Cooler weather and homeless "patients" - page 2

by NurseOnAMotorcycle

We're seeing a larger influx of homeless coming in who aren't accepted at the shelters saying that they "have ankle pain", etc. While they aren't completely overwhelming our emergency room, the worry is that one of these times... Read More


  1. 2
    Quote from NickiLaughs
    I'm kinda curious to know what they did with the frequent flyers. For example, what do you do with the drug addicts, they are going to keep coming to the ER?
    Your providers can more selectively prescribe opioids. Trust me, it works.
    VICEDRN and Crux1024 like this.
  2. 3
    Quote from whichone'spink
    How the hell do you acknowledge their legitimate need for shelter, but keep throughput going smoothly? It's impossible to kick them out without being accused of violating EMTALA.
    Not true....EMTALA doesn't guarantee them a place to stay. It gives them the right to be seen and receive a medical screening exam without insurance verification. EMTALA.COM - Resources and information
    EMTALA requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention to an emergency medical condition.
    VICEDRN, Crux1024, and Altra like this.
  3. 8
    Funny/sad story..

    We had one of our regular homeless come in quite a lot recently (a lot even for him), for stuff like back pain, knee pain, a fall, etc. It was so excessive, I wanted to explode. One day, I see he had arrived once again by EMS, to our main trauma room. I laughed and couldn't believe he was taking up our trauma room. And then I walked in and saw a man who was having a STEMI and AAA rupture.

    Every once in a while you have to get put in your place. Even though they use and abuse you, every now and then they actually are sick, so you must always treat them as such.
  4. 1
    Ours are usually under the influence of something or other, which makes them incompetent and therefore not streetable. Police won't take them into protective custody anymore, so they sleep in our hallways.

    Very few get the whole workup anymore, most don't even get labs. As long as they are maintaining a sat, keeping their own airway open and fairly normal range of vitals, they sleep until they've been in long enough to "sober" and walk straight but before they get the shakes, then we send them out with the dawn.
    Altra likes this.
  5. 0
    Quote from NurseOnAMotorcycle
    Wish we had something we could do about finding them someplace safe to go. Shelters won't take them, they're full.
    Maybe you could work with local authorities to establish a warming center:

    Warming center - Wikipedia, the free encyclopedia
  6. 2
    So give them a blanket and let them sleep inside...better than getting them back via ems for hypothermia. Have some compassion, geez, these people have many problems.
    Pets to People and ~*Stargazer*~ like this.
  7. 0
    Quote from ecerrn
    So give them a blanket and let them sleep inside...better than getting them back via ems for hypothermia. Have some compassion, geez, these people have many problems.
    I would love it if the answer was that simple but the waiting room was not intended for people to pull up three chairs and sleep. It scares decent paying "customers" out of our facility and gives them them the impression that we are a dangerous scary place that reeks of foods, urine and body odor. When the homeless patient collapses from the too much booze that warms them, we end up looking bad. again. Not to mention the bills they are running up from the pretend triage.

    My public/critical access hospital needs to stay open in a big way for the trauma patients/burn patients and the needy. We can not afford these problems in our waiting room.

    For the record, i have discharged a patient who bounced back hypothermic with a heart rate of 35. Wish I had a better answer for this problem.
  8. 0
    Ours learned the trick. Say chest pain, or I want to kill myself and it buys them an overnight stay. ****** me off to no end.
  9. 0
    Quote from That Guy
    Ours learned the trick. Say chest pain, or I want to kill myself and it buys them an overnight stay. ****** me off to no end.
    I was going to reply the exact same thing. Info being passed through the network?
  10. 0
    No reason to keep them overnight with chest pain. Do you keep all chest pain patients? Crazy.


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