Scenario: The Chronic Cab?

[mycrofft]

What if paramedics, and maybe EMT-B's in some cases, were able to delegate a run they to another lesser one, like a median, when it turned out to be not needing their talents and vehicle? Or even let the dispatchers decide to send the Chronic Cab on their discretion?

Example: Ambulance sent to residence for reported dyspnea/difficulty breathing. Patient states SOB when lying flat, has obvious nasal congestion, normal vital signs, but this has gone on for a week and the pt has had "no sleep" and wants to go to the hospital. EMT's could call for the van to transport, with an EMT or EFR (MFR) driving so they could recognize anything which goes south anyways, placing the ambulance back in service and the van can take the pt to the hospital or dr office or whatnot?

Just a thought exercise. Punch some holes in it or say "why not"?

 

[Sam Adams]

Great idea. One that's been toyed with and talked about in my (very) busy Dept. There really are no down sides providing, as you stated, the operator of the sub-acute van be an EFR or EMT. The problem initiating this is having a strong medical director who is able to implement it and ward off State EMS officials who frown on the "turfing" of patients to lower liscenced practitioners.

 

[AnthonyM83]

The idea itself isn't bad. You might have to get around any legal statutes about medical transports. I don't think the downgrading is that big of a deal. In Los Angeles (not that we're a model for anything to do with EMS unfortunately), it's written into protocols that ALS can pass of a patient to a BLS crew as long as they don't meet anything from the "Required ALS" list. This comes in handy since BLS crews often end up holding the walls at hospitals for hours in some areas...frees up the medics (not so handy for the EMTs, though...)

 

[DrParasite]

In Los Angeles (not that we're a model for anything to do with EMS unfortunately), it's written into protocols that ALS can pass of a patient to a BLS crew as long as they don't meet anything from the "Required ALS" list.

This is a statewide protocol for NJ, Deleware, and I think parts of NYC. And most tiered systems when ALS and BLS are seperate agencies.

holes to punch:
if you get 1000 calls for service a year, and you bill for all those calls. now we are turfing 20% of them as not needing an ambulance, so we now only have 800 calls to bill from. how do you make up the lack of income?

what if the van isn't available? or has a 20 minute ETA? If you are 5 minutes from the ER, are you going to tie up the ambulance waiting for the van when you can walk the patient to the ambulance, drive them to the ER and drop the patient in triage?

even if you have an EMT driver of the van, and the resp patient goes south after the ALS/EMS release (which has happened to me ALS released a patient who ended up going into resp arrest when enroute to the ER), than what will happen? what will the lawsuit cost the city?

if you have a 10% admit rate to the hospital, is that a problem? or what about a 1% admit rate to the ICU? I think those were the San Francisco (I think SF, it was a west coast city) numbers when they ran their alternate transport options.