Pre-Hospital Blog

EMS can be better

What happens if we say no?

with 5 comments

In a meeting today, someone offered the timeless reminder that we can’t say no. If someone calls an ambulance and says “I need to go to the hospital” we can’t say “Well, we aren’t taking you because you don’t need to go.”

Why not? I realize that there are probably legal concerns, so what are they?

I want to envision a well-monitored program that allows a the Paramedics in a system to tell a patient that we won’t be taking them to the hospital. This differs from the idea of the “Paramedic-initiated refusal” in that no one is convincing the patent to refuse; we are telling the patient that we won’t be taking them to the hospital.

Surely there is a discreet, teachable, easily monitored set of evaluation criteria that can filter those patients who will not die if they don’t go to the hospital by ambulance. This would be best supported by some public transport system like Access-a-Ride that we have here in Colorado.

It might look something like this:

Patient: “I want to go to the hospital.”
Paramedic: “We aren’t taking you, you oren’t sick.”
Patient: “Well, what am I supposed to do.”
Paramedic: “I’ll call my dispatch and have them send a van over to give you a ride.”
…and so on.

Does anyone do this? Where and how?

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Written by ben

April 15th, 2009 at 12:11 pm

Posted in ideas,rants

5 Responses to 'What happens if we say no?'

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  1. I have worked in a couple of places that do this. The medics generally end up being unavailable for much longer than they would if they just took the patient to the hospital.

    Then there is the problem of the research showing that EMS providers are really bad at deciding who does not need to go to the hospital.

    While this is something that needs to be addressed, until we can improve the quality of EMS education and oversight, we are only making the problem worse.

    It might be better to address the problem from a different approach, but with the fear of Press Ganey reviews, I do not expect the hospitals to be the ones to address this. Perhaps have the police ticket people for EMS abuse.

    The way the system is set up, there is no accountability for people who do not pay their bills. This is a much bigger problem for those in the ED, but they do not seem to have come up with a solution. Abolishing Press Ganey would be a help, but the administrators would only come up with a similar way of making patient care less important than pleasing the patient.

    Rogue Medic

    15 Apr 09 at 12:35 pm

  2. You’re right, and I’m sure the real answer lies somewhere in the realm of public education and better access to primary care. However, from a system usage standpoint this would be very helpful. Even if a crew is unavailable for longer, this is potentially one less non-paying transport to write off and an opportunity to educate yet another person on appropriate use of EMS.

    It seems though, that a set of well-researched criteria (vital signs, complaint sets, other rule-outs) could eliminate the problem of medics sucking at deciding who needs to go to the hospital (yeah, we’re awful at it).

    ben

    15 Apr 09 at 5:10 pm

  3. Dallas does this. They do it poorly. There are quite a few systems looking at refusing patients from dispatch. This can be recorded and reviewed. The dispatcher also does not have a stake in the outcome, so the decision is not skewed.

    Buckman

    25 Apr 09 at 9:47 pm

  4. Yes, and I heard recently that Phladelphia was looking at doing a similar system as well, and the NHS in Britain does it with some success (there’s more incentive there… it saves them a TON of money)

    ben

    26 Apr 09 at 7:18 am

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