New FDNY EMS transport policy

[Capttomo]

Nice to see a Commish listening to the members in the field and working with the EMS union to help reduce the abuse of the 911 EMS system.

Exclusive | New FDNY order sending patients to closest hospital provokes backlash: ‘Stupid — in a word’

The new policy is too rigid and undermines patient safety and care, said Dr. Bret Rudy, executive vice president and chief of hospital operation at NYU Langone Hospital-Brooklyn.

nypost.com

 

[DaveReinstein]

Nice to see a Commish listening to the members in the field and working with the EMS union to help reduce the abuse of the 911 EMS system.

Exclusive | New FDNY order sending patients to closest hospital provokes backlash: ‘Stupid — in a word’

The new policy is too rigid and undermines patient safety and care, said Dr. Bret Rudy, executive vice president and chief of hospital operation at NYU Langone Hospital-Brooklyn.

nypost.com

The Ambulance isn’t Uber. Still cannot believe people don’t know this

 

[Elmerj]

I agree that the system is absolutely abused. It is obvious the new policy is aimed at increasing ambulance availability and reducing response time. I also think policies that take discretion away from ambulance crews and field supervision are not always the best.

There are patients who are not critical or unstable that are debilitated secondary to their medical condition and do not require transportation to the closest facility but do require transportation to a specific / desired facility.

While there is a work around via Medical Control those physicians and the members who staff the operational positions are already working hard to manage the existing work load. Additional responsibilities without staffing or resources will not accomplish the desired result.

A middle ground is likely the better approach. Ambulance crews and field supervision should get additional training on making system appropriate/ compassionate / best interests of the patient transport decisions with comprehensive non disciplinary educational follow up for situations that are exceptions to the policy.

All policy decisions should be reviewed after implementation and adjustments made as appropriate. I think we will be seeing exactly that and adjustments will be made that produce the system benefit / desired result or something close without significantly impacting the members or the patients.

 

[Darrell]

I'm going to assume if the nearest hospital is over capacity, EMS will transport to the next nearest hospital?

 

[Elmerj]

I'm going to assume if the nearest hospital is over capacity, EMS will transport to the next nearest hospital?

One would assume so. The redirection policy if it’s still in effect would automatically preclude additional transports to the busy place and direct units to a less busy place albeit further away.

Now the diversion policy is a whole other discussion.

 

[entropychaser]

When you charge for transportation, you are Uber.

However well intentioned, the Fire Commissioner has made at least two missteps.

1) Never poke a skunk

2) Don't step in it.

I would observe that the final say on this subject will be made well above the Commissioner's pay grade. Also, nobody who wants to become Mayor will endorse this.

 

[Elmerj]

Ahh yes, but we are highly trained and specialized transportation.

I think you might just be right about the above someone’s pay grade part.

 

[FDNY Response Videos]

There are patients who are not critical or unstable that are debilitated secondary to their medical condition and do not require transportation to the closest facility but do require transportation to a specific / desired facility.

That’s where private companies like seniorcare, midwood, assist, etc. come in. Their business and primary purpose is transporting patients in these exact circumstances to and from home, nursing home, etc.

The whole point of this policy is that a 911 ambulance should not be used for a non-emergent, non-critical, routine doctor’s appointment.

Much more to be said about the Post article including the nice quote about how we need to transport the patient to a hospital with “orthopedic surgeon to perform surgery.” Don’t remember that fact being available in the CAD? The CAD will still send us to hospitals that are not the closest of the injury type demands it (trauma, burn, peds, etc.)

TLDR: Policy may rub some the wrong way, but it brings 911 EMS back to what it’s supposed to be for: Emergencies.

 

[Elmerj]

That’s where private companies like seniorcare, midwood, assist, etc. come in. Their business and primary purpose is transporting patients in these exact circumstances to and from home, nursing home, etc.

The whole point of this policy is that a 911 ambulance should not be used for a non-emergent, non-critical, routine doctor’s appointment.

Much more to be said about the Post article including the nice quote about how we need to transport the patient to a hospital with “orthopedic surgeon to perform surgery.” Don’t remember that fact being available in the CAD? The CAD will still send us to hospitals that are not the closest of the injury type demands it (trauma, burn, peds, etc.)

TLDR: Policy may rub some the wrong way, but it brings 911 EMS back to what it’s supposed to be for: Emergencies.

If I may ask, have you never accommodated a patients request for transportation to a hospital of their choice? Within reason of course, or have you always taken patients regardless of their request to the nearest and how is that best for your patient.

I acknowledge and agree that other avenues exist for transportation of non acute patients but that takes a little planning and sometimes financial resources that might be out of reach if you are not on some type of government assistance.

An individuals definition of and emergency is very likely going to be different than yours as a professional in the field of EMS.

But also remember they called 911 for assistance and that assistance is you ! Now you arrive and make an assessment that results in a determination that it’s either the closest or nothing. Now you get into a back and forth with the patient and or their family while you wait on the supervisor or on hold for medical control to get to you. Time being spent on policy and procedure when you could have just transported to the requested hospital ( within reason ) and in short order most likely been 81 with a happy and appreciative patient and family.

In addition you best be doing an “Academy like” patient assessment and physical exam to support your hopefully well documented non transport decision.

I’m sure it’s frustrating and it feels like you are being abused with non life threatening assignments but sometimes that’s the way the day goes.

Like I said previously, some middle ground regarding transportation decisions will likely be best for everyone involved.

Actually here’s a good way to help avoid increasing response time and ambulance unavailability:

Do ones best to get out of the ER in a timely fashion. Give signal’s as appropriate and stop refusing assignments.

 

[FDNY Response Videos]

If I may ask, have you never accommodated a patients request for transportation to a hospital of their choice? Within reason of course, or have you always taken patients regardless of their request to the nearest and how is that best for your patient.

I acknowledge and agree that other avenues exist for transportation of non acute patients but that takes a little planning and sometimes financial resources that might be out of reach if you are not on some type of government assistance.

An individuals definition of and emergency is very likely going to be different than yours as a professional in the field of EMS.

But also remember they called 911 for assistance and that assistance is you ! Now you arrive and make an assessment that results in a determination that it’s either the closest or nothing. Now you get into a back and forth with the patient and or their family while you wait on the supervisor or on hold for medical control to get to you. Time being spent on policy and procedure when you could have just transported to the requested hospital ( within reason ) and in short order most likely been 81 with a happy and appreciative patient and family.

In addition you best be doing an “Academy like” patient assessment and physical exam to support your hopefully well documented non transport decision.

I’m sure it’s frustrating and it feels like you are being abused with non life threatening assignments but sometimes that’s the way the day goes.

Like I said previously, some middle ground regarding transportation decisions will likely be best for everyone involved.

Actually here’s a good way to help avoid increasing response time and ambulance unavailability:

Do ones best to get out of the ER in a timely fashion. Give signal’s as appropriate and stop refusing assignments.

I don't disagree with many of your points - in fact, that is why I only quoted a small portion of what you said.

I absolutely have accommodated a patient's reasonable request for a different hospital. Also yes, perception of what an "emergency" actually is varies from person to person and we respond regardless.

A simple fix to much of this would be to offer 2 choices of facility - this removes the issue of "no choice" and would have the same results in transport time as having 1.

Yes the new policy is imperfect and could use some improvement - but it is a step in the right direction in my humble opinion.

 

[Elmerj]

I don't disagree with many of your points - in fact, that is why I only quoted a small portion of what you said.

I absolutely have accommodated a patient's reasonable request for a different hospital. Also yes, perception of what an "emergency" actually is varies from person to person and we respond regardless.

A simple fix to much of this would be to offer 2 choices of facility - this removes the issue of "no choice" and would have the same results in transport time as having 1.

Yes the new policy is imperfect and could use some improvement - but it is a step in the right direction in my humble opinion.

You see that’s what’s called middle ground ! I like it.