The Infamous Cab-ulance
- 6I'm curious to know some of the things your patients call the ambulance for. Just recently we've had patients who present to the ED via EMS and c/o ripped cuticle, or a med refill, along with many more complaints that, in my opinion, absolutely do not justify the need for emergency medical services. The worst one lately, though, was a patient who presented to the ED and when getting off the stretcher, stated that they just needed a ride to this side of town to get to their friend's house and simply walked out the EMS bay doors. I was flabbergasted.
What inane EMS runs have you experienced?
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- 20Jan 26 by EmergentBasically, you summed it up, there is no more to add. Mild rash, anxiety, cough.
The EMS system is broken. It needs rules. The Paramedics need more authority to refuse transport.
It's the extreme underclass who are the abusers. Those who have nothing to lose. Often they have mental health problems. Our system feeds their problems by rewarding and catering to them. We play along with their game, and won't be honest with them. We do them a disservice by refusing them any accountability.
- 1You're right; it is broken. The problem is that they'd need a physician on board to refused treatment and there's no way they'd ever pay for that. Giving them more authority would be great but there is so much potential litigation involved that I don't think that will happen either. We're stuck; what can we do? Will this ever get better?
I'm still curious to know any absolutely ludicrous EMS stories/complaints like the one that closes my OP if anybody has one to share.
- 1Quote from Sassy5dThe thing about triage is that they're receiving an evaluation by a medical professional. They wouldn't be able to do this for the same reason we can't give medical advice over the phone. Jaw pain or extremity numbness could be result of an injury but it can also signify cardiac related chest pain. I just can't see it working.Maybe there could be a triage system in place like at ER. If you need a ride for a med refill, they can wait for the ride.
It's a shame they can't punish these patients for shenanigans like the one in my OP. People do whatever they want when it comes to healthcare. We had a patient once and had proof of identity theft and told the officer that was on duty here and he simply said what do you want us to do about it? They do and say whatever they want and there are no repercussions. I understand it's not my place to judge but it's hard to watch.
- 3Jan 26 by Sassy5dIsn't that a fine line? I trust if I was in trouble, the paramedics have the ability to think on their feet and intervene. I think they are medical professionals. I'm sure in the field, if frequent caller for a narc refill called, and granny fell and broke her hip, they would respond to grandma first.
Healthcare just stinks! Lol
- 8Jan 27 by RN-CardiacI agree the system is broken! We have two hospitals about 4 miles apart and often have pts leave one ER, go across the street call and ambulance and have them take them to the next ER. This abuse should be illegal!
- 1Jan 27 by wheeliesurferI think that a couple things need to happen.
1) If a person such as the one in the OP's post calls an ambulance to "get to the other side of town" and then leaves the ED, they should also have the joy of paying the bill of the aptly named cab-ulance! The police should also be called to charge the passenger with misuse of the emergency call system!
2) If a patient routinely calls the "cab-ulance" for NON emergent complaints such as a torn cuticle, a med refill, a splinter, etc. Lets call it non-urgent/emergent, not disabling/debilitating or in need of hospital admission to take care of the complaint, then they should be counseled on what constitutes an emergency requiring an ambulance on the first use of the ride. On the second and each subsequent use of the cab-ulance, they should be required to pay the bill (not insurance or Medicaid) and if it becomes a chronic problem they should be charged with misuse of the emergency call system.
It really irks me when people call the ambulance for petty reasons because it ties up the 9-1-1 lines for emergency calls, and also ties up EMTs and ambulances for real emergencies. We all know these people just call the ambulance because they know that going in the ambulance gets you past the waiting room and triage, and in most cases these are the people who are using Medicaid to cover their visit anyways. If the person had a large co-pay for ambulance transportation they would be less likely to use it unless they absolutely needed to!
I really think that if a person comes by way of ambulance and is not in need of the "back door entry", they should be made to wait just like the people who walk into the waiting room. Wouldn't it be nice if instead of putting them in the hall, we could put them in the waiting room instead?!?
With that said, there has been a time when I was in a small community hospital without real specialized care, and needed to be transferred to a trauma center about 50 miles away but the community hospital couldn't arrange the transfer because both hospitals were of the same acuity for insurance. I was discharged from one and was driven to a friends house by the trauma center where we called EMS to transport me the rest of the way because I was unable to go in through the waiting room (I was laying down the whole time because I couldn't sit up due to a CSF leak causing a severe spinal headache). The EMTs took me to the ED and I was admitted immediately to have a neurosurgeon who specialized in CSF leaks do a repair. All that is to say, I understand the RARE need to go from one hospital to another, but only when one is able to offer a service/treatment that the first was incapable of performing.Last edit by wheeliesurfer on Jan 27
- 1Jan 27 by Sam J.Sad but true, every EMS provider in America would vigorously disagree (publicly) with all of the above posts, regardless of what they say among themselves. It's a huge part of their revenue stream. Also sad but true- in many places, Medicaid patients have almost unlimited access to free taxi rides to take them to appointments, and even shopping, as an attempt to prevent them from abusing the EMS system.
- 11Jan 27 by brilloheadI had a discussion with a European friend about this a while back. In a "universal healthcare" setting, they don't have this type of problem with people using EMS for non-urgent calls. Why? Because people who call for a cab-ulance get charged with fraud, criminally and civilly.
I have no problem with requiring drug screens of welfare recipients, but I'd much rather see a law requiring medical necessity for Medicaid-paid ambulance rides. There is WAY more cost-benefit in addressing this type of "welfare fraud"... so why doesn't anyone sponsor this kind of law?
I understand that sometimes "momma's chest pain" is just indigestion instead of an infarction -- that's not fraudulent abuse of the system, those are the type of situations where any medical professional would agree that it's okay to err on the side of caution. And I think there needs to be some sort of protection for the EMS personnel, to protect them from claims of "they refused to give me a ride and I almost died" or "They didn't tell me this wasn't an emergency so I shouldn't be held responsible".
(How about a waiver in which the potential rider has to sign a waiver saying, "my symptoms are X,Y,Z, and even though EMS tells me that this is not a medically urgent situation, I still accept responsibility (legal and financial) for using this ambulance" or, on the flip side, a waiver saying, "I disclosed symptoms of X, Y, Z, only, and no other symptoms, and EMS advised me that, based on these symptoms, I do not have a bonafide need for an ambulance"... that way they couldn't tell EMS they had a hangnail and then claim later that they told EMS about their bulging and pulsating AAA but were refused a ride.)
Heck, how about just having the 911 dispatcher make a short disclaimer: "Use of an ambulance is specifically for situations involving the potential of disability or loss of life. If you request an ambulance to be dispatched to your location, you are accepting legal and financial responsibility for the fact that you do, indeed, have a serious emergency medical situation. Are you willing to accept that responsibility?"
Personal responsibility has gone out the window, and by allowing "cab-ulance" abuse, we are further perpetuating the problem. What is so wrong with making people take responsibility?