Want an ambulance? Too Bad

[msg88 4]

Want an Ambulance? Too Bad

By TAMARA VOSTOK

Updated 8:00 AM EDT, Wed, Apr 22, 2009

A recent proposal by City Controller Alan Butkovitz calls for nurses to be placed in Philadelphia’s 911 call center to give care over the phone for non-emergencies, in an effort to save the city millions of dollars.

http://www.nbcphiladelphia.com/news/local/...e--Too-Bad.html

Edited April 22, 2009 by jack10562
Source Site Copyright Notice

[20y2 43]

Sounds like a good idea to me.

[FFFORD 27]

i can see somewhat of a good side to this as i have responded to plenty of calls which do not need an ambulance. most of them resulting in RMAs anyways. on the other hand i also see TONS of lawsuits that can come from this. i don't see how it would really be cost effective though. obviously a nurse would not take a salary of a dispatcher. so factor the increase in salary pay per year per nurse dispatcher and compare it to ambulance runs which might be unnecessary. i could be wrong though.

[paratrooper75 41]

Seems like a great idea. Alot of people in the city use a 911 ambulance as a taxi service. I once had a guy call for chest pain just to get an ambulance. When we got there he denied any chest pain then made us carry him down five flights. When we got outside he got up walked over to the ambulance hopped inside and went to sleep on the stretcher. This is something that can really make a difference as long as people don't catch on and call in fake complaints like the guy above.

[IzzyEng4 427]

Basically what they are talking about is implementing EMD (Emergency Medical Dispatch) protocols. Every dispatch center that handles ambulance and CFR's should be doing this. This cuts down on a number of things, for excample;

1 - Abuse of calling an ambulance for a ride to the hospital for routine appointments. It frees up an ambulance for true emergencies.

2 - Cutting down on priority responses and sending units with traffic.

3 - Cutting having to send a paramedic if the medical emergency only requires EMT level care.

4 - Being able to re-route units to a priority call.

I know I'm preaching to the choir but this needs to be don. Look at the article Seth posted a few weeks ago about how the same 9 people going to the hospital in emergency mode constituted for what an 1/8th of the calls? Emergency services promoted 911 so much back in the day everyone calls it for every minor thing. Don't get me wrong yes people should have access to pre hospital care.

The only problem I see though is the dispatchers telling the people to go to the hospital and they are not getting an amblance. That gets into the whole legal neglect thing.

[NJMedic 96]

NYC EMS used to have RN is their Comm Center for the same reasons. Don't know why the don't now but I suspect that it wasn't doing what is was designed to do. EMD is (or should be) protocol driven and medically controlled.

Even then I think most people who make a habit of calling 9-1-1 for EMS know what words to say to get a response. Granted there are plenty of callers who admittedly call EMS for non-emergencies and these RNs might have an impact on those calls but I don't see a hugh cost savings.

Dallas was another city that has tried this until a RN used her own protocols to determine who should get a ambulance and a patient died because the response was denied. Dallas lost big $$$$ in that case.

[mikeinet 37]

London does this - they prioritize and even take a step farther - they have doctors that may respond to a call instead of an ambulance if it's not an emergency. Also have staff to give advice over the phone instead of sending any response.

[ny10570 745]

Even in EMD based systems, everyone is getting ambulances just some people are waiting longer. If Philly does this it would be the first in this country that I'm aware of where they will tell people they do not need an ambulance. I can't even tell a guy with a tooth ache he doesn't need an ambulance. An interesting affect of EMD, I've had a couple of people over the years call a cab for real emergencies because when they called for BS it took 20 minutes to get a bus. They thought thats how long it always took. One with a tummy ache put it best, "If I can wait I'll call an ambulance."

[Goose 188]

Basically what they are talking about is implementing EMD (Emergency Medical Dispatch) protocols. Every dispatch center that handles ambulance and CFR's should be doing this. This cuts down on a number of things, for excample;

1 - Abuse of calling an ambulance for a ride to the hospital for routine appointments. It frees up an ambulance for true emergencies.

2 - Cutting down on priority responses and sending units with traffic.

3 - Cutting having to send a paramedic if the medical emergency only requires EMT level care.

4 - Being able to re-route units to a priority call.

I know I'm preaching to the choir but this needs to be don. Look at the article Seth posted a few weeks ago about how the same 9 people going to the hospital in emergency mode constituted for what an 1/8th of the calls? Emergency services promoted 911 so much back in the day everyone calls it for every minor thing. Don't get me wrong yes people should have access to pre hospital care.

The only problem I see though is the dispatchers telling the people to go to the hospital and they are not getting an amblance. That gets into the whole legal neglect thing.

It's beyond EMD. EMD doesn't stop an ambulance from being dispatched, it just prioritizes and differentiates a BLS emergency from an ALS emergency and allows for over-the phone instructions to try and mitigate prior to EMS/FR arrival.

There are a number of agencies that go a step further - Wake County EMS, for example. They have Advanced Practice Paramedics that will make wellness checks, change dressings and administer wound care, suture lacs, and the like. All things that probably would have required 911 to be called out for a shuck to the ER to be addressed - clogging the ER and tying up an EMS ambulance.

Good stuff if you ask me, as long as it is implemented properly.

Edited April 22, 2009 by Goose

[ny10570 745]

NYC EMS used to have RN is their Comm Center for the same reasons. Don't know why the don't now but I suspect that it wasn't doing what is was designed to do. EMD is (or should be) protocol driven and medically controlled.

NYC EMS RN's just handled call typing. Everyone still got an ambulance.

[hookandcanman83 11]

How about add more ambulances on the road instead of cutting firehouses and medic units. Call me crazy but having multiple medic units responding to more than 9000 calls a year is horrible. Dont get me wrong though i think Philly needs to find a way to cut down on the BS calls like every other major city out there.

[Remember585 815]

Reading the title of this thread I thought it was referring to the gamble everyone takes calling for EMS in the north-western part of Westchester County... Let me know when that discussion comes up!

[ex-commish 490]

Isn't there a nursing shortage? Do we want them answering phones or taking care of patients...

[IzzyEng4 427]

It's beyond EMD. EMD doesn't stop an ambulance from being dispatched, it just prioritizes and differentiates a BLS emergency from an ALS emergency and allows for over-the phone instructions to try and mitigate prior to EMS/FR arrival.

There are a number of agencies that go a step further - Wake County EMS, for example. They have Advanced Practice Paramedics that will make wellness checks, change dressings and administer wound care, suture lacs, and the like. All things that probably would have required 911 to be called out for a shuck to the ER to be addressed - clogging the ER and tying up an EMS ambulance.

Good stuff if you ask me, as long as it is implemented properly.

I agree too Goose and I'm a firm believer in EMD. But the problem is that little negligence and abandoment problem the lawyers love to eat it up. Hey if its implimented right hopefully it would be a win and stop the abuse and give those who need the proper care priority. Lets hope it works, you guys and gals in EMS get beat up pretty back with stacked BS calls. I know I worked that end and seen it too.

[x635 4,066]

Easy, if they don't need an ambulance and it's not deemed neccesary, but they still want to go to the hospital.....send a taxi and have the city foot the bill.

[Guest alsfirefighter]

Reading the title of this thread I thought it was referring to the gamble everyone takes calling for EMS in the north-western part of Westchester County... Let me know when that discussion comes up!

Ditto!

[chazEMT 5]

Having dispatched for a number of years, I can tell you that no matter what protocols that are put in place to "weed out" BS calls for service, it will not solve the problem...as was mentioned in an earlier post, people will learn fairly quickly what they need to say to get an ambulance over to them! AND, there IS that liability thing hanging over the heads of the dispatchers!

From the "other side of the phone," I'm not sure I'd be overly comfortable leaving my fate in the hands of a dispatcher reading from a card of "case entry" questions as a determining factor of whether an ambulance should be sent to my emergency!

What I believe would make the most sense is to enable EMS to refuse transport to those patients who're using EMS as a taxi...which, I know, opens a whole new can of liability worms! Just watched an old episode of Emergency! where Johnny & Roy not only packed up and left a "patient" who'd called EMS for obvious BS, but they also read him the riot act!! If most of us did that, it'd be a race who'd get to us quicker...our supervisors or the patient's lawyer!

As for the gamble people take when calling for EMS...if this refers to the volly system, that is also something that needs to be looked at! I'm so tired of hearing how it's tough for people to volunteer nowadays, yet I see these volly agencies with 50+, sometimes 100+ members on their rolls...and none of 'em show for the "diff breather," but suddenly they can all become available to respond to the MVA rollover with entrapment! In my time dong scheduling for volly EMS, I more often got people dodging my calls & e-mails asking for help than a response, much less a commitment to help out! Can of worms there, I'm sure...

[Guest resqstuff]

Basically what they are talking about is implementing EMD (Emergency Medical Dispatch) protocols. Every dispatch center that handles ambulance and CFR's should be doing this. This cuts down on a number of things, for excample;

1 - Abuse of calling an ambulance for a ride to the hospital for routine appointments. It frees up an ambulance for true emergencies.

2 - Cutting down on priority responses and sending units with traffic.

3 - Cutting having to send a paramedic if the medical emergency only requires EMT level care.

4 - Being able to re-route units to a priority call.

I know I'm preaching to the choir but this needs to be don. Look at the article Seth posted a few weeks ago about how the same 9 people going to the hospital in emergency mode constituted for what an 1/8th of the calls? Emergency services promoted 911 so much back in the day everyone calls it for every minor thing. Don't get me wrong yes people should have access to pre hospital care.

The only problem I see though is the dispatchers telling the people to go to the hospital and they are not getting an amblance. That gets into the whole legal neglect thing.

I can't say how EMD is used in CT, but I can tell you how it is used here in Westchester (which I might add, 60 Control has no control of).

1. - In Westchester it does not free up a single unit due to the fact that it is a first call first served system.

2. - We can not dictate what response mode an ambulance uses to get to a particular call - many agencies here go lights and sirens to stubbed toes and stand bys.

3. - Even if the call is EMD'ed to be a BLS call, each jusrisdiction states what goes on a BLS call - and many state that paramedics are to be dispatched even to the most minor calls.

4. - Here, if a unit is responding to a stubbed toe, we can not re route them to a heart attack. Only they themselves can take the unit from one call and respond to the more serious ones, and depending who is in the ambulance they might not take the more serious call.

There needs to to be many changes in policies here before EMD will do anything more than help with CPR instructions prior to EMS arrival on scene. EMS agencies need to give standardized care to residents that does not change from one town to another. But that might be a whole new topic for discussion.

[Goose 188]

I can't say how EMD is used in CT, but I can tell you how it is used here in Westchester (which I might add, 60 Control has no control of).

1. - In Westchester it does not free up a single unit due to the fact that it is a first call first served system.

2. - We can not dictate what response mode an ambulance uses to get to a particular call - many agencies here go lights and sirens to stubbed toes and stand bys.

3. - Even if the call is EMD'ed to be a BLS call, each jusrisdiction states what goes on a BLS call - and many state that paramedics are to be dispatched even to the most minor calls.

4. - Here, if a unit is responding to a stubbed toe, we can not re route them to a heart attack. Only they themselves can take the unit from one call and respond to the more serious ones, and depending who is in the ambulance they might not take the more serious call.

There needs to to be many changes in policies here before EMD will do anything more than help with CPR instructions prior to EMS arrival on scene. EMS agencies need to give standardized care to residents that does not change from one town to another. But that might be a whole new topic for discussion.

Take it a step further....

Most of the ambulances in Westchester at any given time aren't even in service - gotta have providers in an ambulance to make it worth anything.

Forget changing policies - someone or something needs to take total control and either regionalize or make the entire county a single agency.

The first step, however, is centralizing EMS communications. Have the county provider the dispatchers, establish the policies and procedures and go from there. Putnam County did it - granted Westchester is far larger and does exponentially more EMS runs a year, there is no reason why we can't do it either.

[ny10570 745]

What I believe would make the most sense is to enable EMS to refuse transport to those patients who're using EMS as a taxi...which, I know, opens a whole new can of liability worms! Just watched an old episode of Emergency! where Johnny & Roy not only packed up and left a "patient" who'd called EMS for obvious BS, but they also read him the riot act!! If most of us did that, it'd be a race who'd get to us quicker...our supervisors or the patient's lawyer!

Absolutely. People can lie over the phone and often enough calls are sent out BLS that should be ALS. Callers simply cannot be relied on to decided who should and should not receive a bus. Letting crews on scene tell people to take a cab is absolutely the way to go. Even establish a voucher system where these people with a CAD number and a stamp or signature from the clinic/hospital could get reimbursed a few bucks