What stops private ambulance from running every call as code 3? It seems like there is no check and balance. Should there not be one controlling system for emergency calls?
Street EMS vs. Transport
- Thread starter ZombieEMT
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What stops private ambulance from running every call as code 3? It seems like there is no check and balance. Should there not be one controlling system for emergency calls?
Ok I get it. I guess they just bypass some steps out here because honestly the people that call us are doing so because they want a particular ER. They have usually been down that road with the city before and know that CFD will go to the closest ER and most people have an issue with their closest and will sign AMA with the city because they do not like that ER.
Also, people usually run down the list in the phone book before they get to us because most companies will refuse house calls either by saying no rigs are available and/or by recommending they call 911. Some refuse house calls so as not to tie up a rig for a long time because they have contracts to service. Some refuse house calls if the person has only public aid also. We have actually had no rigs for people and they will call repeatedly, like every half hour harassing the dispatcher, even with SOB being the complaint.
Also, people usually run down the list in the phone book before they get to us because most companies will refuse house calls either by saying no rigs are available and/or by recommending they call 911. Some refuse house calls so as not to tie up a rig for a long time because they have contracts to service. Some refuse house calls if the person has only public aid also. We have actually had no rigs for people and they will call repeatedly, like every half hour harassing the dispatcher, even with SOB being the complaint.
Good question. We have the honor system I guess you could say. Also the fear that another crew will see them and the fear that if they have an accident code 3 and it is not legit, they are screwed.
JPINFV
Gadfly
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To add to this, Riverside County requires specific complaints to be transferred to the 911 agency at the dispatch level. So if a private party calls a non-911 agency (which is everyone except a couple fire departments and AMR) for, say, shortness of breath, the private company isn't even supposed to dispatch an ambulance. As someone who has seen this sort of insanity (in fact compounded by the fact that the only paramedics were with the fire department. This leads to the following situation, "So your SNF patient is altered with a BP of 70/40? By all means, we'll send a BLS ambulance right over. We'll be there is 20 minutes!") first hand, I fully support systems requiring that the 911 system be utilized for life threatening emergencies.
http://www.rivcoems.org/downloads/downloads_memos/2009/BLS_Ambulance_Usage_Guidelines.pdf
I do not currently operate in Riverside so forgot about that. What confused me about that directive is what if a company runs both bls and als? I assume they still want you to transfer to 911 if ALS is needed regardless if you have one available as you would need to run code 3?
Gotcha. Well, I understand that and yes, it can happen but that BLS crew needs to make a determination as to if they can handle it or not, and if no ALS from their agency is available, they can transport to the closest if it is within 5 minutes, or they can call 911 for an ALS intercept, but honestly it is way quicker to go to the closest. I have been sent to what should have been ALS, got on scene and the guy's house was across from a comprehensive ER, he refused transport there, requested a farther ER for his many issues which included a sugar of 575, since he was competent, med control told us to have him sign against medical advice that he wanted the farther and knew the risks and instructed us to take him there. It sounds crazy to everyone who does not live in this area I'm sure and sometimes it is a bit. Earlier tonight I was dispatched to an altered mental status and I am a BLS unit. You have to get on scene, determine what is really going on (cuz nursing homes are unreliable) and then decide if you are going to the desired, the closest, calling med control or not, etc etc. Incompetent basics do not last long in this system. The ones that are unsure of their skills and panic end up sounding like an idiot to med control, and sound panicky are told to just call 911. We have this "5 minute rule" in this system to get the pt to definitive care quickly. Waiting for an intercept is often longer than just going. I am sure people are going to hit the roof over this post but this is how the system in this city works. I know how NY city works, and I was told it is one dispatch and whichever rig is closest gets the call, no matter what company or hospital rig or city rig or whatever and that seems like a better system to me.
JPINFV
Gadfly
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I honestly have no clue. I worked for 2 years with a company in OC that had a handful of units (RivCo licensed) based out of Hemet and remember the dispatchers (who were also based in OC) keeping a log of calls that they had to refer to AMR.
JPINFV
Gadfly
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Here's the problem. There's absolutely zero reason a BLS unit should be dispatched for abnormal vital signs, ALOC, or a handful of other complaints. If a BLS unit is getting a page for a patient in a nursing home who's ALOC and hypotensive (that 70/40 was the chief complaint on the pager for a call I was actually on), then the system is failing that patient. I fully understand if what was dispatched and what was found was different. I fully understand if the patient's status changed. However if the complaint is, for example, "congestion" (nursing home speak for acute pulmonary edema secondary to congested heart failure normally), then there shouldn't be a BLS unit on scene deciding whether they should transport or call for paramedics. Paramedics need to be a first response, not a second response to these calls.
I find them very reliable once you understand the buzz words and can normally predict the calls that will require paramedics, emergency transport, or the calls where 911 was called sometime between being dispatched and arriving.
No one's going to hit the roof over EMTs deciding to transport to an ER in light of calling paramedics. The one caveat I'd argue is if the patient is a canidate for a specialty center (i.e. stroke, trauma, cardiac cath, etc). Then the response time for paramedics and direct transport to a specialty center is shorter than EMT transport, evaluation and "stabilization" at a non-specialty center, response of a CCT unit, and then transport to the specialty center.
However, just because the EMTs should be able to recognize that they should transport to the closest ED instead of calling paramedics doesn't mean we shouldn't examine why a BLS unit is on a call that they shouldn't have been dispatched to.
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bstone
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Management and self-policing. I worked with tony1 for a while and we used professional knowledge when to go Code 3 or not. We would for the guy who was SOB w/chest pain, but Code 2 for the cellulitis at 3am.
Would management not want you to go code 3 all the time being that they can get extra calls in during the shift? I can under self-policing by the unit but it's kind of you either do it or we will find someone else that will.
bstone
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Management wouldn't last too long until the Dept of Health shut them down and yanked the ambulance license. There is the state license, the county license, the city license, etc. Lots and lots of gov't eyes looking to make sure we don't screwed up.
bstone
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Believe it or not, BLS crewed are regularly, often and very consistently paged out for these calls.
Then you work in the EMS System from Heaven. The NHs on Chicago's northside are notorious for killing their patients. When they decide to finally call for help (hopefully before rigor has set in) they give the absolute worse reports one can possibly imagine. Ever.
Gosh, I recall one call tony1 and I did. Paged out as a "fever". We got there and the guy was COOKING, clearly pneumonia, lungs filled with fluid, mostly dead. Yet it was paged out as "fever".
We were within 5 of the ER so we did high flow O2, cooled him off and did a "load and go".
Well compare to California it for sure work totally different. In California emt's, medics etc are licensed by the state. Company them self are only licensed by the city's, with exception of vehicle inspection by state police there are no other license from the state. There are licensed that emt's and medics get from the city but those just dot permits. I guess having many eyes on you makes you responsible.
Bstone,...it has been a while. I am now on the south side. The north side is heaven compared to this. We walked in to pick up a pt for general weakness and they were dead. The south side is sooooo much worse. I just do what I can man.
bstone
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See what I mean! A dead pt does not have general weakness. They have complete, irreversible weakness!
Oh bstone,.... what they call in to our dispatch. I went to an altered mental status tonight due to no ALS available and the guy was completely unresponsive! I have no clue what goes through their heads. They call in SOB and the pt is has resps of 18 and is 99% on RA!!!!! Most of our stuff that gets called to dispatch as ALS turns out to be BLS. It's cuz they want a faster response! They have told me this! When they say CP we get there quicker they say! It's more insane than you realize. The south side is a sewer. But i still love my job, go figure. Then when they called me for a g-tube the pt was agonal when I arrived and coded on me! WTF!
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