Three things that I dislike to do as a Paramedic

[DesertMedic66]

Having to write reports and get creative to get them paid. Even if it is a BS call, when need to find some reason they need an ambulance.

That is something that I have not had to do. We have only ever been told to be truthful with our reports. If the patient could have been transported by wheelchair then we say that.

 

[Anjel]

That is something that I have not had to do. We have only ever been told to be truthful with our reports. If the patient could have been transported by wheelchair then we say that.

I don't lie, but things get worded a certain way.

For the I've been sick with a cough for 9 days.

"Pt required transport and monitoring due to possibility of respiratory compromise".

If I don't put that; report gets kicked back, and I have to do it again.

 

[DesertMedic66]

I don't lie, but things get worded a certain way.

For the I've been sick with a cough for 9 days.

"Pt required transport and monitoring due to possibility of respiratory compromise".

If I don't put that; report gets kicked back, and I have to do it again.

No thanks haha. I'll just stick to "patient has had cough for 9 days and is requesting transport to the ED"

 

[PotatoMedic]

I don't lie, but things get worded a certain way.

For the I've been sick with a cough for 9 days.

"Pt required transport and monitoring due to possibility of respiratory compromise".

If I don't put that; report gets kicked back, and I have to do it again.

Ever thought about reporting your employer for insurance fraud?

 

[TheLocalMedic]

Because there might not be a medical problem leading to their behavior problem?

Because there often isn't a "medical" problem that the ER can solve. If they're combative or there is any reason to doubt that there is only a psych crisis going on, sure, take them to the ED. But how about all the people who call us because they know they're having a psych problem, are cooperative and medically check out? Do you know how many times I've had schizophrenic people call for a ride to PES only to be told we can only take them to the ED? Or people in the throes of a manic or depressive episode who have nothing to gain from sitting in the ED for hours on end before a transfer is approved?

 

[systemet]

Because there often isn't a "medical" problem that the ER can solve.

We've just started directing this to community mental health, instead of transporting. An RPN from the team responds to the call with a Community Paramedic. The transport rate is very low.

 

[JPINFV]

A quick call to med control (not med direction, there's a difference for us) for approval, then they get told they're not an appropriate candidate for the ED and they need to follow up with their PCP. No calling for a private or anything. A second option is a taxi voucher; we'll call a taxi for them, give them a taxi pass, then leave.

Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?

 

[STXmedic]

Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?

That's a good question. I see our head research guy today, so I'll ask him.

 

[STXmedic]

Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?

Answer: Not at the moment, but not from a lack of trying. The hospitals are apparently not cooperating in the acquisition of admission data. It is one of the projects he's working on, though.

 

[NYBLS]

We've just started directing this to community mental health, instead of transporting. An RPN from the team responds to the call with a Community Paramedic. The transport rate is very low.

What if a medical problem is causing their psychiatric behaviors?

 

[TheLocalMedic]

What if a medical problem is causing their psychiatric behaviors?

Again, that's one of those things where if there is any doubt, transport them to the ED. But many many many times we encounter problems that are entirely and obviously only psychiatric in nature that would be better treated by PES rather than sitting in the ED for hours before being transferred.

And I (prophylactically) beg you not to take the "well you never know" attitude about these things. We are trained and expected to be able to differentiate between a possible medical problem and a clear cut psych problem, and your assessment should tell you which you are dealing with.

 

[systemet]

What if a medical problem is causing their psychiatric behaviors?

Well, my assumption is that any new-onset event would probably get transported to the ER for more thorough evaluation. There are plenty of people with mental health diagnoses living in the community who access health care via ambulatory clinics, family medicine clinics or outpatient psychiatry or psychology services. There are also plenty of teams that predate EMS operating in the community that assess these patients on a daily basis.

While the group of patients that contact 911 are probably more high risk as a cohort than those using other services, it doesn't mean that all members of this cohort are high risk.

 

[Tigger]

Again, that's one of those things where if there is any doubt, transport them to the ED. But many many many times we encounter problems that are entirely and obviously only psychiatric in nature that would be better treated by PES rather than sitting in the ED for hours before being transferred.

And I (prophylactically) beg you not to take the "well you never know" attitude about these things. We are trained and expected to be able to differentiate between a possible medical problem and a clear cut psych problem, and your assessment should tell you which you are dealing with.

We have a single paramedic transporting most of psych patients to a crisis stabilization unit. So far we have had very few issues with patients being directed to the wrong place.

 

[RedAirplane]

Paperwork

Allowing anyone with a C/C to go to the hospital by ambulance even if it's total BS. You have had that cough for a month now and have not done anything for it. Use one of your 4 running cars and drive your d*** self to the ED or urgent care.

Allowing every patient to pick the hospital they want to go to. I do not want to transport you to a hospital 30 miles away because it's closer to your wife who just got out of jail and bypass 6 hospitals in the process for a BS complaint. If you have an actual reason for not wanting to go to a certain hospital then cool, no issue.

Sorry, I'm a BLS provider hanging out in the wrong forum. But recently at a special event we had ambulances for a few patients and the medics always suggested the furthest hospital they were allowed to transport to without special approval. Seems different than your opinion, but I noticed it in multiple medics at different times. Any thoughts why that might be?

 

[Handsome Robb]

We can triage medically stable psychiatric patients to our private and state run mental health facilities. If they have insurance they go to the private one, if not they go to the state one. The attending provider at the facility we are triaging to has the ultimate say on if they will accept the patient after our report or if they want them taken to the ER for medical clearance. It's the same way our triage system works for Urgent Cares and the detox center.

Sorry, I'm a BLS provider hanging out in the wrong forum. But recently at a special event we had ambulances for a few patients and the medics always suggested the furthest hospital they were allowed to transport to without special approval. Seems different than your opinion, but I noticed it in multiple medics at different times. Any thoughts why that might be?

Trying to lengthen to run. Longer run means more time to do your paperwork and less time available for more runs. Keeps you from getting backed up on paper and from being run into the ground. We have people that do that. I don't think it's appropriate but not everyone agrees with me. Personally if I need time to cut paper to try and catch up I call and ask and rarely am told no. Usually it's "sure just keep your radio on med X and we'll only pull you if we need your or you're right on top of a P1 call."

I don't lie, but things get worded a certain way.

For the I've been sick with a cough for 9 days.

"Pt required transport and monitoring due to possibility of respiratory compromise".

If I don't put that; report gets kicked back, and I have to do it again.

How's being an accessory to insurance fraud treating you? If there's no medical necessity and you create one that's exactly what you're doing. I do exactly what @DesertEMT66 does. "PT complains of a (productive/non-productive) cough x9 days. They deny any other associated symptoms. They request transport to xx ER for further evaluation and treatment." If they ambulate the the gurney it's "PT ambulates to the gurney with minimal (or minor) assistance to the gurney (or bench seat in many of these cases), is seated in their POC and transported without change in assessment or complaint."