DesertMedic66
Forum Troll
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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.
Three things that I dislike to do as a Paramedic
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Anjel
Forum Angel
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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
Forum Troll
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No thanks haha. I'll just stick to "patient has had cough for 9 days and is requesting transport to the ED"
PotatoMedic
Has no idea what I'm doing.
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Ever thought about reporting your employer for insurance fraud?
TheLocalMedic
Grumpy Badger
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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?
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
Gadfly
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Is there any follow up to see how many of those patients are ultimately admitted to the hospital following a transport refusal?
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That's a good question. I see our head research guy today, so I'll ask him.
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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
Forum Lieutenant
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What if a medical problem is causing their psychiatric behaviors?
TheLocalMedic
Grumpy Badger
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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.
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.
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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
Forum Asst. Chief
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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?
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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.
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."
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."
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."
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."