Wednesday, November 26, 2008

Biggest Pet Peeve

No doubt, my biggest pet peeve in EMS is the taxi runs we do. It has been on my mind a lot lately, between the Men's Health article, and some issues we are having at the firehouse. Go to any state in this great union, to any firehouse, and any medic can give you ten examples in the last year of such runs. Why is this such a problem? Ask any child: When do you call for an ambulance? Most likely they will answer: When there is an emergency. Yet, the parents of those kids call for some extremely stupid reasons. If 7-year-olds can figure it out, why not 30-year-olds?

We see abuse of EMS from all walks of life, regardless of race or socio-economic class. Regardless of insurance status. Even regardless of transportation status, and by that I mean the patient is completely ambulatory, stable, not a damn thing wrong, and six family members all with cars are home and able to drive.Over the last few years I have heard many excuses as to why the ambulance was called.
-Going by ambulance will get me seen faster (not true, not true)
-I don't have insurance (this ride isn't free)
-I don't have any other way to get there (OK, I can kind of see that)
-I don't have a regular doctor (huh?)
-Because I want pain meds (I don't think so)
-Because I wanted to (can't argue with that logic)

I have transported stubbed toes, hurt pinkies, and fevers of 99 degrees. I have also transported a 22-year-old who drank one beer and the parents freaked out, a scratched knuckle, and someone who needed inner reflection. I am sure all of you reading have similar stories. I even had a chronic caller, 3 times a day from the same pay phone. He would call and say he was dizzy and he needed to go to the hospital. 3 times a day. I would think that would be an abuse of 911, punishable by law, but PD told us there was nothing they could do. Once, when we were with him, a 3-year-old girl was hit by a car in our district. She had to wait 5 minutes longer for help to arrive. When we explained this to him, his reply was "Oh well. When I call, you have to come." I had no response to that. He had me there.

We educate the public on fire prevention. We educate the public on fire safety. We educate elementary students on E.D.I.T.H., stop, drop, and roll, and stay low and go. We educate on everything fire related. Thanks to all of this public education, fires are down. What about EMS? EMS makes up 85% of FD calls (depending where you live). Why do we not educate on EMS? Sure, we put on CPR and AED classes. But why is it so taboo for us to educate on what is an emergency? When it's OK to use an ambulance? There has to be a solution to this problem. Unfortunately I don't see it coming anytime soon.


Jennifer said...

For the longest time I thought it was just my town that had this problem. It's amazing to see that this is a problem everywhere.. yet kind of sad.

Christopher Mader said...

Right there with ya!! Between the lady who calls when her Internet goes now and she gets nervous to the guy that calls when he can't sleep. I have heard of a law here in Jersey that can be used against people that abuse the system but have never seen the police use it. :(

Paramedic 134 said...

"Ten examples in the last year of such runs" ??? I could give you ten examples in the LAST TWO WEEKS!!

Great post and very true. I often think when we go on these BS runs, "At what point in the course of your 'problem' did you determine you should actually pick up the phone and dial 911 (the EMERGENCY number) for THIS?" Like, "What possessed you?!"

And I love going to houses where you can't even get your ambulance anywhere CLOSE to it and have to try to negotiate your stretcher through the maze of perfectly-good-working-order family member cars in the driveway for someone who says they NEED to go to the hospital because "I threw up once."

My father, who is a city firefighter used to tell me (before I got into this business) about a guy they'd go to at least once- if not more- a shift because he "just can't breathe, boys!" His SpO2 would be perfect, etc. Then he'd insist on sitting there in front of them and smoking cigarettes. One day what they started doing was, when EMS showed up, they had found a letter on his kitchen table with his SISTER'S address on it. EMS started sending HER the bill. I think they hardly ever transported him, but I guess that $200 Refusal bill our service charges started to add up because they said, at least for a while, they stopped going down there so much. I remember when the guy died- I was in paramedic school doing my clinical ride-alongs and EVERY SINGLE CREW that came in the EMS lounge at the hospital would say, "HEY! Did you guys hear Mr 'Jones' finally died!??!!"

I could go on all day about this, but I better stop before I raise my blood pressure...

Bernice said...

I have to say that I am incredibly lucky. The people in my response area generally don't do this.

The facilities that reside in my area... that is a whole different story. Calling for an ambulance for someone with an elevated heart rate or low SPO2 on room air gets old. Really old. With that, I can attest to the power of education. One facility has cut down their calls to 911 by over 75% if not more.

You know what they say. Knowledge is power.

Zumstin said...

Yeah, this problem is a universal problem. You will find stories like this all over the place. Right now there is no solution. It is this way because of the rare things that it could be.

For example, I took a guy in his mid 20's, who ambulated to my ambulance when we got there, holding his jaw and stating he needed to go to the hospital for pains meds for his toothache. We unwillingly obliged and took him. 2 hours later the ER did an emergency transfer with the same guy because he had a subarachnoid bleed. ER doc just sent him to CT to get him out of the ER for a bit because they were tired of hearing him whine. Imagine how shocked they were when they got the film back. The toothache was a manifestation of the bleed.

Stories like this are the reasons why we cannot refuse transport, but I agree . . . there should be a way to weed out the idiots out there that abuse the system. I think there should be a high school class design to teach people when to CALL and NOT CALL for help. Explain what an emergency is. I usually ask the patients that I know is abusing the system, "So you really believe that the headache you woke up with 30 minutes ago needs to be seen by an Emergency Room Doctor? A Doctor who is there to treat people that are dying and admit them to the floor so the other Doctors can save their lives. You REALLY think that your 30 minute headache is a matter of life and death? You don't think MAYBE Tylenol may be in order first, before you skip ahead to life saving procedures?" I just try to get them to think about it. Sometimes I have luck, sometimes I don't. Point is, we are all screwed until a fix is found.