Long Term Care and dealing with EMS with an attitude

[sandyth]

I work in a LTC facility& had a pt with chest pain (crushing); Hx: A-fib, CHF, and multiple other heart problems; also 2 weeks post op Left hip fx. Pt wont ambulate blah blah...Anyway I call the MD after the Nitro doesnt relieve chest pain and he said to send her to ER for evaL AND TX. oKAY the EMS get there and say she is asymptomatic and medicare woulnt pay for transport (the EMS) had just been woke up)and proceeded to try and talk this woman into NOT going. I pressed the issue and finally they transported. Most of the EMS people are nice when they have to come but has anyone had this kind of problem with the EMS before?

[VivaLasViejas, ASN, RN]

I once reported an entire TEAM of paramedics for refusing to transport a Medicaid resident with acute-onset chest pain because "her insurance won't pay for it, and she's a DNR anyway". We stood in the hallway arguing for 45 minutes while the resident got worse and worse, they were extremely snotty about the whole thing, and it all ended with them transporting her under protest. Now, where do EMTs get off refusing to transport a pt. because of his/her insurance?! It's not like they personally won't get paid if the insurance doesn't cough up the dough, and who are they to determine the pt. doesn't need to be treated because he/she is a DNR?

We'd had problems with this team before, but this was the last straw. I made a formal complaint to the city, and as long as I was at that facility they never came again, but I never did find out if they were disciplined, fired, or whatever. Stick to your guns, Sandy---your residents deserve better than this, no matter how poor they are or what their code status is.

[traumaRUs, MSN, APRN]

Where do you live that EMS can refuse transport??? I'm an ER nurse and we get the NH patients...EMS can't refuse here.

[jenac]

I have never experienced EMS refusing to transport-but it sure as heck takes them forever to get there, longer on the DNRs.

Someone please explain to me how they could refuse transport based on ability to pay?! This whole concept is so unbelievable to me-I just can't imagine finding out that my mother or grandmother died or suffered preventable trauma due to the ignorance of the EMS crew. There's a heck of a law suit for ya.....

[SnowieRN]

Since when does DNR mean to ignore the patient and let them die? I was under the impression you should still treat them.

[VivaLasViejas, ASN, RN]

That was MY point when I was arguing with those people. In Oregon, where we have assisted suicide, I am nevertheless unaware of any law that allows EMTs to decide whether or not to transport (or treat) ANY patient. I also do not know of any legislation that states do-not-resuscitate equals do-not-treat, especially if the patient's advance directive or POLST form specifies that they may have antibiotics, IV fluids etc.

I wouldn't have believed it if I hadn't seen it and dealt with it myself, not once, but THREE times with that same team. In all three incidents they ended up transporting, but not until they'd wasted everyone's time (not to mention the residents'!) by fighting with us. I've never seen them anywhere since that last time a couple of years ago, so I'm hoping they were fired, but who knows?

[Nurse Ratched, RN]

Yeah, there'd be some serious new orifice creation if a paramedic tried to interfere with the transportation of a patient in need (and if we have an order to transport and called the ambulance, THE PATIENT IS IN NEED! Health care is not a democracy and the ambulance drivers don't get a vote.) We'd be having a little talk about boundaries, and scope of practice, and the merits of just doin' your freakin' job . Somehow I'm envisioning the cashier at the grocery store telling me what I shouldn't be buying when I'm checking out.

And, a disclamer as always: I have never experienced this personally and have the utmost respect for EMS and their skills and responsiblities. The vast majority I have met are fine, hard-working individuals.

[kmchugh]

Originally posted by sandyth

...EMS get there and say she is asymptomatic and medicare woulnt pay for transport (the EMS) had just been woke up)and proceeded to try and talk this woman into NOT going.

I'm curious what city you live in? When was insurance coverage added to the MI algorithm? I'd write the SOB's up, STAT.

Kevin McHugh

[VivaLasViejas, ASN, RN]

Same here. The overwhelming majority of paramedics I've met in my years in the health care field have been WONDERFUL, including the ones who transported my sister and me to the hospital last week during her bout with angioedema. (A lot of 'em are HOTTIES, too!!) It was just this one team. consisting of one woman and two guys, that we had problems with, and living in a small town & not having encountered any of them since, I have to think they lost their jobs. (Hope so, anyway.)

[P_RN, ADN, RN]

I have never had any problem with EMS. I've dealt with them many, many times both as an RN and as the family member of someone in trouble. Is this the norm for your area?

[SnowieRN]

Next time say "Transport the patient right now, or hand me your EMT license so I can throw it in the trash." Id seriously report them (if they havent already been fired.)

I think a common misconception is that DNR means they WANT TO DIE. I can understand not wanting to be on a machine looking at the ceiling while you drool all over the place, but if its just a matter of being sick.. that doesnt mean you WATCH the die when a simple pill will help them.

Ugh.. done ranting.. must quit...

[canoehead, BSN, RN]

If they argue about the DNR's, do they refuse the sore throats that just want to skip the ER wait?