My BIGGEST pet peeves

[JPINFV]

So, because the patient has an issue with their insurance agency, they get to demand wherever they go for a non-emergency when they are more than capable to find alternate forms of transportation? How is that not an abuse of the system? Yes... asking an ambulance to make a transport to a far away hospital for something that doesn't need to be transported by an ambulance IS silly.

Is abuse of the 911 system not against the law in Texas? I'm not saying it doesn't happen, but if you're so big on being able to unilaterally set policy, call the police yourself. Have the person charged with abuse if they're calling for non-emergencies.

Yes, within reason (and, again, I think that what is "reasonable" should be set at the system level, not at an individual ambulance level) patients have the right to direct their own care, which includes destination.

This is an insurance issue.

This is a continuity of care issue (what happens when your patient is admitted?).

This is an EMS system issue (again, don't complain when you're holding the wall because the ED is waiting for an IFT to transfer out patients that shouldn't be at that specific hospital in the first place).

This is a health care cost issue (IFTs aren't free, nor is uncompensated care).

This is not -just- an insurance issue.

We'll go to the call I had yesterday.

Can you honestly say you can't trust 99.9% of providers to go "Hmm.. isolated foreign body stuck in soft tissue with no possible chance of an emergent condition.... they need a taxi not an ambulance"? If they cannot be trusted with something as simple as that, they don't need to be trusted with anything considered 'ALS'.


(PS.. please don't go off some hypothetical thing like an embolus...)

What if a bit broke off and he had an emboli? (I couldn't help myself, thanks for the idea!)

Seriously, though, the issue isn't the patently emergent or the patently non-emergent. Where's the line? Does that non-traumatic abdominal pain patient really need an ambulance? Does the leg pain patient really need an ambulance (wasn't there a story posted today about a video gamer who developed DVT and died?)? Saying "Does a patient with a splinter need an ambulance?" is as obvious as "Does the chest pain patient need an ambulance?" (...and no, I'm not trying to reference the infamous DC case here). The obvious answer is no and yes respectively. The problem is that there are plenty of cases that are not so obvious, and no, I don't think I'd trust a lot of providers in making those decisions in the non-obvious cases.

 

[JPINFV]

Exactly... where IS the line? Because as of right now, you'd advocate transporting a 911 patient from San Diego to New York because their insurance pays for the NY hospital. Or for a more realistic one... from Houston to Dallas, a 250mi, 4 hour one way trip. That's not responsible.

Ah, except that's not what I've been saying, but thanks for playing. Should I post a link back a few pages where I clearly stated that the time limit should be set at the system level? ...and yes, if your system wants you to transport all the way from Houston to Seattle, then yes, the appropriate thing is to transport the patient to Seattle, and then either quit, grin and bear it, or work towards changing the policy. Intentionally ignoring a policy such as the patient's ability to choose their destination is not an option.

The line is whatever hospital is able to treat the patients complaint that they called 911 for. If it's emergent enough to call 911, and emergent enough to go by ambulance, it's emergent enough to go to the closest appropriate facility.

If not, they can set up an IFT from their house to wherever they choose.

Then call the police for every patient who does not meet your definition of time sensitive emergent. Every patient, every time.

 

[firecoins]

-long internet threads

-EMT-B/Medic trucks

-IFT companies that make you purchase equipment that they should be supplying like O2 regulators.

-People who like long walks on the beach.

-People who expect you to speak their language.:rofl:

-partners who speak over you to patients.

 

[Epi-do]

We have an ungodly number of hospitals in the city including 2 level 1 trauma centers, a level 1 pediatric trauma center, and a level 2 adult. That being said, we can transport to anywhere in the 9 county area, which is about 1800 sq. miles. (Someone from Indy correct me if my math is wrong, I had to go to googlemaps to figure out the area.)

That is department specific, kat. I can tell you that if someone wanted me to take them across the entire county and into Hendricks or Morgan Co, the answer would be no. For the most part, when it comes to transporting to the west, we really don't go much past all the stuff downtown. It would take us forever to go from the east county line to Hendricks Co.

 

[sirengirl]

-People who expect you to speak their language.:rofl:

people who dont speak your language then have the audacity to snap their fingers at you repeatedly and go "ey, ey, ey" and point and beckon you like a dog :glare: gtfo.

 

[Hunter]

people who dont speak your language then have the audacity to snap their fingers at you repeatedly and go "ey, ey, ey" and point and beckon you like a dog :glare: gtfo.

Lol! This is specially true in florida.

 

[the_negro_puppy]

When people call 000 (911) and due to their low AMPDS triage, wait an hour or two for an Ambulance in the middle of the night. When you arrive they are sleeping in bed.

 

[katgrl2003]

That is department specific, kat. I can tell you that if someone wanted me to take them across the entire county and into Hendricks or Morgan Co, the answer would be no. For the most part, when it comes to transporting to the west, we really don't go much past all the stuff downtown. It would take us forever to go from the east county line to Hendricks Co.

Oops, forgot about that. My company has the rule that we can go anywhere in the 9 county area. In saying that, there are several other 911 providers in the city that say different.

Oh, Epi? I sometimes wish they didnt have that rule. We had to transport one from the west side to CHN the other day.... looooong transport.

 

[MrBrown]

When people call 000 (911) and due to their low AMPDS triage, wait an hour or two for an Ambulance in the middle of the night. When you arrive they are sleeping in bed.

super mega hella gangsta big afro styles ROFPMSLMAO

 

[HotelCo]

super mega hella gangsta big afro styles ROFPMSLMAO

Don't make fun of my hair. That's not cool, dude...


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[Hunter]

Don't make fun of my hair. That's not cool, dude...


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I'd take that as a compliment

 

[Tigger]

And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.


However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away. Do you oblige?

How about reading all of my post next time instead of just taking one part out of context? Did you just skip over the first part because it doesn't align perfectly with your stance?

Notice that I said I am personally glad to not have the problem of long distance transports, but I did offer an idea to those that do.

To rehash:

Clearly it is not in the best interest of your service to transport people to a hospital an hour away. There's nothing wrong with that. All the administration has to due is write a policy that states all but specialty patients will be transported to hospitals within x amount of minutes. That way, you don't have to make that choice in the field, your choice to take them to closest appropriate facility has already been justified. I guess I don't see what the problem is with putting such a policy in writing is, it doesn't seem like something you would even want to go against anyway.

To answer your other question, I will take a patient to whatever hospital they want, provided it is inside my EMS region. If not, I can contact my supervisor to see if I can take a patient out of area, though I am yet to do that. Incidentally, a lot of my transports are still over a half hour due to traffic, but we have contingency plans in place for when a unit is going out of service for a significant period of time.


Sent from my out of area communications device.

 

[Farmer2DO]

I'm lucky not to have to deal with this, most of the time.

Almost everyone goes to one of the 4 local hospitals. The exceptions are Veterans (we have 3 VA Medical Centers; 60, 70, and 90 miles) and a major hospital that does cancer only about 70 miles. There have also been a few exceptions for post-surgical complications, which need to go back to their surgeon and the facility where they had the surgery.

I personally think that we SHOULD be able to make these decisions. It's called judgement; we're supposed to exercise it all the time. If you want the person to make the case to a supervisor or medical control, fine. But if we can't decide things like this, how can we ever expect to get any respect as a profession?

I'm more than happy to take someone on the 90 mile trip when there's a hospital across the road when there's a reason. Going out of town because all the hospitals here know your game and won't give you a script for 120 percocets is not enough of a reason.

 

[Farmer2DO]

-EMT-B/Medic trucks

-People who expect you to speak their language.

People who not only expect you to speak their language, but wave their benefits card at you like they own you.

Nurses that get up in the middle of triage and walk away to go do something else.

Medical personnel that work in areas that routinely deal with EMS and have NO idea what our role is, in any way, shape or form, and then think they need to tell us how to do our job.

BTW, what's wrong with EMT-B/paramedic trucks? From what I can see, it's the rule, not the exception, and my place of employment makes it work quite well every day.

 

[JPINFV]

The exceptions are Veterans (we have 3 VA Medical Centers; 60, 70, and 90 miles)

Devils advocate time:

Why are veterans an exception? If you're going to transport them 60 miles because of their insurance (VA access), why shouldn't everyone else get the same benefit (transport to their home hospital if within 60 miles)?

 

[Farmer2DO]

Because in reality, 90-95% of our patients are Medicaid, who doesn't care where they go.

We have an outpatient VA clinic in town that authorizes local hospital ED visits all the time, so it's rarely an issue. I'm talking about someone who's stable enough to make the trip, is going to be admitted, will likely be transferred if we go local, and has some benefit to be gained from making said trip.

But if you aren't a Veteran, and had your leg surgery 70 miles away, and now it's infected, and you aren't ambulatory, and are here staying with your daughter while you recover (a real scenario) then you deserve to go back where you had your surgery.

I think as a paramedic, these are decisions that I should be able to make. I don't actually think they're that difficult.

 

[Aidey]

Actually Medicaid (and Medicare) does care. They only pay mileage for the patient to go to the closest appropriate hospital.

 

[Farmer2DO]

Medicare, perhaps. Medicaid is administered by the state, and only has to meet certain minimum requirements as set forth by the federal gov't (as I understand it). New York is a VERY liberal state, and Medicaid here pays for everything. I've never heard of any Medicaid patients ever having "preferred hospital" issues here.

 

[Leafmealone]

Medicare, perhaps. Medicaid is administered by the state, and only has to meet certain minimum requirements as set forth by the federal gov't (as I understand it). New York is a VERY liberal state, and Medicaid here pays for everything. I've never heard of any Medicaid patients ever having "preferred hospital" issues here.

Medicare/Medicaid makes you jump through a lot of hoops also when it comes to transporting. Not only do they do the whole closest facility thing, but they also require EMS to state why an emergency transport was needed, and why they couldn't have driven themselves. I've taken to placing all my Medicare/Medicaid patients on 2lpm O2 just so I can justify billing.

 

[Sasha]

Medicare/Medicaid makes you jump through a lot of hoops also when it comes to transporting. Not only do they do the whole closest facility thing, but they also require EMS to state why an emergency transport was needed, and why they couldn't have driven themselves. I've taken to placing all my Medicare/Medicaid patients on 2lpm O2 just so I can justify billing.

Thats fraud.

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