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An Observation

11 comments

(and not a flattering one for my EMS colleagues)

Have you ever noticed that there are a lot of paramedics out there whose definition of closest appropriate facility is whatever transport destination is most convenient for the paramedic?

Whenever I hear paramedics advocate for greater autonomy in, say, refusing transport for what they deem non-emergent complaints, I can’t help but think of the number of my colleagues who put their own interests above those of the patient.

And sadly, those paramedics are not rare.

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Posted by on June 22, 2010 • Filed under: Uncategorized

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  • mmorsepfd

    In an overburdened system, the facility that is the most appropriate is the closest facility. That is, the closest facility that is appropriate. We have five hospitals in Providence. One specializes in stroke treatment, therefore that is the appropriate facility for people with stroke signs. Another place in Providence has a great HIV program. And anybody over eighty, or has cancer or something similar goes wherever they want, at least when I'm in charge.

    I've noticed most people who call 911 and insist on a different hospital than the one closest usually are not having a medical emergency. We run six als units for a city of 200,000, doing 40,000 ems calls a year. We simply cannot take people to the hospital of their choice, regardless of the billing advantages. It just isn't fair to turn a forty minute call into an hour long one while other people wait for mutual aid.

    You are correct, however, about people doing what is best for them. I see it all the time.

  • http://twitter.com/Paramedicine101 Adam Thompson, EMT-P

    Ahh, now its been said. This is an astute observation, and quite relevant. While I will agree that there is a growing list of inappropriate reasons that 911 is called, a guideline to refuse service to these emergent-less calls would quickly be abused. Why is it that apathy seems to have a greater affinity to neo-medics than empathy? Not only does EMS need an upgrade, but quite possibly many of our fellow EMSers.

  • EricB- EMT-P

    This very subject is a perpetual issue among some medics I know. I don't understand how they can say they are doing what right for the patient when they take them to a facility that they know can't resolve the complaint. One, it's not beneficial to the patient. Two it adds to an already overburdened system when one ER just has to send the patient on to another. It's another run assignment for the service, so now your down a unit twice for the same patient. It's usually double the cost for the patient, having 2 Ambulance transport and 2 ER bills. I can't see how these kinds of medics think they are doing anything to improve our profession.

  • Pj

    I was always pretty strict on the “patient goes where he wants to go” rule, regardless of “diversion” status. I'd warn the patient that he ran the risk of sitting in the ED for a long time, or of getting transferred for admission because the facility he wanted didn't have any beds, but in the end, if he wanted to go there, we went there.

    (Side note: my own adherence to “diversion” status may have caused me some problems when I myself was transported…I agreed to be transported to center 'B'– a few miles farther away — because center 'A' (almost within site of my incident) was on diversion. I ended up with a doc who mismanaged and nearly killed me. But in fairness, had I been closer to center 'B', I wouldn't have asked to be transported elsewhere.)

    I will admit, though, to having transported more than a few drunks (who didn't give a [darn] about where they ended up) to a hospital that was a) closer to my station and 2) more annoying/abusive to EMS staff than other hospitals. “Punitive transport decisions” I called them. Made no difference in patient care, but certainly pissed off some ED RNs.

  • SeanEddy

    Just as politicians tend to forget who they work for. We as EMS professionals tend to forget who WE work for. Our job is to represent the patient's best interests and act on their behalf. If a patient wants to go to a hospital across town, I'm going to take them across town. They called me to provide them a service.

    Just imagine how long a Taxi service would stay in business if they transported people to places that were convenient to them?

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  • http://www.ambulancedriverfiles.com Ambulance Driver

    Oh come now, that can’t be true!

    Everyone knows that universally free medical care gets you seen in a timely fashion, at the hospital of your choosing, and cared for by competent, caring professionals who are well-paid, never overworked, and never hindered by needless red tape.

    I mean, that would never happen in the U.S., because we’re going to do universal healthcare so much better than the countries that already have it, right. Right???

    We’re going to have our free healthcare cake, and eat it too!

    /sarcasm

  • http://twitter.com/insomniacmedic1 InsomniacMedic

    Not only are you correct in your observation, but it can probably be scientifically proved that the nearer those EMSers are to the end of their shift, the more likely they are to fall into this behaviour.
    However, certainly here in London, the nearest appropriate facility is usually also the nearest A&E (ED), except in certain specialised cases. STEMI, CVA, major trauma and sickle cell are the ones that immediately come to mind.
    Patients who request to go to a hospital further away, excecpt in these cases, generally have non-medical reasons for doing so. Some may be legitimate reasons, but usually not because the hospital is not appropriate for their needs…

  • Jwenting

    Here things are different. Each hospital owns ambulances (if there's more than one hospital in an area, extremely rare in a socialised healthcare system).
    You dial 112 (911), the dispatcher will typically alert the nearest hospital, irrespective of whether it's appopriate for your condition or has room for you.
    Ambulance arrives, you're taken there without any choice on your part. Once there, the search for someone to treat you begins (which might means spending hours on a stretcher in a hallway while staff search call other hospitals trying to find one that will take you in).
    Once a hospital is found, it can take hours more for you to get there, as by law ambulances aren't allowed to deliver patients to other hospitals, only to pick them up.

    Case in point: My father had a heart attack in '02. He dialed emergency, and an ambulance arrived quickly (must have, they found him collapsed on the kitchen floor, phone in hand, unconscious but alive).
    He spent 5 hours without any care whatsoever in a hallway while hospital staff were trying to find an ICU bed for him. It was eventually found 50 miles away, took an ambulance from that hospital 2 hours to get to where he was, while the ambulance that had picked him up at home was idle outside the door (he could see it).
    7 hours after calling emergency he was finally on heart monitoring equipment and undergoing treatment.

    Had ambulance staff been free to deliver him where appropriate instantly, emergency dispatch would have known the nearest hospital with a free ICU bed and they'd got him there hours earlier, maybe preventing the longterm problems he now has.

  • Medic Trommashere

    This was an issue that plagued many an EMS provider, especially where I used to work. The closer to the end of the shift, or at the end of a string of calls even had some of the most empathetic Paramedic trying to shove the patient off at a closer (read: sometimes less equiped) hospital in favor of being able to return to station for an extra few minutes of sleep, or to get home/go to work on time.

    In my neck of the woods, the patient had the final decision of which hospital to go to, and we had to listen. Even if a hospital was on diversion because of no beds being available, we'd always pass up 3 or 4 other perfectly functioning ER's that could take care of their stubbed toe in favor of the Trauma Center. Something needs to be done to weed out the bad apples, both on the patient side and on the provider side.

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