Whats your take ???

isn't there a city that was going to start sending ambulance's(during a slow period during the day) to go and check on their frequent fliers and to handle their needs as best they can, to prevent them from calling so much for non-emergencies?
 
Wow! Sounds familiar? Maybe.. increasing the education and level of practice? $50 million dollars could fund a hella of lot of those programs and positions. Nawww... let's reinvent the wheel and use something that has been proving not to work and hey let's call it something new!

Yeah, typical EMS style.

R/r 911
 
karaya said:
Here are some more links to the Houston and Cincinnati programs:
Click to expand...
Just as I figured, the three specific complaints that they mention as being non emergency are some with the highest risk of misdiagnosis: headache, toothache, and rash. Everytime some fire dispatcher hears any of those words, he's going to kick it to the nurse line, where several minutes will pass before it is determined to be worthy of the firemens' precious time, if at all. Not good.

Even the nurses and the nurses association express serious concerns about the competency of this program, and with good reason. I bet if they read the story from Dallas, they'd be even more worried. But then everyone thinks they're so much smarter than the last guy, so they won't make mistakes.

There was a great Freudian slip in the second article. A nurse said that "[the] risks could be managed with solid quality insurance". Although I'm sure she meant quality assurance, there is no doubt that they're going to need some good quality insurance too in order to pay off the inevitable lawsuits. it's also a bit disconcerting to know that the nurses running the program don't know the difference between assurance and insurance. That can't be a good sign. :wacko:
 
AJ Hidell said:
There was a great Freudian slip in the second article. A nurse said that "[the] risks could be managed with solid quality insurance". Although I'm sure she meant quality assurance, there is no doubt that they're going to need some good quality insurance too in order to pay off the inevitable lawsuits. it's also a bit disconcerting to know that the nurses running the program don't know the difference between assurance and insurance. That can't be a good sign. :wacko:
Click to expand...

Or perhaps the reporter got it wrong? They've been known to mis-quote from time to time.
 
The solution to the problem is send properly educated Paramedics that will evaluate the patient. Then if it is not an emergent problem will educate the person by helping them locate and get to the services they need while not using the ambulance to transport. Initially this will not save time as a properly educated Paramedic will be on scene much longer. But after a year or two the public will start to understand what type of emergency is an ambulance emergency and not a perceived emergency. Thus call volume will go down and problem solved.

1 word answer is "education".
 
I agree with as well as educating the public. Sure, it will not be effective in a lot of the cases but truthfully, how much public education does EMS offer? Other than a few CPR courses, what else does EMS do to inform the public?

Compare this with even the FD of fire prevention education. The LEO have drunk driving and seat belt campaigns. Do we offer PSA's in most cities or even have a national campaign? No. Yet, we are the first to gripe and complain.

Is there an answer. Yes, does most want to investigate something new? No. Its much easier to do nothing or place something in that one pull out of a closet.

R/r911
 
One of the biggest problems I see with phone triage is that it can be virtually impossible at times to get the right information from the caller. Either they know the right phrases to use to get an ambulance there emergency traffic. Or they will make a call sound like a b.s. run until the medics get on scene only to find they have a serious situation on their hands. At least with a EMDPRS system you are still sending medics out then they can make the decision on what needs to be done. As an example one call I took recently a mother called to get her one year old transported. The chief complaint was fever and listless after a minute or two of questioning her I was told that the child was conscious. Alert and breathing normally. When the crew returned to the base after the call I had to explain to them why I had dispatched them routine when the child was actually in respiratory distress and cyanotic. We even went over the tapes as a Q.A. review and all who heard it agreed that they would not have dispatched it emergency. Given the fact that you will have cases like this. Can anybody have much faith in this type of system. I for one would not want to be the one telling someone who might have this type of situation to wait until morning to see their regular doctor.
 
Ridryder911 said:
I agree with as well as educating the public. Sure, it will not be effective in a lot of the cases but truthfully, how much public education does EMS offer? Other than a few CPR courses, what else does EMS do to inform the public?

Compare this with even the FD of fire prevention education. The LEO have drunk driving and seat belt campaigns. Do we offer PSA's in most cities or even have a national campaign? No. Yet, we are the first to gripe and complain.

Is there an answer. Yes, does most want to investigate something new? No. Its much easier to do nothing or place something in that one pull out of a closet.

R/r911
Click to expand...

I would like this, to let people know what IS a serious issue and what isn't. It's not like people call the FD every time a pan of grease catches. They put a lid over it and hope it doesn't smoke too much.

The problem is, I am afraid that our attempts at education, telling people what is and isn't a good reason to call us, would sound too much like whining. With LEO's, you can warn about the safety of seat belts and punitive issues if you don't. Fire, you can warn them about having up-to-date extinguishers and how to properly use a turkey fryer so as not to burn down your house.

But medical... People already know what is and isn't healthy. They have been warned against excessive cholesterol, but still eat their eggs every morning. Their doctor warns them against smoking, but they still take their hourly break. But when something acute comes up, they get scared and want help NOW. And if we start a campaign and tell them "I you have a bad cough which has lasted for three days, it's not really an emergency. Something like this you should just go to an urgent care clinic where they are equipped to handle stuff like this." I'm afraid that a lot of people are going to brush it off as "Hey, I'm sick and this is scary. I feel like I'm gonna die. Do your job!"

What I'm saying is that FD and PD's education programs are designed to prevent injury, save lives, and all that. Our education program is either going to be redundant by warning people of health risks they probably already know about and don't care, or come off as whiny by saying "These are reasons not to call us..." and imply "...so you don't waste our time."
 
medic417 said:
The solution to the problem is send properly educated Paramedics that will evaluate the patient. Then if it is not an emergent problem will educate the person by helping them locate and get to the services they need while not using the ambulance to transport. Initially this will not save time as a properly educated Paramedic will be on scene much longer. But after a year or two the public will start to understand what type of emergency is an ambulance emergency and not a perceived emergency. Thus call volume will go down and problem solved.

1 word answer is "education".
Click to expand...

i can see a downside to this though i think it is a great idea. we all know that women present differently when it comes to MI's. for example, a women is having jaw pain and just brushes it off and later she dies.
 
amberdt03 said:
i can see a downside to this though i think it is a great idea. we all know that women present differently when it comes to MI's. for example, a women is having jaw pain and just brushes it off and later she dies.
Click to expand...
That, of course, is not a problem for the properly educated provider that medic417 fantasizes about in his hallucinogenic pipe dreams. A competent and well educated practitioner will recognize this red flag and follow up on it. Of course, given the quality of most of their medics, that will never happen with HFD.

Now if you mean that callers may themselves not call 911 because of overzealous public education efforts convincing them that a toothache is not a life threatening emergency, then yes, you're absolutely right. And I tend to part with the conventional wisdom on this issue. I don't think it is possible to educate the public well enough to make the slightest difference, and that any effort to do so would be a colossal waste of time and money. Given the choice of educating the public or educating ourselves, the latter is clearly the best bang for the buck.
 
I think the nail has been squarely hit on the head!
 
AJ Hidell said:
That, of course, is not a problem for the properly educated provider that medic417 fantasizes about in his hallucinogenic pipe dreams. A competent and well educated practitioner will recognize this red flag and follow up on it. Of course, given the quality of most of their medics, that will never happen with HFD.

Now if you mean that callers may themselves not call 911 because of overzealous public education efforts convincing them that a toothache is not a life threatening emergency, then yes, you're absolutely right. And I tend to part with the conventional wisdom on this issue. I don't think it is possible to educate the public well enough to make the slightest difference, and that any effort to do so would be a colossal waste of time and money. Given the choice of educating the public or educating ourselves, the latter is clearly the best bang for the buck.
Click to expand...

yeah i was referring to educating the public and not the actual providers. money will definitely be well spent if it was for educating medics instead.
 
PapaBear434 said:
But medical... People already know what is and isn't healthy. They have been warned against excessive cholesterol, but still eat their eggs every morning. Their doctor warns them against smoking, but they still take their hourly break. But when something acute comes up, they get scared and want help NOW. And if we start a campaign and tell them "I you have a bad cough which has lasted for three days, it's not really an emergency. Something like this you should just go to an urgent care clinic where they are equipped to handle stuff like this." I'm afraid that a lot of people are going to brush it off as "Hey, I'm sick and this is scary. I feel like I'm gonna die. Do your job!"

What I'm saying is that FD and PD's education programs are designed to prevent injury, save lives, and all that. Our education program is either going to be redundant by warning people of health risks they probably already know about and don't care, or come off as whiny by saying "These are reasons not to call us..." and imply "...so you don't waste our time."
Click to expand...

In saying no to transporting you are educating them that they have other means of transportation. Yes you will have some get mad. Yes you will still have some calling way to often for problems that do not need EMS or ER. But you stand firm and explain time and time again is better than just hauling all callers. Call volumes will improve. This is not an easy way to get out of doing your job, in fact it will require more work.

Will we solve their problems that they create by ignoring all the info out there? No. But we will not transport them when they do not need an ambulance.
 
AJ Hidell said:
That, of course, is not a problem for the properly educated provider that medic417 fantasizes about in his hallucinogenic pipe dreams.
Click to expand...

Hey you said every one in EMS was smoking and had always smoked. So when you handed me I did it because thats the way it's always been done. Would hate to break a tradition.:P
 
PapaBear434 said:
Fire, you can warn them about having up-to-date extinguishers and how to properly use a turkey fryer so as not to burn down your house.
Click to expand...

The only person I have ever known to start a house on fire with one of those was a fulltime firefighter at a large department. Needless to say he has not lived down a box at his house for a working structure fire. Maybe that program should be mandatory for providers. :)
 
medic417 said:
In saying no to transporting you are educating them that they have other means of transportation. Yes you will have some get mad. Yes you will still have some calling way to often for problems that do not need EMS or ER..
Click to expand...

The problem with this many people perhaps not in your area) do not have any alternative to the ED and EMS.

Like I said before, services tht people can be referred to need to exist. Which they don't. So if you are reducing calls to save money you have to spend that money to create services to refer to. i think it would be much easier (and cheaper) to educate medics to take care of common problems.

That way not only could you evaluate the 3 day old caugh, you could possibly treat it too. Keeps people out of the ED. Sure it makes more work for EMS. But I still think it is cheaper to keep people out of the hospital.
 
Veneficus said:
The problem with this many people perhaps not in your area) do not have any alternative to the ED and EMS.

Like I said before, services tht people can be referred to need to exist. Which they don't. So if you are reducing calls to save money you have to spend that money to create services to refer to . I think this hits the nail on the head,,,and in Houston, a Captain was nominated FF of the year for doing this. He started a program that educated people about these free services to reduce call load on HFD. But, for other services that do not have these programs yet, I think its a must.

i think it would be much easier (and cheaper) to educate medics to take care of common problems.

That way not only could you evaluate the 3 day old caugh, you could possibly treat it too. Keeps people out of the ED. Sure it makes more work for EMS. But I still think it is cheaper to keep people out of the hospital.
Click to expand...




Exactly !!!

I think this hits the nail on the head,,,and in Houston, a Captain was nominated FF of the year for doing this. He started a program that educated people about these free services to reduce call load on HFD. But, for other services that do not have these programs yet, I think its a must.


But even this too poses liability for those "headaches", "intense leg pain", or "heartburn", that end up being bleeds, MIs, or an embolism.....after all, we dont have sonography in the back.........YET !!!! :P
 
Ms.Medic said:
But even this too poses liability for those "headaches", "intense leg pain", or "heartburn", that end up being bleeds, MIs, or an embolism.....after all, we dont have sonography in the back.........YET !!!! :P
Click to expand...

There will always be liability. Some people will always need to go to the ED, if for no other reason than you "think something is wrong but don't know what."

I also think that when (cause it is no longer if) programs like this are put into place there will be some growing pains. We will be asking people to do things they may have never done before. (like a proper history and physical) Not just the answers to SAMPLE and OPQRST. It will take people with critical thinking skills and some providers will not be able to adapt and will be on the outside lookng in. Mistakes always happen when people are involved.

Additionally the equipment on ambulances will have to change. This is where advancements in technology will be able to help. It will make things like on site troponin testing and other labs more valuable. To HELP determine if a trip to the ED may be in good order.

As for medical imaging and all the wonders of the land of Oz. (aka the hospital) They are not fail safe or fool proof. As I witness everyday, a skilled provider doesn't need those things, technology helps. Allow me to put forth a scenario for thought.

Little kid fall off his bike, After your proper assessment, you determine the only injury is an upper extremity. Lets say edema, pain, and echimosis to the distal radial unlar joint and similar findings at the radial carpel joint.

On further assessment you determine that pulse, motor, and sensory are intact but cannot tell if there is a Fx or not. (because of your advanced knowledge of anatomy, you know that crepitus may not be present due to all the muscluature self splinting or pulling of fragments apart in those areas)

Obviously this child would require more care and diagnostics than can be provided on scene. So let me expolore two divergent paths:

Path I:
you put a plaster splint (because you have that on the truck now) on the kid. (assuming properly with reassessing after) While your partner is calling to set up an appointment at the local urgent care or orthopod who takes people in a timely manner without insurance.(where they will also do an xray) (because money not burned in the ER can be redistributed to increase these services) Partner then sets up a non emergent ride at the appropriate time from some local authority or cab company if they do not have transportation. Explain how to use PO ibuprofin for the pain, maybe even give a dose. Properly educate the parents on when to call back if things worsen (like numbness or increased pain) and how to take care of the splint until the appointment. (Which could be within 24 hours) Sign, document and clear. 1 bill. (too cover costs or materials (both consumable and things like the truck) and labor and say an extra 10-20%)

Path II:
You put a board splint on, wrap it with a bandage, administer pain meds via IV, transport to the hospital, where the kid gets a low acuity assignment, the splint gets taken off, reevaluated, waits an hour or 2 for an xray, broken or not, gets a plaster splint, and a referral to an orthodpod or urgent care clinic that takes patients wthout insurance in 3-5 days. Instructions on care of the splint, how to take ibuprofin, maybe a dose, and now 3 bills, one from EMS, one from the ED, and one from the ED doc to either the family or the taxpayers, which will also be paying for the follow up too. (which will not be covering just the costs and an extra 20%) Not to mention all the costs are higher.

In the second scenario, all that is accomplished is adding extra steps and bills. In the first, care is the same but more efficent. Outcome the same. (unless the provider failed in assessment, knowledge, or critical thinking)

What if you found a gross deformity, an open wound, or an impaired MSP? Then the kid gets transported to the ED with the IV and pain management, splints, etc just like you would today.

(Of course all this requires a more skilled, educated, and responsible provider. Not the medic mill for a card, performing a procedure now and again, and somebody who always wants to lay blame for bad decisions on the doc or somebody else claiming "just following protocol.")
 
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