Homepage / Administration & Leadership / May I have the definition please?
Stop Responding for Overdoses? Sign Me Up! Yup. Still Barfing I Heard You, She Heard You, the Baby Heard You Is there a Doctor on board? the Crossover Podcast – Ep 111 – Paramedic Perv Reporter Unclear of Aircraft EMS Operations The new rigs are here! the Crossover Show – Ep 110 – Do You Poop Where You Eat? What to do for an allergic reaction…or not The Last Shift of the Lost Cause The Crossover Show – ep 109 – Is that Cocaine or Anthrax? How to respond when your spouse tells you to be safe at work Always, In Service – EMS Week 2017 Lost Cause gets cocky FDIC 2017 – Structural Response to Aviation Incidents: Engine Company Operations I Got Lost Going to a Call – So I made sure everyone knew about it Crossover Podcast Ep 102 Mrs Happy Medic and Mike the Cop Arby’s Roast Beef Ad angers EMTs, not sure why Strippers and Cocaine watch – 2017 Seizures! Seizures Everywhere! Nothing is certain except death and taxes. I can help you with both What to do when the powers that be – just can’t. Episode 99 the Crossover Ep 98 – Off Duty and Fancy Free NO is Never Easy to Hear Ohio Cop vs Ambulance Crew Member on Video – Crossover Show Investigates! An MCI With Wings: Aviation Incidents EMS Today 2017 First in Ambulance MCI at EMS Today 2017 Crossover Show Learns How to Take a Joke To Haul or Not to Haul – Should the Complexity of a Refusal Influence Transport? Crossover Show – Ep 91 – ACLU cameras Tip of the Helmet – Bj’s Brewhouse the Crossover Show – Episode Eighty Eight Eminence Based Medicine If You Don’t Give Him Insulin He’s Going to Die Lost Cause Strikes Again the Crossover Podcast – Ep 85 – Florida Cry Baby “I Can’t Breathe!” you keep using those words… the Crossover Show – 84 – TN Bus Crash Happy 150th Anniversary San Francisco Fire Department! Thank You For Your Service? A Complete Secondary Assessment the Crossover Episode 81 – Let’s Talk Politics! Aircraft skids off runway, rescue task force ill equipped Crossover Show – Ep 79 – Do we need so much active shooter training? How to Ignore Everyone in the Room: Be an Intern Your Meme is Bad and You’re Not One of Us Anymore Goodbye tarps, I never loved you The Crossover Episode 76 – Flashback to the Beginning You found me how? Less CSI, More Columbo EMS Festival Standby – You can’t just park a car there the Crossover Show Ep 72 – Florida EMT photo game A&O vs able to make decisions Kilted to Kick Cancer Cops vs Firemen Writer calls for Medics to risk more in shootings, misses the target What’s with the French? the Crossover – Ep 69 – Twelve Ninety Désolé the Crossover Show – Ep 67 – Traffic Stops and Profiling Actually, Officer, No. It Really isn’t that hard to try When Patients Don’t Play by the Old Rules Letters in the File – Oklaloosa Selfies the Crossover Podcast – Ep 64 – Turning Passion into Retirement Why Pokemon GO is so much like EMS Us Against Us Apathy is worse than absence So Now I’m Back! Changes are a-comin’ The Sounds of Silence I know that feel, Bro TCS – Ep 59 – SHOOT HIM! CISD with OK GO part VI the Crossover – Ep 56 – Rooms for Shooting the Ballad of Big Dave the Crossover Episode 55 – Text me Bro Why vs How and Book vs Street A Mother’s Day Crossover Show Dear Valencia County Fire Chiefs Dear Random Township Fire Department at FDIC the Crossover Show – ep 50 – Revenge of the Vine Stars Strippers and Cocaine need your help Educational Standards in EMS Engine Company First Strike MCI – FDIC 2016 the Crossover Show – Ep 48 – What’s in your feed? Washing the Chief’s Car What Should I Do With This Knife? – The Crossover Ep 46 Firefighter Jokes Medical/Legal Advice, Google Style the Crossover Show – Episode 45 – Cop Vines and the Cajun John Wayne You Make the Call ebook Now Available To the Intern Who Froze the Crossover Show – Episode 44 – Day of Remembrance New at Uniform Stories – Raising Revenue BLS Fire Officer or Paramedic – Who Makes Scene Decisions? the Crossover Show – Episode 43 – Viewer Questions Why Budgeting Matters – Our Plumbing Nightmare the Crossover Show – Episode 42 – Protesting a Rally with a March DC FEMS MD Quits, calls FD Leadership “Toxic”

A funny video has been making the rounds on the interwebs machine, an ad for Mercedes Benz.

In this video a woman walks into a library and tries to order lunch:

It’s funny, right?

Now imagine she wanders into an ambulance station and asks to be transported for a toothache.  Is it still funny?  She’s still in the wrong place asking for what she wants.

I hear from many corners of the EMS industry that we need to lose our “above them all” attitude and just take people in that want to go in.  “It’s their definition of emergency, not yours” is something I am tired of hearing.

What if I told you it’s her definition of library, not yours?

We are not Jim’s Emergency Medical Services, or Sally’s or even Justin’s.

Responders have been trained to handle specific situations using specific tools, medications and techniques.  If you can not be aided by those things, then perhaps we need to find another resource for you. Most communities do not offer these services on demand, but arrangements need to be made ahead of time. They either wait or call 911 and get immediate service.  In still other communities EMTs and Paramedics are discouraged from or worse, disciplined, for accepting refusal of transport.

I’m not advocating leaving the sick and injured in the streets, but adding some realism in addressing our current problems.  We do not face a shortage of ambulances in America but an overpopulation of “emergencies.”

When you get on scene of the young woman who bit her lip and didn’t know what to do so called 911, no matter how you dice it, that injury is not worth placing responders lives at risk to respond to, not to mention who might be told “We have no ambulances available” while you’re trying to nicely tell your patient how minor the injury is.  Add to that that some private services do not allow refusals, now they’re generating a bill for the bit lip and taking up a spot at the ER.

Rogue Medic reminds us that our concern when at the scene with a patient is that patient and not the next one.  I completely agree that when on scene we need to focus on the needs of that person and not what might happen.  But when looking at the system as a whole, someone needs to be thinking about the next run.  Supervisors, managers, Chiefs, EMS Educators, SOMEONE needs to be looking out for who might need those supplies, skills and equipment your patient is asking about while getting that ride.  In the back of the ambulance is not the place to theorize about EMS.  That place is here in online forums, at conferences and when meeting with your Medical Director, System Managers and Chiefs.

There are things we can and can’t do for our patients.  If all you can offer is a ride, is it still an emergency?  Think about it for a minute.  If it’s just the speakers not working, do we really need to call a tow truck “just to be sure?”

Awhile back I had a good back and forth with David Konig about comparing McDonald’s, Starbucks and Dunkin’ Donuts to modern EMS.  He mentions the way Starbucks outdoes Dunkin not because of superior product, but because of superior customer service and a better customer experience.  It was in response to a series on Liability.

But those companies are still limited in the experience they can provide.  As I mentioned, when someone calls 911 for a reason I can not help with, nor any of my equipment, training or experience help with, do I still have to give them a positive experience?

Absolutely.

And that means not transporting those who do not need it.  The same way Starbucks will not make the girl in the video a hamburger, or arrange for one to be delivered.  They’ll likely smile, ask her if she meant a venti Americano, and remind her she is asking for a service Starbucks can not provide.  Then a good employee will make sure the customer can find what they are looking for, leaving them a positive impression of the company.

“This is a Starbucks.”

“This is a library.”

“This is an ambulance.”

We’ll just load her in the ambulance and take her in because after all, it’s not our definition of emergency, it’s hers.

Should the librarian stop her work and fire up the grill? After all it’s her definition of library, not yours.

Print and Share

Related posts:

27 Comments

  1. Pingback: Tweets that mention May I have the definition please? | The Happy Medic -- Topsy.com

  2. Timothy Clemans August 9, 2010 4:33 pm

    In my opinion there needs to be an explicit criteria for who should be transported by ambulance. One study concluded EMS-initiated refusal is risky because ten patients given a taxi voucher were admitted to the hospital and one was admitted to the ICU. Is that a good criteria for ambulance transport, “likely to be admitted to hospital”?

    What I don’t understand is why agencies can’t refuse for at least “patient requests prescription drugs.”

  3. Anonymous August 9, 2010 4:47 pm

    Most people have no idea what an emergency is and when they should call 911. I think it is time to spend some money on advertising, in both our countries, to explain when you should call 911 and when you should seek other forms of medical help. They should use detailed examples of when to call. You may need to go to the ER, but it doesn’t necessary mean you need an ambulance to get you there when a taxi or a friend driving you will work just as well.

    In Ontario we have a service provided by the Province government called Tele-Health. One phone call puts you in touch with a Registered Nurse 24/7. You can call about any type of medical problem. They are able to answer your questions and direct you to the most appropriate type of medical service, and probably help you locate it if necessary. Depending on your problem, their advice can range from telling you how to deal with the problem at home and what to do if it worsens or they may tell you need to call 911 immediately.

    I think some well spent advertising money informing the public in such a way that they will remember in an emergency when to call for the paramedics would go a long way.

  4. sparrow August 9, 2010 5:55 pm

    Thank you for addressing one of the most pressing issues for our dept, like many others. We are a small rural community with one ambulance, 17 miles from a hospital from our town center – but our district is 70 sq. miles. If we transport a patient, during the approx. 90 minutes our ambulance is out of service, any other emergency would have to draw from a neighboring community, possibly a 20 minute wait for an ambulance to respond, plus transport time. So we must consider “the next patient” as well as “this patient”.
    Something like what TBChick describes would be wonderful. How do we make that happen here?
    On the other hand is a lady I just spoke with who told me about her mother-in-law’s death from anaphalaxis, while they drove her to the hospital. I couldn’t bring myself to ask her why the He11 they didn’t call 911?!?

  5. Timothy Clemans August 9, 2010 4:33 pm

    In my opinion there needs to be an explicit criteria for who should be transported by ambulance. One study concluded EMS-initiated refusal is risky because ten patients given a taxi voucher were admitted to the hospital and one was admitted to the ICU. Is that a good criteria for ambulance transport, “likely to be admitted to hospital”?

    What I don't understand is why agencies can't refuse for at least “patient requests prescription drugs.”

  6. Divermedic August 9, 2010 9:42 pm

    While I agree that we have an issue here, maybe I disagree with where the solution lies. What about changing the way we are dispatched. If the dispatchers can filter out the “real” emergencies from the “toothaches” we would spend less time en route dealing with these types of calls. I am not saying anything bad about our dispatcher co-workers, they do a fantastic job in a rough environment but if they had the resources and training to “strongly advise” personal vehicle transport, it would prevent the risks associated with the callout all together.

    That said, I do understand the liability issues with encouraging refusals. I know that is against our policy although the PT can refuse on their own.

    Great point and I appreciate not only you reminding us of this but also for getting me thinking at the end of a long day!!!!

  7. TBChick August 9, 2010 4:47 pm

    Most people have no idea what an emergency is and when they should call 911. I think it is time to spend some money on advertising, in both our countries, to explain when you should call 911 and when you should seek other forms of medical help. They should use detailed examples of when to call. You may need to go to the ER, but it doesn't necessary mean you need an ambulance to get you there when a taxi or a friend driving you will work just as well.

    In Ontario we have a service provided by the Province government called Tele-Health. One phone call puts you in touch with a Registered Nurse 24/7. You can call about any type of medical problem. They are able to answer your questions and direct you to the most appropriate type of medical service, and probably help you locate it if necessary. Depending on your problem, their advice can range from telling you how to deal with the problem at home and what to do if it worsens or they may tell you need to call 911 immediately.

    I think some well spent advertising money informing the public in such a way that they will remember in an emergency when to call for the paramedics would go a long way.

  8. Aled Treharne August 9, 2010 10:12 pm

    “It’s their definition of emergency, not yours”?!

    What a load of crap.

    I’m sorry if that offends, but that’s my stance on that comment. When a suitably trained, professional medical person (paramedic, doctor, nurse, etc) arrives on scene with a patient and makes a clinical decision based on evidence gathered that the patient is not suitable for emergency transport to the hospital, then why on earth should *any* EMS system transport them to the hospital?

    I truly believe in patient choice and patient education but at the same time, patients need to understand that there are numerous pathways to receiving the treatment they need and that the medical person that is attending to them is giving them the best advice that they can and that they should damn well take it. Transport to hospital is expensive, much less the hospital care itself, and as such is limited in availability – no medical system in the world has an unlimited budget. So why are we wasting resources on those that patently don’t need it?

    Please note that I’m not advocating anyone neglect a patient. If the person-on-scene is unsure, concerned or cannot gather suitable evidence to convince themselves that the patient does not need emergency treatment, then by all means take them in.

    Transporting every patient just because they want it? That’s the product of an over-litigious society and it’s costing us dearly.

  9. sparrow August 9, 2010 5:55 pm

    Thank you for addressing one of the most pressing issues for our dept, like many others. We are a small rural community with one ambulance, 17 miles from a hospital from our town center – but our district is 70 sq. miles. If we transport a patient, during the approx. 90 minutes our ambulance is out of service, any other emergency would have to draw from a neighboring community, possibly a 20 minute wait for an ambulance to respond, plus transport time. So we must consider “the next patient” as well as “this patient”.
    Something like what TBChick describes would be wonderful. How do we make that happen here?
    On the other hand is a lady I just spoke with who told me about her mother-in-law's death from anaphalaxis, while they drove her to the hospital. I couldn't bring myself to ask her why the He11 they didn't call 911?!?

  10. Ladyhavocinc August 9, 2010 11:11 pm

    I’m a respiratory therapist in a hospital on the outskirts of a major metropolitan city. We are not the largest hospital in the area, but we are located in an area with a very high percentage of people with no insurance (nearly 20%). Recently, I was called to the emergency room to administer a breathing treatment on a child with an asthma exacerbation. When I entered the patient’s room, mom and her 5 children (all under the age of 8) were all in the room. I asked what had brought them to the ER today and mom said that two of the kids had colds and one of the others had a heat rash. They arrived in an ambulance. They live 4 blocks from the hospital, along the bus route, and across the street from a drugstore. They have state health insurance.

    I would have loved to have been able to redirect this mom to another choice. Instead, her mass of children was occupying one of our trauma rooms, because the other rooms were too small. The other trauma room was occupied with someone having chest pain. The gunshot wound had to be redirected to another hospital (5 extra transport minutes, but still) because we were full.

    Explain to me how this is better than “everybody goes if they want, whether they need it or not”.

    LadyHavoc

  11. Divermedic August 9, 2010 9:42 pm

    While I agree that we have an issue here, maybe I disagree with where the solution lies. What about changing the way we are dispatched. If the dispatchers can filter out the “real” emergencies from the “toothaches” we would spend less time en route dealing with these types of calls. I am not saying anything bad about our dispatcher co-workers, they do a fantastic job in a rough environment but if they had the resources and training to “strongly advise” personal vehicle transport, it would prevent the risks associated with the callout all together.

    That said, I do understand the liability issues with encouraging refusals. I know that is against our policy although the PT can refuse on their own.

    Great point and I appreciate not only you reminding us of this but also for getting me thinking at the end of a long day!!!!

  12. Aled Treharne August 9, 2010 10:12 pm

    “It’s their definition of emergency, not yours”?!

    What a load of crap.

    I'm sorry if that offends, but that's my stance on that comment. When a suitably trained, professional medical person (paramedic, doctor, nurse, etc) arrives on scene with a patient and makes a clinical decision based on evidence gathered that the patient is not suitable for emergency transport to the hospital, then why on earth should *any* EMS system transport them to the hospital?

    I truly believe in patient choice and patient education but at the same time, patients need to understand that there are numerous pathways to receiving the treatment they need and that the medical person that is attending to them is giving them the best advice that they can and that they should damn well take it. Transport to hospital is expensive, much less the hospital care itself, and as such is limited in availability – no medical system in the world has an unlimited budget. So why are we wasting resources on those that patently don't need it?

    Please note that I'm not advocating anyone neglect a patient. If the person-on-scene is unsure, concerned or cannot gather suitable evidence to convince themselves that the patient does not need emergency treatment, then by all means take them in.

    Transporting every patient just because they want it? That's the product of an over-litigious society and it's costing us dearly.

  13. Ladyhavocinc August 9, 2010 11:11 pm

    I'm a respiratory therapist in a hospital on the outskirts of a major metropolitan city. We are not the largest hospital in the area, but we are located in an area with a very high percentage of people with no insurance (nearly 20%). Recently, I was called to the emergency room to administer a breathing treatment on a child with an asthma exacerbation. When I entered the patient's room, mom and her 5 children (all under the age of 8) were all in the room. I asked what had brought them to the ER today and mom said that two of the kids had colds and one of the others had a heat rash. They arrived in an ambulance. They live 4 blocks from the hospital, along the bus route, and across the street from a drugstore. They have state health insurance.

    I would have loved to have been able to redirect this mom to another choice. Instead, her mass of children was occupying one of our trauma rooms, because the other rooms were too small. The other trauma room was occupied with someone having chest pain. The gunshot wound had to be redirected to another hospital (5 extra transport minutes, but still) because we were full.

    Explain to me how this is better than “everybody goes if they want, whether they need it or not”.

    LadyHavoc

  14. Pingback: Around the Fire Web | Firegeezer

  15. Medic5 August 10, 2010 12:40 pm

    “In still other communities EMTs and Paramedics are discouraged from or worse, disciplined, for accepting refusal of transport”

    Yep, work for one of those. Still not sure why a refusal counts against me.

  16. Anon August 10, 2010 5:32 pm

    I say 3 cheers for some of the US cities that have empowered 911 dispatchers to tell someone “NO”.
    Risky, sure , but isn’t everything?

    Perhaps if the industry didn’t feed off such time-driven goals, like call processing, and allowed better trained 911 dispatchers [the REAL first responders] to TALK with 911 callers, we might filter out calls that should go no further than the telephone call.

    If Mr/Mrs/Miss ObligatoryCellPhoneUserChatterboxDoGooder drives past an individual on the sidewalk, and at a passing glance decides that that individual ‘needs help’, calls 911, says ‘You need to DO SOMETHING’, to the 911 operator, do we collectively drop what we’re doing and race over to help, or slow the process down and have a short conversation with this caller?

    If this same person, driving down the road, sees an individual doing synchronized cartwheels with his/her motorcycle in the opposite lanes, it seems likely we will be needed, and the ‘interview’ could be shortened.

    ‘You call, we haul’ seems to be an unfortunate reality for too many in this industry.

  17. Medic5 August 10, 2010 12:40 pm

    “In still other communities EMTs and Paramedics are discouraged from or worse, disciplined, for accepting refusal of transport”

    Yep, work for one of those. Still not sure why a refusal counts against me.

  18. Anon August 10, 2010 5:32 pm

    I say 3 cheers for some of the US cities that have empowered 911 dispatchers to tell someone “NO”.
    Risky, sure , but isn't everything?

    Perhaps if the industry didn't feed off such time-driven goals, like call processing, and allowed better trained 911 dispatchers [the REAL first responders] to TALK with 911 callers, we might filter out calls that should go no further than the telephone call.

    If Mr/Mrs/Miss ObligatoryCellPhoneUserChatterboxDoGooder drives past an individual on the sidewalk, and at a passing glance decides that that individual 'needs help', calls 911, says 'You need to DO SOMETHING', to the 911 operator, do we collectively drop what we're doing and race over to help, or slow the process down and have a short conversation with this caller?

    If this same person, driving down the road, sees an individual doing synchronized cartwheels with his/her motorcycle in the opposite lanes, it seems likely we will be needed, and the 'interview' could be shortened.

    'You call, we haul' seems to be an unfortunate reality for too many in this industry.

  19. Christopher Updike August 12, 2010 7:12 am

    Hey Justin, just wanted to drop a quick line and let you know that this specific post was printed out and has been floating around the EMS office here…getting much feedback but by far the funniest was “maybe we should put a mini grill in the ambulance!”

  20. Christopher Updike August 12, 2010 7:12 am

    Hey Justin, just wanted to drop a quick line and let you know that this specific post was printed out and has been floating around the EMS office here…getting much feedback but by far the funniest was “maybe we should put a mini grill in the ambulance!”

  21. Burnedoutmedic August 13, 2010 2:21 am

    if we say it’s not emergency and you don’t like it, take a cab. the cab won’t turn you down. unless you pee in the cab.

    i’m not entirely certain where this phenomenon of non-professionals insisting they know better than the professionals comes from. and it’s pervasive both in ems and outside of it. look at politics.

  22. Burned-Out Medic August 13, 2010 2:21 am

    if we say it’s not emergency and you don’t like it, take a cab. the cab won’t turn you down. unless you pee in the cab.

    i’m not entirely certain where this phenomenon of non-professionals insisting they know better than the professionals comes from. and it’s pervasive both in ems and outside of it. look at politics.

  23. Pingback: The EMT Spot » Patients Define Their Emergencies (Part 2)

  24. Steve August 15, 2010 10:14 pm

    Justin. Thank you for the challenging and thought provoking post. My commets ran longer than 2,000 words so I published them at my blog.

    http://theemtspot.com/2010/08/15/patients-define-their-emergencies-part-2/

    Take care my friend. Good luck on the test results. I’m going to make a prediction that you did phenomenally well.

    Steve

  25. Steve August 15, 2010 10:14 pm

    Justin. Thank you for the challenging and thought provoking post. My commets ran longer than 2,000 words so I published them at my blog.

    http://theemtspot.com/2010/08/15/patients-define-their-emergencies-part-2/

    Take care my friend. Good luck on the test results. I’m going to make a prediction that you did phenomenally well.

    Steve

  26. Pingback: The EMT Spot » The August EMS Roundup

  27. Pingback: » Blog Archive » Airport Life – 1 Year Later

Post a Comment

Your email address will not be published. Required fields are marked *

*