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WHAT MAKES AN EMS PROVIDER A TAXI DRIVER/AMBULANCE DRIVER, THE TYPE OF CALLS YOU RUN OR YOUR ABILITY TO PROVIDE PATIENT CARE????
I have been seeing alot of discussions about EMS being referred to as "ambulance drivers" and noticed that some are getting pretty upset at the idea that they are not viewed as a skilled provider. I started thinking what makes an emt or paramedic a taxi driver/ambulance driver. I would love to know what people think the difference is between a skilled provider and a taxi driver and what kind of things have you done lately to keep from falling into that category??
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Replies to This Discussion
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Permalink Reply by Paula Miller on -
My sentiments exactly...
Scott Lancaster said:Why are we arguing with her again? Pointless effort that leads to annoying bickering, medic bashing, and ' no one wants ems education ' statements that inflame the thread. One persons personal bias and lack of industry knowledge, or respect, shouldn't derail the conversation.
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Permalink Reply by Neil White on -
Another interesting thread steadily heading off course....
If attention can be turned....How can we balance the demands of increased supply of patients, the need to increase education of medics and provide a benefits package that matches the responsibilities of the modern day medic doing skills beyond straight forward treat and drive to the er....
Answers on a postcard....
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Permalink Reply by Justin P on -
I think that we definitely need to address the large number of patients that we see who dont really need the ER, it has always been an EMS standard that if we transport from a 911 call the patient must go to an ER. probably half of our patients could be handled at a clinic or 'treat and release', this is where the community health paramedic and alternative pathways to treatment come in, as it will be shown that more cost effective alternatives other than the ER are both safe and efficient.
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Permalink Reply by Skip Kirkwood on -
There are several problems with that, Justin.
First, all the research done so far shows that the EMS community "gets it wrong" way too often when we decide who needs to go to the ED and who does not. Obviously our education and training are deficient in this area.
Second, many of our "frequent users" are uninsured or under-insured. These are people that clinics and private practices don't want to see, because they don't get paid, or don't get paid enough, for caring for them. EMTALA only applies to hospitals and only to patients that present requesting "emergency care." So, we have to have developed some alternative places where these patients WILL be seen by a health care provider, regardless of their ability to pay.
Last concern - not all of the emergency medicine community believes that it is the right thing to do to keep these people out of the ED. They, too, have to pay the bills, and some in emergency medicine believe that serving the low acuity patients helps "pay the bills" to keep the doors open for those whose conditions are truly emergent.
The fact that we in EMS don't "like" or feel that it should be "our job" to assess and transport low-acuity patients doesn't make it so. Our communities, not we in EMS, get to define the services that they want us to provide - and so far, nobody in the health-policy realm seems to feel very strongly about changing the current paradigm. Perhaps, as the CMMI grants and some other research start to yield results, we will get some policy-level action to help our communities define what they want, and what they don't want, to be provided by their emergency medical services.
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Permalink Reply by Robert Lanious on -
Maybe in your area, Justin, EMS programs are becoming college degreed, but not in Western Pa.. Colleges may still teach the program and though they have to be accredited, they are not college degree programs. We have a B.S. program at my Alma mater and an Associates program in a neighboring county, but otherwise, the programs which meet the new guidelines for accreditation, are not required, and not becoming college degree programs. There is too much political resistance to that. I sure hope that does change, but I don't see it happening for a while.
Justin P said:Actually, the trade schools are going by the wayside, and as of January 1st 2013, all paramedic programs must be accredited, and programs must be taught to the new national EMS standards. As far as licensing exams, yes there are different exams in different states, however many states actually use the NREMT exams as their licensing exams, and those that do not their exams are all based on the same national standards.
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Permalink Reply by Robert Lanious on
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When more and more people have insurance thanks to Obamacare, we will see the growing use of EMS as is seen in most of the rest of the industrialized world who ensures everyone is covered. I foresee we will be forced financially to make changes. The low priority calls will have to wait longer and will not be subject to the standard 8 minute response time, and insurance companies are already denying claims, and I see them doing it more. We recently had a woman who's foley catheter came out, a crew transported her to the ER to have another one put in and the insurance denied it as not medically necessary. Certainly an ER visit probably was not the best thing.
However, with the current level of education, that being simply vocational training being the minimum standard, I agree that EMS providers should simply stick to being ambulance drivers and resuscitation techs. However, those with education and visionary foresight, should be continually pushing the envelope for changes.
People continue to call us simply for rides because we continue to do it and then cry when we don't get paid for it or take crews out of service, delaying response times for more acute patients. In time, someone will get it right, and when there is a screw up, the baby will not be thrown out with the bathwater.
Now I wonder, aside from the occasional jack-ass who will tell an MI patient they have indigestion and should not be seen, if we asked for payment up front for those who simply need a ride. We have them sign disclosure forms that warn them insurance will not pay and they will be responsible for the bill, but most just throw away the bills and don't care about their credit. Many agencies and regions have protocols involving medical command to simply just say no to people who don't need an ambulance. What I found in my area is not all of the medical command MDs are willing to agree to no transport, for many reasons. However, I just don't see how EMS can continue to operate as the public expects before going bust. Maybe I am wrong. We'll see. I still thing there is a use for Prehospital RNs, NPs, PAs, and even MDs in EMS, on the ground, and not just in the role of Critical Care.
Skip Kirkwood said:There are several problems with that, Justin.
First, all the research done so far shows that the EMS community "gets it wrong" way too often when we decide who needs to go to the ED and who does not. Obviously our education and training are deficient in this area.
Second, many of our "frequent users" are uninsured or under-insured. These are people that clinics and private practices don't want to see, because they don't get paid, or don't get paid enough, for caring for them. EMTALA only applies to hospitals and only to patients that present requesting "emergency care." So, we have to have developed some alternative places where these patients WILL be seen by a health care provider, regardless of their ability to pay.
Last concern - not all of the emergency medicine community believes that it is the right thing to do to keep these people out of the ED. They, too, have to pay the bills, and some in emergency medicine believe that serving the low acuity patients helps "pay the bills" to keep the doors open for those whose conditions are truly emergent.
The fact that we in EMS don't "like" or feel that it should be "our job" to assess and transport low-acuity patients doesn't make it so. Our communities, not we in EMS, get to define the services that they want us to provide - and so far, nobody in the health-policy realm seems to feel very strongly about changing the current paradigm. Perhaps, as the CMMI grants and some other research start to yield results, we will get some policy-level action to help our communities define what they want, and what they don't want, to be provided by their emergency medical services.
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Permalink Reply by Justin P on
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A few innovative things that I've seen are bringing a patient who only needs a ride to the hospital to the triage are of the ER, patient is placed in a chair and DOC comes over, looks at EMS report and tells the 'patient' that their visit isn't likely going to be covered under their insurance and gets them to sign a acceptance of financial responsibility before they go back to the ER, seems to be cutting down on inappropriate use of the system not sure about medical control taking responsibility for EMS referrals for alternate transport (ie yellow cab), one thing we used to do in Miami (I worked for AMR) was we had cab vouchers to give to people if they said they just needed a ride to the ER--thoughts?
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Permalink Reply by Neil White on
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The difficult contention here is who would take responsibility if something adverse were to happen during the taxi ride to hospital.
Really, the diversion has to start before an ambulance arrives on scene otherwise there is little point. Either thats through telephone triage or through fly car medics.
As Skip mentioned this is going to need to be a multidiscipline effort, we need an alternative place to accept people, we need nurses and doctor's to accept the decision making of the paramedic and that links to education standards. But the financial model of the whole healthcare system would need to change. Here in the UK our NHS system operates on a payment by results system with the ER receiving reimbursement based on a tariff of triage need so minor urgent and critical.
Minor patients are worth about £70 to the ER and an experienced physician could possibly see 10 of these patients in an hour. Critical Patients are worth £200 and a physician would probably only see 1 per hour. £700 versus £200. If EMS diverts these minor patients elsewhere, the ER looses a significant chunk of its budget and therefore is unwilling to engage in changing the system from an administrative point of view.
EMS is a public service and as such has to meet the health needs of the public it serves. If the populous face minor medical ailments and because of social circumstances need transport then that is what they expect EMS to do. We as a profession need to design services to meet those needs, lower tier transport services staffed by non medic ambulance staff. Keeping medics skilled and focussed on true emergency situations. For that to succeed a reliable triage system is needed at the initial point of contact be it dispatch or be it the initial medic on scene, this is the chink in the armour of the way forward
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Permalink Reply by Chris Azevedo on -
WOW!! Thou hast been served!
Scott Lancaster said:Why are we arguing with her again? Pointless effort that leads to annoying bickering, medic bashing, and ' no one wants ems education ' statements that inflame the thread. One persons personal bias and lack of industry knowledge, or respect, shouldn't derail the conversation.
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Permalink Reply by dr-exmedic on -
Neil White said:
Minor patients are worth about £70 to the ER and an experienced physician could possibly see 10 of these patients in an hour.
Please tell me you just made that number up. Either that, or I'm going to be extremely jealous of how much support your docs over there have that they can see a pt and not have to spend any time on documentation etc. :)
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Permalink Reply by Neil White on
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The doc orders and there is a nurse and an auxiliary allocated to him...The model is called See and Treat. The Doctor sees and a nurse practitioner treats.
Docs also use Dictaphones that can scan a barcode of the patient....he records what he wants to say and it is typed up by admin staff and filed. Our health system strongly believes in Time and Motion Studies....every process has been raked over the coals to see if it can be over engineered...comes with the ER target time that says 98% of all patients will be admitted or discharged within 4 hours or face financial penalties
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Permalink Reply by dr-exmedic on
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I suppose if I were just supervising a midlevel I could see 10/hour...but then when I said those 10 pts were "seen by a doctor," they would literally have been seen, not examined. Glanced at, more like. Interesting.
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