[caption id="" align="alignleft" width="240" caption="Detroit by Patricia Drury on flickr"]
[/caption]I've discussed this here many, many, many times before.
When you trade actual liability for perceived liability, it kills people and gets bad press in the process.
The perceived liability that a patient will sue you for not taking them in for a clearly non-medical complaint pales in comparrison with the ACTUAL liability of having too few ambulances to handle actual emergencies.
Whether your solution to this mess is privitization (Yeah, try to turn a profit there. Or here for that matter) or not, the solution is clear. It is time EMS stands up and says "NO."
I am a trained medical professional armed with state of the art equipment to assess your chief complaint and I have found that you do not need an ambulance so I will arrange alternative transport to the physician.
No more transport them all and let the MDs sort it out. It never worked, it will never work.
Detroit EMS, as with most other systems, including my own, have chosen to hide behind a false definition of liability, instead rolling the dice and hoping nothing will happen.
And we all know what happens when you work in EMS and hope nothing will happen.
A senior staffer will likely step down, replaced by another senior staffer who will enact the same policies and wonder if something new will happen.
See also: Insanity
Comments
I'm more focused on the sore wrists, tooth aches, recurring back pain from 25 years ago, Doctor's Office closing time transports (this is just from yesterday) can be redirected.
Thanks for reading
1. I can find no liability for a system that runs out of ambulances. There is this thing called the "public duty doctrine" that says that the government has no inherent duty to rescue anybody who calls the police, fire, EMS, etc. There are exceptions, but if all the cops are busy and somebody gets robbed or killed, or if the fire department is busy and has a long response and the hourse burns down, the town is not liable.
2. We may be health professionals with a bunch of training, but I know very few (zero) paramedics who have one minute of training in hospital destination triage or decision-making. It's not part of our curriculum, nor our licensure testing, nor our standing orders. Do I think it should be (all of these)? Absolutely! But it is not. Until it is, the risk is ours.....
3. Getting people to someplace besides the ED is a problem. Lots of our patients are poor, uninsured, etc. Unfortunately, the ONLY place that MUST see them is the hospital ED. EMTALA doesn't apply to the urgent care clinic, the doc in the box, etc. In America we have socialized medicine - that includes EMS and the ED, but nobody else. So until something changes (everybody has insurance, or EMTALA extends its reach), the ED is the only alternative.
Not a pretty picture - but it is a SYSTEM problem and should be solved at a system level - not by individual medics free-lancing without the requisite training or authority.
2. It was a pulmonary embolism, not an MI. http://firelawblog.com/files/2011/02/thomasdecision.jsp_.pdf
3. Deciding to transport any case based only on a chief complaint is foolish, dangerous, and well, stupid. That decision needs to be based on a complete assessment using point of care testing as appropriate. Not all sore throats should be left at home. Nor should all abdominal pains be left at home.
The best defense against liability is completing a thorough history and physical, not transporting everyone blindly.
The best defense against liability is evidence based medicine, not tradition.
-Joe Paczkowski
The EMT-Medical Student
You nailed it on the head right here: "There is this thing called the "public duty doctrine" that says that the government has no inherent duty to rescue anybody who calls the police, fire, EMS, etc." I apply that definition to code 2 sick eval calls and lacerated fingers. After all, if we're not required to respond, why are we required to transport?
My system has an annual refresher on our destination hospital policies, directing us to take MIs to one place, PEDS to another, CVAs to another and microsurgery to yet another. I'm asked by triage nurses the severity of injury and moving patients from my cot to the waiting room based only on my judgment. we're already doing their job, why not let us do it BEFORE we waste the transport unit on a non transport necessary call?
If I can be trusted not to activate the trauma team on the lacerated finger, perhaps I can be trusted to direct them elsewhere.
We all know health care is expensive because we waste the most expensive methods of evaluation (EMS and the ED) on every single case. The system will not change until it is no longer a for profit model. As I've said before, there is no profit in a refusal, no matter how appropriate for the patient. we seem to be patient advocates right up until we can have the most impact: non-transport.
Thanks for reading and commenting. I want that definition from earlier on a T-shirt!
I am starting to see your point and can agree with you (as long as it is well regulated).
Thanks for the response
THAT is where the next innovation needs to be.
Thanks for reading box 8520...Is that 19s or 40s 1st due?