I need your hippa compliant case summaries

TernionEMSdoc

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Hey guys,

Need your help. Working on an ET3 project and I need as many hippa compliant cases and triages. I will be using the cases to help develop alternative transport sites protocols for patients that call 911. So of course the cases I need are cases that you felt could have or should have been treated some where other than an emergency department i.e. urgent care center, doctors office. As always please be hippa compliant with no patient identifiers.
 

DrParasite

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I'm sorry, but who are you?
What is this project for?
Have you reached out to your local EMS providers? What did they say?
Who is sponsoring this project? the EMS agency, 911 center, someone else?
Why don't you ask those in the system you will be implementing this for scenarios?
 

CCCSD

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Here:

I responded to an accident. I felt, as an EMT, that they were all faking their injuries, so I told them to go to their own Doctors or a clinic.
I instructed them NOT to call 911 as it would be a waste of services because somewhere, a really sick person might need help.
 

RocketMedic

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Doc, what specifically are you looking at? Lots of what could be alternatively handled is limited by what primary care will do.
 

DrParasite

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OK, I'll bite.....
The first question I would ask is what are the capabilities of the doctors office, the urgent care, compared to the ER? Is the standard of needing an ER to be admitted, where all treat and discharge means they can go elsewhere?

Case in point: was working an event, and had 4 guys carry this other guy to me, with an obviously deformed knee. looked dislocated. pain 12/10, he's in tears. isolated injury. should get go to the ER? I would have recommended it, but we took him to our first aid tent (staffed with doctors and nurses), the doc popped it back into place, and he was walking around with it braced up 3 hours later.

most external hemorrhages can be handled by doctors offices or urgent care.

most isolated traumas can as well, provided they have xrays available.

most sick person calls can get handled by a doctors office, unless there is a reason not do.

If an asthma attack is given albuterol, atrovent, and solumdrol by EMS, do they need to go to the ER, or can a doctor's office handle it?

if you have a hung over and hypertensive patient, who just needs fluids by IV, does that warrant an ER or a doctors office?

The vast majority of psych calls don't need an ER.

Majority of Omega coded ProQA calls don't need an ER; ditto many Alpha calls, and some bravos.

Are you looking to have EMS alternatively transport to the non-ERs, following a complete ALS or BLS assessment? or sending a taxi based on dispatch?
 

RocketMedic

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A really good place to start would be the NHS ambulance dispatch criteria from the UK.
 

TernionEMSdoc

Forum Probie
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I'm sorry, but who are you?
What is this project for?
Have you reached out to your local EMS providers? What did they say?
Who is sponsoring this project? the EMS agency, 911 center, someone else?
Why don't you ask those in the system you will be implementing this for scenarios?
[/QUO
Doc, what specifically are you looking at? Lots of what could be alternatively handled is limited by what primary care will do.
Just looking for real world call that anyone has recently transported that you thought could have been either treated on scene or transported to a place other than the ED without harm to the patient.
 

TernionEMSdoc

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Here:

I responded to an accident. I felt, as an EMT, that they were all faking their injuries, so I told them to go to their own Doctors or a clinic.
I instructed them NOT to call 911 as it would be a waste of services because somewhere, a really sick person might need help.
I get it, there are plenty of times that I have cared for pts and thought they had alternative motives rather than actual illness that brought them to the emergency department ...but unfortunately I personally can't practice medicine that way. Didnt your mother ever read you the story of the boy who cried wolf? there are two sides to that fable (of course the boy gets eaten....but noone ever talks about the men that didnt run to his aid that heard him screaming for help).

True story, a close friend had a frequent flyer in Houston, always complained of chest pain, always got transported to same hospital, always jumped ship at the door of the ed (Theory was she just wanted a ride across town). Fast forward to call number 13 for the year and it was only APRIL!! - CC: Chest pain, they turned the corner to the hospital - SHE CODES!!, and she had no line, no EKG, no monitoring.....and she died!!! My friend felt like crap and will always have to wonder if hadn't let her repeated misuse of the system cloud his treatment if she could have been save.
 

TernionEMSdoc

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OK, I'll bite.....
The first question I would ask is what are the capabilities of the doctors office, the urgent care, compared to the ER? Is the standard of needing an ER to be admitted, where all treat and discharge means they can go elsewhere?

Case in point: was working an event, and had 4 guys carry this other guy to me, with an obviously deformed knee. looked dislocated. pain 12/10, he's in tears. isolated injury. should get go to the ER? I would have recommended it, but we took him to our first aid tent (staffed with doctors and nurses), the doc popped it back into place, and he was walking around with it braced up 3 hours later.

most external hemorrhages can be handled by doctors offices or urgent care.

most isolated traumas can as well, provided they have xrays available.

most sick person calls can get handled by a doctors office, unless there is a reason not do.

If an asthma attack is given albuterol, atrovent, and solumdrol by EMS, do they need to go to the ER, or can a doctor's office handle it?

if you have a hung over and hypertensive patient, who just needs fluids by IV, does that warrant an ER or a doctors office?

The vast majority of psych calls don't need an ER.

Majority of Omega coded ProQA calls don't need an ER; ditto many Alpha calls, and some bravos.

Are you looking to have EMS alternatively transport to the non-ERs, following a complete ALS or BLS assessment? or sending a taxi based on dispatch?
So currently in the US most payers will only pay for an ambulance transport after a 911 call if you transport them to the ED.(*there are a few exceptions like a dialysis center). So if you only pay for transport to the ED where does everyone get transported?? I have been in medicine since 1998 and I had NO idea!!

- Patient refuses to go to the hospital - Payers don't pay
- Patient is treated on scene - That is care provided for FREE, cause Payers don't pay for that either
- Patient should be taken to a urgent care center or PCP's office - GREAT but again under current payer model - they don't pay for that.

Finally, CMS (medicare payer) is listening and are willing to trial a payment model that will reimburse for:

treatment on scene.
continued payment for transport to the ED.
transport to alternative sites i.e. pcp, behavioral health centers, and/or urgent care centers.

So Health Economics 101 - if medicare will reimburse for something usually other payers will follow suite. So the ET3 Model that is about to role out is a pilot program, meaning it is research to see if they can pay for all these alternative modality, not harm patients, and OF COURSE save money.
----

I'd love to discuss the options you listed above Dr.Parasite what role do you play in EMS so I can know how best we can discuss them.

Thanks


-
 

TernionEMSdoc

Forum Probie
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I'm sorry, but who are you?
What is this project for?
Have you reached out to your local EMS providers? What did they say?
Who is sponsoring this project? the EMS agency, 911 center, someone else?
Why don't you ask those in the system you will be implementing this for scenarios?
I am an emergency room physician - specializing in EMS

This is form my own personal growth but most likely I will share what make it open access for providers and services that are planning to participate in the ET3 Model.

I will be getting cases from my local providers as well, but ET3 model is going to be a national so I don't want to limit myself to just my local area.

ET3 model specifically is a cms innovation model that is through the US government - but the CMS payor's don't know all the logistics of how to make the model work so they will be looking to services and providers to come up with safe, sound, and cost effective model proposals.
 

CCCSD

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Some counties pay the ambulance service a fee for a response and refusal/no transport.

How can you call 911 and have it go to your MDs office? You aren’t on the list for the day.
Doc in the box? Please. The treatment there beyond band aid level is horrible. Besides, what do they know about emergency medicine..?
 

DesertMedic66

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Some counties pay the ambulance service a fee for a response and refusal/no transport.

How can you call 911 and have it go to your MDs office? You aren’t on the list for the day.
Doc in the box? Please. The treatment there beyond band aid level is horrible. Besides, what do they know about emergency medicine..?
Not all 911 calls require a doctor trained in emergency medicine. A lot of calls can be handled at an Urgent Care and some can be handled at a normal doctors office.
 

CCCSD

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You won’t get into a drs office, how can you justify bumping all the patients who have appointments?

Not all 911 calls require paramedics either. So why have them?
If they need @n ambulance, they can go to an ER.

It would be better served to have a Security Guard at triage, sending ALL non emergent patients to the doc in the box, instead of allowing them to flood the ER.
 

DesertMedic66

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You won’t get into a drs office, how can you justify bumping all the patients who have appointments?

Not all 911 calls require paramedics either. So why have them?
If they need @n ambulance, they can go to an ER.

It would be better served to have a Security Guard at triage, sending ALL non emergent patients to the doc in the box, instead of allowing them to flood the ER.
Not all 911 calls receive paramedics. EMD is a thing that is used all over the place. Minor complaints get a BLS unit at the most.

Think of it as an EMD system for our transport destinations. The truly sick will get sent to the ED where they can be appropriately treated. The kinda sick ones will get sent to an Urgent Care where they can be appropriately treated. The not sick ones can be sent to a contracted doctors office where they can be appropriately treated.

As many ED doctors will tell you they will discharge a patient with no treatments being done and say “follow up with your PCP”.

If every hospital was big enough and had enough staffing then sure every 911 call can be transported there and not cause overcrowding however that is not the reality. We have ambulances waiting on bed delay for hours upon hours for patients who can be treated elsewhere because everyone uses the ED as their PCP.
 

GMCmedic

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Not all 911 calls receive paramedics. EMD is a thing that is used all over the place. Minor complaints get a BLS unit at the most.

Think of it as an EMD system for our transport destinations. The truly sick will get sent to the ED where they can be appropriately treated. The kinda sick ones will get sent to an Urgent Care where they can be appropriately treated. The not sick ones can be sent to a contracted doctors office where they can be appropriately treated.

As many ED doctors will tell you they will discharge a patient with no treatments being done and say “follow up with your PCP”.

If every hospital was big enough and had enough staffing then sure every 911 call can be transported there and not cause overcrowding however that is not the reality. We have ambulances waiting on bed delay for hours upon hours for patients who can be treated elsewhere because everyone uses the ED as their PCP.
I think you're wasting your breath just as much as he is.

I've told new people for years, that without the BS calls, most of us would be out of a job. Not every city needs community paramedicine, but this is exactly how EMS as a whole protects their jobs while simultaneously helping with ED overload. Not much different than how nursing has protected their jobs by protecting their scope of practice.
 
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