Emt problems

allnurses Guide · Nov 17, 2016

I've had EMT's kinda give me a hard time about calling them, and

insinuate that the patient does not need ambulance transport, but

I don't think I've ever had them flat out refuse to take the

patient.

Is your paperwork and documentation correct, outlining exactly

why the patient/resident needs ambulance transport?

NuGuyNurse2b · Nov 17, 2016

It's hard to say without the details. Why are they refusing? Most of the time it's paperwork.

Midazzled · Nov 17, 2016

Edit: I may have misunderstood your post: you say the physician has ordered the patient to go to the hospital? Could the patient be refusing care/transport and the EMT/Paramedics be refusing a kidnapping?

From the other side, I am a Paramedic with both a 911 service, and an interfacility service.

1)What is the destination?

2)Is it a 911 service, or a transport service?

3)EMT's or Paramedics? Do you know the difference? (I mean this seriously, not to be abrasive or disrespectful)

4)Is the report you give complete, accurate, and professional?

5)Is the patient clean?

1)destination: I am not taking a sick patient to a nursing home. It makes me super angry when someone tries to trick me into doing this by feeding me inaccurate information.

2) 911 personnel do not usually like picking patients up from hospitals. But, we cannot legally refuse any patient, unless our personal safety is at stake. Transport Medics and EMT's signed up to do interfacility, but can refuse a patient sometimes.

3) EMT's (interfacility type) cannot take some patients, such as those on drips. Paramedics have a broader scope, and can take most or all patients, depending on local rules.

4) report/paperwork: if the paperwork is incorrect, I'll just hang out until it is fixed. Dispatch may send me elsewhere in the meantime. If the medicare transport form says that they are bedbound, when they are not, I still take them, but my documentation will reflect what I see, which may affect reimbursement. When I do interfacility, I expect to get a turnover, including a recent set of vitals. Not ones from 14 hours ago. Old vitals will not cause me to refuse, but it will get more scrutiny. Please do not tell me the respirations are 16 if they are 30, etc.

5) cleanliness: I have no way of cleaning BM's, nor can my agency bill for this. If everytime I get a patient from you the sheets are soaked, I will rapidly think less of you. I still take these patients, some of my friends do not.

Bottom line: I will take any patient if the destination is an ED, which is where all of my 911 patients go, anyway. I will also take any patient to an ICU. Its the discharges that I may turn down. Or I will re-route them to an ED, for which the accounting types will hate me.

Also, be aware that some EMT's and Paramedics have had bad experiences with nurses. I'm certain this goes both ways. I feel like this relationship is repairable and choose to treat everyone with respect and professionalism, and avoid generalising the attitudes of individuals.

CoffeeRTC, BSN, RN · Nov 17, 2016

In my 20 years of LTC, I've never had EMS refuse a transport to the hospital.

We call 911 for emergencies and all others we call a local transport agency that is staffed with both EMTs and Paramedics. If they only have an EMT crew available and the situation warrants a paramedic or if they cannot give us an ETA, we are often told to call the local 911.

When you call for a transport, you should be giving a mini report: Why does this patient require transport to the ER?

If it is not a 911 full code/ cpr in progress/ circle the drain type of event....I call the family, make mini chart copies (one for ems and one for ER), call the ER for report etc. If things are going down fast...it is a 911 call and after they get in and assume care, then i make the calls.

Treat all EMS with respect. When they come into your facility greet them with report, go to the room and go over your assessment and why the MD ordered a transfer to the ER...give them the baseline of the resident and most of all...make sure the resident is ready (not soiled)

Brandie333 · Nov 18, 2016

All of the paperwork is filled out correctly and pt is clean. The emt's that come to transport pts are, 9x out of 10, rude to our staff and will argue with us about taking the pt to the hospital. They act like they know our job better than we do. I've had to call the md back a few times and tell him that pt was not taken and why. It's getting to the point that we hate calling 911 because of the attitudes and treatment that we receive.

brownbook · Nov 18, 2016

I believe what you are posting, but at the same time I hope, assume, it is a little exaggerated. I can't imagine a MD not being extremely annoyed by having to be called a few times, that the patient was not being transported!

This problem is way above your pay grade. Your manager or charge nurse, someone with authority, needs to sit down with the MD and the manager of whatever local medical transport service you use and stop this foolishness. Maybe even include the director of the local ER facility they would be going to?

If needed you can, should, fill out an incident report every time the transport team refuses the MD's orders.

Wuzzie · Nov 18, 2016

It's getting to the point that we hate calling 911 because of the attitudes and treatment that we receive.

Is your facility using 911 to do routine transfers to the ED?

Midazzled · Nov 18, 2016

I'm sorry about the negative attitudes you are encountering.

You said 911; as far as I know 911 activated patient contacts can only be refused for transport if the patient or proxy refuses. If this is happening otherwise, I would suspect these providers charts are being audited already, but I suggest you fill out incident reports on your end.

Edit: prior to frozenmedic's post, I was not aware that some systems allow 911 calls to be deferred to other services.

Do these patients wish to go to the hospital, or does the physician want them to go without asking their opinion? What are these patients' complaints?

frozenmedic · Nov 18, 2016

Is your facility using 911 to do routine transfers to the ED?

When I worked as a paramedic we had this problem all the time. LTC care staff calling 911 for clear non-emergencies because (duh) we'd get there faster than the local transport services. Their protocols also required them to call 911 for any resident fall, even those without injury.

Even if the transfer is ordered by the (off the scene) MD that doesn't mean it's an emergency. The EMS system I worked in also had protocols that allowed us to refer patients to other types of non-emergent services. So, conceivably, the crews responding to you might actually have the ability to "refuse" patients.

Another issue we had with LTC were "emergency" calls being completely mis-managed. For example, we would commonly arrive on scene to find a patient in severe distress/actively seizing/in full cardiac arrest etc, unaccompanied by staff. Mid-intubation a staff member would present themselves as a nurse, know nothing about the events leading up to 911 being called, claim they "didn't know this patient" or "it's my first day," or "I last checked on this patient 6 hours ago, but yes, I just called 911 now" and "no, I don't have the transfer paperwork ready."

I'm a realist-not every facility is like this, but when 911 services are consistently misused, critical patients poorly cared for, and limited 911 response ambulances taken out of service to shuttle these residents around it can be hard to provide service-with-a-smile.

Guest219794 · Nov 18, 2016

All of the paperwork is filled out correctly and pt is clean. The emt's that come to transport pts are, 9x out of 10, rude to our staff and will argue with us about taking the pt to the hospital. They act like they know our job better than we do. I've had to call the md back a few times and tell him that pt was not taken and why. It's getting to the point that we hate calling 911 because of the attitudes and treatment that we receive.

Why would you call the doctor? They don't work for the doctor.

Report them to the appropriate agency.

There is something weird about your story- at least the way you are explaining it.

Why on earth would EMS refuse to transport an emergent patient?

Do they just say "No thanks, I'm trying to cut down."?

heinz57 · Nov 18, 2016

We hear about nursing home nurses all the time in the ER from EMTs and Paramedics as being real ********* or their favorite term for all nurses is "buttwipers". But, if the patient isn't in pieces on the street bleeding out, it is just a ******** call. We often have to get the patient away from them as fast as possible because some don't care if they are making the patient feel worthless by calling their complaint ******** while complaining them as they are pushing the ambulance stretcher. I hate seeing an elderly patient made a fool of in the middle of an ER because they are septic, have PNA, an UTI or some other ******** complaint. I guess in the hospital and nursing homes we just take these things, including lab values or CXRs, too seriously according to some EMTs and Paramedics.

If the EMTs or Paramedics continue to not understand why a patient needs to be taken to the hospital, instead of you just calling the doctor, get the number of the EMT/Paramedics' Medical Director. It can be a doctor to doctor conversation. That might get some attention.

Keep track of all the incidents. If they are private, chances are it is with a contract which can carry some wait when it comes to getting good service. Probably most EMS 911 hates nursing home calls, anyone considered long term care and frequent flier and there is just nothing you can do to change that unfortunately.

Not all EMTs and Paramedics have bad attitudes toward patients, patient care and nurses. The better ones usually get tired of working with the constant about whining patients and nurses and eventually move on to be nurses or some other medical professionals.