Oregon's Senate Bill 213

[Foxbat]

http://www.leg.state.or.us/11reg/measpdf/sb0200.dir/sb0213.intro.pdf

(1) “Emergency medical condition” means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or a fetus in the case of a pregnant woman, in serious jeopardy.
....
(3) An emergency medical technician has a duty to refuse to provide the inappropriate use of emergency transportation and to refer an alternative means of transportation to an individual who the emergency medical technician determines does not have an emergency medical condition.

That's an interesting one. System that gives EMS option to refuse transportation is one thing, but a system that requires to refuse to transport certain patients is something new to me.
Are there similar laws anywhere else?

 

[PotashRLS]

We do not have anything in Wisconsin like that. I think there are a ton of pros and cons to legislation like that. Liability could become an issue. Documentation in those instances will become paramount!!!!!!!!

 

[VFlutter]

This has bad idea all over it. I agree taking time and resources to transport "frequent fliers" that abuse the system is costly and annoying but there are so many situations that may look like nothing that turn into real problems. Also i remember my teacher telling us a story about a homeless man in his town who would call 911 when it got cold out and say he had raiding chest pain etc know that they would take him to the hospital and he would get a free meal out of it. He did this all the the time for months until one day he the medics transported him without taking any vitals or doing protocol and he had a massive MI and died. I know its his fault for crying wolf all those times but still....sounds like a bad idea

 

[Akulahawk]

Even with the language in the bill, (just a quick glance through it) I can see that not very many providers will use that option. Why? I didn't see any civil protection against suit. The law protects the license of the provider as long as the provider ensures that the patient has an alternate means of transportation available. I just didn't see immunity from civil suit in there...

So you stubbed your toe, I refuse transport to you because you can take the bus or a taxi or your friend can drive you... and those are available to you. You don't like the fact that refused you transport and left... so you sue. Sure, I get to keep my license, but I'll go broke quickly by defending myself (or my employee) from your lawsuit...

Yeah... the provider initiated refusal would be there but...

 

[JPINFV]

"Emergency medical condition” means a medical condition that manifests itself by
acute symptoms of sufficient severity, including severe pain, that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or a fetus in the case of a pregnant woman, in serious jeopardy."

Key word is "prudent lay person" and "health of a person.. in serious jeopardy."

So many condtions that both lay people and EMS providers thinks are non-emergent can very well be emergent. Additionally, what is the average person going to consider an emergency? How long are we going to wait for the person with a broken arm to find a ride to the ER?

 

[Madmedic780]

Being out here in good'ol Oregon, I think this bill might actually come to pass with the provision that if EMS personnel deem it as a non-emergency they will have to offer an alternative means to an appropriate care facility (Clinic, urgent care, ED waiting room) via a fly car (medical taxi) driven by a FR or EMT-B. One large fire district here is already in the works of designing implementing this as a trial period for the 2nd half of 2011.

Too often will we have "patients" that all they want is a medicaid paid trip (45 minute code-1 transport) into Portland. Just yesterday we had this gal c/o generalized pain to her left elbow and refused all care enroute. The minute we arrive and pass her off to the nurse, she gets up say's changed my mind and walks out AMA. As we leave we then see her waiting at the bus stop across from the hospital for the downtown line. So she effectively took one of our ALS units for an hour and a half, and used us as one flipping expensive taxi. While this happens fairly often, at least the other patient will pretend or act ill, but she just pissed everyone off.

 

[8jimi8]

Being out here in good'ol Oregon, I think this bill might actually come to pass with the provision that if EMS personnel deem it as a non-emergency they will have to offer an alternative means to an appropriate care facility (Clinic, urgent care, ED waiting room) via a fly car (medical taxi) driven by a FR or EMT-B. One large fire district here is already in the works of designing implementing this as a trial period for the 2nd half of 2011.

Too often will we have "patients" that all they want is a medicaid paid trip (45 minute code-1 transport) into Portland. Just yesterday we had this gal c/o generalized pain to her left elbow and refused all care enroute. The minute we arrive and pass her off to the nurse, she gets up say's changed my mind and walks out AMA. As we leave we then see her waiting at the bus stop across from the hospital for the downtown line. So she effectively took one of our ALS units for an hour and a half, and used us as one flipping expensive taxi. While this happens fairly often, at least the other patient will pretend or act ill, but she just pissed everyone off.

Fly car sounds great. Send a bls provider to drive them and that keeps two medics and a MICU on the road for a real emergency.


This whole idea of provider initiated refusal to transport smells like impending lawsuits / accusations of abandonment.

 

[Shishkabob]

Eventually the system will have to move to provider initiated refusals... and there will always be a chance of 'getting it wrong' unless you're literally able to run every single lab test and image test in the field and can have a doctor touch every patient in their house.



But for those of you that have been in the field for more than a week, I can guarantee you've run on a patient who you KNEW did not need to go to the ER, and could wait till morning for their PCP and not waste ER or EMS resources.

 

[MEDIC802]

I would love to tell some of the "sick people" who are standing at curb side with suit case in hand who insist on ambulance transport about the oregon law. We beat oregon at football but they are smokin us on ems rules.