Refusing to transport

[huzzie59 75]

Are there any circumstances where an ambulance crew dispatched to a call can refuse to transport the person asking to be transported.

Or in other words, Can we refuse to transport a "frequent flyer" when they trully don't have anything wrong with them; and we've transported them 4 times in the last 2 days for the same issue?

[Guest x901]

you consider four times in 2 days a frequenter? Talk to me when you get the same guy three times in an eight hour shift

[Guest x901]

and it would be nice to refuse, no more i stubbed my toe or i have a tooth ache. Problem is the side of my truck doesn't say advanced life support it says "Cabulance", thus all must be taken. I don't know of any way we can refuse, legally. (although, putting them on the train to grand central so that FDNY can deal with them, has been done before)

[tbendick 27]

FDNY Does have a SOP for things like this.

Pretty much they call Medical Control and talk with the DOC.

This is also the same SOP used when the DOC responds to the scene of a school bus MVA and they don't transport all the kids..

[Shantz02 0]

hey 901, how many times have you pulled that one off? Have you started charging flat rates? How about a fuel surcharge these days?

[mikerabbit 2]

Having the Med Control Doc come to the scene of a school bus MVA is a great idea has anybody ever had an experience with that being done with any ER Doctors in Westchester?

As far as your frequent flier issue mabe they may need psych evaluation at the suitable hospital.

[Guest]

Huzzie59,Here's your answer...no

tbendick, has the 10-95 protocol been used yet? I thought it was meant for real MCIs with hundreds of patients, not for frequent flyers or people you just don't think should go.

[tbendick 27]

10-95 is used all the time.. The main place is school bus MVAs and school related incidents. Doc will respond and traige out the people who do not need to transport. Turn over the ACR and use the section on the back.

Yes can be used during an MCI.

It also could be used for day to day stuff..

[RU 911 0]

I worked in NYC during the early 90's (while it was still Health & Hospitals) and we called Medical Control for 10-95's Refuse to transport. But like so many things it was abused by some. Those who wanted to take no one to the hospital so they stopped it.

[BuffMedic236 0]

I belive that we can't refuse but we can try talking them out of going tp the ED, for example, tooth aches, most ED's don't have dentists on staff. As far as frequent flyers, calling MC and get the approval not to transport, if you are sure that an ED visit is not needed. And of course there is always are great friends in law enforcement who are also tired of the frequent flyers and lock them up for calling to much!

[tbendick 27]

RU 911 I know what you mean when you say " Those who wanted to take no one to the hospital"

I always found this funny. I looked it things s little diffrent. NYC we in away are competing with the privates. They tell the city they will save them money. FDNY EMS has been working over the past few years to say we can make you money. With better education on documentaion and things the money has gone up.

Me I will take you pretty much any place you want to go and I don't care what is wrong with you... Make sure I fill out the report and get you billed for the service. I also take the Trip counter on the dash and reset it. Give me an accurate count on miles. Anything over the mile is the next full mile. All this = $$ and more jobs..

If and when they can stop the abuse then EMS will end up like the FD's fighting to keep jobs and find new things to do, such as public education, giving flu shots, etc.

[huzzie59 75]

I appreciate all of the responces. I had the same guy 2 times within 3 hours.

If we can't refuse, can the hospital refuse to take him, or sign our PCR for him?

[x635 4,066]

I'm not a proponent of complelty refusing to transport patients, but I like the idea of Paramedics being able to use the ALS assesment skills to triage a patient to a taxi or other means of transportation. However, I don't think you'll ever see anything like that, due to liability concerns, unless there is serious structure and safeguards put into the program. And we cannot forget us, along with the ED, are first line primary healthcare for many we servce.

Something is going to have to be done of these days about the rampant abuse of EMS, and the Emergency room all over the US...it destroys EMS and healthcare in general. It's a problem much bigger then us.....

[Guest alsfirefighter]

There are a couple of agencies upstate that I know of that does refuse to transport. But its not that they just say "we are not taking you." If push comes to shove you should transport. They will generally get a grasp of the injury and advise them it would be better for them to self transport. For instance in the case of a laceration w/bleeding under control and a car in the driveway and someone can drive or the person can safely.

One concept that can be looked at is working with local cab companies to get a flat fee for you to utilize them for minor complaints instead of wasting your resources. May come out to be cheaper then using your resources and often they will like the idea of the added business even if you negotiate the cost down.

[CAM502 6]

No matter how many times so and so has called you for no good reason, it is still your job to transport, if thats what the party wants.

But it sure would be nice if a medic could say, "take two asprin and call your doctor in the morning." With our luck they'll still call back for an ambulance.

[Guest WolfEMT]

Your standard of care says that if a patient calls 911, then they perceive their condition to be an emergency. If, by some chance, you get to the scene, render aid, and the patient does not want to go to the hospital, then it is acceptable to have them sign an RMA. However, it is not acceptable to refuse to transport or force the patient to sign the RMA.

That's not to say that the 911 system isn't abused. I had a patient call 911 for a "respiratory" (the association in the senior development that she lives in tells all the residents that if they call it in as difficulty breathing, the ambulance will come faster) when in fact she could not sleep. Yes, folks, she called 911 for insomnia. She later RMAed after the cops told her that she would be arrested if she didn't.

So basically, you're duty-bound to transport, no matter how much of a pain in the neck the patient is or how much he/she is a frequent flyer.

[Guest mediconpatrol]

Having the Med Control Doc come to the scene of a school bus MVA is a great idea has anybody ever had an experience with that being done with any ER Doctors in Westchester?

As far as your frequent flier issue mabe they may need psych evaluation at the suitable hospital.

<{POST_SNAPBACK}>

For the question has anyone ever had a med. control Doc come to the scene...

Before leaving for Iraq...you could always count on Doctor Mcgurty showing up to a call....and I bet he will be the same when he comes back. Doc. never missed a "good call" and bless his heart would even come out to the stubbed toe..just to tell them that they didnt need an ambulance for this problem...

[Guest]

The way I understand it, and I could be wrong, is that in NY we are legally bound to transport, but in CT the ambualnce personnel can decide that it is not an emergency and refuse transport. Refusing transport, however, would open the ambulance crew and company up to so much legal liability that I can't imagine an organization ever allowing its employees to make that call.

[WAS967 97]

For the question has anyone ever had a med. control Doc come to the scene...

Yup. A couple of times. And not John either! Was nice having orders for a bad anaphylaxis on scene and having Solu-Medrol running before we even began transport.

[Guest]

Hey Not,

Your answer is incorrect. In CT, we are legally bound to transport even if the ambulance crew thinks it is not necessary.

Like most states, CT sometimes has either cabulance or limo driver on the side of its doors LOL

Erik

The way I understand it, and I could be wrong, is that in NY we are legally bound to transport, but in CT the ambualnce personnel can decide that it is not an emergency and refuse transport.  Refusing transport, however, would open the ambulance crew and company up to so much legal liability that I can't imagine an organization ever allowing its employees to make that call.

←

[DaveTFD 0]

hey all,

id like to comment on this one because just recently i had a frequent flyer (6 times in my 12 hr shift for 3 days straight...no joke) the guy happend to be addicted to hydrocodone and claimed he had a new pain in his body every time he called. the doctor would give him tylonal (not satisfying his addiction) and send him home. well on the 3rd day of this i got a little fed up because there was a legitiment emergency happening at the same time of him wanting to be transported for drugs. so i called medical control and spoke to the doctor who was very very very familiar with this case and he cleared me not to transport him. i guess its all about cover your own a**, the number 1 ems rule. so if this guy decides to sue i was under direction of a doctor

[IzzyEng4 427]

Hey Not, 

Your answer is incorrect.  In CT, we are legally bound to transport even if the ambulance crew thinks it is not necessary. 

Like most states, CT sometimes has either cabulance or limo driver on the side of its doors LOL

Erik

←

But you forgot something. Even though we can't refuse transport and the whole legality issue, we can determine the "severity of themedical emergency" with the med doctors at a hospital. The doctor / triage nurse can prioritize the patient and wether they go into teh ER or triage. I have had many of the "hey taxi" calls where the problems are "non emergency" calls. Thank you EMD for the cold reponses and thank you triage for putting people in order by severity. Many of these calls are starting to subside, but we still have to act. People are starting to realize that coming by an ambulance does not get you in faster. Especially when the hospials start going on certain diversions.

[Guest]

its called job security.....................