EMS and 911 System
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The pt goes to the most appropriate hospital for their condition. So it depends on the pt and what is going on. If it doesn't really matter it is pts choice..... within reason.
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Sometimes pts will ask advice on which hospital to go to and we make a recomendation based on the complaint, workload and wait times . We are not contracted by hospitals or anything like that. That Said if a pt requires a speciality center, cath lab, trauma center etc ..... That is where they go.
EpiEMS
Forum Deputy Chief
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Do you feel that you might have more impact given the single-payer system in Canada?
DesertMedic66
Forum Troll
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We have 3 hospital in my area that we will transport patients to. All of them are STEMI and stroke centers. Only one is a trauma center and one will not take OB patients.
The main issue with patients that we have is they want a further away hospital when they are not in good shape.
After talking to the patient and family the patient has always decided to go with what we want.
We've had patients that want to be transported to a hospital that is 60+ miles away. Not going to happen in our system. The only time we trans that far away is for IFT transfers and our closest burn center is about 50-150 miles away depending where we are at in our response area.
The main issue with patients that we have is they want a further away hospital when they are not in good shape.
After talking to the patient and family the patient has always decided to go with what we want.
We've had patients that want to be transported to a hospital that is 60+ miles away. Not going to happen in our system. The only time we trans that far away is for IFT transfers and our closest burn center is about 50-150 miles away depending where we are at in our response area.
While we always try to follow the patient's preference for the hospital they want to go to, we often give advice. For example, we are roughly equidistant from 2 hospitals (roughly 10-15 min. transport). However one is generally considered to be a better hospital and most patients request transport there, and if we are asked, we generally recommend this one unless we know there is a long wait or we are closer to the other hospital and the patient has a minor illness/injury. 90% of ALS calls go to the better facility regardless of patient choice. All psych patients go to the other one. ETOH patients go there or to a small community hospital about 15 minutes away. Occasionally a patient will request to go to the VA hospital or another larger hospital - 15-20 minute transport time. The level 1 trauma center is also about 15 minutes away.
Rarely, we transport to 3 other hospitals, all about 25-30 minutes away. The only time we go to these facilities is when the patient vitally needs transport and will RMA unless transported to one of these hospitals. This also generally requires approval from our chief.
Rarely, we transport to 3 other hospitals, all about 25-30 minutes away. The only time we go to these facilities is when the patient vitally needs transport and will RMA unless transported to one of these hospitals. This also generally requires approval from our chief.
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Working in Boston, I generally let the patient choose so long as we do not have to take them emergent due to something significant. All the big hospitals are Level 1s (I think one might be a 2 but still) and if the patient is not in immediate duress I have no problem transporting to one ten minutes farther away if that's what they want.
Some patients want to go to the VA hospital which has an ED, if the patient is serious we try not to take them there as the ED is tiny and we'll just have to transfer them later.
The company has a big sign in dispatch that says "The answer is yes." I try to help out my patients in any way possible and the company does not get angry when you add transport time to satisfy the patient's wishes.
Some patients want to go to the VA hospital which has an ED, if the patient is serious we try not to take them there as the ED is tiny and we'll just have to transfer them later.
The company has a big sign in dispatch that says "The answer is yes." I try to help out my patients in any way possible and the company does not get angry when you add transport time to satisfy the patient's wishes.
JDub
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We have only two different ER's that we can transport to and they are about 3 minutes apart from each other. The only difference between them is that one is a trauma center. So for most calls, it is completely up to the patient.
I have one exception though.
/rant
Technically it is in our protocols that we must transport all trauma to the trauma center, however most crews will ignore that rule if they feel that the traumatic injuries are so minor that it won't matter.
It irritates me to no end when someone is involved in a minor MVC and insists on going to the non-trauma center for whatever reason. If you are a trauma patient, you are going to the trauma center, no questions asked if you are my patient. I don't care if it was fender bender and I am positive you have no injuries, if you insist on going to the hospital then I am going to insist you go to the appropriate facility. If you feel that your injuries are so minor that you don't need a trauma facility, then you most likely don't need an ambulance to take you there.
/rant
I have one exception though.
/rant
Technically it is in our protocols that we must transport all trauma to the trauma center, however most crews will ignore that rule if they feel that the traumatic injuries are so minor that it won't matter.
It irritates me to no end when someone is involved in a minor MVC and insists on going to the non-trauma center for whatever reason. If you are a trauma patient, you are going to the trauma center, no questions asked if you are my patient. I don't care if it was fender bender and I am positive you have no injuries, if you insist on going to the hospital then I am going to insist you go to the appropriate facility. If you feel that your injuries are so minor that you don't need a trauma facility, then you most likely don't need an ambulance to take you there.
/rant
JPINFV
Gadfly
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bigbaldguy
Former medic seven years 911 service in houston
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In general I think most medics have a considerable amount of influence over where the patient goes. I find it a bit odd that hospitals are allowed to offer free food, drinks, ect. to EMS when doctors can't even take a free pen.
JPINFV
Gadfly
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There's no stigma attached to ambulance service like there is with pharmaceuticals.
bigbaldguy
Former medic seven years 911 service in houston
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If they only knew
The freebies ban extends to equipment and services as well doesn't it? I know I have a friend who's a dentist and he can't take free toothbrushes ect.
We take the patient to the most appropriate facility. But we can also recommend which hospital they go to.
For example, Harborview is the only Level 1 Trauma Center in 4 states. However, it is also the only public hospital in the region. Therefore almost all homeless and indigent people are taken there.
Patient condition will dictate where we go as first priority. After that patient discretion / want dictates where we go. 9 times out of 10 they will go where I recommend.
For example, Harborview is the only Level 1 Trauma Center in 4 states. However, it is also the only public hospital in the region. Therefore almost all homeless and indigent people are taken there.
Patient condition will dictate where we go as first priority. After that patient discretion / want dictates where we go. 9 times out of 10 they will go where I recommend.
JDub
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I feel the difference would be that pharmaceutical companies would sway an MD into prescribing or not prescribing drugs that could dramatically affect a patient's health.
Ignoring calls requiring specialty centers, does it really matter which ER the patient goes to? For the most part they will be getting the exact same care.
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On a daily basis. Whether it be for specialty services ie trauma, cath, stroke center or due to hospital diversion (closed, ER capacity, internal disaster, critical care) type situations.
Patient goes where they want unless they need something special or their choice of hospital doesn't have space and even then they can technically still go she they want but it requires some hoop jumping on my part.
No preference in hospital then we abide by pre-established catchment zones to determine the patient's destination.
Patient goes where they want unless they need something special or their choice of hospital doesn't have space and even then they can technically still go she they want but it requires some hoop jumping on my part.
No preference in hospital then we abide by pre-established catchment zones to determine the patient's destination.
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bigbaldguy
Former medic seven years 911 service in houston
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Usually perhaps but there are exceptions. My father because of local protocols had to be taken to a hospital with a very poor ER record. One which he didnt want to go to. They sent him home after a fall and he went to a different hospital 3 days later after he developed nausea and vomiting he died a month later due to complications from the bleed they missed at the first hospital. Would he have had a better outcome at a different hospital? Probably not due to his age but the first hospital still missed the bleed and this wasn't an isolated incident. Hospitals are like anything else soe are better than others. Just because hospital A has the same equipment as hospital B we shouldn't automatically assume the care is identical as well.
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I'm not sure that this still exists, it's not in the actual protocol book nor have I ever heard of that.
Most of the time there's at least two within ten minutes drive, but the patient always seems to want to go crosstown at rush hour. Oh well, to the Faulkner we will go from southie.