Declining Transport

[medic417]

As I already stated, it may take weeks and months, not hours, for an appointment with a physician at another alternative site.

We actually will call ahead and most places will work in the patient at our request. So we are actually getting them in where they need to be rather than going to the ER and get told that they need to see someone else.

 

[medic417]

You can educate only to a certain extent. You are not Social Services and can not sign them up for the assistance they may need. Some must make it to the ED for a need of these services to be recognized and the patient is then entered into the "system". Unless your agency has a direct link that can summon a home consult or follow up, there may be little you can do and it may actually prevent them from jumping through those initial hurdles of getting into the right care program.

Actually we meet with various agencys and are allowed to refer them patients. If the situation is bad we even have the 24 hour on call list so we can get them in with case workers quicker. Honestly the ER here is less proactive in this regard than us.

 

[Sasha]

Reaper while I can not respond for the OP in our case we do it to educate the public. Honestly in a busy system it would add more work to it. You are on scene longer. You have more paperwork. So denying is not a convience to the crew, its actually more work.

Myself I prefer to do the more work and educate rather than allow the abuse or even if its the first call ever educate to what is really an emergency. This in the long run benefits the caller and the system.

While it may be more paperwork, there are those that feel unless they can drive from the scene l/s, it's a waste of EMS and not worthy of their services.

It's safer to transport everyone than trust that people have the education to educate their patients to what is an what isn't an emergency and to "think outside of the box" for atypical presentations, like MIs presenting as back pain.

 

[VentMedic]

I also don't see Fire-Based services taking an engine with 4 FF/Paramedics out of service long enough to explain the healthcare system to the patient. That would be tossed to the private service who will not benefit if it is not a transport.

Which brings us to another point: would you charge for a non transport exam even if EMS is the one to initiate the refusal? If the patient still wants to go to the hospital but now must pay your service AND another agency? And, if your service is heavily supported by the taxpayor, this might not sit well.

 

[MarkBaribeault]

Do you mind if I ask a simple question?

Why would the county even be considering this? You stated that you run 7 trucks full time and respond to 13,000 a year. That equates out to 5 calls per truck, every 24 hours or 2.5 calls per 12 shift.

Seems to me that your system is far from being stressed out. So why not provide care to the citizens that want it?

I am all for denying care, in a system that is stressed to the limits and has lots of abuse.

This system seems far from that. That is why I am wondering why they are looking into it.

Hi Reaper, & thanks for the reply.

True, our overall call volume doesn't look that busy. Still, there are times when we have problems keeping resources in service due to call volume. Our County is largely rural and thinly populated, so maintaining reasonable response times to true emergencies is very much a concern. With only one ED in the County, a single transport can have a truck out of service for three hours to transport, transfer, re-supply, & get back to their area. For that three hours, response times to remote areas of the County can approach fifteen minutes, even with other units on stand-by. We've had several complaints about those extended response times (justifiably so, I think). Does that answer your question?

Thanks,
Mark B.

 

[VentMedic]

True, our overall call volume doesn't look that busy. Still, there are times when we have problems keeping resources in service due to call volume. Our County is largely rural and thinly populated, so maintaining reasonable response times to true emergencies is very much a concern. With only one ED in the County, a single transport can have a truck out of service for three hours to transport, transfer, re-supply, & get back to their area. For that three hours, response times to remote areas of the County can approach fifteen minutes, even with other units on stand-by. We've had several complaints about those extended response times (justifiably so, I think). Does that answer your question?

Thanks,
Mark B.

You do use the words "true emergency" alot. Does that mean if you can not readily see the patient will die in 4 minutes they are not worthy of your service?

So you are going to drive all the way out to the patient, do a thorough assessment and then tell them to call a cab?

I have also found that people who live in the rural regions to be honest, hard working and independent folks who rarely call an ambulance unless they have no other option. With the conditions you just described, I really hope you consider to not deny the elderly or a child transport if they do not have access to alternative transportation immediately.

My remarks may sound rude and crude but lucky for you I don't pay taxes to your service and I am not the media.

 

[reaper]

Hi Reaper, & thanks for the reply.

True, our overall call volume doesn't look that busy. Still, there are times when we have problems keeping resources in service due to call volume. Our County is largely rural and thinly populated, so maintaining reasonable response times to true emergencies is very much a concern. With only one ED in the County, a single transport can have a truck out of service for three hours to transport, transfer, re-supply, & get back to their area. For that three hours, response times to remote areas of the County can approach fifteen minutes, even with other units on stand-by. We've had several complaints about those extended response times (justifiably so, I think). Does that answer your question?

Thanks,
Mark B.

Response times are the death of great services. To many are worried about getting under that magic number.

My service runs 19 full time trucks and respond to 70,000 calls a year. The calls in the rural areas still receive 15-20 minute response times. There is no controlling that fact. If the citizen that lives in the rural area was worried about response times, that much, they would not be living in a rural area.

I have lived in very rural areas with response times of 30-40 minutes. I knew this when I moved there and did not expect a miracle if I needed EMS.

As I stated before. I can see declining transport in some obvious cases( ie: stubbed toe or Paper cut), but who is to say that it is not a true emergency to those people?

In 20 years, I have yet to see a service where every medic was great. There is always the ones that I would not trust to make that decision. Until we up the education standards and raise the bar in Para-medicine. We can not guarantee that all providers have the knowledge to make that call. That is how you will setup the service for huge liability.

 

[daedalus]

...but only if the providers can do an adequate medical assessment. I do not see 3 month wonders doing this.

Whole heartedly agree.

But OP, if your medics have the education in your system, go for it! It will be a wonderful precedent for the rest of us as soon as we get our acts together.

 

[medic417]

Mark as you can see this is a hot subject. I am involved in one of the systems that allows it. Our Medical Director is very much involved in our agency and is a firm believer in education. I used to feel that all Paramedics and even Basics should have the right to deny transport. But since then I have traveled the country and sadly find many really should not even be driving the ambulance much less caring for patients so they definitly should not be deciding who goes to the hospital.

I will again point out it really will not save you time in the long run. Even with our transports and turn around times that are higher than yours we still transport most. The ones we deny you spend hours first explaining and working with them to get proper care and services. Then you and your partner must right up seperate reports. Good change you will spend time in peer review to discuss the case in detail. So honestly it is much more time consuming to deny than just transport.

Personally as an educator I enjoy working with the people to get them to the proper services and providing patient education. But before you can even begin to start denying you need to have set up committes that include the various organizations in your area to include clinics and social services, amoungst others. You need to have complete information about what each does. Then you need continueing meetings following the start of this to continue improving the process. Honestly you need a year or more to be prepared to implement such a protocol. Then you also have to honestly decide what consequences are for any Paramedic that abuses the arrangement, which should be termination.

In the future as EMS as gets true education this will be part of all Paramedics job descriptions but at this time most are not ready.