1. #1
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    Angry EMS System Abuse...............

    Discussions on several other threads are starting to show that a lot of people are unhappy with a lot of things happening in the EMS field. One BIG problem is abuse (in my opinion) of the EMS system by the public. I'm bringing this up here, instead of in the EMS forum, because Firefighters seem to be a lot more upset than those who only do EMS. So, What are your perceptions of what is wrong with EMS Services that are Fire Based, What is wrong with our customers attitudes about EMS, and what can we do about it, WITHOUT MOVING EMS OUT OF THE FD.??? I have 2 major gripes here in my area:
    1. People have the idea that they will be seen quicker in the ER if they are brought in by Ambulance.
    2. Hospitals have a shortage of space in their ERs which requires us to stand there with the patient on our stretcher, waiting for a ER stretcher/bed.
    My questions: Do you have these problems? Do you have a solution? Do you have other problems? What are they? Do you know how to fix them? Why aren't our problems being addressed? Thanks. Jump in.
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    E.M.S. is the same circus everywhere, just with a different bunch of clowns. People have always abused E.M.S. and they always will. Most of the people you see abusing it are the lower class citizens who may not have the money to go to a private practice. Most of these people know that they cant be turned away if they call the ambulance. That being said, in theory the only way to fix the problem is to "screen" the call when it comes in by 911. If a call doesn't meet certain standards, then a medic unit should not be dispatched. Those calls should be left for a convalescent transport company to handle, and they should be considered low priority by the hospital. That would give the abusive patient exactly what they want, a ride to the hospital along with a $350-500 dollar bill to go along with it. In actuality, there is no real solution without someone complaining that their civil liberties are taking away. All in all what you are describing is just the nature of the beast.
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    EMS abuse...

    Is that when the volunteers role out of bed in the middle of the night, drive to the station, drive to the call, and then have the State Trooper take your patient out of the back of the cruiser, remove the handcuffs, and put them in the rig because they're no longer allowed to transport to the hospital?

    Then they follow you up to the hospital to fill out the protective custody evaluation paperwork for the ER?

    And you're doing this a couple times a week...

    ==============================

    Or hey, one of my favorites...

    Hospital gives our dispatch number to someone bringing her mother back to the assisted living center in town to help her move Mom from the car to the apartment.

    Hey, I honestly don't mind doing that for private residences...BUT I HAVE A BIT OF ****ING PROBLEM WHEN THERE IS 24x7 PAID STAFF AT A FACILITY AND THEY CALL THE VOLUNTEER FD SINCE THEY DON'T WANT TO HELP SOMEONE FOR FEAR OF "LIABILITY."

    ===============================

    Unfortunately Harve, the real solution is to start becoming a culture of survivors again and not a culture of victims. Every little adversity in life is not a 911 emergency. ***** happens, deal with it.

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    We have a protocol that allows us to not transport a patient because it is not an emergency and/or there is no need for an ambulance to transport you.

    An example: stubbed toe, minor wound laceration, bug bites, bee stings (without anaphylaxis as it occurred a couple of hours ago).........

    It is not abused and therefore we get to keep our protocol.


    And when the wonderful Medicaid/Medicare system is happy to dole out a $500 check for an ambulance ride but not the $5 for a taxi ride you get abuse.

    I frequently tell my patients that the ambulance will not get them there any quicker and you will be put in triage and seen in the appropriate order behind the people that really have a medical problem - this usually ****es them off, but I am just telling them the truth.

    Problems are not being addressed because the only solution is more hospitals and with the decreasing reimbursemtn rates for treatment all along the medical line, that just is not going to happen.
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    Good old "GOMER"(Get out of my emergency room)totes. The cops here did file a charge of 911 abuse against one of our local drunks who calls everytime he gets hammered a few months back. Slowed him down a little bit, but, he's back to calling again. Then like you said, you have the "average" Joe citizen who thinks a stretcher is a one way, no waiting ticket to the ER. We've had them waiting on the curb with their bags packed. The hospital is trying to help us with this. Their policy is that if you are a genuine emergency, you are seen ASAP. If you call at 3:00AM for a sore throat, a bad case of roids, or some of the other BS stuff I've seen, they park you in a triage area, and if you're lucky, you might get to see a Dr. in about three or so hours. This seems to deter all but the most hearty of hypochondriacs. As far as screening calls, we were promised when we got our state of the art dispatch center, and went to paramedic engine companies that we would operate on a tierd response system. I.E. we would respond only on cardiac calls, unresponsive pts, major accidents and such. Well, 8 years later, and we are still getting up in the early hours for nose bleeds, skin rashes, etc. If someone could come up with a solution to this, he'd be a hero.

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    We are in the beginning stages of paramedic intiated refusals, our ems director is more than willing to sign off. Sharkie any chance you could e-mail or fax your protocals? let me know i will get you my address or fax #

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    Default I knew we annexed, but that far???

    Chief,

    The exact same problems here with the addition of a lack of bus fare. We have a handful of "resourceful" patrons that have figured out that ambulance rides across town are free, at least for them, where a bus ride costs a couple of bucks, so they call us.

    Your out east and need to go downtown, call an ambulance and go to The Med. Downtown and need to get back east? Call an ambulance and get transported to St. Francis......and so on. Many of these patients arrive in the ER, refuse treatment and walk out.

    One of our most frequent abusers was transported to the bus station. A one way ticket to Nashville was purchased out of the station "extras" fund, and away he went.

    It didn't take long, he was back with a note from Nashville Fire. Seems they didn't want him either!! lol

    Seriously Harve, I don't have the answers. I am a mere company officer on an engine company. You may contact our Deputy Chief of EMS. We recently hired Gary Ludwig. He is a nationally known EMS expert, you may catch his columns in "Firehouse" and other publications. He has some ideas and a strategy in place that deals with your very issues. Let me know if you would like his contact info.
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    The sad thing is the abuse of the system is the reason I have to wait 2 to 3 hours at the local ER becuase something stung/bit me and I am swelling up like .

    I have actually walked out of the ER and just 'dealt' with something before because the ER (which appeared to be empty) was trying to screen me out or something.

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    I think a better job of call triage might help.

    Some of the BS calls that we were dispatched because someone called 911 for include...

    Difficulty breathing: someone's sinuses were congested due to a cold.
    Severe vomiting and headache: Someone severely hung over.

    and my favorite: the unknown medical. Can range from someone upset because their wife/husband/gf/bf significant other yelled at them to a full blown cardiac arrest.
    Last edited by CaptainGonzo; 01-17-2006 at 12:34 PM. Reason: spelling
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    Quote Originally Posted by CaptainGonzo
    and my favorite: the unknown medical. Can range from someone upset because their wife/husband/gf/bf significant other yelled at trhem to a full blown cardiac arrest.
    I had one like that...no info...arrive on scene neighbors direct us around back without saying a word about what it is. We find a man with his face blown off and no cops around...needless to say we got the f*ck outa there until the PD arrived 3 minutes later! I don't know how we get a gunshot as an unknown...but someone dropped the ball somewhere.

    Around here they do priortize EMS runs and one can wait quite awhile for them...however the abusers(10,000s of them) know all they have to do is tell them chest pains or difficulty breathing and everyone comes fast like. They always find a way to manipulate the system.

    FTM-PTB

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    I think the most important thing you can do is get out there and educate the public on what your service does and is there for. Go to schools, SR citizen clubs, the mall, etc and give them information on when to call or not to call. If the public doesn't hear it from you they will from the media or some other source and you can't complain if they are getting the wrong info at that point.

    After that having a dispatch system that doesn't 'screen' the calls but gathers enough info to assign a proper unit and responce asuming you have a BLS and ALS system. There has been a proven problem with 'screening' calls and lives have been lost in errors that could have been preventend or couldn't have simply because the medically trained dispatcher, nurse, etc was behind a phone and could only get so much info.

    I think as the next few years come providers will be doing more treat & release, turf to clinic, primary, etc and may other things to keep the load off of the ED's. To do our jobs as physican extenders just like PA's, Nurses, etc we will have to prove that we can handle it and when a Command Doc gives his service that chance to either have something as simple as clearing a C-Spine its up to use to stay educated and never get lazy in the care of the patients.

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    Quote Originally Posted by DaSharkie
    We have a protocol that allows us to not transport a patient because it is not an emergency and/or there is no need for an ambulance to transport you.

    An example: stubbed toe, minor wound laceration, bug bites, bee stings (without anaphylaxis as it occurred a couple of hours ago).........

    It is not abused and therefore we get to keep our protocol.


    And when the wonderful Medicaid/Medicare system is happy to dole out a $500 check for an ambulance ride but not the $5 for a taxi ride you get abuse.

    I frequently tell my patients that the ambulance will not get them there any quicker and you will be put in triage and seen in the appropriate order behind the people that really have a medical problem - this usually ****es them off, but I am just telling them the truth.

    Problems are not being addressed because the only solution is more hospitals and with the decreasing reimbursemtn rates for treatment all along the medical line, that just is not going to happen.

    Must be nice. Here, if you want to be transported by an ambulance, no matter the reason, we take you. We are not permitted to tell them about triage, or that their insurance may not cover the ride. You want the bus, you get it.

    As for screening calls, also not going to happen here. The county EMS authority is so worried about lawsuits, they wont screen calls. You call 911, you get an ambulance. Oh, and all ours are ALS, so a sore toe (like I had the other day) gets a paramedic to go with their ride. The only thing the system does is use EMD cards, so not every call is an emergency response.

    And its not just EMS calls that I see what I consider abuse. At FD we get plenty. My favorite is electrical service problems. Someone will see a tree branch touching a power line and causing a little spark once in a while. Do they call the power company? Of course not, they call 911, so we have to go out, look at something were not ever going to deal with, and call the power company for them.

    I just dont understand what the problem is. Its not rocket science. Power problem=power company. Gas problem=gas company. Water problem=water company. Fire=fire company. Is it really that hard? Have we become so lazy that its to hard to pick up the phone book and look for a number? It takes to much effort to push 7 numbers on the phone instead of 3?

    I dont know how we got to this point either. When I started in '83, 9 out of 10 times we rolled, it was an actual emergency. People who called an ambulance actually needed it. We used to be surprised when we ran a call and found we didnt really need to be there (not counting auto alarms of course). Now, the numbers are basicly reversed. Like the last ambulance shift I worked. 7 transports, only one needed an ambulance (CVA). 1 out of 7, and thats pretty much the norm. Its almost gotten to the point that were shocked when we pull up and find an actual emergency, fire or EMS.

    How did this happen???
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    I think the problem is that for the most part, at least in my area, the ambulance does get you in quicker. There have been the rare occasions where the ER is full and they are "triaging" pts in the waiting room. (I put that in quotes because it ends up being you are seen in the order you showed up, not necessarily by severity of problem). We have been called for headaches... that have been going on for 3 days, difficulty breathing... since yesterday, and bowel troubles. The amount of abuse here is not anywhere near what is seen in other areas, but it does get annoying at times.
    As far as solutions? I dont know, Dasharkies protocols sound like a step in the right direction. I think to some extent we do it to ourselves, they call, we come and take them to the hospital. As FFFred said, if we institute a protocol to screen out abusers, they will find a way around it, I just wonder why they cant be that resourceful with solving their own problems.
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    We can't forget we are there to help people, sometimes at 4am and to us it seems like for no reason. So we need to have the means to offer them alternate methods of care when we know they will be waiting in triage for four hours no matter who takes them. We can't also forget that if you asume the attitude that eveything is BS one day its going to look like it and be totally different and you'll be on the street looking for a new job.

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    Quote Originally Posted by emtcsmith
    We can't forget we are there to help people, sometimes at 4am and to us it seems like for no reason. So we need to have the means to offer them alternate methods of care when we know they will be waiting in triage for four hours no matter who takes them. We can't also forget that if you asume the attitude that eveything is BS one day its going to look like it and be totally different and you'll be on the street looking for a new job.
    Listen, Mother Teresa, We aren't Social workers and we aren't wasting FD resources on some Bull Sh*t artist who wants a free ride to the hospital (Free for them anyhow..it ends up costing us) or someone who was looking for attention or the company of 5 men for the evening. Sometimes I feel like a cheap escort service for the elderly! Once the bus shows up...we are outa there and after decon and restocking go back in service for a real fire or emergency. And I don't know what you mean about looking for a new job.

    FTM-PTB

    PS- If someone is really in need of care we do what needs to be done...we've done that even before EMS offically started here. But we don't play into these persons games or needs by giving them any attention or sympathy.
    Last edited by FFFRED; 01-17-2006 at 12:51 PM.

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    Glad to be in the truck!! Although EMS runs don't bother me when I'm in the engine for a tour!

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    All you need to do her is pay your $34 per household Ambulance Tax (it's included in the yearly parish tax bill) and you get as many free rides as you like. While we have very few chronic abusers, we do get called for a lot of minor problems, and hence, wind up with a bout a 30% no transport rate.

    The medics here can tell patients that they will be triaged, and often use the fact that they will have to set up the patient for a possible IV during transport as a selling point when discussing the no transport option.

    It is a problem, but generally does not cause a ton of operational issues. It has burned some of our vollies out and has gotten them out of the EMS arena, which can be a problem when we actually need the EMS help. The bottom line is though it is part of the job because the community now expects fire department envolvement, and those who can't accept it need to as it's not going away. Or maybe they need to get out of the fire service as a career and sell pretzels or something.

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    Default Sharkie hit part of the problem

    Medicaid will not pay a dime for a trip to a doctor's office or an urgent care center. They will pay for an ambulance ride to the ER and the ER bill. They don't pay the full amount but you take what you can get.

    I chair the board of a true "3rd Service". We are owned by seventeen governmental units and operate all ALS ambulances. We put priorities on both call response and transport modes. Very few transports from scene to ER are run code. About 55 percent of our transports are ALS.

    We cover a population of about 109,000 and our paramedics belong to a union. Bottom line is that more calls means more income and less subsidy from the governmental units. We have not had to raise the subsidy rate in two years.

    We run over 10,000 calls a year not including the wheel chair division. Budget is about 5.2 million.


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    One of our most frequent abusers was transported to the bus station. A one way ticket to Nashville was purchased out of the station "extras" fund, and away he went.

    It didn't take long, he was back with a note from Nashville Fire. Seems they didn't want him either!! lol
    HAHAHAHAHAA thats funny. Very sad in a really strong way, but funny too.
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    To pay for Fire School, I took a job as a dispatcher for a nonemergency, interfacility transfer company. Basically, we took grandma to the ER from the nursing home for falling down 4 hrs ago. It does help relive the tension on the Public EMS Service, but it still abuses the ER, and when we are unable to take a MINOR pt, the threaten to call 911, and tie up valuable resources. *sigh, I love my job, I love my job, I love my job
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    Quote Originally Posted by LaFireEducator
    The bottom line is though it is part of the job because the community now expects fire department envolvement, and those who can't accept it need to as it's not going away. Or maybe they need to get out of the fire service as a career and sell pretzels or something.
    OK, I'll turn my resignation in at work tomorrow. Or...... maybe the girl who has an upset stomach at 3am and wants to go to the hospital for a pregnancy test really IS a mutt. I think that is more likely. Cancel my resignation.

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    My only point Chicago was that EMS in the fire service is here to stay. Just like a lot of aspects of my teaching job were not part of the mix 5 years ago, they are now, and they aren't going away either. The reality is the EMS and the fire service have become joined at the hip because that is what the public expects, and the chiefs and politicians know that. No matter how much you may hate it (and while I may not like it either I am realistic enough to accept it) it won't change the fact that next tour you'll probably run on the same pain in the azz customers.

    All I was saying was that anyone who does not want to run EMS should probably consider a field other than firefighting as that is what you'll be doing most of the time. The reality is you could almost change the name and take the word "fire" out of it as it really is now a small part of the job. My suggestion would only be instead of fighting it, use that energy to somehow embrace it (ok, maybe that's a bad word) as in all liklihood, it's going to be around for the rest of your career.

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    As others have said, we need to educate the public as to when & why to actually call EMS...I realize this won't make a tremendous difference BUT maybe 2 or 3 people might take heed and take a Tylenol or drive themselves to the hospital. There will always be "mutts" of every color, religion, creed, sexual orientation or otherwise who will call us to take a taxi ride.

    Priority dispatching/EMD do not make a difference...people, particularly habitual abusers learn very quickly what to say to get a fast response...I've dealt with many a mutt with a 6th grade education who knew if they said they had chest pains, they would get the "ambulanx" there quicker (usually two of 'em, one with those paramedics).

    I have heard of "abuse of service" citations issued by PD at EMS's request
    (in PA, you get a $150 fine)...that might deter the hard working, tax paying citizen who made a mistake but the welfare mutt who calls 3x a week 'cause he doesn't have air conditioning in his "crib" doesn't give a SH&* about a citation (hell, he/she probably has warrants for other stuff so what's one more, right???)...they will probably hand you their Medicaid card to pay for it!!!!

    This perception of "I'll get in quicker going by ambulance" is what is strangling EMS in a chokehold but without educating people that this isn't the case, we aren't doing anything to remedy the problem. Case in point (actually two cases to be exact) - we recently had a very negative newspaper series run here about the fire/EMS service on Long Island (I know, I know...let's not start that mess again...over 1,100 replies was enough)...one of the key things Newsday neglected to mention (I pointed this out to the writer in my 6 page reply to her) is that NOWHERE in the article did it address the issue of abuse of service calls. It's easier to bash volunteers (or paid providers for that matter) that they were too slow to respond or didn't have enough resources but when you don't address that the resources (which at times are indeed limited, just like ANYWHERE in the US) are being abused by people with a 3 week old headcold, a toothache or a yeast infection, this paints a very jaded view of EMS.

    Second case in point was another local rag newspaper (one of those free jobs in the delis) that ran a 2 page precursor to the 8 day Newsday blitz...it highlights how volunteers are scarce during the day (a problem EVERYWHERE)...the article details about a friend of the chief's wife who fell & dislocated her shoulder (a painful injury I agree) while jogging...FD can't get a crew together, the cop (presumably an EMT) offers to take her in his car to the ER (Ok, not a bad solution)...the chief's WIFE being "the wife of a fireman" vetoed that idea & started screaming (according to the article)
    "This is why we need a paid system!!!" No, this is why we need your stupid ***** to either volunteer and be part of the solution or get out of the way and keep your 2 cents to yourself!! While I sympathize with the lady (a dislocated shoulder IS painful), if the cop offered to drive her so she could get help, why not accept the offer and deal with the situation? NOOOO...because "the chief's wife" said otherwise!!! OMG!!!

    There's no easy solution to solving the problem of abuse of service calls...in today's world, everyone thinks they are more important & god forbid they should have to wait for someone else who is in worse shape than they are, they are ready to sue. With this litigous (sp?) society we live in nowadays, EMS systems (and EMT's personally...some of these new guys are petrified) are so afraid of being sued that the attitude is "oh f@#$ it, just transport 'em so we don't have a problem". When we contact our Medical Control for RMA's, they will very rarely approve it 'cause the docs are worried about liability (can't blame 'em but it still stresses EMS).

    We could all sit here & swap great war stories about the stupidest abuse call you've ever run (I could contribute quite a few after 15 yrs. in the ghetto) but until we find a miracle cure, I think this problem will continue on. Wish I has some magical input here but I don't.

    Just my 2 cents...Stay Safe.

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    I don't know how we are getting back into this debate from months past but I sure wasn't to start it by what I said. I didn't say anything about fire side, quick responce, CFR or anything like that. Its simple until our medical directors give the power not to transport everyone and we prove as providers that we know how to use it then there isn't all that we can do beyond educate the public and offer them other means beyond the 911 call.

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    Quote Originally Posted by LaFireEducator
    My only point Chicago was that EMS in the fire service is here to stay. Just like a lot of aspects of my teaching job were not part of the mix 5 years ago, they are now, and they aren't going away either. The reality is the EMS and the fire service have become joined at the hip because that is what the public expects, and the chiefs and politicians know that. No matter how much you may hate it (and while I may not like it either I am realistic enough to accept it) it won't change the fact that next tour you'll probably run on the same pain in the azz customers.

    All I was saying was that anyone who does not want to run EMS should probably consider a field other than firefighting as that is what you'll be doing most of the time. The reality is you could almost change the name and take the word "fire" out of it as it really is now a small part of the job. My suggestion would only be instead of fighting it, use that energy to somehow embrace it (ok, maybe that's a bad word) as in all liklihood, it's going to be around for the rest of your career.
    I for one certainly understand that. FD was doing EMS here before I started on the job. And while I dont care for it, I knew what the deal was when I hired on.

    My problem isnt EMS per say, its the general abuse of emergency services. As I said in my first post, people call 911 for every little thing now. And save your rants about "its our job" and "we are here to serve". Bull shi*. We are just that, EMERGENCY services. We are not power company lineman, plumbers, valet's, home health care providers, dog catchers or any other task you can insert. Yet we get called for all of thoese and more.

    I sometimes wonder how we as a species managed to progress as far as we have. I mean, 911 has only been around since what, 1980? And yet now it seems people cant take care of anything on their own.

    We put a man on the moon but now we cant figure out how to put ice on a sprained ankle?.
    Fire Marshal/Safety Officer

    IAAI-NFPA-IAFC/VCOS-Retired IAFF

    "No his mind is not for rent, to any god or government"
    RUSH-Tom Sawyer

    Success is when skill meets opportunity
    Failure is when fantasy meets reality

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