have that happen, then these runs may slow down.

 

[rescuecpt]

Sorry Luno, I think I need to clarify - as an emergency only service, our only calls are emergent (although there are degrees of emergent) and our only receiving facilities are hospitals (not clinics, labs, houses, etc).

We can pick someone up at a doctor's office who is having a heart attack. That's fine, it's an emergency. But if a doc decides someone needs an x-ray, but the person doesn't have a car so he calls us to transport - if it is not an emergency situation and the patient is not going directly to the ER, we are not allowed to transport the patient. If I do, against my SOPs, I will be suspended since I am usually the highest medical authority on the rig. The dispatcher will also be suspended since they let the bus leave the building for a non-emergent call.

All calls that come to us via 911 (medcom) are considered emergent, even if it's an Alpha cut finger, but if it comes in as a "transport" we are to refer the caller to a private service, and medcom is supposed to do the same.

We usually only have one crew on duty. If I use up ALS & BLS resources to take an old lady from doctor's office A to radiology services B, and a REAL emergency comes in, there will be consequences within my organization.

There are two exceptions to this. 1. if it's an EMERGENCY at a doc's office or lab and the patient needs to go to the hospital immediately, or 2. if it is a MOS' family member and the transport has been pre-scheduled and the crew is composed of non-duty crew personnel.

**** And currently in my county, they are putting laws into effect which will hold our organization responsible for not getting to calls (not us individually, but the organization as a whole). The major penalties relate to not being able to get certain types of funding and having CLOSE governmental oversight if we don't achieve certain time and percentage response goals on a consistent basis.

 

[ffemt8978]

Originally posted by PArescueEMT+Sep 30 2004, 12:57 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (PArescueEMT @ Sep 30 2004, 12:57 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ffemt8978@Aug 19 2004, 11:54 PM
Also, by state guidelines, we are not a transfer service but are an emergent ambulance service. Basically, we are not allowed to do inter-facility transfers.

We've tried talking to the clinic on several occassions, and even have had our medical director talk to them, but this continues to be a problem. It has gotten so bad, we are having a hard time to get a crew to respond to the clinic for these types of calls.

:huh: have you had PD respond with you to explain that what they are doing is abuse of emergency services? in my area, I know that that's against the law and carries a $5000.00 fine.
I think that your service should have that happen, then these runs may slow down. [/b][/quote]
I don't think that would work here. Right now, our Medical Director is duking it out with them so I'm trying to stay well clear of it.