Re: Two cities pilot efforts using EMS to curb ED visits

[Guest guest]

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

It is if you can't put up enough Unit Hours. LOL.

>

>

> Just a question -- abdominal pain is low risk?

>

> Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

> Austin, Texas

>

> Sent from my iPad

>

> On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...>

> wrote:

>

> >

> >

> > Two cities pilot efforts using EMS to curb ED visits

> >

> > 06/03/2010

> >

> >

> > Two U.S. cities have implemented a new program intended to screen EMS

> calls to identify non-emergency cases and direct them away from hospitals to

> more appropriate health care providers, in an effort to alleviate non-urgent

> ED use, USA Today reports.

> >

> > Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout

> its potential to ease the burden on hospital EDs that face high patient

> demand and to lower the number of non-emergency ambulance dispatches.

> Individuals calling 911 who are deemed at " lowest risk " are transferred to

> an RN or nurse practitioner who assesses the severity of a patient's

> condition. Nurses also may direct a patient to a proper source of care, such

> as a primary care physician (PCP) or clinic, and help connect patients who

> do not have a PCP with clinics that are accepting new patients.

> >

> > According to USA Today, 10 to 15 calls each day to ambulance dispatchers

> in the Louisville area can be identified as low risk. These low-risk calls

> often involved leg pain, abdominal pain and wound care. A Louisville EMS

> official said that saving a trip to the ED may result in better follow-up

> care and, ultimately, a better prognosis for patients, adding that the

> program will expand to offer " intensive follow-up " to ensure no patient

> " falls through the cracks, " USA Today reports.

> >

> > The program costs about $100,000 to set up per city. An official from the

> National Academies of Emergency Dispatch said that such programs are widely

> used in Australia and the United Kingdom but that the programs in Louisville

> and Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

> >

> >

> > Ron

> >

> > P Please consider the environment before printing this e-mail.

> >

> > All e-mails or files transmitted are considered confidential and intended

> solely for the use of the individual to whom they are addressed. Any

> unauthorized dissemination, review, distribution, or copying of these

> communications is strictly prohibited. If you received an e-mail in error,

> please contract the sender and delete/destroy the message.

> >

> >

[Guest guest]

It is if you can't put up enough Unit Hours. LOL.

>

>

> Just a question -- abdominal pain is low risk?

>

> Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

> Austin, Texas

>

> Sent from my iPad

>

> On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...>

> wrote:

>

> >

> >

> > Two cities pilot efforts using EMS to curb ED visits

> >

> > 06/03/2010

> >

> >

> > Two U.S. cities have implemented a new program intended to screen EMS

> calls to identify non-emergency cases and direct them away from hospitals to

> more appropriate health care providers, in an effort to alleviate non-urgent

> ED use, USA Today reports.

> >

> > Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout

> its potential to ease the burden on hospital EDs that face high patient

> demand and to lower the number of non-emergency ambulance dispatches.

> Individuals calling 911 who are deemed at " lowest risk " are transferred to

> an RN or nurse practitioner who assesses the severity of a patient's

> condition. Nurses also may direct a patient to a proper source of care, such

> as a primary care physician (PCP) or clinic, and help connect patients who

> do not have a PCP with clinics that are accepting new patients.

> >

> > According to USA Today, 10 to 15 calls each day to ambulance dispatchers

> in the Louisville area can be identified as low risk. These low-risk calls

> often involved leg pain, abdominal pain and wound care. A Louisville EMS

> official said that saving a trip to the ED may result in better follow-up

> care and, ultimately, a better prognosis for patients, adding that the

> program will expand to offer " intensive follow-up " to ensure no patient

> " falls through the cracks, " USA Today reports.

> >

> > The program costs about $100,000 to set up per city. An official from the

> National Academies of Emergency Dispatch said that such programs are widely

> used in Australia and the United Kingdom but that the programs in Louisville

> and Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

> >

> >

> > Ron

> >

> > P Please consider the environment before printing this e-mail.

> >

> > All e-mails or files transmitted are considered confidential and intended

> solely for the use of the individual to whom they are addressed. Any

> unauthorized dissemination, review, distribution, or copying of these

> communications is strictly prohibited. If you received an e-mail in error,

> please contract the sender and delete/destroy the message.

> >

> >

[Guest guest]

Not if you ask an Emergency Physician. Abdominal pain patients are considered

one of the highest medico-legal risks.

Rick

Sent via Blackberry

________________________________

From: texasems-l texasems-l >

To: texasems-l texasems-l >

Sent: Thu Jun 03 16:48:06 2010

Subject: Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...> wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

Not if you ask an Emergency Physician. Abdominal pain patients are considered

one of the highest medico-legal risks.

Rick

Sent via Blackberry

________________________________

From: texasems-l texasems-l >

To: texasems-l texasems-l >

Sent: Thu Jun 03 16:48:06 2010

Subject: Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...> wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

Here we go again. Doesn't anybody in either of these two cities ever read the

paper?

This has been tried before, and none of the programs has lasted that I know

about. If somebody here knows otherwise, please inform me. (I'm speaking of the

USA here).

Why do folks immediately jump to the conclusions that a nurse on the phone is

any better at triaging calls than an experienced paramedic? That's nonsense in

my mind, unless said nurse has extensive field EMS experience as well. And I

don't know any EMS nurse/paramedics who would take such a job, since every one

of them that I know would say this is a bad idea and they cherish their nursing

licenses. And who kids themselves that calls can be accurately triaged over the

phone with much accuracy, other than some doc in Utah. [tongue firmly in

cheek.]

Now, keeping in mind that one cannot trust the mainstream print media or TV news

ever to get things right, it boggles the mind to see that somebody could

actually say for print that leg pain or abdominal pain are low-risk complaints.

We all know the fallacy of that. And trying to assess a patient's wound healing

over the phone is like trying to negotiate a mine field blindfolded. About the

first time somebody throws a PE or has a AAA rupture or dies of sepsis a day

after being denied ambulance transport, the fecal matter will interact with the

revolving rotors.

Yes, there is a problem with folks calling 911 for reasons that are not

emergencies, but you can't triage them over the phone. Tucson has a good

working program where those folks get an " Alpha truck " that has EMTs, and they

see the patient in person. I am not privy to the stats, but a good amount of

the time they end up calling for either BLS or ALS transport.

I can see the TV commercials now: " Have you or a loved one been denied

emergency care by a nurse on the telephone when you called 911? You may be

entitled to compensation and damages. If so, don't wait. There are time limits

on seeking compensation. Call the lawyers at Beatum, Cheatum, and Howe,

immediately. Se Habla Espanol. Operators are standing by. CALL NOW! "

It is also interesting that the National Academy of Emergency Dispatch is,

according to the print article, somehow involved in this. One wonders to what

extent. Further, citing what happens in Australia and the UK is not apropos,

since the legal systems there are far less open to medical claims than ours.

And if it costs $100,000 per city to set this up, who is setting it up and

getting the $100,000? Hmmmmmm?

Oh crap. There I go being negative again. But sometimes hard questions need to

be asked and answered. One wonders where the decisions to do this originated?

With the off-line medical director? With the EMS administrators? With the

Mayor and City Council or City Manager? Did the city attorney sign off on it,

and if so, what are his/her credentials in EMS? It would be nice to know how

the decision was made and what the EMS knowledge level of those deciding was.

To paraphrase Hegel, the only thing we have learned from history is that we do

not learn from history.

This will be something to watch closely. I certainly hope it works, but I'm

very afraid, and if these cities were my clients, I would tell them to be very

afraid and to set aside some reserves for lawsuits.

And for the many here who are interested in legal aspects, consider whether the

tort claims act in your state would protect a city from liability for this type

of claim.

Sorry to be " Negative Gene " but that's where I have to come down on this one.

I can't find a smiley face for this one.

Negative (Sometimes) Gene

Bujia EMS Education

Tucson

Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...>; wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

As both a RN and Paramedic I know Gene is very right. Even those nurses that

work for HMO’s in phone triage for the most part don’t stick with it very

long. Way too much liability to tell someone on the phone that they don’t need

medical treatment. Even if you refer them to a physician’s office, if they

don’t follow up and have a bad outcome it is going to fall back on the

provider that said they did not need the ambulance.

Rick

From: texasems-l [mailto:texasems-l ] On Behalf

Of wegandy@...

Sent: Friday, June 04, 2010 12:31 AM

To: texasems-l

Subject: Re: Two cities pilot efforts using EMS to curb ED visits

Here we go again. Doesn't anybody in either of these two cities ever read the

paper?

This has been tried before, and none of the programs has lasted that I know

about. If somebody here knows otherwise, please inform me. (I'm speaking of the

USA here).

Why do folks immediately jump to the conclusions that a nurse on the phone is

any better at triaging calls than an experienced paramedic? That's nonsense in

my mind, unless said nurse has extensive field EMS experience as well. And I

don't know any EMS nurse/paramedics who would take such a job, since every one

of them that I know would say this is a bad idea and they cherish their nursing

licenses. And who kids themselves that calls can be accurately triaged over the

phone with much accuracy, other than some doc in Utah. [tongue firmly in cheek.]

Now, keeping in mind that one cannot trust the mainstream print media or TV news

ever to get things right, it boggles the mind to see that somebody could

actually say for print that leg pain or abdominal pain are low-risk complaints.

We all know the fallacy of that. And trying to assess a patient's wound healing

over the phone is like trying to negotiate a mine field blindfolded. About the

first time somebody throws a PE or has a AAA rupture or dies of sepsis a day

after being denied ambulance transport, the fecal matter will interact with the

revolving rotors.

Yes, there is a problem with folks calling 911 for reasons that are not

emergencies, but you can't triage them over the phone. Tucson has a good working

program where those folks get an " Alpha truck " that has EMTs, and they see the

patient in person. I am not privy to the stats, but a good amount of the time

they end up calling for either BLS or ALS transport.

I can see the TV commercials now: " Have you or a loved one been denied emergency

care by a nurse on the telephone when you called 911? You may be entitled to

compensation and damages. If so, don't wait. There are time limits on seeking

compensation. Call the lawyers at Beatum, Cheatum, and Howe, immediately. Se

Habla Espanol. Operators are standing by. CALL NOW! "

It is also interesting that the National Academy of Emergency Dispatch is,

according to the print article, somehow involved in this. One wonders to what

extent. Further, citing what happens in Australia and the UK is not apropos,

since the legal systems there are far less open to medical claims than ours.

And if it costs $100,000 per city to set this up, who is setting it up and

getting the $100,000? Hmmmmmm?

Oh crap. There I go being negative again. But sometimes hard questions need to

be asked and answered. One wonders where the decisions to do this originated?

With the off-line medical director? With the EMS administrators? With the Mayor

and City Council or City Manager? Did the city attorney sign off on it, and if

so, what are his/her credentials in EMS? It would be nice to know how the

decision was made and what the EMS knowledge level of those deciding was.

To paraphrase Hegel, the only thing we have learned from history is that we do

not learn from history.

This will be something to watch closely. I certainly hope it works, but I'm very

afraid, and if these cities were my clients, I would tell them to be very afraid

and to set aside some reserves for lawsuits.

And for the many here who are interested in legal aspects, consider whether the

tort claims act in your state would protect a city from liability for this type

of claim.

Sorry to be " Negative Gene " but that's where I have to come down on this one. I

can't find a smiley face for this one.

Negative (Sometimes) Gene

Bujia EMS Education

Tucson

Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...

>; wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

As both a RN and Paramedic I know Gene is very right. Even those nurses that

work for HMO’s in phone triage for the most part don’t stick with it very

long. Way too much liability to tell someone on the phone that they don’t need

medical treatment. Even if you refer them to a physician’s office, if they

don’t follow up and have a bad outcome it is going to fall back on the

provider that said they did not need the ambulance.

Rick

From: texasems-l [mailto:texasems-l ] On Behalf

Of wegandy@...

Sent: Friday, June 04, 2010 12:31 AM

To: texasems-l

Subject: Re: Two cities pilot efforts using EMS to curb ED visits

Here we go again. Doesn't anybody in either of these two cities ever read the

paper?

This has been tried before, and none of the programs has lasted that I know

about. If somebody here knows otherwise, please inform me. (I'm speaking of the

USA here).

Why do folks immediately jump to the conclusions that a nurse on the phone is

any better at triaging calls than an experienced paramedic? That's nonsense in

my mind, unless said nurse has extensive field EMS experience as well. And I

don't know any EMS nurse/paramedics who would take such a job, since every one

of them that I know would say this is a bad idea and they cherish their nursing

licenses. And who kids themselves that calls can be accurately triaged over the

phone with much accuracy, other than some doc in Utah. [tongue firmly in cheek.]

Now, keeping in mind that one cannot trust the mainstream print media or TV news

ever to get things right, it boggles the mind to see that somebody could

actually say for print that leg pain or abdominal pain are low-risk complaints.

We all know the fallacy of that. And trying to assess a patient's wound healing

over the phone is like trying to negotiate a mine field blindfolded. About the

first time somebody throws a PE or has a AAA rupture or dies of sepsis a day

after being denied ambulance transport, the fecal matter will interact with the

revolving rotors.

Yes, there is a problem with folks calling 911 for reasons that are not

emergencies, but you can't triage them over the phone. Tucson has a good working

program where those folks get an " Alpha truck " that has EMTs, and they see the

patient in person. I am not privy to the stats, but a good amount of the time

they end up calling for either BLS or ALS transport.

I can see the TV commercials now: " Have you or a loved one been denied emergency

care by a nurse on the telephone when you called 911? You may be entitled to

compensation and damages. If so, don't wait. There are time limits on seeking

compensation. Call the lawyers at Beatum, Cheatum, and Howe, immediately. Se

Habla Espanol. Operators are standing by. CALL NOW! "

It is also interesting that the National Academy of Emergency Dispatch is,

according to the print article, somehow involved in this. One wonders to what

extent. Further, citing what happens in Australia and the UK is not apropos,

since the legal systems there are far less open to medical claims than ours.

And if it costs $100,000 per city to set this up, who is setting it up and

getting the $100,000? Hmmmmmm?

Oh crap. There I go being negative again. But sometimes hard questions need to

be asked and answered. One wonders where the decisions to do this originated?

With the off-line medical director? With the EMS administrators? With the Mayor

and City Council or City Manager? Did the city attorney sign off on it, and if

so, what are his/her credentials in EMS? It would be nice to know how the

decision was made and what the EMS knowledge level of those deciding was.

To paraphrase Hegel, the only thing we have learned from history is that we do

not learn from history.

This will be something to watch closely. I certainly hope it works, but I'm very

afraid, and if these cities were my clients, I would tell them to be very afraid

and to set aside some reserves for lawsuits.

And for the many here who are interested in legal aspects, consider whether the

tort claims act in your state would protect a city from liability for this type

of claim.

Sorry to be " Negative Gene " but that's where I have to come down on this one. I

can't find a smiley face for this one.

Negative (Sometimes) Gene

Bujia EMS Education

Tucson

Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...

>; wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

the medic gets one history, the triage nurse gets another, the resident

gets a third, and then the attending comes in who has been treating the

patient for years and points out the important things that the patient forgot

to

mention...

ck

In a message dated 6/5/2010 01:50:14 Central Daylight Time, wegandy@...

writes:

It's hard enough to get an adequate history from a patient you're face to

face with. I just can't see it happening over the phone.

[Guest guest]

the medic gets one history, the triage nurse gets another, the resident

gets a third, and then the attending comes in who has been treating the

patient for years and points out the important things that the patient forgot

to

mention...

ck

In a message dated 6/5/2010 01:50:14 Central Daylight Time, wegandy@...

writes:

It's hard enough to get an adequate history from a patient you're face to

face with. I just can't see it happening over the phone.

[Guest guest]

Houston has been doing it for over 2 years I believe...structured with very

rigorous protocols...and, although it has decreased some ambulance

responses...it has not been nearly as effective at preserving unit hours as

their public health/social services focused projects have been.

Still, in large urban environments, properly implemented, with history very well

understood...I believe it can be implemented effectively...but the real question

will be to see if it truly saves enough dollars to pay for the cost of properly

doing it.

Dudley

Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...>;; wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

Houston has been doing it for over 2 years I believe...structured with very

rigorous protocols...and, although it has decreased some ambulance

responses...it has not been nearly as effective at preserving unit hours as

their public health/social services focused projects have been.

Still, in large urban environments, properly implemented, with history very well

understood...I believe it can be implemented effectively...but the real question

will be to see if it truly saves enough dollars to pay for the cost of properly

doing it.

Dudley

Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...>;; wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

Yep, I heard about Houston. Haven't heard how it's working and whether there

have been any serious failures. From my lawyer's seat I still cringe when

somebody mentions phone triage. I just think it's a Deepwater Horizon waiting

to happen, no matter how rigidly one structures it. But I'm not the one who

will have to pay the damages.

Maybe it can work in the right place and with the right controls. I remain the

skeptic.

It's hard enough to get an adequate history from a patient you're face to face

with. I just can't see it happening over the phone.

GG

Re: Two cities pilot efforts using EMS to curb ED visits

Just a question -- abdominal pain is low risk?

Wes Ogilvie, MPA, JD, NREMT-P/Lic.P.

Austin, Texas

Sent from my iPad

On Jun 3, 2010, at 16:38, " Ron Haussecker "

haussecker87@...>;;; wrote:

>

>

> Two cities pilot efforts using EMS to curb ED visits

>

> 06/03/2010

>

>

> Two U.S. cities have implemented a new program intended to screen EMS calls to

identify non-emergency cases and direct them away from hospitals to more

appropriate health care providers, in an effort to alleviate non-urgent ED use,

USA Today reports.

>

> Advocates for the program-used in Louisville, Ky., and Richmond, Va.-tout its

potential to ease the burden on hospital EDs that face high patient demand and

to lower the number of non-emergency ambulance dispatches. Individuals calling

911 who are deemed at " lowest risk " are transferred to an RN or nurse

practitioner who assesses the severity of a patient's condition. Nurses also may

direct a patient to a proper source of care, such as a primary care physician

(PCP) or clinic, and help connect patients who do not have a PCP with clinics

that are accepting new patients.

>

> According to USA Today, 10 to 15 calls each day to ambulance dispatchers in

the Louisville area can be identified as low risk. These low-risk calls often

involved leg pain, abdominal pain and wound care. A Louisville EMS official said

that saving a trip to the ED may result in better follow-up care and,

ultimately, a better prognosis for patients, adding that the program will expand

to offer " intensive follow-up " to ensure no patient " falls through the cracks, "

USA Today reports.

>

> The program costs about $100,000 to set up per city. An official from the

National Academies of Emergency Dispatch said that such programs are widely used

in Australia and the United Kingdom but that the programs in Louisville and

Richmond are the only ones in the U.S. (Halladay, USA Today, 6/1).

>

>

> Ron

>

> P Please consider the environment before printing this e-mail.

>

> All e-mails or files transmitted are considered confidential and intended

solely for the use of the individual to whom they are addressed. Any

unauthorized dissemination, review, distribution, or copying of these

communications is strictly prohibited. If you received an e-mail in error,

please contract the sender and delete/destroy the message.

>

>

[Guest guest]

Yep. It's a cardinal rule of medicine: history never repeats itself.

And if history NEVER changes, then it's probably rehearsed, and fake anyway.

Re: Two cities pilot efforts using EMS to curb ED visits

the medic gets one history, the triage nurse gets another, the resident

gets a third, and then the attending comes in who has been treating the

patient for years and points out the important things that the patient forgot

to

mention...

ck

In a message dated 6/5/2010 01:50:14 Central Daylight Time, wegandy@...

writes:

It's hard enough to get an adequate history from a patient you're face to

face with. I just can't see it happening over the phone.

[Guest guest]

Yep. It's a cardinal rule of medicine: history never repeats itself.

And if history NEVER changes, then it's probably rehearsed, and fake anyway.

Re: Two cities pilot efforts using EMS to curb ED visits

the medic gets one history, the triage nurse gets another, the resident

gets a third, and then the attending comes in who has been treating the

patient for years and points out the important things that the patient forgot

to

mention...

ck

In a message dated 6/5/2010 01:50:14 Central Daylight Time, wegandy@...

writes:

It's hard enough to get an adequate history from a patient you're face to

face with. I just can't see it happening over the phone.

[Guest guest]

How true Chuck and .

If it's perfectly recited, suspect Munchausen's.

GG

Re: Two cities pilot efforts using EMS to curb ED visits

the medic gets one history, the triage nurse gets another, the resident

gets a third, and then the attending comes in who has been treating the

patient for years and points out the important things that the patient forgot

to

mention...

ck

In a message dated 6/5/2010 01:50:14 Central Daylight Time, wegandy@...

writes:

It's hard enough to get an adequate history from a patient you're face to

face with. I just can't see it happening over the phone.

[Guest guest]

How true Chuck and .

If it's perfectly recited, suspect Munchausen's.

GG

Re: Two cities pilot efforts using EMS to curb ED visits

the medic gets one history, the triage nurse gets another, the resident

gets a third, and then the attending comes in who has been treating the

patient for years and points out the important things that the patient forgot

to

mention...

ck

In a message dated 6/5/2010 01:50:14 Central Daylight Time, wegandy@...

writes:

It's hard enough to get an adequate history from a patient you're face to

face with. I just can't see it happening over the phone.