Tuesday, April 7

Code 3 hospice referrals

With my project to change the way EMS is delivered in my system plugging right along, I keep collecting specific cases of EMS abuse and misuse.

Along with those cases I'm also starting to find some that fall under the "You don't need us, but have no other options" category.

Just such a patient:

Terminal CA patient, wants to stay at home for the duration of her painful days. Her sister wants help around the house, lifting and bathing and such. No problem there, getting hospice involved after a quick call to her primary care makes sense.

Except today is Sunday and the answering service will only transfer the call if it's an emergency. When the sister says, OK it's an emergency, please connect me to the doctor, the answering service instructs her to call 911 and hangs up. No joke.

We arrive to a woman who simply wants to stay home but her caretaker needs help. The caretaker, her sister remember, also says she needs some time to get the house in better order to take better care of her.
In touch with our supervisor I'm instructed that the only option is to transport her and hope the attending physician can get through to her primary and arrange the hospice intake. So she's loaded up and I'm trying all my best bad jokes to get her to smile and luckily she does.

Had I had the authority through channels to get a hospice intake scheduled, not only would this woman be able to stay in her home, but we could have had an ambulance back in service.

And the best part of this call was the way the dispatch center coded it. 26D1- Fall, unconscious, difficulty breathing. In the narrative I can see the answers to the questions: The pateint is alert (awake), the patient denies any injuries, the patient is not clammy/changing colors/having difficulty breathing. The problem is: Pt has soiled self, needs help into bed.

Again, no joke. Lights and sirens for the hospice referral. Changes are coming.


Little Girl said...

I feel your pain. I am a Fire/EMS Dispatcher from Canada.

I am not arguing your predicament, I have picked up the 9-1-1 lines for the same thing, its a catch 22 situation - they need help, but do they really need an ambulance.

I am arguing your dispatches use of the medical cards set. Personal speaking knowing very little about this particular call, and going only on the information you have supplied, I would have coded that call a card 26A9 (sick person, requiring transportation only).

The Happy Medic said...

Welcome Little Girl,

That sounds naughty.
Yes they do use the cards, but the call taker also has the ability to edit the final dispatch to recode it as an emergent so the call is assigned and sent faster, having an effect on their stats.

This call would have been fine as a 26A9, heck even a 26A1, other, with a code 2 resource sent when other emergency calls have been addressed.
I know dispatchers can't see through the phone, I just need an honest and effective assignment of resources.
From there we need the authority to route people through the system.

Thanks for reading,


Michael Morse said...

I admire your willingness to fix the EMS problem. I average eight calls per 10 hour shift, usually only one or two "legit" calls mixed up with the abuse. I've written extensively about the problem and have had numerous articles published in the Providence Journal...all met with yawns from the general public.