patient right to demand ambulance transport

Aidey said:
When people pick a hospital that can't handle their condition we advise them that XYZ hospital is better for whatever reason, and I've yet to have someone refuse to go to the more appropriate hospital. If they do refuse we are supposed to call the more appropriate facility and have the patient speak with a doc. If they still refuse, we transport where they want to go and document the heck out of it.
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I find this interesting. Mostly because we do the exact opposite. We contact the hospital of choice, and fill them in on the patient condition with the patient/family right there to hear all the traffic. Once that hospital refuses to accept the patient due to not having the services needed/being on diversion/etc., we then suggest once again, the more appropriate hospital.

I had one patient that was so upset the hospital wouldn't accept her as an ambulance patient, she insisted upon getting out of the ambulance and going in her own vehicle, so they couldn't turn her away. We tried to explain the situation to her, and she wanted no part of it. That was her hospital, so that is where she was going to go, regardless of the reason she was being advised to go elsewhere. Fortunately, that has been the only time I've had that happen. Everyone else has always agreed to go to the different ER.
 
My life is easy in this section of NJ. We have a level II in my town with cath lab and stroke facilities. Pretty much every patient goes to this hospital because there isn't a more appropriate facility closer. The next closest HOSPITAL is about 15 minutes north or 20 minutes west.

So everyone goes to the level II, and the company owns 2 other hospitals in my county and 2 in the county south of me so very few issues with insurance or billing. In fact I have never had a patient raise and issue with our transport destination based on insurance reasons. And I work for a non billing agency so thats never an issue either.

As far as hospital transfers, every hospital I've been to has dedicated triage areas before they go into a floor or ED proper. We bring then in and put then on the bed immediately and give a report and are out the door. We maybe wait 10 minutes before care is transfered.
 
JPINFV said:
I'm done. If you want to continue living in the fantasy world where insurance doesn't matter and the only thing people use the 911 system is for immediate life threatening conditions, then so be it. The rest of us, who live in the real world, realize that this isn't the case can continue this discussion.

Oh, and there's power in "why" and "why not," and someone who asks those questions can very easily get a reply along the lines of, "I don't know, why don't we do that?" Viola, the system is changed.
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How about YOU keep living in YOUR fantasy world of making up **** ok? I never said people only use 911 for immediate life threatening conditions. Or maybe you should learn to read and comprehend before you go popping off on your high horse.

And as for your "oh, and blah blah blah", yeah, no ****. Anyone can answer anything they want to any question they're asked. You're not making any big revelation there.
 
JJR512 said:
How about YOU keep living in YOUR fantasy world of making up **** ok? I never said people only use 911 for immediate life threatening conditions. Or maybe you should learn to read and comprehend before you go popping off on your high horse.
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Yet...

JJR512 said:
The patient called 911 because they believed they had an emergency need to get to the hospital. If the patient's medical condition is such that an extra 10, 15, or even 30 minutes in an ambulance is of no medical signficance, then in my opinion, they don't really need to be in the ambulance in the first place,
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So, which is it. If 10 minutes doesn't make a difference, then they don't need an ambulance, or are there patients who are legitimately transported by ambulance where 10 minutes doesn't make a difference? You can't have both.
 
medic417 said:
It is idiotic to transport every caller that requests transport. This leads to people learning to abuse the system. All progressive quality systems either have or will soon have a denial of transport guideline.
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Wake County is in the very very early stages. We are currently working to sync our triage algorithms with the hospital to see if we can triage patients the same. Once this is done I think at some point people who triage to the lowest level will be encouraged to seek care at an ER or urgent care POV. We already have alternative destination transport through our APP program.
 
JPINFV said:
So, which is it. If 10 minutes doesn't make a difference, then they don't need an ambulance, or are there patients who are legitimately transported by ambulance where 10 minutes doesn't make a difference? You can't have both.
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I'll grant him this, at the basic level with no pain management, cardiac monitoring and ECG acquisition, N/V treatment, inhaled beta agonist ,ect, there's probably not a lot of distinction. At more advanced levels there's a lot more shades of grey.
 
In my area this is very common. Why? There's a party near the hospital, individual doesn't have a vehicle or money and wants to go - medicade at it's finest. We typically make them sign a form stating if their insurance doesn't cover the bill they may be charged - and by may - i mean they will be charged. They get their ride, sign AMA, and go to the party - get a medicade taxi back home and everything is good. I had one lady respond to the problem of possibly being billed by stating "I will just send the paper to the DSS and they HAVE to take care of it!"
 
Hey guys... yeah, this got a little out of hand.

Back to (somewhat) on point - to quote House, Everyone Lies. Why am I going to believe a patient who is insisting on going to a certain hospital because it's "In Network"? We have enough idiots who somehow know exactly what to say with regards to pain levels and allergies to get the good narcs, so they certainly know how to game the system. I realize that it's a cynical perspective, and I'm fully aware that 90% of the patients I see are actually pretty straight with me, but I don't like setting precedents. We don't bill for any EMS services, and have no way to verify anything having to do with insurance.

Some of what JJR said about billing and insurance is a little naive, but not all of his points are off-base. Our stations are both fairly close to Baltimore and Anne Arundel counties (and his also runs to Laurel in PG county) - if we transport to St Agnes (Baltimore Co) or BWMC (AA Co), we not only put Howard County down an ambulance, we run the distinct risk of getting "stuck" out of county as our neighbors have been known to go to us first to try and keep a "free" extra unit in their county to run as many calls as possible. It doesn't stop me from transporting out of county - I probably run 60% of the time to HCGH, 35% to St Agnes - but it is something to consider.

As a post-script, I'm an EMT, and fairly pro-active when it comes to things like my own health, and I'm not even sure what hospitals in the area are In or Out of network. (I know how to check on docs through Aetna; never looked up a hospital)
 
Has anyone offered a convincing reason for always transporting to the closest facility that centers on the patient?

What I've seen are a whole host of excuses regarding provider connivence and referring to "the community" rather than the patient that is actually asking for help. I'm sorry but the overstated concern for the community rings a bit hollow seeing as how many of you don't seem to give two hoots about the patients social well being.
 
JPINFV said:
Yet...



So, which is it. If 10 minutes doesn't make a difference, then they don't need an ambulance, or are there patients who are legitimately transported by ambulance where 10 minutes doesn't make a difference? You can't have both.
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Earlier you referred to me living in a dream world where people only call 911 if they have a life-threatening emergency. What I wrote indicates that this concept is the ideal, but nowhere in what you quoted do I indicate that it's what I think is truly the case in the real world. This is why I suggested earlier that you improve your reading and comprehension skills. You're seeing things that aren't there. I maintain everything I wrote, as written. I'm not responsible for, and will not get drawn into an argument over, your interpretation of what I write. What I mean is right there in black and white, or whatever forum color scheme you're using.
 
IMO if a patient demands transport, even if nothing is actually wrong. Transport the patient. In canada or at least where i'm in training you can not in any circumstances refuse transport if the patient wants to go to the hospital. They get too go, and yes people abuse the system. But what can ya do.
 
EMTPassion said:
IMO if a patient demands transport, even if nothing is actually wrong. Transport the patient. In canada or at least where i'm in training you can not in any circumstances refuse transport if the patient wants to go to the hospital. They get too go, and yes people abuse the system. But what can ya do.
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I am with you even if it is bull crap that is what we are there for. Half the time they change the story enroute. All we can do is just educate and hopefully make a difference in at least on person's life during our career.
 
We have the option of CPC for an intoxicated pt. Vitals are WNL but they can't care for themselves PD is coming and taking them to the tank. There's no reason to tie up an ALS resource with a drunk person who requires no medical intervention.

caveat: this is for intoxicated people who are grossly intoxicated, not the transient who wants a ride, there's not much you can do about that situation besides transport.
 
medic01 said:
I am with you even if it is bull crap that is what we are there for. Half the time they change the story enroute. All we can do is just educate and hopefully make a difference in at least on person's life during our career.
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This is the type of reply I was looking for. It sums up my personal feelings and the majority of my co-workers feelings. It is not our place to judge our patients.
 
epipusher said:
This is the type of reply I was looking for. It sums up my personal feelings and the majority of my co-workers feelings. It is not our place to judge our patients.
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By refusing transport you are not judging you are educating the patient. If you say I'm sorry your illness does not require an ambulance then explain where they should seek help you have educated them. You have also save them or the tax payers money.

Quit taking the lazy way out by transporting everyone. Be a medical professional and be honest with the patient. Honesty sometimes means saying no.
 
medic417 said:
By refusing transport you are not judging you are educating the patient. If you say I'm sorry your illness does not require an ambulance then explain where they should seek help you have educated them. You have also save them or the tax payers money.

Quit taking the lazy way out by transporting everyone. Be a medical professional and be honest with the patient. Honesty sometimes means saying no.
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It's far from laziness. In my experience in the area I work, you will spend more time trying to educate than it would take to just transport. The majority of them have their mind made up way in advance of me showing up. Or it is one of my "frequent flyers" who are going to go regardless of what I or the police on scene may tell them. Even scarier, invoking a policy of educating versus transport can become a very slippery slope.
 
epipusher said:
It's far from laziness. In my experience in the area I work, you will spend more time trying to educate than it would take to just transport. The majority of them have their mind made up way in advance of me showing up. Or it is one of my "frequent flyers" who are going to go regardless of what I or the police on scene may tell them. Even scarier, invoking a policy of educating versus transport can become a very slippery slope.
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So by your statement the lazy way is to transport because it is easier. Work harder now and smarter by educating, then it will become the easier way as well as the better way for your patients. Fear of doing what is right is what is holding EMS back. So get your system on board to start educating patients, including educating by saying no.
 
medic417 said:
By refusing transport you are not judging you are educating the patient. If you say I'm sorry your illness does not require an ambulance then explain where they should seek help you have educated them. You have also save them or the tax payers money.

Quit taking the lazy way out by transporting everyone. Be a medical professional and be honest with the patient. Honesty sometimes means saying no.
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Some systems/countries don't allow "No". We can do our best to persuade people towards other options though :P
 
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