The Infamous Cab-ulance

Emergent, RN · Jan 26, 2014

Basically, 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.

MedicalPartisan · Jan 26, 2014

You'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.

Sassy5d · Jan 26, 2014

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.

MedicalPartisan · Jan 26, 2014

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.

The 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.

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.

Sassy5d · Jan 26, 2014

Isn'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

BrnEyedGirl, BSN, MSN, RN, APRN · Jan 27, 2014

I 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!

wheeliesurfer · Jan 27, 2014

I 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?!?

/rant

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.

Sam J. · Jan 27, 2014

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.

brillohead, ADN, RN · Jan 27, 2014

I 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?

*sigh*

CowboyMedic, DNP, APRN, CRNA · Jan 28, 2014

Trust me as a paramedic that has worked in EMS for 4+ years and now in the ER, the EMS system is very, very, very broken. The worse is when they meet you at the door with their bags packed and complaining of trouble breathing. The pt is talking fine and the only reason they called us was for just a transport. I've had pt's that didn't even want me to do anything. No O2, no IV, no monitor, NOTHING...

TraumaSurfer · Jan 28, 2014

What has EMS done to improve things? There is no way Paramedics in the US are prepared to run at the same level as those in other countries which have a Masters degree. Six to eight months of training do not make you a mid level practitioner. Most of the "treat and release" by Paramedics in the US are done by convenience for the Paramedics and with the benefit of the patient in mind. Usually there is some "emotional" motive which determines who the Paramedic wants to transport and who they don't. Just ask any of the EMTs for BLS ambulance which does most of the transports because the ALS truck has something better to do like get back to the station. If Paramedics are allowed to treat and release or refuse to transport the patient, they still get the patient to sign an RMA or AMA form rather than taking responsibility themselves for chosing not to transport.

Here is an article which is an embarrassment and didn't get many comments because it sent the wrong message.

People That ‘Fly’ Frequently Behave Badly Â« KRON4

Three trucks to one call and then for these Paramedics to complain about a patient not being an emergency even though they gave narcan. Unfortunately this an example of EMS in the US for many major cities. Why do you need 3 trucks and 4 - 6 Paramedics for every call and then complain about not having enough trucks for "emergencies"?

I also wonder what would happen to the EMT and Paramedic classes if the students were told on the first day that 98% of the calls they will do will be routine and all that emergency hero life saving stuff is mostly in the movies to sell tickets? It is too bad the training for Paramedics is not done a little differently to better prepare them for reality. Then maybe a different set of professionals could actually see things clearer and come up with a better way.