Wait... don't you do this now? Do you not have these discussions with patients before you transport them?
I mean, look... not everyone is reasonable, and sometime you have to default to the "you call, we haul" mentality, but I try to have a real discussion with anyone who will listen.
I understand that if we don't transport, we don't get paid and I want to make money for the system, but I know that the EDs are overwhelmed with minor issues and our reimbursement rates are low. In many cases it makes sense to take a step back and say, "I know you've had this cough for a week, but the urgent care is right down the street, they'll see you quickly and you'll be home in an hour. They accept cash and your insurance. And honestly, you don't need an ambulance."
Maybe I'm trying to bail out the flood with a teaspoon, but every time I am successful, I feel a small victory. Advocating for the patient and helping to reduce the stress on the system makes it worth while for me.
I know of one EMS agency where crews would have a nightly competition for who would get the most non-transports...... regardless of if they were in the patient's best interest or not.....
I used to discuss this with the patient; however, the longer I spent in EMS, the less I did it, as in the end, it didn't benefit me at all. The risk for provider liability is higher with an RMA vs a transport. If the patient wants to go, even for a sniffle, I can't deny them transport, and trying to talk them out of it might result in a complaint (where you are guilty until proven innocent). my boss wants me to take them to the hospital. and when I worked in they city, I can spend 20 minutes working out a patient refusal, or spend 10 minutes transporting the ambulatory patient to the hospital.
As for the original question, some people are different, but many are not. Too many bosses run their crews into the ground (an ambulance that isn't on a run isn't making any money), and equip their ambulances with the bare minimum level of supplies; if the state doesn't require it, even if it will help the patient (or the provider) you won't see it on the ambulance. Too many employees don't learn more than the bare minimum to maintain their certs, and won't (or can't) think outside the box. Too many bosses see their employees as just warm bodies, so they don't invest in them at all; likewise many employees will jump ship to a new agency that pays them better.
If my superiors supported me referring people to an alternative destination, I would do it every time. "Sir, you don't need an ER, you need to go to your PMD or the urgent care. you will be seen quicker, be discharged quicker, and it will be cheaper for all involved." or "sir, you aren't dying, why do you want to go to the ER we a urgent care or your PMD?" and of course, I would take sick people to the ER. But until I get the support from above, it's "you call, we haul." At the end of the day, it wasn't worth losing my job over.
