Discouraging frivalous calls

[mycrofft]

DrP has it. CLose the thread.

 

[AnthonyM83]

Dr. P,

Around here, that quick assessment and a transport for a those kinds of chief complaints often mean a 2-4 hour wait (as a range...it's often more and sometimes less). That's a lot of resources being moved around when you get a few of those. I might sometimes spend 8-10 hours out of a 24 hour shift standing/crouching/leaning against the ER hallway wall waiting for an available bed. After these days, I usually have back pain and spasms the next day. There's the very real issue of fatigue as well. Overall quality of medicine and customer service goes down sometimes unfortunately :-/ Sometimes society or local government might decide their resources are more important elsewhere and some part of the system suffers (be it EMT/Medics or critical patients or stable non-emergency patients).


Good read: - Los Angeles Times article on 911 abuse
http://articles.latimes.com/2012/may/14/local/la-me-911-changes-20120515

 

[Veneficus]

Dr. P,

Around here, that quick assessment and a transport for a those kinds of chief complaints often mean a 2-4 hour wait (as a range...it's often more and sometimes less). That's a lot of resources being moved around when you get a few of those. I might sometimes spend 8-10 hours out of a 24 hour shift standing/crouching/leaning against the ER hallway wall waiting for an available bed. After these days, I usually have back pain and spasms the next day. There's the very real issue of fatigue as well. Overall quality of medicine and customer service goes down sometimes unfortunately :-/ Sometimes society or local government might decide their resources are more important elsewhere and some part of the system suffers (be it EMT/Medics or critical patients or stable non-emergency patients).


Good read: - Los Angeles Times article on 911 abuse
http://articles.latimes.com/2012/may/14/local/la-me-911-changes-20120515

I think what you have unfortunately discovered is that the whole idea of transporting everyone who calls for an ambulance doesn't work.

It may have been a good idea in the 60s and 70s maybe even the early 80s. But by the 90s it became obvious that as the knowledge of society became more hyperspecialized, that transporting everyone for eval at the ED was a strain.

Some 20 years later, rather than find medical aid for those without basic access or understanding of common afflictions and treatments, ideas like discouraging calls does not solve the problem.

Call volumes will continue to increase and you pack pack waiting rooms in EDs, have a line of paramedics holding the wall, but until the issue of primary care that is both available (doesn't force people to take time off of work to go or 30 days to make an appointment) and affordable (doesn't cost $100+ dollars a visit) then you are in a viscious cycle.

Call it BLS, ALS, or whatever you like, the US form of EMS just doesn't work anymore.

 

[AnthonyM83]

I agree that this form of EMS no longer works, but wondering why you think PSA's discouraging calls for non-emergency complaints does not work. It seems like it's a mindset that might be changed.

It would be different if people were calling the ambulance simply because of lack of options (which is a certain amount), but in my area for example, there are urgent cares and clinics left and right. Many patients have families with cars.

But I said patients directly tell me they choose the ambulance because taxis cost money and ambulance companies don't come after them for the bill (because they don't much), that they get into the ER faster (and that they know it's not true when we tell them it's the same wait), or that MediCare/MediCal pays for it, so why not use it?

Then there's another subpopulation that simply doesn't know what ambulances are for. It seems to almost be a cultural thing. She has the flu, well call an ambulance. Those are usually responsive to teaching moments...but dependent on the EMS personnel in charge to do so. In areas like many/most parts of LA, the FD contracts out private ambulances, so doesn't have to go along with BLS patients, so they actually encourage many patients to go (not all, but most).

I guess for all those reasons combined with limited resources local governments have (reference previous post), I think the PSA's are a reasonable idea. There are M.D.'s and public health personnel backing these PSA campaigns too, so I don't think they were rash decisions. The system might have simply decided to assume the very low risk of some people not calling when they need to call. But it was done consciously...just as every society chooses what health/safety checks they can take on...


Respectfully,

Anthony

 

[Veneficus]

I agree that this form of EMS no longer works, but wondering why you think PSA's discouraging calls for non-emergency complaints does not work. It seems like it's a mindset that might be changed.

Like I said, it doesn't discourage the patients you want to discourage. It is most likely to stop the 55 year old guy who needs an excuse not to call for his "indigestion", or the 80 year old lady who doesn't think she has a "real" emergency.

It is my understanding (read a study somewhere, don't remember where) that showed most people transported by EMS actualy need medical care (if I recall it was close to 80%, but you must forgive me, it was ages ago and I really can't remember where it was)

I also remember it showing that the care they needed was not the ED, but general medicine.

Most PCPs want either copay or payment up front, which is a problem for most fixed income (retirement, disability, welfare). It is also a problem for people who live pay cheque to pay cheque.

It would be different if people were calling the ambulance simply because of lack of options (which is a certain amount), but in my area for example, there are urgent cares and clinics left and right. Many patients have families with cars.

As above, if you can't pay, it is not an option. It is rather easy to run up a bill in an urgent care. Not as easy or as high as an ED usually, but still out of most peoples' price range.

Getting a bill you will not pay or make payments on later is the goal of many.

But I said patients directly tell me they choose the ambulance because taxis cost money and ambulance companies don't come after them for the bill (because they don't much), that they get into the ER faster (and that they know it's not true when we tell them it's the same wait), or that MediCare/MediCal pays for it, so why not use it?

They have told me the same thing too. The first part is exactly my point, the second part is where education comes into play. Education is not a billboard or PSA, it is one on one or community centers, or back to work training, etc. The PSA is simply self serving propaganda.

Villifying people who need assistance.

The problem with making calling an ambulance socially unacceptable is that it doesn't work on a target population, it works on all populations.

Then there's another subpopulation that simply doesn't know what ambulances are for. It seems to almost be a cultural thing. She has the flu, well call an ambulance. Those are usually responsive to teaching moments...but dependent on the EMS personnel in charge to do so. In areas like many/most parts of LA, the FD contracts out private ambulances, so doesn't have to go along with BLS patients, so they actually encourage many patients to go (not all, but most).

This is exactly why the current EMS system in the US needs to advance. You have to remeber to see things from the other side. When my family gets sick, I can handle it rather fast and efficently. But what if I didn't know anything about medicine?

Seeing my daughter suffer or wondering if it could be more seruious (especially when the tv plays unreal medical dramas ad the news constantly talking about somebody who died of meningitis with flu like symptoms), wondering if a cut does need stitches, all of these things contribute.

It is a call for help.

I guess for all those reasons combined with limited resources local governments have (reference previous post), I think the PSA's are a reasonable idea. There are M.D.'s and public health personnel backing these PSA campaigns too, so I don't think they were rash decisions. The system might have simply decided to assume the very low risk of some people not calling when they need to call. But it was done consciously...just as every society chooses what health/safety checks they can take on...

Trying to fix a broken system by having people not use it is not going to save resources. It just means you will need more resources later on when they are sick.

I have no doubt there are MDs and public health officials who believe what they are saying. (I watched as news clip of Ron Paul say churches, not the government, should pay for charity care while the audience chanted "let them die")

You can even find MDs who will give you propofol at home.

I know several doctors (all EMs) who think just like paramedics, thta if you are not dying you shouldn't show up in the ED for your petty problems.

A medical degree does not confer empathy, benevolence, or understanding of social issues.

Maybe instead of PSAs they could put on some classes in high school about common maladies and what to do for them? That way you educate and effect generaltional change.

Would those same MDs put their money where their mouth is and take on the liability and spend the time teaching?

If you think of the US, not as the the leader of 1st world nations, but see what it really is, a middle and upper class so removed from the realities of sustenance living, they don't believe poverty or need exists. Go to websites like remote area medical, or free clinics, etc. Watch people drive 300 miles and wait in line for days to have their teeth pulled or a mamogram.

If you went to a poor nation in Africa, East Asia, India, European gypsies, war refugees, etc you would find deficencies in knowledge in basic health and hygeine, with the need for self reliant medical care and knowledge. Those same conditions exist in every state in the union.

Telling people that don't understand or have access to alternatives is the exact same as telling people in a 3rd world country not to drink the pond water they bathe and toilet in because they might get sick.

When it is the only game in town, a lecture from those better off is not helping, it is just degrading and demonstrates the ignorance of the reality they live in.

 

[the_negro_puppy]

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.

This is the easy way out. Unnecessary transport of patients to hospital places strain on both EMS and Emergency Departments. As clinicians the answer to every problem shouldn't be "transport to hospital'. Transporting everyone to an emergency department regardless of the nature of their problem encourages EMS abuse, increases response time pain, suffering, morbidity and mortality for the smaller number of patients who actually need EMS interventions.

On the topic of frivolous calls, they keep us in business..... 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.

I call it a waste of taxpayers money. Here our state Ambulance service is funded through taxes. No bills are given to State residents for treatment or transport. If the state (and thus the populace) has decided Ambulances and 000 (911) are for emergencies then the State is fully justified in discouraging people from non-emergencies from calling. In a utopian society there would be plenty of ambulances, medical staff and hospital beds to deal with all of society and its problems. We don't live in a utopia. I feel bad for lonely people, homeless, narcotic abusers and others.

I know it is heavily cliche but I wonder how some members here would feel if they or a family member or friend was suffering from an emergent medical condition or injury and had to wait/couldn't get an Ambulance because all the units were too busy playing social worker/ counsellor or taxi driver?

 

[the_negro_puppy]

Most PCPs want either copay or payment up front, which is a problem for most fixed income (retirement, disability, welfare). It is also a problem for people who live pay cheque to pay cheque.

Here in Aussie land low income earners are given 'health care cards' entitling them to no out of pocket expenses at many many PCP/GPs

The problem with making calling an ambulance socially unacceptable is that it doesn't work on a target population, it works on all populations.

We have simultaneous advertisements sometimes run here. Ones discouraging frivolous calls, and other pointing out signs and symptoms of M.Is and what to do (including calling an ambulance)

 

[Veneficus]

Here in Aussie land low income earners are given 'health care cards' entitling them to no out of pocket expenses at many many PCP/GPs

Where I am from in the states, there are a lot of working poor. They cannot miss a day of work to make a 9-3 appointment and certainly cannot afford to miss the wages of a day of work and pay the average of $120 for the doctor. (which is more than they make in a day)

They earn "too much" for government aid. Consequently, in many cases, it is actually more economically beneficial for them to die than to call an ambulance or go to the hospital.

So is "the greatest nation in the world."

Where I live in Europe, "insurance" is paid either by the government, private employer, or private pay. The prices (and therefore costs) are reasonable.

Even on the most basic plans, a PCP visit can be walk in, which usually results in a wait of about 1/2 hour before being seen and costs nothing out of pocket.

After working hours you can go to the urgent care or if you cannot make it yourself, call them and they will send a nonemergent ambulance out to you with a doctor on it.

It also costs nothing out of pocket.

It saves the issue of emergency ablulance usage and ED over crowding. (not to mention the outrageous cost of the ED)

Funded through VAT, but keeps people working.

Keeping people working while containing costs. Not a perfect system, but usually takes a good direction.

 

[the_negro_puppy]

Heres a new video from the UK

http://firstrespondersnetwork.com/videos/999-ambulance-abuse/