ALS/BLS Emergencies Vs. ALS/BLS Transports

[ONEEYEDMIC 68]

HERE IS A HYPOTHETICAL SITUATION. What ever you read from this point on is something I made up. OR IS IT? Let's say you have a fully staffed medical facility in your jurisdiction with many patients. On an occasional basis E-911 is called to your local PD (lets say every 17 days or so) and a request is made for an AMBULANCE. The AMBULANCE gets there and it turns out that the PATIENT has had lets just say for the sake of arguing DIFF BREATHING for SOMETIME. You are also told by the staff that the Patient is going to a particular floor at a nearby HOSPITAL and not to the ER. This doesn't happen all the time, but it does happen.

Now let's say that there may be a FULLY STAFFED PAID SERVICE about 1 mile away at all times unless out on another RUN. Who should be called? Do you think that a PO should also go on this call? From a PD standpoint I don't see the need for a PO on this call unless it is a legit EMS CALL or another need for PD response. Not for a TRANSPORT because a DR finally calls back and see that the numbers are not in the patients favor and decides that is the time to call for an ambulance.

Taking a dedicated MEDIC out of service is wrong and taking a VOLUNTEER AMBULANCE CORPS out of service is also wrong. Especially when the PATIENT isn't even going to the ER.

This isn't a PAID/VOLLIE issue this is a MEDICAL FACILITY ISSUE that I believe is doing the WRONG THING by calling 911 when they should be calling a LOCAL TXP SERVICE.

If this sounds familar to you or you can relate just leave it at that. I don't want to name names or SMEAR a MEDICAL FACILITY. Like I said in the beginining, This is strictly HYPOTHETICAL.

[Goose 188]

I suppose it all depends on the type of facility we are talking about. If your talking about an interfacility transport from one hospital to another then i would say things should be pre-arranged with a commercial agency and the facilities involved. If the transport is ALS or BLS would be relayed to the transporting agency and they would send the appropriate unit. Nursing and assisted living facilities are a whole different ball game.

[mikeinet 37]

Personally... there needs to be a distinction as to what an "EMERGENCY" is - are they going to the hospital because their life is AT RISK or because the facility they are at can't give a given tx.

If it's a true emergency... IE a "real" diff breathing call that would qualify for ALS care then I have no issues with it going by ambulance...

If it's say a "facility" looking for an excuse to offload a pt... then there's no reason why an EMS agency should be taken out of service to deal with it - tax dollars, personal time (if a vol agency) or putting the community more at risk (what happens when 2min after getting on scene you hear a full arrest being mutual aided??).

But don't try telling a facility that... :-)

[ONEEYEDMIC 68]

I understand what you are saying about what type of EMERGENCY or if the facility is just DUMPING off the PATIENT. To the FACILITY STAFF calling 911 makes it an EMERGENCY on my end. That forces ME/US to dispatch a MEDIC/AMB. When you get there you may find that the Patient has been having trouble for some time and probably needed to be TXP earlier than later. That is where it gets hard. Do you tell the FACILITY not to abuse the 911 system? They like to play like they don't know when the really do. That is my question. Where do we draw the line?

[KelliPVAC 32]

If someone calls 911, can you deny them an ambulance? Or how many calls do we get from a house that don't really need an ambulance or medic?, and could go to the hospital in their own car? Yes it may be annoying but I would never turn a patient away.

[mikeinet 37]

no, of course you can't DENY someone an ambulance... but personally - a medical facility should know better than to call for an ambulance in it's own situations... It's not like someone at home calling for an ambulance and not needing one

[Medic137 6]

Although it has been a few years since I worked in the HYPOTHETICAL JURISTICTION, I remember the problem being:

The FULLY STAFFED MEDICAL FACILITY always called the EMERGENCY CONTROL CENTER who insisted on considering every call they received as an emergency. Rather than contacting the FULLY STAFFED PAID SERVICE directly, they sent the closest available ambulance and medic. If the FULLY STAFFED PAID SERVICE was already on a call, the nearest available VOLUNTEER SQUAD and medic were sent.

I can't say anyone was doing anything wrong, everyone was following the procedures their administrators put in place.

Edited August 9, 2007 by Medic137

[nycemt728 49]

As many have said, 911 cannot refuse once called, but I do see the origional point: 911 should not be called in these situations. There are plenty of private companies who are available and willing to do interfacility transfers, emergency or non. If it is truly an emergency, they by all means call 911 but then, it should not be a direct admit, but brought directly to the ER, then transfered once examined, admitted and stabilized if necessary. We, the EMS community as a whole, I think need to help get these facilities out of the mindset of calling 911 in these instances. What needs to be made clear, is if its an emergency it gets called in ASAP and brought to the ER. Every private bus has trained staff on board, its not like calling a taxi or an ambulette, the pt is still in capable hands either way. If ALS is needed, well the privates have ALS as well...

[ONEEYEDMIC 68]

I am not saying to deny anyone who calls 911 a MEDIC/AMB. What I am saying is that FACILITIES need to realize that they can't just call 911 when they feel like to get a patient out of their FACILITY.

What happened to the FD/PD TOPIC? I was just about to post and it was gone. SETH YOU SHOULD HAVE LET THAT GO ON. You will never be able to get to the root of the problem if you don't let people vent about what is wrong. Just my Opinion.

I guess what I need to do is talk to the people in charge. I know they don't understand EMS as well as I do but maybe I can make it clear somehow.

[Medibart 55]

Many people look at this as a simple problem but it really isn't. The pertinent questions are:

What is an emergency? - this is a very subjective question with no established protocols. Someone would have to create a standardized protocol and then train all of the staff to follow them. We'd also have to assume that the staff is capable of assessing the situation and we all know that that is not always the case. There's also a potential for liability on whomever develops the protocols. As often as a 911 agency is called for a non-emergency, a transport agency is called for a non-emergency that should definitely have been an emergency.

If it is an emergency, what is an acceptable ETA? - again this is subjective and situational. If a transport agency is running efficiently, they probably won't have many ambulances sitting around to service a 911 call, so oftentimes these calls end up being scheduled. Is the patient stable enough to wait?

Our general practice is that we work with the local EMS agency to jointly provide the service. If we can respond with an appropriate ETA we will, otherwise we contact the local EMS agency or advise the caller to dial 911. While we like the business, we have no interest in having an emergent patient wait for us. It's just not what we are about. There really needs to be a three party dialogue between the local EMS agency, the transport agency and the facility administration. It's irresponsible for a transport agency to try to take sole responsibility for a facility unless they have dedicated 911 units. It's also irresponsible for a 911 agency to try to shirk their responsibility to service a facility in their area. By working together, a transport agency and a 911 agency can develop a method to provide the appropriate level of service to the patient.

[ltjay157 10]

in the town i dispatch for, we have one of these problem facilities. they're only supossed to call 911 for true emergencies, other thatn that, the paid service will pick them up. i've complained about the misuse of the system by this facility (which shall remain nameless). they know how to work the system. they call up and say dif breathing, vhest pain, etc when they call 911. i've had the ambulance crew tell me when they get back from the ER, that th person wasn't that sick. the facility didn't want to deal with them and passed them along. the person even had a bag packed and was ready for the ambulance once it arrived. why can't 911 ambulance refer the stable, non life threatning to the private/contracted agency? how can we stop the abuse from these facilities? iknow there are days i've sent the 911 ambulance to that facility for the sniffles bs call, only to get a 911 call from the same facility 5 min later with a true emergency. trying to get a mutual aid ambulance there is a nightmare.

[RC2389 0]

Local medical facilities using the 911 service for transports has become an issue in our district. It is rare that we arrive and they tell us the patient is being brought to a specific hospital floor as opposed to the ER, but all too common that we get there and the patient has no immediately life-threatening issues, and we were called because we can get the patient off their hands faster than a transport service.

A number of calls are similar to this:

"Ma'am, what seems to be the problem?"

"I have terrible pain in my back."

"And how long has this been going on for?"

"About a week."

In my opinion, either EMS should have been called the moment the pain started, or a transport could have been called if they were going to wait so long anyway. I remember one specific call from the same facility where even their medical staff acknowledged that the patient had no medical issues, but was being "abusive" to staff members and thus by calling 911 they could get rid of her faster. Some sort of training and protocol is needed for the staffs at these facilities, because it isn't fair to the rest of the area to have the primary ambulance and a full crew taken out of service because it will take 2 hours for a scheduled transport to arrive.

[RescueKujo 130]

I feel your guys' pain. Luckily, our County EMS Agency has enacted a protocol as to what constitutes the useage of 9-1-1 by an ER.

It must be a Trauma Transfer or if in the opinion of the ER physician, the patient will suffer if not transported to another facility due to hospital capabilities or such (STEMI, ortho injury that the hospital cannot handle, surgical case). When we get a transport I'm not sure about, I pass it on to our supervisor, who will research it.

posted by Medic137 August 9th

The FULLY STAFFED MEDICAL FACILITY always called the EMERGENCY CONTROL CENTER who insisted on considering every call they received as an emergency.

We have one of those here, too. They do EMD, but send ALS and an engine on everything. So here we are, sending medics on stubbed toes, finger lacerations, etc. What a waste of resources.

[Guest]

I guess what I need to do is talk to the people in charge. I know they don't understand EMS as well as I do but maybe I can make it clear somehow.

uh...what??

Edited August 27, 2007 by vacguy