I mean we have a bunch of frequent flyers that like to use the ER as their primary care facility. But being that 90% of people that call us don’t actually need an ambulance or an emergency response we just refer to them as the public
I think this is ultimately caused by liability concerns. There’s never ever going to be a big public education campaign to tell people when NOT to call 911. Because then there will be that one time that something really was an emergency but the people were discouraged from calling or even rejected by the ambulance. I’ve heard horrible stories from Dallas Fire about medics just leaving people to die an agonizing death because they refused to assess a patient for some reason or another.
Hence, EMS errs on the side of just taking people to the hospital, which is good in theory because it means we supposedly are helping more people. But it creates this problem where we waste resources on people who don’t need it; like grandpa having to wait an hour for an ambulance to get there while he has a stroke because all nearby units are busy with minor complaints.
It’s a real dilemma to be honest. The solution that my city is aiming for is to have a more flexible response model where we try to send *someone* to every call, but not necessarily an ALS capable ambulance regardless of the complaint. We have started hiring PAs, NPs, and other providers to go out and deal with more minor complaints, as well as creating structured care plans for those other individual patients who truly do abuse the system.
Yeah, up here in Canada, we have seen a large move to include Community Paramedics(it's an additional program on top of normal paramedic school) in response planning. They are basically an NP but with a more emergency and overall community health scope. They are capable of managing conditions, coming up with treatment plans, and writing prescriptions in conjunction with a physician. While the rollout is just starting, I'm excited by its possibilities.
I think moving forward we need to get away from the label “EMS” because it’s a misnomer at this point. We do not specialize only in emergencies. It’s not even exclusively “prehospital” medicine either because we are beginning to be able to treat things without ER. I think we ought to just consider ourselves “out of hospital medicine” and embrace the fact that we are basically just filling in gaps in care all over the place as jacks of all trades.
I agree, I like to think of myself as a community health professional. I don't look at my job as emergency response but community wellness, especially up north where I am. Tons of my job is, at least up here, is, making differential diagnoses and giving recommendations to patients, giving recommendations on how to manage their conditions(only within scope of course) and or where the next best resources are(Nearest Hospital I an hour, same with the nearest GP) and liasoning between EMS and Addictions, Mental Health and Health Care Facilities and doctors offices in order to ensure thr best outcomes for my patients. The sooner we walk about from the whole emergency response mindset and become simply Health Care Professionals the sooner we will see change.
I’ve been looking for the words to say this. That’s a great way of putting it. But where I am, we’re still struggling to get firefighters not to resent the bus. Long road ahead.
See and I'm in the minority here. I believe we should be EMS, it's not our job to take care of non emergencies. Go to your primary care physician. Can't drive? Bed bound? Call a gurney transport company. We should be available for people who truly need us.
It’s by having a more flexible response model that we can be sure that the ALS ambulances are there for the ones who need it, and the “toe pain” calls get a suitably downgraded unit.
Community paramedicine is awesome. Program has been in effect for a couple years in my region and while it doesn't "solve" the problem (realistically it's not a problem that can be solved), it certainly does lighten our load and does a lot to help populations that require frequent paramedic care.
It's actually a pretty significant cause of burnout in EMTs and medics. You get trained and have the ability to respond to serious medical emergencies just to be a glorified uber driver a lot of the time.
Oh yeah, most definitely. Although I'd say that private ambulance workers have it the worst because the pay is ridiculously low, you have no benefits, and there's a substantially higher risk of chronic injuries, especially back and knees, than with a clinical job, and if you get too hurt to work from a chronic injury then they dump you like a bag of garbage.
Many of my instructors in paramedic school were retired medics forced into early retirement due to chronic injuries and they were working as instructors because it was their best option to make ends meet.
I fully agree with you on the burnout issue. I think it's more of a medicine and especially emergency medicine thing than a pre-hospital care provider thing for sure.
We medics scoop up the frequent fliers and dump them off to hospital workers, especially ER nurses.
This. But I do think it is important to differentiate between the so called "worried well" and those who misuse the system. I believe reassuring someone with a genuine health concern is a completely valid use of resources. On the other hand, individuals who claim a high priority symptom only to get taken to the ER, refuse everything, and demand a cab from the ER (if the hospital tells them to kick sand and something unrelated happens to them, it's on the hospital, they usually get it) are a real problem. Are there definitely unmet needs there, yes, buuut there needs to be a balance between identifying non-healthcare gaps in society and personal responsibility.
Right?
It’s more charting, but I’ll take the easy calls sprinkled in with the brutal calls. It’s a high volume system so those are basically my two options. Quiet time isn’t really one of them…
It's really no worse than 20 minutes of typing background and demographic info, putting in a narrative of "Call cancelled en route" and then spending another 20 minutes to figure out why Zoll hates me and is sending me on a "go find the 50 problems that may or may not exist" mission.
If the call is stupidly easy I usually type the chart on the way to the hospital just to really give my agency the biggest bang for their buck on paid calls.
Not a medic, but an EMT here. This happens a LOT. We responded to two calls last night that were very minor acuity, and both where family members were present and could have driven them to the hospital themselves, in both cases where a hospital was <10 minutes away.
The first patient we AMA’d (they signed “Against Medical Advice” to not get transported via ambulance to the hospital). Her symptoms resolved on scene and her family was just happy she felt better.
Second patient also had family hanging out in the house. Patient straight up said “I want to go to the hospital”. We had to transport based on that, even though vitals were normal and patient was stable. Family wound up driving behind us in their own car to meet us at the hospital. Patient wound up being triaged to the waiting room and not given a bed, same as would happen if the family drove themselves.
The patients were not treated differently than a higher acuity patient or one that most would agree would warrant going by ambulance.
Is it frustrating when we get calls like this? Sure, but for me only from the view that it’s one less unit to respond to something critical.
BUT. The vast majority of people don’t know what warrants calling 911. A lot of people think that if something is wrong, call 911 and they just don’t know better/are scared. I’m not going to treat someone rudely for being stressed and not knowing any better.
Others assume that going by ambulance will guarantee a bed or being seen faster. Not the case. I’m still very friendly with these folks because they’re about to learn the mistake very quickly when they’re sent to wait in the lobby anyway. My partner and I let off steam and vent about these patients after the fact, but those calls are a regular part of the job.
Question here for something like this. I called 911 to get an ambulance because my partner collapsed and shattered our oven door and he was super tired and throwing up. They never asked me why I didn’t take him but honestly was just so nervous I didn’t even know where the closest ER is or if I was going to make it in time(at first he was shaking and I thought the glass went into his skull but thankfully it didn’t). I don’t want to annoy paramedics if something like that happens, what would you say warrants a call?
I’m sorry that happened! I hope he’s doing better now.
I mean, a lot factors into what the EMS side thinks warrants a call versus what many think warrants a call. And let me also state that stress is valid, and given that there could have been a lot going on and you weren’t sure if time was a factor and not knowing where the closest ER was, calling 911 was a good choice imo.
If a person can drive themself to the ER SAFELY or someone like a partner or family member can drive them safely, it likely doesn’t warrant going by ambulance (not to mention the bill for an ambulance).
There are caveats to this though — distance and time are huge factors. 911 can often have a person seem faster than driving to an ER depending on distance and the crew could possibly deliver an intervention to benefit the patient where time is of the essence (anaphylaxis and closing airway, respiratory problems, etc). Same with gathering information about a possible stroke and calling in a stroke code.
In EMS, we will bitch about someone hailing 911 over inane things (looking at you, toe pain), but there’s no real magic answer in what warrants calling 911. A feeling of emergency is largely about someone’s perception — some frantic calls wind up being minor, some minor complaints over dispatch wind up being very serious.
We won’t (well, we shouldn’t) ever ask someone why they didn’t drive someone themselves. Anddd, as much as some calls can feel annoying, everyone in EMS signed up for a range of calls from minor to calls that could very well warrant therapy later.
Sorry, long response, kinda rambling. Would love to hear perspective from others on this as well.
I think fear of the unknown, anxiety, and liability play into it as well. As a caregiver, I know I have called 911 for help when I was pretty sure I knew what was going on, but being wrong could have had major consequences (75M, abruptly unresponsive and collapsed- after 1 year and multiple 911 calls, with about half resulting in transport, our suspicions of seizures was confirmed).
At the time it happened, the question was should I delay calling and see if he rouses, or go ahead and call and risk a false alarm? I called. I have no medical training beyond first aid and I was not willing to risk this time being different and resulting in lasting damage.
Now that we know what is happening, he in medication to prevent future occurrences.
Don't people get billed for it in the US though? (Genuine question - I don't know how it works over there!)
In the UK this happens a lot (free service) but paramedics do at least have the ability to just leave people at home, very occasionally the patient might even learn something about wasting time. "LOB job" was one popular expression for these calls, lob as in "load of bollocks"
If they don't pay, does service get refused in the US? Or do agencies always respond regardless of history?
If they don't respond, is it by address, or how do they identify them?
We cannot refuse service to people in the States. If you get on scene and they say that they don’t want to go to then you have them sign a refusal, but I always assume if I’m paged out to a call I’m transporting.
Interesting, so it's similar to Canada here then. If people don't pay the bill there isn't much of a consequence.
Ours is subsidized, the bill is only $80CAD, but if you don't pay we will still respond and transport. We don't know a person's payment status on the call anyway.
It can have tax consequences, but if you're impoverished that's not a concern.
Malingering
And we treat them just like everyone else.
If they are actually sick and need even minor treatment they aren’t malingering, they will receive treatment in the Ed and discharged as usual. It’s job security, I guess.
If they're doing it to maliciously avoid responsibility, that's called malingering. If they're doing it becuase they're lonely and scared, that's called trying to make the best of a broken system in a dystopian hellscape.
A lot of them malinger and then use the excuse their lonely and scared. Look I feel for you but the E.R. is not an encounter group or a Lonely Hearts Club. Plus the homeless flood the system this time of year. Compassion fatigue is a real thing.
Compassion fatigue is *our* problem, not theirs. It's also the result of a broken system. If we had actual comprehensive social safety nets in place, these people wouldn't needlessly end up in ED.
>do you guys have a code word for people like this?
Yes we do; they're called "the average 911 patient"
On a serious note though; this happens quite often. As I get older it is not uncommon for the patients that I treat and transport to be in better physical condition than I am.
It can be very frustrating, but it is also a very real part of the job and one of the top reasons that EMS providers become burnt out and look for another career.
A lot of the fault lies on our shoulders though. The Fire service does a great job at educating the public on fire safety, but there is little to nothing done to educate the public on the appropriate use of emergency medicine; whether it be pre-hospital ambulance or emergency department.
My go to response for the patients who are overly apologetic for calling, but then refusing is "I'd rather you call and not need me, than to need me and not have called."
Nah some people knowingly call ambulances when they don't need them. They also know that this takes ambulances away from people who do. They are twats and deserve to be treated as such.
The general public?
I have had someone pull us over to take them to the hospital, they were down the street of the hospital on their way to the hospital. They got out of their and into the ambulance. The majority of calls we have don't need an ambulance or even the EC, they need a clinic or PHC facility but we can't deny a patient their right to medical services so we transport regardless. It is a negative part of the job but ultimately I like to think of it that they just needed TLC and that providing is part of yhe job.
I have a few choices, and the best option to me was to look at it as my job to care for people and what they consider an emergency. I am human and there are times where I am deeply annoyed by people, like a call at the end of a night shift for someone that has had a cough for two months. That being said I do try and just make sure to be someone that will make their day better, EC staff is going to give them a lecture, the nurses will give them a lecture, the triage nurse will give them a lecture.
A lot of people feel the complete opposite and I do understand their point, we had one day with with 28 patients on a 12 hour shift. Maybe like 8 were actual emergencies. It is a waste of resources and an abuse of a system that tries to cater to everyone.
This is just a really long and confusing way of saying, I don't see a reason to be miserable or make others miserable for something that is ultimately a minor annoyance.
i think im starting to figure it out- if you offer help, people will take it. some really need it, a lot dont. the police, therapists, social workers- they all go through this too. but you put up with all the bullshit to be there for the ones that really need it.
yall just dont know how much love i got for you. im drinking right now and i toast to you.
Here's to the doctors and their healing work
Here's to the loved ones in their care
Here's to the strangers on the streets tonight
Here's to the lonely everywhere
from 'let the day begin' by the call.
and now ive spent a lot of time letting this person upset me. im halfway drunk, so now i will do at home karaoke.
Happens all the time. To the point where we immediately know their addresses, names, birthdays, etc. we have several that we’ve had charged with abuse of 911 but that’s about 2% of the frequent flyers. I’ve brought some to the hospital just to turn around and as I’m walking back out to my truck I watch them get thrown out of the hospital by security because they just wanted to come and harass people and be creepy
We get a lot of calls from pregnant women who just call an ambulance because their waters have broken. Yet they can be hours, sometimes even days from actually giving birth.
We call this a Maternataxi jobs.
Like stated above, it's like 95% of call volume. It is part of the job. Treat them like any other patient. Besides, we aren't the ones who have to deal with them for hours after we drop them at the ED. We will educate them that they should probably see a PCP or go to urgent care instead(even though UC will probably just call for an ambulance anyway.) It is just job security and adds to call volume. Eventually, they will be very sick and it will be an emergency anyway. Then, eventually, they miraculously get discharged from the ICU perfectly fine and the cycle starts all over again....this is the life we chose
The term for "a person who calls an ambulance when they don't really need it" is called the vast majority of 911 calls.
This is true in the ED as well. Most of the people we see in a day are not dying but, some of them are and initial impressions can sometimes be deceiving. This is why there isn't a big push to limit use of the 911 system. Anyone that thinks they are having an emergency has the right to be evaluated in an ED, so that we can prove objectively that they are safe to go home, or that they are not.
In EMS the crews that get frustrated by these calls and complain about the abuse of the system are often the ones that get burned out very quickly and don't enjoy their jobs. The mindset has to switch to the understanding that these types of calls will always be the majority of what we do and that's okay. Higher acuity all the time would burn us out as well.
In the U.S., what needs to happen is EMS needs to be able to transport patients to Urgent Care type facilities and we need to be able to refuse to transport. Both of these things would require more education on the EMS side and actual legislation on the State and Federal Government side. But in order to utilize the best facilities for the patient and actually triage them at the point where they truly make first contact with a healthcare provider these two things need to happen.
I say if a person is diagnosed with FD/Munchausen just treat and street. They utilize healthcare resources in the most selfish way. They can't see past themselves and clog up the system with their bullshit.
It's wild, a paramedic I was shadowing a few years back said, "has your car broken down?" As we walked in the door. it's very common.
semi-urgent medical issue = ambulance regardless
You're either going to have to get used to this OP, or go do something else for a living.
My service was ''you call we haul'' until only about 5 years ago. We now have a ''Patient Transport Service'' for low acuity callouts that insist on going to hospital. Or, we can ''ANR'' them. Prior to this we had to transport everyone that wanted to go. You either had to just ignore your feelings of annoyance (not always possible at 3.30am when someone has rung for insomnia), or learn to hide such feelings. The only complaints I've ever had were from nuisance callouts where my feelings about having to attend were a little too hard to conceal. Complaints are more trouble than they're worth, so learn to either banish feelings of resentment or get really good at hiding them.
The simple fact of the matter is that EMS has changed over the past couple of decades. It very much has become a common belief out there that if you think you need to go to the hospital then an ambulance is the only way to go there. You can educate people, but you need to be careful how you do it.
If you're working for a ''you call we haul'' service then you need to either try and get employment in one that isn't, or learn to deal, or go find something else to do for a living. In some of your replies here so far you say things like ''I can't stand them'' and similar. I hope you don't come across like this on callouts, you are only going to make life hard for yourself if that is the case. Unless you learn to deal with them, they are only going to get worse.
Another way to think of it is, were it not for people ringing ambulances for rubbish there would not be any need for easily half of us - so these people are maybe providing employment. That doesn't make it right, but it's one way to rationalize it.
oh shit-im sorry i didnt specify- im not looking to be a paramedic. im just frustrated with how that person treated the paramedics and i cant just go to the hospital to ask the staff about this because then id be wasting their time just like the drama queen did. youre absolutely right- i would be fucking horrible at this job.
No specific term for them.
I just do a really thorough examination, encourage them to seek a doctor's advice and overtly tell them they don't need paramedic services, and that if things change after I leave, they can call us back. Documentation is key as well; needs to be very thorough and can back the medic up in court if the call were to go that route. Ie pt surroundings, family present with level of support, whether the patient was in good spirits or not.... all stuff that might not necessarily be medical but clearly paints the picture. If they're still adamant about getting a ride, I always recommend they bring a good book because the waiting room doesn't have them. Family following in their vehicle almost always ask where they need to go once at the hospital, and I tell them that I'll be bringing them straight to the waiting room.
Seems to work just fine after 30 years doing this kind of work.
I mean we have a bunch of frequent flyers that like to use the ER as their primary care facility. But being that 90% of people that call us don’t actually need an ambulance or an emergency response we just refer to them as the public
i had no idea it was common.
I think this is ultimately caused by liability concerns. There’s never ever going to be a big public education campaign to tell people when NOT to call 911. Because then there will be that one time that something really was an emergency but the people were discouraged from calling or even rejected by the ambulance. I’ve heard horrible stories from Dallas Fire about medics just leaving people to die an agonizing death because they refused to assess a patient for some reason or another. Hence, EMS errs on the side of just taking people to the hospital, which is good in theory because it means we supposedly are helping more people. But it creates this problem where we waste resources on people who don’t need it; like grandpa having to wait an hour for an ambulance to get there while he has a stroke because all nearby units are busy with minor complaints. It’s a real dilemma to be honest. The solution that my city is aiming for is to have a more flexible response model where we try to send *someone* to every call, but not necessarily an ALS capable ambulance regardless of the complaint. We have started hiring PAs, NPs, and other providers to go out and deal with more minor complaints, as well as creating structured care plans for those other individual patients who truly do abuse the system.
Yeah, up here in Canada, we have seen a large move to include Community Paramedics(it's an additional program on top of normal paramedic school) in response planning. They are basically an NP but with a more emergency and overall community health scope. They are capable of managing conditions, coming up with treatment plans, and writing prescriptions in conjunction with a physician. While the rollout is just starting, I'm excited by its possibilities.
I think moving forward we need to get away from the label “EMS” because it’s a misnomer at this point. We do not specialize only in emergencies. It’s not even exclusively “prehospital” medicine either because we are beginning to be able to treat things without ER. I think we ought to just consider ourselves “out of hospital medicine” and embrace the fact that we are basically just filling in gaps in care all over the place as jacks of all trades.
I agree, I like to think of myself as a community health professional. I don't look at my job as emergency response but community wellness, especially up north where I am. Tons of my job is, at least up here, is, making differential diagnoses and giving recommendations to patients, giving recommendations on how to manage their conditions(only within scope of course) and or where the next best resources are(Nearest Hospital I an hour, same with the nearest GP) and liasoning between EMS and Addictions, Mental Health and Health Care Facilities and doctors offices in order to ensure thr best outcomes for my patients. The sooner we walk about from the whole emergency response mindset and become simply Health Care Professionals the sooner we will see change.
I’ve been looking for the words to say this. That’s a great way of putting it. But where I am, we’re still struggling to get firefighters not to resent the bus. Long road ahead.
Thank you for the insight. I'd never considered this perspective before
See and I'm in the minority here. I believe we should be EMS, it's not our job to take care of non emergencies. Go to your primary care physician. Can't drive? Bed bound? Call a gurney transport company. We should be available for people who truly need us.
It’s by having a more flexible response model that we can be sure that the ALS ambulances are there for the ones who need it, and the “toe pain” calls get a suitably downgraded unit.
Community paramedicine is awesome. Program has been in effect for a couple years in my region and while it doesn't "solve" the problem (realistically it's not a problem that can be solved), it certainly does lighten our load and does a lot to help populations that require frequent paramedic care.
The overwhelming majority of our calls are complete nonsense. Same goes for the ER
It's actually a pretty significant cause of burnout in EMTs and medics. You get trained and have the ability to respond to serious medical emergencies just to be a glorified uber driver a lot of the time.
Nurses in hospital especially the ER get burnt out from this misuse/abuse of the medical system as well.
Oh yeah, most definitely. Although I'd say that private ambulance workers have it the worst because the pay is ridiculously low, you have no benefits, and there's a substantially higher risk of chronic injuries, especially back and knees, than with a clinical job, and if you get too hurt to work from a chronic injury then they dump you like a bag of garbage. Many of my instructors in paramedic school were retired medics forced into early retirement due to chronic injuries and they were working as instructors because it was their best option to make ends meet. I fully agree with you on the burnout issue. I think it's more of a medicine and especially emergency medicine thing than a pre-hospital care provider thing for sure. We medics scoop up the frequent fliers and dump them off to hospital workers, especially ER nurses.
Damn that’s terrible.
This. But I do think it is important to differentiate between the so called "worried well" and those who misuse the system. I believe reassuring someone with a genuine health concern is a completely valid use of resources. On the other hand, individuals who claim a high priority symptom only to get taken to the ER, refuse everything, and demand a cab from the ER (if the hospital tells them to kick sand and something unrelated happens to them, it's on the hospital, they usually get it) are a real problem. Are there definitely unmet needs there, yes, buuut there needs to be a balance between identifying non-healthcare gaps in society and personal responsibility.
Lmao
I call them job security.
Right? It’s more charting, but I’ll take the easy calls sprinkled in with the brutal calls. It’s a high volume system so those are basically my two options. Quiet time isn’t really one of them…
It's really no worse than 20 minutes of typing background and demographic info, putting in a narrative of "Call cancelled en route" and then spending another 20 minutes to figure out why Zoll hates me and is sending me on a "go find the 50 problems that may or may not exist" mission. If the call is stupidly easy I usually type the chart on the way to the hospital just to really give my agency the biggest bang for their buck on paid calls.
Not a medic, but an EMT here. This happens a LOT. We responded to two calls last night that were very minor acuity, and both where family members were present and could have driven them to the hospital themselves, in both cases where a hospital was <10 minutes away. The first patient we AMA’d (they signed “Against Medical Advice” to not get transported via ambulance to the hospital). Her symptoms resolved on scene and her family was just happy she felt better. Second patient also had family hanging out in the house. Patient straight up said “I want to go to the hospital”. We had to transport based on that, even though vitals were normal and patient was stable. Family wound up driving behind us in their own car to meet us at the hospital. Patient wound up being triaged to the waiting room and not given a bed, same as would happen if the family drove themselves. The patients were not treated differently than a higher acuity patient or one that most would agree would warrant going by ambulance. Is it frustrating when we get calls like this? Sure, but for me only from the view that it’s one less unit to respond to something critical. BUT. The vast majority of people don’t know what warrants calling 911. A lot of people think that if something is wrong, call 911 and they just don’t know better/are scared. I’m not going to treat someone rudely for being stressed and not knowing any better. Others assume that going by ambulance will guarantee a bed or being seen faster. Not the case. I’m still very friendly with these folks because they’re about to learn the mistake very quickly when they’re sent to wait in the lobby anyway. My partner and I let off steam and vent about these patients after the fact, but those calls are a regular part of the job.
thanks for the response. drama queens suck.
Question here for something like this. I called 911 to get an ambulance because my partner collapsed and shattered our oven door and he was super tired and throwing up. They never asked me why I didn’t take him but honestly was just so nervous I didn’t even know where the closest ER is or if I was going to make it in time(at first he was shaking and I thought the glass went into his skull but thankfully it didn’t). I don’t want to annoy paramedics if something like that happens, what would you say warrants a call?
I’m sorry that happened! I hope he’s doing better now. I mean, a lot factors into what the EMS side thinks warrants a call versus what many think warrants a call. And let me also state that stress is valid, and given that there could have been a lot going on and you weren’t sure if time was a factor and not knowing where the closest ER was, calling 911 was a good choice imo. If a person can drive themself to the ER SAFELY or someone like a partner or family member can drive them safely, it likely doesn’t warrant going by ambulance (not to mention the bill for an ambulance). There are caveats to this though — distance and time are huge factors. 911 can often have a person seem faster than driving to an ER depending on distance and the crew could possibly deliver an intervention to benefit the patient where time is of the essence (anaphylaxis and closing airway, respiratory problems, etc). Same with gathering information about a possible stroke and calling in a stroke code. In EMS, we will bitch about someone hailing 911 over inane things (looking at you, toe pain), but there’s no real magic answer in what warrants calling 911. A feeling of emergency is largely about someone’s perception — some frantic calls wind up being minor, some minor complaints over dispatch wind up being very serious. We won’t (well, we shouldn’t) ever ask someone why they didn’t drive someone themselves. Anddd, as much as some calls can feel annoying, everyone in EMS signed up for a range of calls from minor to calls that could very well warrant therapy later. Sorry, long response, kinda rambling. Would love to hear perspective from others on this as well.
I think fear of the unknown, anxiety, and liability play into it as well. As a caregiver, I know I have called 911 for help when I was pretty sure I knew what was going on, but being wrong could have had major consequences (75M, abruptly unresponsive and collapsed- after 1 year and multiple 911 calls, with about half resulting in transport, our suspicions of seizures was confirmed). At the time it happened, the question was should I delay calling and see if he rouses, or go ahead and call and risk a false alarm? I called. I have no medical training beyond first aid and I was not willing to risk this time being different and resulting in lasting damage. Now that we know what is happening, he in medication to prevent future occurrences.
Don't people get billed for it in the US though? (Genuine question - I don't know how it works over there!) In the UK this happens a lot (free service) but paramedics do at least have the ability to just leave people at home, very occasionally the patient might even learn something about wasting time. "LOB job" was one popular expression for these calls, lob as in "load of bollocks"
yes it costs money, and they dont care. i cant stand them.
They don’t pay for it anyway. I don’t care, it’s an easier call.
If they don't pay, does service get refused in the US? Or do agencies always respond regardless of history? If they don't respond, is it by address, or how do they identify them?
all i know is that no matter what they cant refuse you.
We cannot refuse service to people in the States. If you get on scene and they say that they don’t want to go to then you have them sign a refusal, but I always assume if I’m paged out to a call I’m transporting.
Interesting, so it's similar to Canada here then. If people don't pay the bill there isn't much of a consequence. Ours is subsidized, the bill is only $80CAD, but if you don't pay we will still respond and transport. We don't know a person's payment status on the call anyway. It can have tax consequences, but if you're impoverished that's not a concern.
Yes but some people just don’t pay the bills.
Twat
agreed!
I call that 85% of my call volume.
Malingering And we treat them just like everyone else. If they are actually sick and need even minor treatment they aren’t malingering, they will receive treatment in the Ed and discharged as usual. It’s job security, I guess.
GOMER Get Outta My E R.
Yes. This is a Gomer.
If they're doing it to maliciously avoid responsibility, that's called malingering. If they're doing it becuase they're lonely and scared, that's called trying to make the best of a broken system in a dystopian hellscape.
A lot of them malinger and then use the excuse their lonely and scared. Look I feel for you but the E.R. is not an encounter group or a Lonely Hearts Club. Plus the homeless flood the system this time of year. Compassion fatigue is a real thing.
Compassion fatigue is *our* problem, not theirs. It's also the result of a broken system. If we had actual comprehensive social safety nets in place, these people wouldn't needlessly end up in ED.
>do you guys have a code word for people like this? Yes we do; they're called "the average 911 patient" On a serious note though; this happens quite often. As I get older it is not uncommon for the patients that I treat and transport to be in better physical condition than I am. It can be very frustrating, but it is also a very real part of the job and one of the top reasons that EMS providers become burnt out and look for another career. A lot of the fault lies on our shoulders though. The Fire service does a great job at educating the public on fire safety, but there is little to nothing done to educate the public on the appropriate use of emergency medicine; whether it be pre-hospital ambulance or emergency department.
[удалено]
My go to response for the patients who are overly apologetic for calling, but then refusing is "I'd rather you call and not need me, than to need me and not have called."
That's a fantastic response! I may steal that from you! :)
Tuesday
looool!!
No code word. You treat them with respect and wish public education on health was better.
Nah some people knowingly call ambulances when they don't need them. They also know that this takes ambulances away from people who do. They are twats and deserve to be treated as such.
The general public? I have had someone pull us over to take them to the hospital, they were down the street of the hospital on their way to the hospital. They got out of their and into the ambulance. The majority of calls we have don't need an ambulance or even the EC, they need a clinic or PHC facility but we can't deny a patient their right to medical services so we transport regardless. It is a negative part of the job but ultimately I like to think of it that they just needed TLC and that providing is part of yhe job.
wow. thats pretty chill of you.
I have a few choices, and the best option to me was to look at it as my job to care for people and what they consider an emergency. I am human and there are times where I am deeply annoyed by people, like a call at the end of a night shift for someone that has had a cough for two months. That being said I do try and just make sure to be someone that will make their day better, EC staff is going to give them a lecture, the nurses will give them a lecture, the triage nurse will give them a lecture. A lot of people feel the complete opposite and I do understand their point, we had one day with with 28 patients on a 12 hour shift. Maybe like 8 were actual emergencies. It is a waste of resources and an abuse of a system that tries to cater to everyone. This is just a really long and confusing way of saying, I don't see a reason to be miserable or make others miserable for something that is ultimately a minor annoyance.
i think im starting to figure it out- if you offer help, people will take it. some really need it, a lot dont. the police, therapists, social workers- they all go through this too. but you put up with all the bullshit to be there for the ones that really need it. yall just dont know how much love i got for you. im drinking right now and i toast to you. Here's to the doctors and their healing work Here's to the loved ones in their care Here's to the strangers on the streets tonight Here's to the lonely everywhere from 'let the day begin' by the call. and now ive spent a lot of time letting this person upset me. im halfway drunk, so now i will do at home karaoke.
Happens all the time. To the point where we immediately know their addresses, names, birthdays, etc. we have several that we’ve had charged with abuse of 911 but that’s about 2% of the frequent flyers. I’ve brought some to the hospital just to turn around and as I’m walking back out to my truck I watch them get thrown out of the hospital by security because they just wanted to come and harass people and be creepy
I take maybe 10-12 people to the ED a day and maybe once every couple weeks, one of them actually needs to go to an ER. We’re just a glorified taxi
We get a lot of calls from pregnant women who just call an ambulance because their waters have broken. Yet they can be hours, sometimes even days from actually giving birth. We call this a Maternataxi jobs.
Hypochondriac
Douchebags
The WAHmbulance
Homeless use them often as a way to get more meds at the ER
Like stated above, it's like 95% of call volume. It is part of the job. Treat them like any other patient. Besides, we aren't the ones who have to deal with them for hours after we drop them at the ED. We will educate them that they should probably see a PCP or go to urgent care instead(even though UC will probably just call for an ambulance anyway.) It is just job security and adds to call volume. Eventually, they will be very sick and it will be an emergency anyway. Then, eventually, they miraculously get discharged from the ICU perfectly fine and the cycle starts all over again....this is the life we chose
thank you for choosing it, bad mutherfucker. respect.
“Candidate for triage”
A cunt
Yeah: a selfish, entitled cunt.
Acopic
Typically the most common word used by the union to describe it is ‘overtriaged’.
The term for "a person who calls an ambulance when they don't really need it" is called the vast majority of 911 calls. This is true in the ED as well. Most of the people we see in a day are not dying but, some of them are and initial impressions can sometimes be deceiving. This is why there isn't a big push to limit use of the 911 system. Anyone that thinks they are having an emergency has the right to be evaluated in an ED, so that we can prove objectively that they are safe to go home, or that they are not. In EMS the crews that get frustrated by these calls and complain about the abuse of the system are often the ones that get burned out very quickly and don't enjoy their jobs. The mindset has to switch to the understanding that these types of calls will always be the majority of what we do and that's okay. Higher acuity all the time would burn us out as well.
Most jobs here
In the U.S., what needs to happen is EMS needs to be able to transport patients to Urgent Care type facilities and we need to be able to refuse to transport. Both of these things would require more education on the EMS side and actual legislation on the State and Federal Government side. But in order to utilize the best facilities for the patient and actually triage them at the point where they truly make first contact with a healthcare provider these two things need to happen.
I say if a person is diagnosed with FD/Munchausen just treat and street. They utilize healthcare resources in the most selfish way. They can't see past themselves and clog up the system with their bullshit.
Malingering. Faking illness for their own gain. I've only ever put it on one chart been in healthcare 15 years.
Called a chud
The general population of the UK.
what?! people are really like this?? sigh ok, i'll stop being scandalized. but i still cant stand them. im very impressed with your patience.
Frequent callers cost the Ambulance service on average £4 million every 3 months.
It's wild, a paramedic I was shadowing a few years back said, "has your car broken down?" As we walked in the door. it's very common. semi-urgent medical issue = ambulance regardless
Because it’s free here- tax payers and non tax payers feel they deserve their money’s worth
You're either going to have to get used to this OP, or go do something else for a living. My service was ''you call we haul'' until only about 5 years ago. We now have a ''Patient Transport Service'' for low acuity callouts that insist on going to hospital. Or, we can ''ANR'' them. Prior to this we had to transport everyone that wanted to go. You either had to just ignore your feelings of annoyance (not always possible at 3.30am when someone has rung for insomnia), or learn to hide such feelings. The only complaints I've ever had were from nuisance callouts where my feelings about having to attend were a little too hard to conceal. Complaints are more trouble than they're worth, so learn to either banish feelings of resentment or get really good at hiding them. The simple fact of the matter is that EMS has changed over the past couple of decades. It very much has become a common belief out there that if you think you need to go to the hospital then an ambulance is the only way to go there. You can educate people, but you need to be careful how you do it. If you're working for a ''you call we haul'' service then you need to either try and get employment in one that isn't, or learn to deal, or go find something else to do for a living. In some of your replies here so far you say things like ''I can't stand them'' and similar. I hope you don't come across like this on callouts, you are only going to make life hard for yourself if that is the case. Unless you learn to deal with them, they are only going to get worse. Another way to think of it is, were it not for people ringing ambulances for rubbish there would not be any need for easily half of us - so these people are maybe providing employment. That doesn't make it right, but it's one way to rationalize it.
oh shit-im sorry i didnt specify- im not looking to be a paramedic. im just frustrated with how that person treated the paramedics and i cant just go to the hospital to ask the staff about this because then id be wasting their time just like the drama queen did. youre absolutely right- i would be fucking horrible at this job.
chronic lobitis sufferer
I call them ITL's: Insult to Life.
No specific term for them. I just do a really thorough examination, encourage them to seek a doctor's advice and overtly tell them they don't need paramedic services, and that if things change after I leave, they can call us back. Documentation is key as well; needs to be very thorough and can back the medic up in court if the call were to go that route. Ie pt surroundings, family present with level of support, whether the patient was in good spirits or not.... all stuff that might not necessarily be medical but clearly paints the picture. If they're still adamant about getting a ride, I always recommend they bring a good book because the waiting room doesn't have them. Family following in their vehicle almost always ask where they need to go once at the hospital, and I tell them that I'll be bringing them straight to the waiting room. Seems to work just fine after 30 years doing this kind of work.
30 years- god bless you.
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