patient right to demand ambulance transport

[STXmedic]

I believe I'm mildly spoiled here.....

 

[18G]

Because the vast majority of patients don't need an ambulance, let alone care during an ambulance transport?



Quit being lazy / cheap. Get a taxi. Save the ambulance for someone that needs it.

I completely agree. Im not even remotely saying that all 911 calls are legit. And yes it would be nice to be able to screen patients and refer them to alternate care services other than transport to an ED. Unfortunately EMS isn't set up that way in most parts of the country.

I can see the headline now... "EMS crew refuses to transport patient, patient dies two hours later".

 

[thegreypilgrim]

Some systems allows for alternative transport decisions or for paramedic initiated refusals of care.

Do you happen to know the relevant legal references for this in California? My attempts at researching this haven't yielded any results.

 

[Shishkabob]

I completely agree. Im not even remotely saying that all 911 calls are legit. And yes it would be nice to be able to screen patients and refer them to alternate care services other than transport to an ED. Unfortunately EMS isn't set up that way in most parts of the country.

I can see the headline now... "EMS crew refuses to transport patient, patient dies two hours later".

Mistakes happen. How often do you see doctors misdiagnose something and a patient ends up dying? Yet I don't see anyone demanding hospitals be shut down. If you aren't going to die soon, you don't need an ambulance, but NO ONE is stopping you from driving yourself.




The reason why healthcare is the way it is in this country is due to the feeling of entitlement people have. They think they are entitled to an ambulance transport just because their toe hurts. They think they're entitlted to every single diagnostic test in a hospital due to an ear infection. They think they're entitled antibiotics for a simple infection that the body should fight off in no time.


Then they think they're entitled to having it cheap, and when it isn't, they refuse to pay, which raises the costs for others who DO pay, which leads to a viscous cycle.



We just need to get the balls up and say "No, you don't need this."

 

[Sasha]

Mistakes happen. How often do you see doctors misdiagnose something and a patient ends up dying? Yet I don't see anyone demanding hospitals be shut down. If you aren't going to die soon, you don't need an ambulance, but NO ONE is stopping you from driving yourself.




The reason why healthcare is the way it is in this country is due to the feeling of entitlement people have. They think they are entitled to an ambulance transport just because their toe hurts. They think they're entitlted to every single diagnostic test in a hospital due to an ear infection. They think they're entitled antibiotics for a simple infection that the body should fight off in no time.


Then they think they're entitled to having it cheap, and when it isn't, they refuse to pay, which raises the costs for others who DO pay, which leads to a viscous cycle.



We just need to get the balls up and say "No, you don't need this."

First before we need balls we need education to know that just because theyre not bleeding or flopping around gasping for breathe doesnt mean their condition is not serious and in need of immediate attention.

And the education is not there for many paramedics yet.

Sent from LuLu using Tapatalk

 

[18G]

Mistakes happen. How often do you see doctors misdiagnose something and a patient ends up dying? Yet I don't see anyone demanding hospitals be shut down. If you aren't going to die soon, you don't need an ambulance, but NO ONE is stopping you from driving yourself.

The reason why healthcare is the way it is in this country is due to the feeling of entitlement people have. They think they are entitled to an ambulance transport just because their toe hurts. They think they're entitlted to every single diagnostic test in a hospital due to an ear infection. They think they're entitled antibiotics for a simple infection that the body should fight off in no time.

Then they think they're entitled to having it cheap, and when it isn't, they refuse to pay, which raises the costs for others who DO pay, which leads to a viscous cycle.

We just need to get the balls up and say "No, you don't need this."

You and I may be able to handle this approach but think of the many ALS providers short changing the patient and not taking them to the hospital because they are lazy, lack the ability to do a good assessment, are plain ****s, or don't feel like getting off an hour past their shift.

Unless we have a system in place to refer these patients right then and there (ie nurse line, etc), we don't have an option really unless it is blatantly obvious an ambulance ride isn't necessary.

 

[18G]

First before we need balls we need education to know that just because theyre not bleeding or flopping around gasping for breathe doesnt mean their condition is not serious and in need of immediate attention.

And the education is not there for many paramedics yet.

Sent from LuLu using Tapatalk

Agree. More education is needed. Definitely possible, but not with the way EMS works in most places right now.

 

[JPINFV]

Do you happen to know the relevant legal references for this in California? My attempts at researching this haven't yielded any results.

It's not really something I can reference. Personally, I thought it was common knowledge that a handful of systems allowed, or at least toyed with, paramedic initiated refusals. From what was discussed at Expo in Vegas (Community Paramedicine session), Austin and a few other systems have had great success with community paramedicine trials and alternative transport options. Let me email a few people and see if I can get something I can link to.

Edit: I also don't know of any legal references. I've always assumed that transport decision in California were set at the LEMSA level and not the EMSA/legislative level. I was actually sort of surprised that the APP proposal included the option to refuse or alternative transport option simply because I've always assumed that there was nothing at the state level limiting it.

 

[Shishkabob]

MedStar in Fort Worth has Advanced Practice Paramedics (Community Paramedics) that can refuse to transport a known system abuser. They even advertise that ability on their info of APPs.


Don't know the percentages on it, but it's there.

 

[JJR512]

Errrr, so in MD your not allowed any choice in where your transported to, it's solely up to a possibly lazy burned out provider?

What part of "transport to the closest appropriate facility" makes you think that anything is up to the provider at all, lazy/burned out or not?

The truth is, as dixie_flatline explained, the patient can make any request they want. They will get transported to the closest appropriate facility. Extenuating circumstances will be considered, at least in my experience they are. At my station, there are two hospitals that, in different directions, are near enough to the same distance away as makes no difference that if the patient prefers one over the other, we'll honor their request. But there is none of this "transport the patient wherever they want to go" nonsense.

And one more thing...In Maryland, a patient has just as much chance of getting a "possibly lazy burned out provider" as they would in any other state, and frankly, the attitude I detect in that question can get shoved. In deference to forum rules, I won't say where.

 

[Handsome Robb]

systems ought to have guidelines stating how far past the closest 911 receiving hospital you're allowed to transport.

In my system the patient can request any facility they want, but we don't transport to out of area hospitals unless you meet the criteria to go there. In my system would only be burn center criteria and in that case your going by HEMS seeing as your looking at 2 1/2-3 hours by ground to the nearest burn center.

We have 4 hospitals in our area, One Level II which along with 2 others have cath labs and accept stroke patients. The 4th being a satellite center off the level II that is working on putting a cath lab in but for now is just a basic ER.

 

[usalsfyre]

What part of "transport to the closest appropriate facility" makes you think that anything is up to the provider at all, lazy/burned out or not?

The truth is, as dixie_flatline explained, the patient can make any request they want. They will get transported to the closest appropriate facility. Extenuating circumstances will be considered, at least in my experience they are. At my station, there are two hospitals that, in different directions, are near enough to the same distance away as makes no difference that if the patient prefers one over the other, we'll honor their request. But there is none of this "transport the patient wherever they want to go" nonsense.

And one more thing...In Maryland, a patient has just as much chance of getting a "possibly lazy burned out provider" as they would in any other state, and frankly, the attitude I detect in that question can get shoved. In deference to forum rules, I won't say where.

Obviously it was a loaded question. However, there's a large (perhaps majority) group of paramedics who's ability to determine "appropriate facilities" I seriously question. Both on the over and undertriage categories. Your right however that you can encounter these in any state. In addition, who determines "closest appropriate" when say insurance is involved? Because if you refuse to go 15 minutes further to a hospital that's in-network for me I'm going to be seriously pissed, and your not doing your patient any favors sticking them with a higher bill.

Finally, yes I poked at your myopic defense of the Maryland EMS system. I urge you again to explore the world outside of MD and why the only people who say they are the best are involved in the MD EMS system.

 

[18G]

I agree that a patient has the right to request and be transported to a hospital of their choice as long as it is reasonable distance.

The patient is ultimately in charge (given a life or death issue) and when they are footing the bill they better have a say on where they receive their medical care.

Too many EMS providers tend to forget that the patient is not powerless in the back of the ambulance and that the patient has the right to decide their care. That right is not forfeited because they dialed 911.

In my region, we have taken patients an hour away to their hospital of choice. That is pretty much the limit for distance. Patient also needs to be made aware that insurance won't cover the additional mileage.

 

[the_negro_puppy]

The question of "how far" we should transport patients is a complex one.

We have a number of public and private hospitals within my city, all within about 30 or so minutes drive away. We generally take patients where they want to go within reason. But what is within reason? driving past 4 different hospitals for a wound that requires sutures because the patient "heart specialist" works there? It different for us here as although the patient may be indirectly 'footing the bill' through taxes (ambulances are free for residents of the state)they are not directly out of pocket.

When you are already on overtime past your finish time is it reasonable to 'taxi' someone past 4 different hospitals or take them to the closest suitable ED? Some may argue that if they call 911/000 then they are sick enough to go to the closest suitable hospital.

The needs and wants for the patient needs to be balanced with the needs of the local community. Should an ambulance be tied up taxiing patients 30kms past multiple hospitals? deny other potential sicker people an ambulance?

I don't know what the answer is but I try to accommodate most peoples needs whether it be due to continuity of care/ pt hx at the hospital, or preference.

I think paramedics should be able to refuse transport to hospital within certain guidelines. As others have said, most people calling ambulances probably don't need one, let alone to be seen in an ED. Dispatchers should also have some authority for refusing Ambulances based on strict guidelines such as a caller requesting an ambulance with simple isolated complaints such as minor cuts, runny noses and minor aches and pains.

 

[JPINFV]

Patient also needs to be made aware that insurance won't cover the additional mileage.

Medicare might not, but the private companies may. Otherwise they're just going to have to pay for a second transport anyways.

 

[JPINFV]

The needs and wants for the patient needs to be balanced with the needs of the local community. Should an ambulance be tied up taxiing patients 30kms past multiple hospitals? deny other potential sicker people an ambulance?

It's not quite that simple in non-single payor systems. How many people are in the ED waiting for a transfer to an in-network hospital for admission, and how does that affect hospital diversions and offload times? If the problem is so bad, the ability to drive 10-15 minutes further could easily align the needs of the many with the needs of the individual.

Dispatchers should also have some authority for refusing Ambulances based on strict guidelines such as a caller requesting an ambulance ...runny noses ...

Call the police. They're better with runners.

 

[Shishkabob]

Too many EMS providers tend to forget that the patient is not powerless in the back of the ambulance and that the patient has the right to decide their care. That right is not forfeited because they dialed 911. .

No, but it does piss me the hell off when they go that route without any rhyme or reason. You call for my help, but refuse every single way I can help? Just take a taxi, it will be cheaper and I can do good for someone else.

 

[Hunter]

Yay for once Florida got it right.

That "Wherever they want to go" is silly... What if they're in South FL on vacation and want to go to their hospital in GA? Are some of you people saying that you'd have to transport them on something like that??

Thankfully in most of south Florida the county/city run EMS crews only transport to nearest facility, for something like this we have ton of IFT ambulance companies which would probably be called. Of course in any scenario where the patient doesn't require immediate transport they'd probably call an IFT company to come pick em up.

 

[mycrofft]

Parse it.

Do they have a right?
No.

Might they be in a district that has policy to transport everyone they encounter?
Yes.

Is it prudent to transport every single person who demands it?
If every one is sick or injured or it is in your policies and it is safe, then yes.

"Message is hazy, try again later".

 

[46Young]

In my system the patient can request any facility they want, but we don't transport to out of area hospitals unless you meet the criteria to go there. In my system would only be burn center criteria and in that case your going by HEMS seeing as your looking at 2 1/2-3 hours by ground to the nearest burn center.

We have 4 hospitals in our area, One Level II which along with 2 others have cath labs and accept stroke patients. The 4th being a satellite center off the level II that is working on putting a cath lab in but for now is just a basic ER.

That's what I meant by closest "appropriate."