My BIGGEST pet peeves

[Sasha]

Nope. My company if ift, nursing home to er(which is emergency lots of times because nursing homes cant find the 11 key), and critical care transports.

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[jgmedic]

I'm not trying to come across as a jerk and I can see how I did. I see all of your points and I understand that not every company is the same. I think we can all agree that there needs to be a time when you draw the line where we try our best to meet the expectations of the patient, and make the best judgement based on availability of ambulances and higher priority calls in the area.

I do believe that EMS is a customer based service, that is my opinion. I feel that meeting and exceeding the expectations of patients not only makes a happy patient, but also generates positive reviews and attitudes towards the company you work for. Can you satisfy every request that a patient has? No. Can you try to do everything you can to make your patient happy while doing what's best for your co-workers and city? Yes.

Some ambulance companies have more ambulances than others, some have less. Some ambulance companies have contracts with fire and some don't. It's a situation to situation based thing. There are many factors that would play into what hospital you would take a patient to. A patient showing signs and symptoms of an MI is not going to go to a hospital further than the closest one. Sorry to everyone for sounding ignorant. Must have been having a bad day!

Peace & Love

You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with. Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center). OTOH, I do agree that EMS, especially at a for-profit agency is seen as customer service.

 

[JPINFV]

You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with.

Let's be honest here. Yes, the transport contract is with the city itself and approved by the city council, but do you honestly think that the city council cares enough to go against the fire department's recommendation and vetting?

Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center).

To be nit picky, I don't think Anaheim General has been approved as a paramedic receiving center after regaining their accreditation earlier this year.

 

[jgmedic]

Let's be honest here. Yes, the transport contract is with the city itself and approved by the city council, but do you honestly think that the city council cares enough to go against the fire department's recommendation and vetting?



To be nit picky, I don't think Anaheim General has been approved as a paramedic receiving center after regaining their accreditation earlier this year.

Fair enough, I think it depends on the city though, I know when I worked in OC, OCFA had apparently wanted to use CARE as their exclusive ambo provider but got shot down by the contract cities using other providers, I know it's different due to it being a county issue, but it happens. I hadn't heard about AGH, but when I worked in that area, we had an agreement that if one of us coded at work, we were to immediately bypass AGH, even if we were in their parking lot(i'm being facetious, a little) and go to WAMC.

 

[JPINFV]

Well, it's pretty much Doctors and Care now running the show. Costa Mesa (which is looking at contracting to OCFA or going to civilian paramedics) replaced Schaffer with Care and Medix lost all of their contracts but Mission Viejo to Doctors (except Seal Beach, which went to Care). Basically everything North of the 55 is Care and South is Doctors with MV and a few cities using Emergency as exceptions.

 

[fafinaf]

You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with. Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center). OTOH, I do agree that EMS, especially at a for-profit agency is seen as customer service.

I see your point

 

[Tigger]

That's an issue (maximum time one way) that needs to be set up by the system administrators or 911 contract and not something decided on an ad hoc basis by field providers.

Exactly. The operations staff should be responsible for these sorts of things. It is not the field providers job to plan out operational and deployment contingencies. The field providers job is to treat their patient(s). Worrying about what will happen to the rest of the system while you are treating/transporting is not the providers responsibility.

If you work at a service with a small number of ambulances that cover a large area, then hopefully your SOPs reflect that and do not typically allow for long distance transports. Clearly, no blanket solution will fit all agencies.

I'm happy I don't have that problem where I. We have four adult Level 1s and two Level 2s in my service area, along with three pediatric Level 1s and a Level 2. Usually the big question is which one the patient or family wants to go to, which is usually the one that is the farthest one away during rush hour.

 

[DesertMedic66]

You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with. Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center). OTOH, I do agree that EMS, especially at a for-profit agency is seen as customer service.

As of tomorrow all of the hospitals in my response area are now a STEMI center. So no more bypassing hospitals for STEMIs.

 

[Shishkabob]

I'm happy I don't have that problem where I. We have four adult Level 1s and two Level 2s in my service area, along with three pediatric Level 1s and a Level 2. Usually the big question is which one the patient or family wants to go to, which is usually the one that is the farthest one away during rush hour.

And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.


However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away. Do you oblige?

 

[usalsfyre]

As of tomorrow all of the hospitals in my response area are now a STEMI center. So no more bypassing hospitals for STEMIs.

Considering one of the ideas behind STEMI centers was a high volume of procedures to minimize complications...isn't this kind of defeating the purpose?

Gotta love Medicare dollar grabs...

 

[katgrl2003]

And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.


However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away. Do you oblige?

We have an ungodly number of hospitals in the city including 2 level 1 trauma centers, a level 1 pediatric trauma center, and a level 2 adult. That being said, we can transport to anywhere in the 9 county area, which is about 1800 sq. miles. (Someone from Indy correct me if my math is wrong, I had to go to googlemaps to figure out the area.)

 

[JPINFV]

And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.


However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away. Do you oblige?

...and again, the decision of the limits to transport should be set by policy by the people involved with managing the system, not the providers themselves on an ad-hoc basis.

...and again, just because you're rural doesn't mean everybody else is, so in a properly designed system, it's a non-issue for rural agencies as well.

 

[Shishkabob]

What makes an administrative decision to refuse silly (lets be honest, they are silly) transport destinations any more viable or "correct" than a field providers? Is not a field providers very job TO make decisions ad hoc and not stick to some concrete plan?



Yesterday, called for a sliver stuck in someone, no bleeding, no true reason to transport, but they asked if we could take them to a hospital 1.5 hours away, closer to their home. You know what I said? "You are more than welcome to go by personal car if you want. There's nothing that I can do for you inside the ambulance. I'll take you if you want us to, but I'm giving you some options to think about"

You know what I SHOULD be legally able to say? "You don't need an ambulance, you need to find alternate travel arrangements, have a better day"


We aren't taxis, and the sooner we quit acting as such the better.

 

[JPINFV]

What makes an administrative decision to refuse silly (lets be honest, they are silly) transport destinations any more viable or "correct" than a field providers? Is not a field providers very job TO make decisions ad hoc and not stick to some concrete plan?

There's a difference between justifying refusing a patient's request regarding their own medical care (including which hospital to go to) because of medical necessity (specialty hospital or closest, which even then should be able to be overridden akin to any other specific procedure) and refusing a destination because of some amorphous system design concerns.

Furthermore, the patient is not going to see increased out-of-pocket expense for going to an out of network hospital (especially when they are either admitted or required to pay for an ultimately unnecessary interfacility transport) as "silly." Neither is their physician going to see such a request as "silly" when they find themselves unable to provide inpatient care because the patient isn't at a hospital where the physician has practice rights because the ambulance crew threw a fit because of a 10 minute greater transport time.

You know what I SHOULD be legally able to say? "You don't need an ambulance, you need to find alternate travel arrangements, have a better day"

I agree, provided the average paramedic has formal education in determining who needs additional care and has more training than 150 or so at the EMT level and a year or so (total, post secondary) for paramedic. I think the entire concept that EMS has shown themselves unable to determine even when a helicopter is medically necessary (what's the number for the amount of people who are discharged directly from the ED within 24 hours of their helicopter flight again?) how shown that they, as a whole, are incapable of determining which patients need a hospital and which don't.

Furthermore, as long as there are legitimate concerns that providers are going to refuse care so that they can get back to watching Emergency! on their iPad, it's not going to happen, and it's up to EMS providers to clean their own house for this concern.

 

[MrBrown]

Is there anywhere in the US that is leaving people at home?

 

[Shishkabob]

Furthermore, the patient is not going to see increased out-of-pocket expense for going to an out of network hospital (especially when they are either admitted or required to pay for an ultimately unnecessary interfacility transport) as "silly." Neither is their physician going to see such a request as "silly" when they find themselves unable to provide inpatient care because the patient isn't at a hospital where the physician has practice rights because the ambulance crew threw a fit because of a 10 minute greater transport time.

So, because the patient has an issue with their insurance agency, they get to demand wherever they go for a non-emergency when they are more than capable to find alternate forms of transportation? How is that not an abuse of the system? Yes... asking an ambulance to make a transport to a far away hospital for something that doesn't need to be transported by an ambulance IS silly.

I agree, provided the average paramedic has formal education in determining who needs additional care and has more training than 150 or so at the EMT level and a year or so (total, post secondary) for paramedic. I think the entire concept that EMS has shown themselves unable to determine even when a helicopter is medically necessary (what's the number for the amount of people who are discharged directly from the ED within 24 hours of their helicopter flight again?) how shown that they, as a whole, are incapable of determining which patients need a hospital and which don't.

We'll go to the call I had yesterday.

Can you honestly say you can't trust 99.9% of providers to go "Hmm.. isolated foreign body stuck in soft tissue with no possible chance of an emergent condition.... they need a taxi not an ambulance"? If they cannot be trusted with something as simple as that, they don't need to be trusted with anything considered 'ALS'.

(PS.. please don't go off some hypothetical thing like an embolus...)


Emergency care is a right... palliative care is not.

 

[Sasha]

Jp you are the ONLY one talking about a ten minute difference. Linuss and i were referring to 30 minute differences

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[JPINFV]

Jp you are the ONLY one talking about a ten minute difference. Linuss and i were referring to 30 minute differences

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Ok, 30 minutes. What about 25? 20? 10? Where is the line, or does every crew get to decide what their own line is?

 

[Shishkabob]

Ok, 30 minutes. What about 25? 20? 10? Where is the line, or does every crew get to decide what their own line is?

Exactly... where IS the line? Because as of right now, you'd advocate transporting a 911 patient from San Diego to New York because their insurance pays for the NY hospital. Or for a more realistic one... from Houston to Dallas, a 250mi, 4 hour one way trip. That's not responsible.





The line is whatever hospital is able to treat the patients complaint that they called 911 for. If it's emergent enough to call 911, and emergent enough to go by ambulance, it's emergent enough to go to the closest appropriate facility.

If not, they can set up an IFT from their house to wherever they choose.

 

[DesertMedic66]

Exactly... where IS the line? Because as of right now, you'd advocate transporting a 911 patient from San Diego to New York because their insurance pays for the NY hospital. Or for a more realistic one... from Houston to Dallas, a 250mi, 4 hour one way trip. That's not responsible.





The line is whatever hospital is able to treat the patients complaint that they called 911 for. If it's emergent enough to call 911, and emergent enough to go by ambulance, it's emergent enough to go to the closest appropriate facility.

If not, they can set up an IFT from their house to wherever they choose.

If our patient gets to be able to chose the hospital (assuming they are not trauma, burn, stroke etc) they only get the choice of the 3 hospitals in our response area. They are free to schedule an IFT transfer from that hospital.