EMTs should be able to refuse to take someone to the hospital 1/26/2023

Wow. Having retired from a large urban metro sized fire department that ran a busy, and abused fire rescue EMS system , that is a slippery slope. Yea the system is abused. Yes that kind of policy might help reduce some abuse of the transport system and the hospitals But we all have our shares of lazy assed emts and paramedics now that do whatever they can to avoid transporting , often without a complete and thorough exam, and they get jammed up when the patient goes POv or suffers a serious medical event after the crew leaves with a signed refusal of transport. Then the IA investigations begin and lawsuit settlement checks start getting printed. I don’t know the answer. Again perhaps. But tread cautiously- it’s a slippery slope.
 
Capttomo said:
Wow. Having retired from a large urban metro sized fire department that ran a busy, and abused fire rescue EMS system , that is a slippery slope. Yea the system is abused. Yes that kind of policy might help reduce some abuse of the transport system and the hospitals But we all have our shares of lazy assed emts and paramedics now that do whatever they can to avoid transporting , often without a complete and thorough exam, and they get jammed up when the patient goes POv or suffers a serious medical event after the crew leaves with a signed refusal of transport. Then the IA investigations begin and lawsuit settlement checks start getting printed. I don’t know the answer. Again perhaps. But tread cautiously- it’s a slippery slope.
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I think you would probably be okay if they would sign a refusal of transport but in the majority of cases they probably wouldn't sign it because they want a free ride! If it isn't signed than you would definitely be opening yourself up for lawsuits if a serious medical event happened after you refuse to transport them.
 
Bulldog said:
I think you would probably be okay if they would sign a refusal of transport but in the majority of cases they probably wouldn't sign it because they want a free ride! If it isn't signed than you would definitely be opening yourself up for lawsuits if a serious medical event happened after you refuse to transport them.
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So true, Either its signed & your good or transport ....not worth lawsuits, and your job.
 
Firstly, It's not refuse, it's decline.
Decades ago, the old head paramedics told me they had about a 50% no-load rate and still felt they were a taxi service.

With today's telemedicine capabilities, appropriate supervision , working guidelines, and quality control feedback, a huge reduction in transport can be achieved safely.

"Price is no object if you have no intention of paying," People value something more when they have to pay for it. The old Charity Hospital in New Orleans was locally known as "The Big Free". EMS systems are the same. Make people pay-something (or deduct it from welfare benefits). Make it regressive. Starting from zero- the less the emergency, the more you pay.

The other issue; cities have EMS billing offices. Medicare, Medicaid, and private insurance (health or liability) may pay for ambulance transport. I think the charge is around $1500. While the engine company is sound asleep upstairs, the medics can be generating potential income for the city fathers.

Hospitals have the same incentives. Whenever an EMS unit brings an unnecessary transport to a local ER, the hospital has to do two things; render care and generate a bill as noted above. Plus, hospitals that take care of a lot of non-paying customers get a special disproportionate (known as "dispro") payments from the state.
 
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We deal with many 911 EMS calls that there is Zero reason for an ambulance let alone a transport to the hospital. I like the CA idea with a DOC and Paramedic in a Fly car and they determine if an ambulance is needed or the doctor can handle right at the patient's home. Also the Insurance companies I have head pay in full because the patient did not go to the hospital.
 
Here in Cincinnati, an Engine or Ladder company is assigned to every medical emergency, and in some cases, an ambulance might not be assigned or at least not initially as the Engine or Ladder may request one after being with the patient. The ambulance crew does not get involved until the patient is ready to be transported, they just sit outside in their rig until called upon by the Engine or Ladder. All Engine and Ladder companies, as well as Ambulances (called "Medics") are paramedic staffed.
 
LaurenSkye said:
Here in Cincinnati, an Engine or Ladder company is assigned to every medical emergency, and in some cases, an ambulance might not be assigned or at least not initially as the Engine or Ladder may request one after being with the patient. The ambulance crew does not get involved until the patient is ready to be transported, they just sit outside in their rig until called upon by the Engine or Ladder. All Engine and Ladder companies, as well as Ambulances (called "Medics") are paramedic staffed.
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In Boston an engine or ladder is dispatched, they alternate in engine/ladder houses, and usually give the ambulance an update as to the situation.
 
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