Senior Essay: The cost of 911 abuse.

[Skeeter Cruz]

I'll preface this by saying I'm not a firefighter. I'm getting there, but where I'm at right now is that I just finished an internship at a CA fire department and am about to graduate with my BA. If I shouldn't be posting on this forum I'll delete this, but I know there is a wealth of experience and knowledge on this site that I am hoping to be able to humbly draw from.

I'm in the process of writing my senior essay right now. It is focusing on the issue of non-emergency 911 calls that some consider abuse of the 911 system: the calls that might make you wonder why they were ever placed. While I was an intern I remember reading a story about two children who were killed in a fire because the nearest engine was on a call for a lift assist at a nursing home they go to at least every day. This is the kind of incident and tragic cost I'm talking about. Also in this category is all the people who use the fire department as their personal "free taxi service" or attempt to get to the front of the ER line by calling 911.

I think many of you know what I'm talking about and have found yourselves frustrated by the same thing. Right now I'm compiling data, stories, and laws (see: Oregon's new Senate Bill 213 and Lakewood FD's use of taxis) for this paper. I am hoping that people here will be willing to share perspective, experience, and/or advice on how I should be looking at this.

Thanks everyone, stay safe.

[RFDACM02]

I hope someone can figure it out and fix it, as as both a taxpayer and a Fire/EMS Department officer the overuse and abuse is truly harming those in real need.

A few things I'd consider:

One of the biggest obstacles in taxi voucher systems or other "right to refuse" systems is the liability. Many service chiefs and city attorney's are very concerned with the legal liability if we fail to take someone who really needed EMS or if they allege they did. Remember that only our side is sworn to tell the truth and allegations alone can be damning of a city department, especially when times are tough. And in all honesty, some providers are more likely to use vouchers when their tired, hungry, ready to go off shift, etc. Is this common? Likely not, but it happens and making it easier will certainly increase the frequency. If we hadn't become so "sue happy" in this country or we had adequate civil litigation reform, we might not have nearly the healthcare insurance and liability issues. A proactive EMS system administration with a decent medical control person should be able to overcome this to a significant degree, but too often nobody wants to take on that much work. Of course the easy road is rarely the right one.

How do the vouchers work? Do both EMS and the patient need to agree? Can unused vouchers be used to get to the liquor store? Will this flood ER's with more needless patients? Do the people get the vouchers up front through the Medicaid system or does EMS hand them out?

Good luck, this is an issue that needs to be addressed soon. Given shrinking budgets and increasing EMS calls, we need to only be seeing true emergencies.

[DeputyChiefGonzo]

Lift assists at nursing homes... most nursing home facilities are for profit. They call 911 because they have a minimum amount of employees on the floor. They use the FD as labor. While there can be extenuating circumstances, such as an extremely obese patient, most should be handled by staff.

It isn't only nursing homes.. there are those in our elderly population who refuse assistance from edler services and other social agencies for fear of losing their independence. When they have an issue, they call 911. .. for things like helping them look for their remote control for the TV or they are out of vodka ( yes, I have actually responded to a call for vodka as the "emergency"...)

Another abuse is those who live in homes that have basement flooding problems. Instead of buying their own sump pump, they call the FD because" that what they pay taxes for"...

[Bones42]

...While I was an intern I remember reading a story about two children who were killed in a fire because the nearest engine was on a call for a lift assist at a nursing home they go to at least every day...

That is not 911 abuse. That is resource usage abuse. And unfortunately, that happens way too often.

[DennisTheMenace]

When we go on these calls we are still available, an emergency call trumps a public service call and we will leave them if need be. Since we are in our first due for these things I can't see such calls being delayed by any more than 90 seconds over being in quarters and we will have the same responce time as if we were at the store or doing a public education trip at the elementary school.

Do some people abuse 911? Sure they do, but I would still rather have people call when they don't really need us than wait too long to call when they do need us.

[Skeeter Cruz]

Thanks for the info and clarifications. Does anybody else's departments have different ways of dealing with this problem? (Vouchers, etc...)

A mentor of mine told me that when people call 911 it's usually because something going on in their life feels like a real emergency - regardless of whether it seems like an emergency to you. Do you find this to be true? I'm trying to write the paper respectfully of patients, especially considering some of them don't have much else.

Thanks.

[CKirk922]

Just a thought, but we cannot sit idle at the station waiting for the big one while ten or twenty small ones pass us by.

One of my first lift assists was an obese gal two houses down from the station. She fell getting off the toilet. We get there at 11:00 pm and her 97 lb husband was under her. His hip was broken and he didn't even realize it until we got ready to move her.

(As a side note, he never made it out of the hospital because he was pretty well down from taking chemotherapy and this trauma pushed him over the edge.)

I've done more band-aid and frequent flier runs than I care to count, but for every crack pot run, there always seems to be another similar call that turns into the biggie.

I have closed that ambulance door for the last time on many people I grew up around. You never know when you may be loading this person for the last time. Treat the job with respect, grin and bear it, and move on.

As conflicted and angry as I get about band-aid runs, I always think back to what would have happened if I did not respond to the granny off the toilet run and instead waited for the big fire that never happened that night....

[tree68]

As I recall, the Brits have taken this issue on head on. They put doctors on the street, and, IIRC, some of their paramedics are advanced practice and may even be able to issue scrips.

The end result is an old fashioned "house call" and no trip to the ED.

[GTRider245]

As I recall, the Brits have taken this issue on head on. They put doctors on the street, and, IIRC, some of their paramedics are advanced practice and may even be able to issue scrips.

The end result is an old fashioned "house call" and no trip to the ED.

France does the same thing.

[The nots so new FNG]

I see this as three catagories - the first is the true waste. An example would be the person who called 911 for vodka. We would hope most of these would be filtered by dispatch and send a PD unit rather than an ALS/FD unit.

The second case is equally annoying if not more so - the 'free labor' idea. This usually comes as lifting assistance or something similar because the for profit entity did not commit the resources required. A good solution to this would be for billing the for profit entity labor time and resources used for tasks they should be able to do in house. An example is for the FD to come to the aid of a private ambulance transport comany to help carry an obese patient back upstairs in thier house. (clearly within what the patient is paying the ambulance company to do).

The last case is the ones you'll never get rid of. These are the people who truly believe that they have an emergency and call for help. It could be a stubbed toe or what not. 99.9% pecent of the time - its probably nothing. Its that 0.1% of the time that makes us keep coming back. Some of this is abuse - some of it is lay people who simply get scared and overreact.

[flfirebuff86]

In my zone. And let me clarify that this is a small zone about 5000 full time residence that swells to 10000 for the cooler months of the year, small seaside urban area run about 1200 fire/ems calls a year.

We had a few "urban outdoors man" the political correct term. that would frequently be called on for various things such as "man down" or "Person passed out" that turned out they were just sleeping or intoxicated.

Our local cops took it upon themselves that instead of just dumping them on the med unit crews to actually go out and get these people some help, getting them set up in local shelters and programs to get them off the streets. Arrested the habitual offenders and just overall cleaned up the area. This overall impacted our responses in a positive way as we don't run nearly the amount of calls we use to on the same group that would often call just to go to the er to get some chow.

On the other hand we have run on the water main leak that turns out to be a leaky sprinkler pipe. (a little over reaction from a concerned neighbor) your never gonna stop those calls.

And a call to give another example, an elderly female living by herself called one very early morning because her microwave wouldn't stop running. She felt that it could of turned into something "nuclear". long story short we unplugged the microwave gave her a phone number for a repair man from the yellow pages.

[tree68]

Another abuse issue from the past comes to mind.

We were called several times to the same address, for the same patient. Different complaint each time.

Once in the ambulance, the patient would complain about how their family members didn't care about them and such.

After about the third such call, we requested law enforcement respond with is.

By the fifth call, the patient had been warned, and that was the last one. I don't even recall if we transported that time. I'm presuming the patient got some help.

Had another couple where the wife would call 9-1-1 because the husband was experiencing some discomfort. They were usually dispatched as cardiac. Most times he'd belch after we got there an feel just fine, followed by a sign-off. And sometimes, before we left, we'd have to listen to some fiddle (he was part of an old-time fiddlers group). On the other hand, there were a couple of times when he really did need care, including one where he actually coded. I missed that call.