Discouraging frivalous calls

[the_negro_puppy]

Curious to see if any Ambulance services/companies around the world take active steps to discourage frivolous calls/ educate about what 911/000/999 is for?

Here's a recent vid from a neighbouring states service
http://www.youtube.com/watch?v=8zLAI7Rr-m4

Here's a poster from an older campaign my service has run in the past

 

[Veneficus]

I think that is an extremely bad idea al around.

People call for help, because they need help. They may not need a paramedic, or a firefighter, or a police officer, but for time immemorial these public servants have always helped.

It is only within the past 15 or so years that they started seeing themselves more as role specific than servants of those in need.

We watch every day people who are afraid to help others because they worry about messing up or making things worse. How do Fire, EMS, Police professionals suddenly decide who is worthy or not of their help?

Calling for help is one of the hardest things people do. Discouraging a call for help is about the most inhumane thing I can think of.

Ads like these do not affect the frequent flyers, because they have nobody else to call.

They do affect the people who usually put others above themselves. (Like many in the older generation, military vets, etc.)

From a medical standpoint we know many life threatening conditions are insideous. MI, Stroke, and Aneurysm, are also time dependant.

You cannot say on one hand "if you think you are having a heart attack or stroke call early and call often", and on the other tell people not to call unless it is critical, serious, or whatever.

People who come up with this crap have no business in public safety or medicine.

They should be relegated to a job where the only people who can be hurt by their hubris, ignorance, lack of empathy, and self importance, are themselves.

F****** morons.

 

[frdude1000]

I think that is an extremely bad idea al around.

People call for help, because they need help. They may not need a paramedic, or a firefighter, or a police officer, but for time immemorial these public servants have always helped.

It is only within the past 15 or so years that they started seeing themselves more as role specific than servants of those in need.

We watch every day people who are afraid to help others because they worry about messing up or making things worse. How do Fire, EMS, Police professionals suddenly decide who is worthy or not of their help?

Calling for help is one of the hardest things people do. Discouraging a call for help is about the most inhumane thing I can think of.

Ads like these do not affect the frequent flyers, because they have nobody else to call.

They do affect the people who usually put others above themselves. (Like many in the older generation, military vets, etc.)

From a medical standpoint we know many life threatening conditions are insideous. MI, Stroke, and Aneurysm, are also time dependant.

You cannot say on one hand "if you think you are having a heart attack or stroke call early and call often", and on the other tell people not to call unless it is critical, serious, or whatever.

People who come up with this crap have no business in public safety or medicine.

They should be relegated to a job where the only people who can be hurt by their hubris, ignorance, lack of empathy, and self importance, are themselves.

F****** morons.

Take a chill pill man...:wacko:

 

[johnrsemt]

When a person calls 911 over 400 times in the first 180 days of the year it is BS and frivolous. It should be discouraged.
We had one in Indianapolis that had severe pancreatitis that was well controlled with meds; until he drank. I worked his area for 24 hrs in one shift and took him to the hospital 5 times in 24 hrs.
Finally Medical director and his doctor sat down together and worked it out that if he had the least amount of alcohol in his system he would go to jail not hospital.
It took two years to get it to happen but he stopped calling.

Another patient wasn't as often; but he would go to ED for Pneumonia, get an antibiotic shot and script. go home without getting script filled and call 911 to go back to ED cause he wasn't feeling better 2 hours after leaving the ED. He would do similar things 2-3 times a month. When he was Dx'd with pneumonia he went to the ED 29 times in 4 days, before he started feeling better. He was a professional type person with good insurance and a masters degree. SHould have known better

 

[mycrofft]

The Super Frequent Fliers

Such cases need addressing. The ER's plan (we call that a case conference, and they do not take place often enough for my taste) to coordinate the response to that one alcoholic was great. Don't know about now but our local ER's long ago each informally kept a "turkey file" on 3X5 cards; if one ER bounced a regular or a faker (GOMER...get out of my emergency room), they alert some of the others. The was after assessment, triage, and never involved the doc...and potentially very hazardous because ignorant, inebriated or mentally ill pts cannot be trusted to self-diagnot the seriousness of their situation.
Argues for a tiered response with more power to the very first responder (public health nurse, PA, or super-qualified* tech of some sort) to call for backup, call off response, and maybe even set an appointment at a clinic or start a treatment or medication from a set of standardized procedures.

The courts could be called in on this one too. (Sorry, Your Honors!). 911 or 000 abuse = psych and drug/alcohol eval, 48 hrs observation, a fine to cover costs, then three outcomes: it was sincere but due to ignorance (stern warning and required to have medical followup); it was due to inebriation (furnish proof of having completed a detox regimen and being engaged in a support program afterwards); it wear due to mental illness (treat pt as any other troublesome person with mental illness would be).




*"super-qualified": being certified within a branch of prehospital or hospital medicine but with extra (hence "super") certification in public health, the standardized procedures, and the administrative/professional/ethical/legal niceties.

 

[MSDeltaFlt]

Curious to see if any Ambulance services/companies around the world take active steps to discourage frivolous calls/ educate about what 911/000/999 is for?

Here's a recent vid from a neighbouring states service
http://www.youtube.com/watch?v=8zLAI7Rr-m4

Here's a poster from an older campaign my service has run in the past

I think that is an extremely bad idea al around.

People call for help, because they need help. They may not need a paramedic, or a firefighter, or a police officer, but for time immemorial these public servants have always helped.

It is only within the past 15 or so years that they started seeing themselves more as role specific than servants of those in need.

We watch every day people who are afraid to help others because they worry about messing up or making things worse. How do Fire, EMS, Police professionals suddenly decide who is worthy or not of their help?

Calling for help is one of the hardest things people do. Discouraging a call for help is about the most inhumane thing I can think of.

Ads like these do not affect the frequent flyers, because they have nobody else to call.

They do affect the people who usually put others above themselves. (Like many in the older generation, military vets, etc.)

From a medical standpoint we know many life threatening conditions are insideous. MI, Stroke, and Aneurysm, are also time dependant.

You cannot say on one hand "if you think you are having a heart attack or stroke call early and call often", and on the other tell people not to call unless it is critical, serious, or whatever.

People who come up with this crap have no business in public safety or medicine.

They should be relegated to a job where the only people who can be hurt by their hubris, ignorance, lack of empathy, and self importance, are themselves.

F****** morons.

I believe there are some services here in the U.S. that are working towards that end. And while Veneficus may have a point, I believe it is only "a" point.

We should have a more tiered response to include non emergency paramedic services specifically for those calls that are not emergency calls. Get the CD9 codes to bill for a treat and street, or even transport to the clinic instead of ER.

Hell even make it a tiered response to have a paramedic sprint. Most rural services have too many medics. Go back to sprinting.

But the biggest obstacle there is here is education. And these ads are doing just that. There are times where there is an emergency. There are times where there isn't one. The problem is knowing the difference. It all boils down to being about a man and a fish. Give a man a fish and he'll eat for a day. Teach a man to fish and he'll eat for a lifetime.

 

[mycrofft]

...and give a man fourteen fishing poles and he will wear out the EMS/911-000 system.

Or is the "fishing with a hand grenade" aphorism a better metaphor?

Rural EMS often has "too many medics" because they are concentrated around the towns and volunteer.

 

[Sasha]

When a person calls 911 over 400 times in the first 180 days of the year it is BS and frivolous. It should be discouraged.
We had one in Indianapolis that had severe pancreatitis that was well controlled with meds; until he drank. I worked his area for 24 hrs in one shift and took him to the hospital 5 times in 24 hrs.
Finally Medical director and his doctor sat down together and worked it out that if he had the least amount of alcohol in his system he would go to jail not hospital.
It took two years to get it to happen but he stopped calling.

Another patient wasn't as often; but he would go to ED for Pneumonia, get an antibiotic shot and script. go home without getting script filled and call 911 to go back to ED cause he wasn't feeling better 2 hours after leaving the ED. He would do similar things 2-3 times a month. When he was Dx'd with pneumonia he went to the ED 29 times in 4 days, before he started feeling better. He was a professional type person with good insurance and a masters degree. SHould have known better

Those patients aren't going to be the ones who see billboards or ads like those and stop calling.

The ones who are, are going to be grandma with tummy pain who doesn't feel quite right but needs to get to the ER because she's having an MI.

 

[NYMedic828]

Half my patients think I am automatically a racist because I happen to be a white person with a uniform.

God forbid I told them they don't need to call an ambulance...

(mind you I act professional and to polite to everyone, always.)

 

[the_negro_puppy]

I think that is an extremely bad idea al around.

People call for help, because they need help. They may not need a paramedic, or a firefighter, or a police officer, but for time immemorial these public servants have always helped.

It is only within the past 15 or so years that they started seeing themselves more as role specific than servants of those in need.

We watch every day people who are afraid to help others because they worry about messing up or making things worse. How do Fire, EMS, Police professionals suddenly decide who is worthy or not of their help?

Calling for help is one of the hardest things people do. Discouraging a call for help is about the most inhumane thing I can think of.

Ads like these do not affect the frequent flyers, because they have nobody else to call.

They do affect the people who usually put others above themselves. (Like many in the older generation, military vets, etc.)

From a medical standpoint we know many life threatening conditions are insideous. MI, Stroke, and Aneurysm, are also time dependant.

You cannot say on one hand "if you think you are having a heart attack or stroke call early and call often", and on the other tell people not to call unless it is critical, serious, or whatever.

People who come up with this crap have no business in public safety or medicine.

They should be relegated to a job where the only people who can be hurt by their hubris, ignorance, lack of empathy, and self importance, are themselves.

F****** morons.

I'm not necessarily talking about frequent fliers, but those calling for minor ailments/ taxi rides.

I do agree with your view that we need to be careful in discouraging people from calling, and yes, from these campaigns, people might not call when they need us. However, far more people here are being put at risk from frivolous calls. Most of our calls are non acute taking ambulances off road, out of service and even ramped at hospitals. This reduces response time and people actually suffering from life threatening injury and illness are seeing higher morbidity and mortality as a result of resources being wasted. Here ambulances rides and treatment are free. By your logic, they should also be free in the U.S so the bill doesn't discourage people from calling.

I understand people need help and are sometimes not sure what to do. But there are a variety of resources available for help, non emergent phone numbers (13HEALH) that triage to ambulance if required. Bulk billing (free) and after hours GPs, (family doctors) that come to you. Instead some people take the lazy route and dial for an emergency ambulance. Its all nice and idealistic to say that emergency services exist to help anyone in any sort of need, its just not practical.

 

[Veneficus]

This reduces response time and people actually suffering from life threatening injury and illness are seeing higher morbidity and mortality as a result of resources being wasted.

??? How many of your calls are actuall life threatening?

If we only sent ambulances to live and death emergencies there would be far fewer need of ambulances and the crews that staff them.

Of these life and death calls, how many will actually be altered by EMS treatment?

Here ambulances rides and treatment are free. By your logic, they should also be free in the U.S so the bill doesn't discourage people from calling..

Yes, that is my logic. It is interesting to note that for more almost 10 years of my career, municiple fire based EMS did not bill people. A few years later they only soft billed non-residents. Now it is unheard of not to get a bill.

I understand people need help and are sometimes not sure what to do. But there are a variety of resources available for help, non emergent phone numbers (13HEALH) that triage to ambulance if required. Bulk billing (free) and after hours GPs, (family doctors) that come to you. Instead some people take the lazy route and dial for an emergency ambulance. Its all nice and idealistic to say that emergency services exist to help anyone in any sort of need, its just not practical.

I stand by my earlier statement, the people who will be dissuaded from calling are not the people who use the system the most.

 

[AnthonyM83]

I disagree that calling for help is one of the hardest things people have to do. You can see when you arrive whether the family/patient thinks it's an emergency and if not one, you can see when they're embarrassed that they had to call you out anyway because it was last resort.

Around my specific work area, people specifically call and (state it it outright) in order to bypass ER lobby waiting times or their insurance provides it for free (versus a taxi that would cost $20) or they know they won't be made to pay. This isn't just some of our patients, rather a very large number of patients.

I don't think examples of common frivolous calls is necessary in this post, but when it gets to the point of even non-medical events like wanting a ride home from the club...it seems some education is in order.

It comes a point where the system might not be able to handle it. Society needs to figure out a way to make their cities work. Think this an attempt at that. 911 calls use up resources (not just momentary ambulance out of service, but gas, wear/tear, overtime, heck even emotional interest in the job and your next patient) and has risks when on the road going to the call. Not every city has the money to put into the frivolous calls...or desire to.

While you may believe that people pushing these videos have no business in the field, many of those people are your peers doing the job you want to do (doctor) for many years. Don't dismiss them that easily....

 

[Shishkabob]

Vene, I full heartedly disagree.


The issue is that we don't really try to educate people on the matter for fear of getting in trouble. For some reason, it's seen as bad to tell someone "This is not what 911 is intended for". Typically I'll bite my tongue, but there are some patients who I have no issue at all with getting the point across, brashly or nicely.

I will ask a patient why they waited so long to get an issue checked out. I'll ask them what they would like me to do, as in "So would you like us to take you to the hospital?" as I've figured out that when you ask something as that, people will then have a light go off in their head "Oh, maybe this wasnt an emergency" then proceed to ask what their choices are to get their issue taken care of (which often are "We can take you in the ambulance, you can go in your own car, or you can set up an appointment with your primary physician")


-----------------------------------------
Yesterday, we had a patient call us for being sick for the last several weeks, no changes today to prompt the call. We were in the truck doing our usual thing before transport when he got irrate and said "Are we going to go to the hospital anytime soon?" My response: "Sir, did you want a taxi or an ambulance? If you wanted a taxi you called the wrong number. If you wanted an ambulance to get healthcare, then you need to let me do my job". He apologized.

We transported a patient to the ER for 'chest pain' (attributed to her shingles) that was treated 4 days prior, and today she wanted to go to a different ER. We abided and took her. The ER sent her to triage and told her it'd be a 7 hour wait. She called 911 again, while we were still in the ambulance bay, complaining of chest pain. She goes outside to wait (This is a level 1 trauma center, BTW) and when we hear the call go out, we jump on it. When we drove up to the front door and she saw us get out, her demeanor changed. I made it QUITE clear that 911 is not a taxi, and you cannot call 911 just because she didn't want to wait. We ended up contacting our supervisor and transported her to the next ER a mile down the road, and before leaving her in THEIR triage to wait even longer (charge nurses choice), I asked "And are you going to call 911 again when you get tired of waiting?"


Yet another call for a patient who was eating Pringles earlier in the day and got a crumb stuck between her tooth and gum, and waited 9 hours before calling 911 (and berating us for arriving with our lights and sirens off). No doubt a potentially painful issue. However, an ambulance is not needed in any way, shape, or form, and most ERs do nothing for oral complaints beyond non-narcotic analgesics.



Anyone working any length of time in EMS can come up with similar stories.
----------------------------------------------------


I have no issue with Paramedics and ambulances being used for basic health issues that need to be discussed or checked out, hence the idea of Community Paramedicine. My issue is people calling 911 for minor complaints that are most often not even treated in the ER, then expecting/demanding an ambulance as if it's some kind of God given right that cannot be denied, then they get angry when A) You don't show up lights and sirens, and B ) they get a bill because Medicare deems it not an emergency and as such not payable on their behalf.

Is it ok to call 911 because you locked yourself out of your house? What about your football getting stuck in a tree? Then why is it ok to call because your leg has hurt for the past 3 weeks, and then your family follows you in a car to the hospital where the only thing done inside the ambulance is a staring contest that I always win?

An emergency is defined as "an unforeseen combination of circumstances or the resulting state that calls for immediate action". IMMEDIATE action. A complaint going several days or weeks without an exacerbation of symptoms is therefor not an emergency.

Patients do NOT define the emergency, and that fallacy needs to be taken out of the vocab of some EMS personnel. People define why they call 911. The emergency is defined as those trained and educated in said 'emergency'.




Depending on where you look, about 10% of our calls are 'life or death', another 40% are 'life or limb threatening'. The other 50 % needs to take a taxi. Just because there are legit medical complaints does not mean they need nor benefit from ambulance transport.

 

[mycrofft]

Well put.
==============
How about they can't afford a taxi and taxi drivers won't be as kind as an ambulance crew when no money is forthcoming?
Or they feel they "deserve the same" treatment as "other folks"?

Sort of reminds me of a joke...no not here.

 

[mycrofft]

Grnad Aide program reduces demand for primary care assets

http://www.medscape.com/viewarticle/763533?src=mp&spon=38

Presumably ambulances too.

 

[Irish42]

Here's one - I was on a run once for a female with chest pains and trouble breathing. We get there and she showed no obvious signs of Medical distress. Turned out that she was a drunk and her "friends" thought we would transport her to a shelter, because "thats what we do" apperently.
I gave my Ambulence Captin props for not freaking out. One of the stuff the patients and her friends were saying was rediculous.

 

[DrankTheKoolaid]

re

We have had multiple patients over the years that were absolute system abusers. Once it passes a certain point the powers that be got together as a team and tried to approach it from a multi-discipline approach. When that didnt discourage the abuse and since these patients were (you guessed it) Medicare/Medical the cases were referred to them and the patient simply stopped calling 911 except for true emergencies.

Medicare/Medical simply threatened them with losing the benefit altogether due to the abuse. That behavior has not happened since

 

[Cmidfield14]

Generally speaking, if my partner and I are pretty sure they will be going to triage, we will let them know. If they understand and still want to go via ambulance, I make them sign, let them know about the incoming bill, and buckle them up. I would rather be sleeping.

Now maybe if I wasn't on my 22nd hour of my 15+ call shift I would attempt to educate... But you can't usually educate a lifetime of ignorance in one Ems call, much less deductive reasoning.

 

[epipusher]

A slippery slope to say the least.

 

[DrParasite]

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.

EMS is not the gatekeepers to the ER. more BS walks into triage than EMS brings in. And yes, i have received 911 calls form the ER waiting room, for people who are tired of waiting. Can't send an ambulance because it's an EMTALA violation, but they do happen. And I know of two hospitals in an urban area that will not send anyone who comes in by ambulances to triage, regardless of how frivolous the complaint is. Despite my suggestion that the patient is in better shape than I am.

The biggest system abuser I know of called 911 7 times in 6 hours. And he was transported by 6 separate crews, in a city that only has one dedicated BLS 911 unit. And every unit transported him to the ER.

On the topic of frivolous calls, they keep us in business. My current job gets about 70,000 EMS requests a year. Subtracting obvious death, ambulatory patients, M+T only calls where a car/taxi would do just as much to help the patient as an ambulance, non-dying patients who just can't sit in a car for any reason, calls where the patient RMAs without EMS doing anything, I would pick the actual number of non-frivolous calls at maybe 20,000? and that's high, it's probably between 5,000 and 10,000 every year.

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.