Your Views on Non-Emergency/Self-Inflicted Calls

[chem1cal]

I am not sure whether it's a state or county law, but according to some members in my department it is branded illegal for a volunteer fire department to charge for calls, or stand-bys.

Now, we get a pretty decent amount of calls a year (generally 2,500-3000+), and are an EMS/Fire combination department. Everyone, aside from our first responders, are volunteer.

My question: What's your view on non-emergency and/OR self-inflicted calls?

I am talking about calls such as intox calls. We get tons of these calls, however I don't personally deem them an emergency unless that person is showing signs of alcohol poisoning. A police officer should cuff them and take them to the hospital, but an ambulance shouldn't be wasted unless it's deemed necessary. If anything, only the first responder(s) should show up to make a call as to whether medical transport is essentially needed.

What bothers me the most about these calls is that is wastes volunteers time, as well as the taxpayers money on a self-inflicted, non-emergency call.

Intox calls aren't the only ones. One night we were toned out for a woman who hadn't had any bowel movements. Upon arrival we foudn the woman fine, and her daughter standing there waiting with her. The hospital is down the road, and this clearly wasn't an emergency.

Another time during the day we were toned out for a guy whose electric wheelchair's battery was dying.

Where do we draw the line? And what do you believe we should do?
It's all semantics.

[dmleblanc]

Like so many other things that are wrong with this country, blame the lawyers. No municipality is going to open itself to the liability of not sending a response when someone calls for help, however stupid or unnecessary the call may be. We've been successful in educating the public that if you call 911, someone will show up (quickly) to address your problem. Anytime you put that kind of no-questions-asked service on the table, someone will take advantage of it.

[tree68]

That's one reason many of the fire department based ambulances in our area are getting out of the business. An independent, not-for-profit squad can bill, and that's the direction we're going in right now. At some point we'll probably go all commercial, but who knows when that will be? Being rural, the call volume isn't there to make it even borderline profitable.

A lot of people view the ambulance as both a method of transportation (like a taxicab) and, more importantly, a direct conduit into the ER. Your case with the BM was probably exactly that. They undoubtedly figured that if they were a "walk-in" they'd have a several hour wait, but if they went by ambulance, they'd get right in. Our ER often queries the transport crew as to whether a patient is suitable for triage, especially if they are very busy. If the crew agrees, said patient goes into the waiting room right along with all the other walk-ins. And they've still got a bill for the transport many times higher than the cost of a taxi...

An education/public information campaign may help you somewhat. You may need to instruct your constituents what constitutes an emergency, and when they really should call for an ambulance (and by implication or statement, when they shouldn't). Tied together into a regional media campaign, you might save yourselves and everyone around you some future headaches.

Our dispatch now sends law enforcement on potentially dangerous (to the EMS crews) calls, with instructions for the responding crews to stage in the area. This includes suicidal persons, injuries from domestic incidents, and the like. Since most of our law enforcement folks have some EMS training, they can do a quick assessment. Sometimes we roll into the scene on their request, sometimes we go home without ever seeing a patient.

[Eng34FF]

We have our share of those and just consider it part of doing business. We don't bill, so we don't have that option. When we get one of those patients, we transport them non-emergency and sometimes drop them off in the waiting room if we can't get a refusal. Unfortunatly because a few of these calls may turn out to be a true emergency, we have to respond, and once there we end of transporting.

The real shame is that most of these calls come from nursing home or assisted living centers that should know better. It's just easier sometimes to call us instead of waiting for the private ambulance.

Most of the people who call from home really believe that it is an emergency, and it is to them.

We run about 2000 calls a year combined fire, rescue and EMS. We are a 100% volunteer department, so really not that different from the OP.

[BoxAlarm187]

Non-emergency calls have been, are, and will continue to be a burden on EMS. This is a fact, no matter if the agency responding is fire-based, EMS-only, career, volunteer, for-profit, or not-for-profit.

Once you accept that the fire/EMS department is expected the public to be the people that "fix everything," including their seemingly minor medical emergencies, this might be easier for you to deal with. The minor EMS calls aren't going away, in fact, they're probably going to increase.

Many times, responders will view billing as a way to deter non-emergency responses. It doesn't work. The calls will continue to come in, the bills will be sent to the patients, which some of them will choose to pay and others won't. Typically, the bills are paid by the patients with insurance, and the bills aren't paid by those who don't.

Tree68's volunteer response sounds much like what we do at work and the volunteer station. If the patient doesn't need to go straight into the ER, we'll take them to the waiting room. And we'll tactfully tell them this prior to leaving the scene. Furthermore, we can also tactfully tell the constipated patient (and her daughter) that we, as EMS providers, can't do anything in the ambulance to fix the problem, the patient will likely go to the waiting room anyway, and that we'd be delighted to assist them to their car if that would be beneficial.

Based on your thread here, and some of your other earlier postings, I have the distinct feeling you're more concerned with your time being "wasted" as a volunteer. You know, all of us that volunteer would like to only catch the good calls and not have our time wasted on nuisance calls, routine EMS transports, and the like. However, it just isn't going to happen. There are going to be far more routine calls than exciting calls, no matter if the responders are career or volunteer based.

[Blulakr]

In our case, we rely on dispatch to weed out some of the non-emergency calls. They should be asking questions when on the phone with the R.P. about the true nature of the emergency.

We don't transport so that's not an issue.

We often respond to 'lift assist' or 'public assist' calls. Again, we rely on the dispatch to determine the level of emergency.

Isn't that one of the main reasons why we volly?? To assist and to serve our community regardless of the need??

We recently had an older couple where the husband became ill but not life threatening. The wife was unable to get him to\from the car to the house without help. This went on for a few days with him making frequent doctor visits until they set up in-home health care. The first two times they called 911 and we responded. Our chief then gave him his home phone # and he would send out a page for a lift assist himself if needed.

I guess when you're in a small town and know many of the folks you are helping it's less of a burden.

If any laws or codes are broken resulting in a response then we bill for that. DUI MVA's even if the pt refuses treatment, fires of any type\size where there are code violations, assaults etc all get billed.

Now what frosts my hide is when we respond to a residense for a public assist call then a few weeks later we go there for our yearly raffle ticket fundraiser and they won't buy one stinkin' $1 ticket!!

[chem1cal]

We have our share of those and just consider it part of doing business. We don't bill, so we don't have that option. When we get one of those patients, we transport them non-emergency and sometimes drop them off in the waiting room if we can't get a refusal. Unfortunatly because a few of these calls may turn out to be a true emergency, we have to respond, and once there we end of transporting.

The real shame is that most of these calls come from nursing home or assisted living centers that should know better. It's just easier sometimes to call us instead of waiting for the private ambulance.

Most of the people who call from home really believe that it is an emergency, and it is to them.

We run about 2000 calls a year combined fire, rescue and EMS. We are a 100% volunteer department, so really not that different from the OP.

Our situations seem identical.

I understand that it is a liability issue due to the fact that it may evolve into a true emergency, but a lot of these assisted living homes should really know better. The worst part is that when we go to these homes (we have 3 in our district) that the staff generally is NO help whatsoever. They don't assist in lifts, hardly ever have paperwork ready, and just don't seem to care (I didn't say they ALL didn't care, just a large majority).

People need to know that calling 911 is for emergency situations only. But since this policy isn't enforced we're essentially hired as a flashy taxi. We used to have this one guy call in AT LEAST 4-5+ times a week. Every single time it was one of about three reasons, but we had to go. It got so bad that he knew almost all of our names, the first responders knew his medical and personal information by heart, and my old EMS captain tried to even deter it by scolding him... It persisted anyway.

As someone said before about police assistance - we have that as well. Generally, though, we tend to respond anyway. If it's an MVA and it's not bad, the police will dismiss it (as long as the involved parties RMA).

It's sad that taxpayers wonder where their money is going. Yes, a lot of it is being drained into law enforcement and other areas, but at least that's going for something. These instances are such a waste that it sickens me.

Like dmleblanc said before, an education meeting for the public may work well, but I HIGHLY doubt anyone, especially the people I am referring to, would show up.

[dmleblanc]

An education/public information campaign may help you somewhat. You may need to instruct your constituents what constitutes an emergency, and when they really should call for an ambulance (and by implication or statement, when they shouldn't). Tied together into a regional media campaign, you might save yourselves and everyone around you some future headaches.

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That'll never work in our area. Our "constituents", as you generously refer to them, know how to work the system. It's not a case of not knowing what does or does not constitute an emergency. They know EXACTLY what symptoms to give the dispatcher to get a full response (make sure you tell the dispatcher "chest pains" or "difficulty breathing" when you call...you can tell the ambulance crew you're really just constipated and need a ride to the E/R when they get here...)

As a matter of fact, for the ones who aren't that bright, I'd rather not give them hints as to what kind of emergency they should call in to get quick service.....

[lexfd5]

So you only want to go on the cool stuff and none of the stuff you think is not important...

Get out now.

I've done all of the stuff you have listed ten times over as a volly and career. I am in this to help people not get a wacker high from turning on my little blue woo woo light.

One of the best runs I ever made was to help a guy who's electric chair was broken. Most of the time people do not thank us. That guy appreciated us so much I still remember the run five years later.

The idea you have to get through you head is that it is not your definition of an emergency that matters. It's the person who dialed 911. To them they have no where else to turn (true some abuse the system, but they are few.) You don't know their situation. Who gave you the right to judge them and their decision to dial 911?

I bet you are one that does the volunteer pager roll over on private/automatic alarms at 3am.

As for the runs to the assisted living facilities get a job in one before you spout off. Are you going to treat the patient poorly because of the staff? The poor patient has nothing to do with the staff. Nine times out of ten they contacted the on-call doctor who said send them out.

We have our regulars here also. Used to get one every morning at 7:30 same place. When he finally passed away, guess what we missed him. Same with most of our regulars. As opposed to scolding them why not find a way to help them? Point them towards the homeless shelter, church organization, etc... Some even have ways to pick them up and take them to the shelter.

Sorry for the rant but this new attitude is **** poor for the fire service. If you can't handle the little runs get out of the profession, career or volunteer. Your tenure with either will be miserable, because your "Non-emergency/Self-Inflicted Calls" far outnumber the true emergency calls.

BTW dmleblanc: There are on-line forums for the homeless. You ask how...

Public Libraries.

They tell you how to get to where you want to live. Like how so many homeless have made it to Hawaii (NY program that would send the homeless back "home" as long as they had a relative where they were going.)

It even tells them how to get to where they need to go and what key words to use for 911 service.

[Blulakr]

Sorry for the rant but this new attitude is **** poor for the fire service.
.

You have nothing to apologize for. You are right. Those whom you've offended need to re-evaluate why they joined.

I would much rather help on elderly person up off the bathroom floor than perform CPR on an unresponsive child.

[Blulakr]

One of the best runs I ever made was to help a guy who's electric chair was broken. Most of the time people do not thank us. That guy appreciated us so much I still remember the run five years later.

I bet the guy sitting in the electric chair wasn't so appreciative.

[XRaysJL]

Real responders

I agree with those that say, "It's the minor calls that you can tell who's really doing this because they genuinely care.".

[FIRE117]

Fees for Service

Even though we do not want to charge a fee for providing service, there must be a means to fund the service. Fire/EMS vehicles, equipment and training must be funded to provide the service.

Traditionally, fire protection is provided by taxing property. In most states, a mill levy, etc. (subject to statute(s)) can be used to provide that funding. Some entities are unable to obtain all their funding this way, so they must obtain additional funding from other sources.

Since there are 50 different states with probably 50 different statutes that pertain to taxation, fire protection, etc. and other laws, you will need to consult your attorney for legal advice on whether your entity can or cannot bill for service.

To determine if your FD/EMS agency can bill a fee for service, have your jurisdiction attorney research the statute(s) to determine if you are allowed to do this. Have this attorney write an attorney's opinion stating whether or not your FD/EMS agency can or cannot bill a fee for service. (Do not forget to research any applicable Medicare laws, as they do pertain to EMS billing.)

After you obtain that attorney opinion, then you will know what your FD/EMS entity can or cannot do for billing a fee for service.

[chem1cal]

You have nothing to apologize for. You are right. Those whom you've offended need to re-evaluate why they joined.

I would much rather help on elderly person up off the bathroom floor than perform CPR on an unresponsive child.

You guys are COMPLETELY off course. Read carefully, please.

Don't worry... I'll wait.

Now that you've allowed all of this information to compute inside your brains, we were talking about calls such as intoxs and people whom abuse the system. I am talking about getting a call at 3AM for some constipated lady whos daughter whom was fully capable of driving down the road (literally, the hospital was around the corner) was standing right there. I am talking about a guy who called us 4 or 5+ times a week saying he was having seizures just for a ride to the hospital.

Learn to read and COMPREHEND things before you jump into such a thread.

AKA - Size-up. You seasoned members should know what that means.

[lexfd5]

You guys are COMPLETELY off course. Read carefully, please.

Don't worry... I'll wait.

Now that you've allowed all of this information to compute inside your brains, we were talking about calls such as intoxs and people whom abuse the system. I am talking about getting a call at 3AM for some constipated lady whos daughter whom was fully capable of driving down the road (literally, the hospital was around the corner) was standing right there. I am talking about a guy who called us 4 or 5+ times a week saying he was having seizures just for a ride to the hospital.

Learn to read and COMPREHEND things before you jump into such a thread.

AKA - Size-up. You seasoned members should know what that means.

Been there and done both of those. Get over yourself junior its the system and many of us with much more time on the job have gone through the same thought process you have.

Yes they are BS, do your job, be professional and get over it,.

Your life and career will be so much better when you learn to stop sweating the little junk.

If you come up with a way to stop people from abusing the system let those of us with 20+ in the business know.

There is no fix to your issue on the BS runs. The problem is in you and letting these BS runs get to you. Think of the positives, you transport seizure dude to the hospital now you get to flirt with the nurses (as long as its not my wife .)

What I am trying to tell you is just do your job and don't let the BS runs get in your head. If you do you'll be miserable. Just like you are getting upset at replies on an internet message board. Learn to live with the BS before you get burned out.