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Old 09-21-2011, 07:12 AM   #11
the_negro_puppy
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If that is the case where does it say that. That is like saying that just because you called 911 you have to go to the hospital. I understand we have an obligation to treat and transport life threats but do we also not have a duty to educate our public on proper use of emergency services. Some agency's i believe have forgotten this.
Let me re-write that. Our Ambulance service is run by and paid for by the State. Anyone who calls 000/911 is entitles to an ambulance and we are not allowed to refuse transport to anyone unless it is dangerous to do so. That is our current policy.

I wish we could refuse in certain circumstances.


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Old 09-21-2011, 09:11 AM   #12
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Per my State's Dept of Health, we must transport the patient anywhere they want to go (and yes, when I mentioned crossing state lines, I was told anywhere they want to go). we get used as a cross town taxi all the time too.

If they call for the ambulance, taken em to the hospital of their choosing, unless you have an administrative support in writing saying you can deny them transport.
In Maryland we transport to the closest appropriate facility, as per protocols. Gee, I guess I finally found one example where MD isn't so backwards (in the opinion of many other members here, not including myself) compared to other jurisdictions.
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Old 09-21-2011, 09:35 AM   #13
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In any 911 systems that I've worked. 1. We only transport to an ER. 2. Closest facility (for the complaint/problem) We can not flat out refuse transport to an ER. We will always offer to take the pt to the ER. If they refuse to go to one of the options we have for an ER they can find a ride from a family member/friend or call a private
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Old 09-21-2011, 09:37 AM   #14
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In Maryland we transport to the closest appropriate facility, as per protocols. Gee, I guess I finally found one example where MD isn't so backwards (in the opinion of many other members here, not including myself) compared to other jurisdictions.
Errrr, so in MD your not allowed any choice in where your transported to, it's solely up to a possibly lazy burned out provider?
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Old 09-21-2011, 09:39 AM   #15
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We can't refuse transport. Both cases get transported, with accurate documentation as to the reason for the call.

I am curious about the "scene control saying get them out of the city". What exactly does that mean? How are transport decisions not up to the transporting medic?
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Old 09-21-2011, 09:47 AM   #16
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In my area anyway if a patient calls 911 we are not allowed to refuse transport to a hospital. We have no alternative care programs so ambulance transport to a hospital is our only option.

If 911 is called, EMS responds, patient want's to go to the hospital, why would EMS refuse?

It's kinda like a patient goes to the hospital ED, triage nurse calls BS, and tells patient they can't be seen. Eh.. no.
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Old 09-21-2011, 01:16 PM   #17
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Scenario
You get called for a pt who is complaing of general illness. Upon arrival you find a 23 year old female. No apparent distress and states to providers both Fire and EMS that she just needs a ride to her doctors appointment. After verifying there is no medical emergency and documenting inform her that we can not transport her to her doctor's appointment. She still insists on being transported by ambulance.

Second scenario.

You arrive on scene of a 40 year old man. Call was for unknown medical. Pt is AOx4. Pt is homless and his only complaint is it is to hot outside and wants to be taken to a hospital that is 40 miles away bypassing several closer facilities. Scene control once again states that he called 911 and we should just get him out of the city. Pt later states prior to transport that his friend lives by requested hospital and he knew he could get a free ride and just sign out AMA, on arrival.
Some regions have a "no need for EMS" guideline. That's where someone calls, and there really and truly is nothing wrong with them. This could apply to someone that walks into the station to have their BP check, for example. This guideline has limited applications, of course.

In general, once pt contact is established, they're yours until they can be handed off to a qualified provider of equal or higher capabilities, or delivered to a 911 receiving hospital. Other countries have systems where the pt can, in fact, be taken to a MD's office, an urgent care, or straight to a psych. facility, for example, but not here in the U.S. You can't just tell them that you can't take them where they want to go, and then leave. That would be pt abandonment; you need to have them sign an RMA first, to absolve you of liability.

Example one - Inform the pt that your service can only transport to a 911 receiving facility, which is the hospital ED. Inform them that you are not authorized to transport anywhere else. Inform them that either you can transport them to the hospital, or they can sign the refusal; that's it. The 911 system does not provide transport to tertiary facilities for appointments and procedures; that is not the role of this type of service. Inform them that a private interfacility ambulance service can provide this service for them, for a fee.

Example 2 - systems ought to have guidelines stating how far past the closest 911 receiving hospital you're allowed to transport. For example, in NYC, it's ten minutes past the closest appropriate hospital. In others, it's the closest appropriate period. This is to stem 911 abuse such as what you're describing. Refer to your local guidelines, or call your EMS supervisor on the scene if you're not sure what to do. If no guidelines address txp destinations, then bring this to the attention of admin, who would stand to benefit from not having their units OOS for long, frivolous txp times, often for the uninsured and underinsured to begin with.
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Old 09-21-2011, 01:37 PM   #18
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Errrr, so in MD your not allowed any choice in where your transported to, it's solely up to a possibly lazy burned out provider?
The patient is allowed to make a request, but we certainly don't have to listen to the request - as long as the hospital we choose is a facility that can provide the care they require.

We can't decline a transport unless it's unsafe, but at the same time we aren't beholden to a patient's whims as to where they go. How far can a patient dictate you transport them?
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Old 09-21-2011, 01:39 PM   #19
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That "Wherever they want to go" is silly... What if they're in South FL on vacation and want to go to their hospital in GA? Are some of you people saying that you'd have to transport them on something like that??
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Old 09-21-2011, 01:48 PM   #20
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If 911 is called, EMS responds, patient want's to go to the hospital, why would EMS refuse?
Because the vast majority of patients don't need an ambulance, let alone care during an ambulance transport?



Quit being lazy / cheap. Get a taxi. Save the ambulance for someone that needs it.
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