What do you guys do with frequent fliers?

LanceCorpsman

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I'm sure that every agency has them, your frequent fliers who call almost everyday. Anyway, we have a gentleman that calls 911 for "chronic back pain." He does have a extensive medical history, and without a doubt he is in pain. But his docs won't prescribe him any pain meds or what he likes to say is that he "ran out" after being in the ER just yesterday. Anyway, are there any solutions/ideas so that I don't get called to his house for the same damn thing at 2am everyday?
 

STXmedic

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MIH/Community Paramedics
 

EpiEMS

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I'm sure that every agency has them, your frequent fliers who call almost everyday. Anyway, we have a gentleman that calls 911 for "chronic back pain." He does have a extensive medical history, and without a doubt he is in pain. But his docs won't prescribe him any pain meds or what he likes to say is that he "ran out" after being in the ER just yesterday. Anyway, are there any solutions/ideas so that I don't get called to his house for the same damn thing at 2am everyday?

Refer to social services? I wish I had the option to say: "I can't transport you, but here's a taxi voucher to get you to and from a pain management specialist's office twice a month for the next year", but all I can do is transport or take a refusal. In my system, he's probably getting a BLS ride to the hospital, only to be discharged in a couple hours.

MIH/Community Paramedics

That's a good option, too...sadly unavailable near me.
 

STXmedic

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Taxi Vouchers and No-Loads are also options for us. Our MIH program does good work with frequent flyers though. They took one of our callers from 400ish/yr to 30-50ish/yr
 

EpiEMS

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Taxi Vouchers and No-Loads are also options for us. Our MIH program does good work with frequent flyers though. They took one of our callers from 400ish/yr to 30-50ish/yr
No-loads? Like you refuse to transport?
 

STXmedic

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No-loads? Like you refuse to transport?
Correct. We have to call our Med control for those though. They'll usually approve it (assuming you don't try to no-load something obvious), but you certainly still have to call for it.
 

Bullets

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Home visits in my system, but before we started that program we would try and refer them to our senior center where appropriate.

IF they are transient types, we would just take them to the next hospital down the line, one that isnt on the rail line so they cant come back to our town without 3 bus transfers. Or they would just ask to go somewhere else because the local "wont treat me".

As for just getting out and "running out". I believe that. Our ER wont give people a whole bottle. They usually give like one dose in the hospital then another for the road and a scrip to be filled. So if he doesnt have the money to spend on filling that scrip, hes only got one pill to take,
 

EpiEMS

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Correct. We have to call our Med control for those though. They'll usually approve it (assuming you don't try to no-load something obvious), but you certainly still have to call for it.

Makes good sense. Do they typically ask for an ALS assessment or can BLS do this too?
 

TransportJockey

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Refer to social services? I wish I had the option to say: "I can't transport you, but here's a taxi voucher to get you to and from a pain management specialist's office twice a month for the next year", but all I can do is transport or take a refusal. In my system, he's probably getting a BLS ride to the hospital, only to be discharged in a couple hours.



That's a good option, too...sadly unavailable near me.
We do have that option. If their main complaint is that they are out of meds, we can refuse transport.

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STXmedic

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Makes good sense. Do they typically ask for an ALS assessment or can BLS do this too?
I think depending on the complaint, BLS can get one too. Though they usually just let us show up.
 

WolfmanHarris

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Depends. Some of our patients are cases of complete abuse of the system that are resistant to all efforts to adjust their behaviour. We're often just stuck transporting and they become some of the quickest easiest calls, yet still frustrating. Those ones are rare but they stand out.

Otherwise our system automatically runs a report each month (or quarter, not sure) that flags repeat callers for our Community Paramedicine Unit which will review the charts and see if there's an opportunity to engage services. Members of that unit will follow-up and make a home visit often times w/ a social worker, assess the home existing supports, risk factors, etc. In higher risk cases they can bring the case to the "Rapid Response Table" which is a joint agency meeting including EMS, Social Services, Mental Health Services, etc. which can move the case along quickly and do things like placing the Pt. on the fast track for placement in LTC.

In regular operations our Paramedics can do a referral to the Community Care Access Centre which coordinates home care in the Province automatically through our ePCR system which faxes an abbreviated version of our chart to them directly. We can also e-mail or Community Paramedicine Unit directly to flag a call for them to look at.

Despite all this some of our frequent fliers will continue to call as they have for years. The ones I'm thinking of off the top of my head have many chronic conditions, poor insight and poor coping skills and are resistant to any effort to do more than take them to the hospital where they will almost certainly be discharged home w/o admission and with little to no treatment. One lady I can think off has called a couple times a week for non-specific symptoms for about 20 years.
 
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LanceCorpsman

LanceCorpsman

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This guy calls 911 for the same reason every time, exactly around 2am. He says he is in "pain." His vitals are always normal and is completely ambulatory. Ends up getting discharged 45 mins after getting to the ED
 

Akulahawk

EMT-P/ED RN
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This guy calls 911 for the same reason every time, exactly around 2am. He says he is in "pain." His vitals are always normal and is completely ambulatory. Ends up getting discharged 45 mins after getting to the ED
Suggest to the hospital that they contact a social worker. The hospital I work for has a list of frequent fliers that the medical social workers want us to call them about. This simply means every time one of our frequent fliers shows up at the the ER, the medical social worker gets called. While the SW doesn't usually show up at night, a visit by the SW will occur and it usually happens at home. Instead of seeing some of these patients nearly daily, it's now monthly or even less frequently.

Also, by us paying attention to frequent fliers (and their family members too), we found that there was a family or two that were getting scrips to fill and then sell to the local populace at a bit of a profit.

Watch out for those. You might do a back pain run on mama today and tomorrow do a hip or shoulder pain on kid or husband or grandpa.
 
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LanceCorpsman

LanceCorpsman

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Suggest to the hospital that they contact a social worker. The hospital I work for has a list of frequent fliers that the medical social workers want us to call them about. This simply means every time one of our frequent fliers shows up at the the ER, the medical social worker gets called. While the SW doesn't usually show up at night, a visit by the SW will occur and it usually happens at home. Instead of seeing some of these patients nearly daily, it's now monthly or even less frequently.

Also, by us paying attention to frequent fliers (and their family members too), we found that there was a family or two that were getting scrips to fill and then sell to the local populace at a bit of a profit.

Watch out for those. You might do a back pain run on mama today and tomorrow do a hip or shoulder pain on kid or husband or grandpa.


Social workers have been working with this gentleman for years now, but he is very uncooperative. I am pretty sure the daughter of the pt (who lives with the pt) is taking advantage and smuggling some of the scripts. The daughter is usually sleeping in the next room when we come to his house around 2am. I even saw her take off in her car right when our ambulance came because I confronted the daughter, telling her that it would be a better idea if she just drove the pt to the ED.
 

EpiEMS

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I think depending on the complaint, BLS can get one too. Though they usually just let us show up.

Makes sense. I know that for lots of complaints, I'd rather not take a BLS refusal -- syncope, for example, I can't rule out a cardiac cause (or at least be sure that there's not an acute cardiac event going on) as an EMT.

We do have that option. If their main complaint is that they are out of meds, we can refuse transport.

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Can BLS make that refusal too?

This guy calls 911 for the same reason every time, exactly around 2am. He says he is in "pain." His vitals are always normal and is completely ambulatory. Ends up getting discharged 45 mins after getting to the ED

Doesn't mean he's not in pain, though, he doesn't necessarily need EMS transport...

Social workers have been working with this gentleman for years now, but he is very uncooperative. I am pretty sure the daughter of the pt (who lives with the pt) is taking advantage and smuggling some of the scripts. The daughter is usually sleeping in the next room when we come to his house around 2am. I even saw her take off in her car right when our ambulance came because I confronted the daughter, telling her that it would be a better idea if she just drove the pt to the ED.

How about adult protective services? Depends on the state and municipality, I'm sure, but sometimes they can help.
 

johnrsemt

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We had a bad one in the place we used to work; he would drink which would flare aggravate his pancreatitis, which he described as chest pain and would call 911. after 250 calls in the first 180 days one year our medical director got involved and wrote orders that we would check him out, have him walk out towards the ambulance and the police would arrest him for public intox as soon as he hit the sidewalk.

Doesn't work for everyone but did for him for awhile
 

TransportJockey

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