Suicidal patient refusal?

[DrParasite]

So a FD 911 ambulance still waits in line behind an IFT BLS truck? so an entire first due area is unprotected because the ambulance is still in the ER for hours? I understand (and agree) that patient acuity is how patients are accepted, but I'm surprised management permits this. At my last agency, we used to give our units 10 minutes to turn over care, 20 if they were really busy. The agency prior to that, we were available the moment you arrived at the ER (and yes, I was dispatched to another call as I was backing into the ER).

While the issue isn't the nurses being mean or lazy, has anyone filed complaints with CMS over this? it appears to be an issue with lack of beds, and lack of staffing on the hospital side, and they are using EMS as free help because they don't want to pay for the proper amount of personnel.

And who pays for this? does the patient get billed wait time, does the hospital get a bill for using EMS to monitor their EMTALA required patients, does the insurance company cover it? I mean, provider's salaries, additional units called in to cover their area, there are costs incurred by the EMS system, who ends up paying for them?

 

[NPO]

Ambulances should not be used to transport 5150 patients that do not have a medical condition.

Law enforcement will place the patient on a hold on scene and transport to and EPAC (Emergency Psychiatric Assessment Center).

Alternatively, remote area deputies have access to a system that allows telemetry access to a Kern County Mental Health evaluator.

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[EpiEMS]

Law enforcement will place the patient on a hold on scene and transport to and EPAC (Emergency Psychiatric Assessment Center).

I like this idea...but how does law enforcement verify that they're not seeing, say, somebody who's actually having a stroke, or is hypoglycemic, or is...on drugs?

 

[NPO]

I like this idea...but how does law enforcement verify that they're not seeing, say, somebody who's actually having a stroke, or is hypoglycemic, or is...on drugs?

Paramedic assessment and discression. Most of these patients simply say "I'm feeling suicidal, I need help." That's hardly a stroke or drugs. If the patient requests an ER, is altered, or otherwise seems like they could be having a medical issue, the Ambulance is to take them to the hospital.

But for the simple patient needing psychiatric help, law enforcement is to handle

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[EpiEMS]

Paramedic assessment and discression. Most of these patients simply say "I'm feeling suicidal, I need help." That's hardly a stroke or drugs. If the patient requests an ER, is altered, or otherwise seems like they could be having a medical issue, the Ambulance is to take them to the hospital.

But for the simple patient needing psychiatric help, law enforcement is to handle

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Interesting, interesting - so there is no EMS response to most of these calls?

 

[NPO]

Interesting, interesting - so there is no EMS response to most of these calls?

I can't say how many law enforcement handles without me knowing, but we do respond to a fair number. It's actually not all that common for us to send a patient with law enforcement because unless they specifically request a psych eval, and specifically deny medical aid, they go to the ER. It's usually just the frequent psych patients that know the psych facility by name and request it that go with a LEO. Otherwise, most patients think the ER is the gateway to it, so they ask for an ER.

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[EpiEMS]

@NPO Gotcha, makes sense.

 

[Ensihoitaja]

We are available for the next call as soon as we arrive at the ED with the patient, if we don't get a call we are expected to clear and go back into service in 20 minutes. I think our system would implode if we had hour + wait times in the ED. Crazy.

Right? How often do you go out at the hospital and get told there's another call for you. I've seen stories like this before and it blows my mind that it's just accepted.

 

[Tigger]

(and yes, I was dispatched to another call as I was backing into the ER).

On bad days here in the city the dispatcher will see you getting close to the hospital on the tracking board and then call you on the radio (before you call destination) to tell you that as soon as you say the word destination they'll be tagging you up to another call.

 

[NPO]

Our County LEMSA just posted a directive to outline how to have ALS hand off to BLS when at the hospital waiting for a bed.

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[GMCmedic]

I said it in a thread (might have been this one, and I was only jalf joking when I said it), pin a note to their shirt and go available.

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[DesertMedic66]

I said it in a thread (might have been this one, and I was only jalf joking when I said it), pin a note to their shirt and go available.

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Our county actually allows that now. After 30 minutes on bed delay with a BLS patient we will sit them on a chair and have them hold their paperwork and tell that staff “hey guys, he is sitting here. Bye”

 

[hometownmedic5]

I fully and completely get that every system is different and you cant use one way of doing things to define what everybody else should be doing everywhere.

That being said, I feel like if for whatever reason I was required to go work in California, it would very seriously make me reconsider whether or not I still wanted to be a paramedic. Holding the wall with patients for hours at a time would drive me up the wall. I'm not certain I could make that adjustment. Maybe if it was all I'd ever known and really really wanted that fire job and would do anything to get it I could suck it up; but being a committed single role guy and having experienced life elsewhere, I just dont think I'd even make it through my first shift before downloading an application for Target just to not have to hold the wall anymore. I get super frustrated when I call an entry note in to the hospital 15 minutes out and they dont have my bed ready and waiting for me(being that 99% of the reason to call in stable nonsense patients is so the hospital can prepare for their arrival). I'd lose my mind by about minute thirty.

 

[VentMonkey]

Eh, sometimes it's a much needed, and welcomed reprieve from turning around and bringing in the same crap over and over. Other times it's all about the individual paramedic and their power of persuasion.

Edit: also, unless any of the people in my county have come from Los Angeles, they have zero idea what "holding a wall" really means. That is the epitome of a fractured healthcare system; a compound fracture.

 

[gonefishing]

Eh, sometimes it's a much needed, and welcomed reprieve from turning around and bringing in the same crap over and over. Other times it's all about the individual paramedic and their power of persuasion.

Edit: also, unless any of the people in my county have come from Los Angeles, they have zero idea what "holding a wall" really means. That is the epitome of a fractured healthcare system; a compound fracture.

Amen.

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[NPO]

I fully and completely get that every system is different and you cant use one way of doing things to define what everybody else should be doing everywhere.

That being said, I feel like if for whatever reason I was required to go work in California, it would very seriously make me reconsider whether or not I still wanted to be a paramedic. Holding the wall with patients for hours at a time would drive me up the wall. I'm not certain I could make that adjustment. Maybe if it was all I'd ever known and really really wanted that fire job and would do anything to get it I could suck it up; but being a committed single role guy and having experienced life elsewhere, I just dont think I'd even make it through my first shift before downloading an application for Target just to not have to hold the wall anymore. I get super frustrated when I call an entry note in to the hospital 15 minutes out and they dont have my bed ready and waiting for me(being that 99% of the reason to call in stable nonsense patients is so the hospital can prepare for their arrival). I'd lose my mind by about minute thirty.

That sounds more spoiled than gifted. If that post is supposed to make us think that you're paramedicine is better, it doesn't. All it says to me is your hospitals have more beds, more nurses, and doctors that don't admit every patient; essentially a better hospital system.

Our paramedics arent "less" because we hold the wall. Sometimes the altered dementia patient with no acute illness just doesn't have a place to go. Can't go to the waiting room, and no open beds. What do you propose we do? Lay them on the floor and go back in service?

Your post really left me with a bad taste. Really, holding the wall would make you leave the industry? Are you so spoiled that you cant handle a little inconvenience?

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[gonefishing]

That sounds more spoiled than gifted. If that post is supposed to make us think that you're paramedicine is better, it doesn't. All it says to me is your hospitals have more beds, more nurses, and doctors that don't admit every patient; essentially a better hospital system.

Our paramedics are "less" because we hold the wall. Sometimes the altered dementia patient with no acute illness just doesn't have a place to go. Can't go to the waiting room, and no open beds. What do you propose we do? Lay them on the floor and go back in service?

Your post really left me with a bad taste. Really, holding the wall would make you leave the industry? Are you so spoiled that you cant handle a little inconvenience?

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Maybe we could get the hospitals to invest in a ball pit?

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[Jdog]

So a FD 911 ambulance still waits in line behind an IFT BLS truck? so an entire first due area is unprotected because the ambulance is still in the ER for hours? I understand (and agree) that patient acuity is how patients are accepted, but I'm surprised management permits this. At my last agency, we used to give our units 10 minutes to turn over care, 20 if they were really busy. The agency prior to that, we were available the moment you arrived at the ER (and yes, I was dispatched to another call as I was backing into the ER).

While the issue isn't the nurses being mean or lazy, has anyone filed complaints with CMS over this? it appears to be an issue with lack of beds, and lack of staffing on the hospital side, and they are using EMS as free help because they don't want to pay for the proper amount of personnel.

And who pays for this? does the patient get billed wait time, does the hospital get a bill for using EMS to monitor their EMTALA required patients, does the insurance company cover it? I mean, provider's salaries, additional units called in to cover their area, there are costs incurred by the EMS system, who ends up paying for them?

The thought of getting a call before clearing is insane. In LA, you don't know how long it's going to be once you step foot in the ER. If you have an ALS patient, with any luck, you get a bed right away. With a BLS patient, good luck. You could be stuck for hours. Also, the ambulance company absorbs this cost, since they're paying the EMTs hourly wages for holding the wall plus opportunity costs of that unit not being able to run calls during that time.

 

[gonefishing]

The thought of getting a call before clearing is insane. In LA, you don't know how long it's going to be once you step foot in the ER. If you have an ALS patient, with any luck, you get a bed right away. With a BLS patient, good luck. You could be stuck for hours. Also, the ambulance company absorbs this cost, since they're paying the EMTs hourly wages for holding the wall plus opportunity costs of that unit not being able to run calls during that time.

But thats where the LA wait time charge comes in at $75 every 15 minutes.

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[Jdog]

But thats where the LA wait time charge comes in at $75 every 15 minutes.

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???
I've definitely never heard of this and can't find anything on LA county's website.