Is starting an unnecessary IV fraud?

[AeroClinician]

like your nausea vomiting patient is technically BLS but can benefit if administered Zofran

Technically? Really.

More like nausea/vomiting is without a doubt ALS, and needs full ALS exam including 12-lead if not 15-lead assesment, with an IV! Fluids/Zofran as well.

I see that your a student, so I don't fault you for this as much as I would an experinced provider. The last thing Paramedicine needs is more non-agressive money medics, please don't be one of these, take pride in the quality of your care.

 

[mycrofft]

Skipping all other comments (sorry, folks):

Purposefully starting unnecessary treatment is a tort, and can constitute assault and battery. Purposefully administering unnecessary drugs is poisoning as well. Charging for such may constitute fraud, see a lawyer.

 

[EMSforever]

Where i work the general consensus is if theyre going to the ER, the ER expects us to have a line in place. It just looks better when bringing a pt in. Its less work for the hospital staff, it gives them a quicker route to giving meds or getting labs, and generally just makes us look better that we have the pt all set up before getting there.

 

[Tigger]

Where i work the general consensus is if theyre going to the ER, the ER expects us to have a line in place. It just looks better when bringing a pt in. Its less work for the hospital staff, it gives them a quicker route to giving meds or getting labs, and generally just makes us look better that we have the pt all set up before getting there.

Since when is "it looks better" a reason to perform an invasive procedure? This is (among other reasons) why much of the healthcare community looks down on us.

Let us not forget Rule 13.

 

[Dougw133]

Pre Hospital IV's are grossly over used. So are backboards however. I have worked in a lot different systems. Some were so thankful you even came into the ER with a line while others would raise holy hell if the 21 year old with ear pain didn't have one. With the current state of health insurance most EMS providers are trying to find anyway to increase revenue. I know of many Private/City based services requiring ALS assessments and in some cases the medic to ride every call for every patient. This way they can always bill for the ALS assessment.

Fraud? I don't think so. Fraud is more like getting a refusal and then trying to bill their insurance for an ALS 1 call.

I know thankfully in my area pre hospital IV's have recently been withered down to "Only if needed or unstable". That is why we had IV's pre hospital in the first place. We needed to actually use it to administer something through it. Not just to say we can and please the miserable ED nurse. I dont get intimidated by ER staff anymore and when they whine about me not having a line in place I tell them to consult my protocols and that's my only boss, my protocols. Things change...Look at CPR in the last 5 years...ACLS has changed dramatically and I expect more will follow. Hopefully we'll ditch the backboards soon and (No offense this true to my locale) BLS will stop fully immobilizing grandma that fell and broke her arm.

 

[Dougw133]

Again I am not advocating starting IV access on every single person. However if you only initiate IV access on people you are giving IV medications to that number will be very small to maintain IV skill proficiency.

So more experience and more iv sticks = more successful insertions.

Totally disagree. You should be proficient regardless. I honestly don't think IV's are a very difficult thing to do. You either know how or you don't. Some people are better than others. In the case of being green and new, yes time and experience will certainly help. However, any one of us should be able to put down the needle and come back without issue. Like riding a bike. I just don't think maintaining IV skill proficiency is any argument to start unnecessary IV's. Tired of seeing medics bring in a PT that didnt need an IV in the first place with 3 gauze and tape sights because of the "I must get an IV mentality". Ego's and EMS are dangerous.

 

[ExpatMedic0]

Fraud? I don't think so. Fraud is more like getting a refusal and then trying to bill their insurance for an ALS 1 call.

It depends on the situation. If you start an IV with no medical necessity or benefit to the patient, and this bumps your billing code up, yes, this is fraud.

I think most billing staff would agree on that. However, it would appear that many of us are debating on what is considered an unnecessary prehospital IV. Which is a pretty interesting argument.

 

[Dougw133]

It depends on the situation. If you start an IV with no medical necessity or benefit to the patient, and this bumps your billing code up, yes, this is fraud.

I think most billing staff would agree on that. However, it would appear that many of us are debating on what is considered an unnecessary prehospital IV. Which is a pretty interesting argument.

I tend to agree with you on that remark. I do know of situations where Fire Companies/EMS have used Air Medical in "unnecessary" situations resulting in insurance refusing to pay. In these cases the patients are suing those departments responsible for the activating Air Medical. While a 15K bill is a different story it follows the same line. If intention of starting an IV is based on the ability to bill for it, then yes it's absolutely fraud.

Even if a patient turn south quick we as providers should be able to initiate access quickly enough that we don't need to ride around with insurance IV's in place on all patients. Again, times have changed. Most of us now have IO in our trucks and protocol. Of course, the typical cases of low BP, cardiac and trauma or exceptions. I feel like when I came through medic school IV's and Drugs were the cure all. I quickly discovered elevating someones legs often brought a patients pressure up as opposed to dropping 2 liters in. Focus used to be intubation and drugs on codes. Now its CPR CPR CPR and maybe a blast of Epi if you feel like it. Things changed quick, we're getting smarter and being asked to more everyday in our protocols.

 

[ExpatMedic0]

If you are going to use the IV for something, or if there is potential for the IV to be used while the patient is in your care then I say fine.

However, if you start the IV for the hospital as a courtesy, I say no for most situations(there are some when it may be acceptable). Pre-hospital IV starts have been linked to high infection rates and most hospitals try not to use them or D/C them within a few hours.

If you start the IV for no medical reason at all, for practice, or "because you can", then I also say no.

 

[Carlos Danger]

Technically? Really.

More like nausea/vomiting is without a doubt ALS, and needs full ALS exam including 12-lead if not 15-lead assesment, with an IV! Fluids/Zofran as well.

Why?

 

[AeroClinician]

Why?

Have you ever had a STEMI present with only nausea/vomiting before?

I have. That's why.

 

[AeroClinician]

Pre-hospital IV starts have been linked to high infection rates and most hospitals try not to use them or D/C them within a few hours.

I blame this on the bad apple paramedics that don't care enough to use proper method resulting in higher infection than hospital lines.

 

[triemal04]

The last thing Paramedicine needs is more non-agressive money medics, please don't be one of these, take pride in the quality of your care.

If you mean that the last thing we need is people who are "aggressive" and over-treat patients, treat patients that don't need it, and try to justify their existence by by hyperbole, then yes, I agree completely.

If by "non-aggressive" you mean people who won't learn and get educated about medicine so that they won't be able to determine what is, and what isn't actually needed and thus fall back on hyperbole for deciding their treatements, then yes, I also agree completely.

I you mean something else I disagree.

Have you ever had a STEMI present with only nausea/vomiting before?

I have. That's why.

Have you ever had a patient go into cardiac arrest for no immediately discernable cause?

I have.

Probably should start putting defib pads on everyone...because you never know...

If people actually bother to take the time to learn and go beyond what get's taught in paramedic school and the handful of weekend certification classes and paper endorsements, a lot of this type of arguement will go away.

Doing something because of "well this one time" or "something could change" is very different than doing something because there is a distinct possibility that the cause of the problem may be something abnormal, or because it's likely, based on the problem and presentation that the patient's status will decline.

Our job is not to do stuff because it's fun or because we want to, it's to do what is in the best interests of the patient. A lot of times that means doing very little.

 

[dixie_flatline]

Have you ever had a STEMI present with only nausea/vomiting before?

I have. That's why.

Well, sure, but Occam's Razor needs to be applied here. Odds are that your nausea patient is food poisoning, or an infection, or pregnancy much more often than it is a STEMI. Getting a 12-lead doesn't mean that it can't be turfed back to the BLS transport unit when it turns out that it really is a BLS nausea call.

 

[Carlos Danger]

Have you ever had a STEMI present with only nausea/vomiting before?

I have. That's why.

Cardiac problems can present with nausea?

Oh my. I guess everyone who is nauseous does need an EKG then.....

While we are at it I suppose we better CT every headache, spinal tap every stiff neck, and culture every cough.

And just to be safe, let's give everyone oxygen and use c-spine precautions for all trauma.

 

[Bullets]

Would you object IV access on these patients?

1- Postictal patient, who is now A&OX3 not seizing on your arrival. Family states has hx of epilepsy and had a seizure 20 minutes ago prior to your arrival. If you start IV on him now what IV medicine are you giving? Do you advocate not starting IV access?

Patient with seizure history are BLS patients, no ALS is dispatched, so they would not get an IV

2- Chest pain 8 (1-10), has cardiac history, 12 lead no elevations or depressions looks normal, sinus rhythm. You protocols do not have IV meds to be given for this call. If you start IV on him now what IV medicine are you giving? Do you advocate not starting IV access.

If there is no IV medication, then this patient should also not get an IV


Is IV access the new backboard? Anecdotal evidence is not evidence. My last transport was a patient that was complaining of nausea and vomiting. Do you think she was having a heart attack or more likely a normal side effect fo the clindamycin she was just prescribed yesterday

 

[unleashedfury]

Technically? Really.

More like nausea/vomiting is without a doubt ALS, and needs full ALS exam including 12-lead if not 15-lead assesment, with an IV! Fluids/Zofran as well.

I see that your a student, so I don't fault you for this as much as I would an experinced provider. The last thing Paramedicine needs is more non-agressive money medics, please don't be one of these, take pride in the quality of your care.

Whilst I can agree to an extent, This is where a solid assesment comes into play. Hx of present illness and PMH included.

Have you ever had a STEMI present with only nausea/vomiting before?

I have. That's why.

Yes I have had similar much more prevelant in women than men. But like I stated earlier. Solid assesment skills are the key, alot of Paramedics I meet do things "cause thats whats protocol" Which is totally acceptable, but if we want to distinguish ourselves as healtchare providers and clincians we need to work on a differential diagnosis, and a working hypothesis of the patient to decide what care they need, what they don't need,what you suspect the problem is.

 

[MedicPam]

Where i work the general consensus is if theyre going to the ER, the ER expects us to have a line in place. It just looks better when bringing a pt in. Its less work for the hospital staff, it gives them a quicker route to giving meds or getting labs, and generally just makes us look better that we have the pt all set up before getting there.

Since I don't work for the ER, I like to run my calls based on my assessment and plan for the actual patient. And when the ER nurse asks where the UNNECESSARY IV is, I usually tell them I assume it's in their cabinet awaiting an unnecessary "physician order".

 

[Rialaigh]

And what is your response when the patient truly requires IV access and you are unable to obtain it due to skill degradation? So you will stab him multiple times and then transport to the ED telling you battle story "It such a hard stick you know, very hard!".

Certainly it's called empirical evidence. Do you have any evidence to disprove my claim?

Can you show me any evidence that says the mortality rate or hospital stay length for patients is lower with prehospital IV access than without....because I can show you plenty of evidence outlining the infection risk of prehospital IV's.


If the situation is not emergent, than IV access if generally secured for patient comfort (pain, nausea, fluids, steroid, etc). If IV access if emergent then IV access would be preferred but any access if acceptable including IO (cardiac arrest, RSI, etc...). IO in cardiac arrest is just like King airway in cardiac arrest, not as fun, not as invasive, not as "cool"...but just as if not more effective.



I'm all about starting IV's on people that have a good chance of getting use out of them. what a "good chance" is depends on the provider.


Rarely can providers not obtain access in truly emergent situations. If I try twice to stick the Abd pain and can't, then they get no fluids or zofran on their 15 minute ride to the hospital....

 

[ffemt8978]

I see that your a student, so I don't fault you for this as much as I would an experinced provider. The last thing Paramedicine needs is more non-agressive money medics, please don't be one of these, take pride in the quality of your care.

Don't put too much faith in the training levels listed in our members' profiles. They aren't always updated, accurate, and sometimes people choose a student level because they believe they are always learning in this field.