View Full Version : Advice/opinions needed: was this EMS abuse?


GuitarGirlRN
07-06-2007, 01:33 PM
Hi all! Sorry for a long post.

A difficult situation came up last night at work and I'm looking for advice and opinions.

A very elderly man (upper 90s) was sent in by his PMD for evaluation after an episode of A-fib with RVR. When he got to us, he was hemodynamically stable, A&Ox3, ambulatory, and in no distress, but there was no doubt that he would be admitted to telemetry for further monitoring. He was brought in by two people who turned out to be a neighbor and a co-worker (yes, this man still worked as a consultant!).

The two were anxiously awaiting news about the patient's condition, and I heard them discussing "feeding R and getting her settled for the night." I thought they were talking about a pet, but when I asked it turned out that R was the patient's even more elderly and demented wife. It seems that she can be left alone for a few hours, but that the patient was her only caretaker, and they had no family to call or help out. I expressed my concern that she not be left alone all night long, due to the fact that she could be confused and try to leave the apartment, or fall and hurt herself, etc etc. I told them they needed to bring her in for a social admit (we do this often in this situation, the couple can often stay in the same room) and that social work would come by in the AM to figure something out so that the wife would be taken care of. They agreed, and left to go take care of the wife.

About an hour later, I got a call from the man's co-worker, who was very upset. They had called 911 and the EMS responders (or one of them) was irate and cursing and telling the friends that they didn't have to transport the wife, this was NOT an emergency, that if they did, they would take her to another hospital and not to the one her husband was in. I got on the phone with him and asked him if he was refusing to transport the patient. He yelled at me and told me I was "in trouble" for telling these people to call EMS (which I had not), that he was calling his supervisor AND my supervisor, and apparently everyone else he could think of. I said fine, gave him the names and pager numbers of everyone I could think of who was above me in the hospital totem pole, and told the EMS person and the co-worker to call me back if EMS was refusing to transport.

About a half-hour later, EMS brought in the wife. She was alert and calm, but frail, could not walk well without assistance (they were WALKING her in, not even a wheelchair--I guess trying to prove a point, but come on!), and a little confused. In the meantime, I had told our night nurse manager the situation, and she had notified one of our attendings who also is the head of our hospital EMS program. I took the wife to be triaged, and our attending took the EMS guys aside and had a word or two with them. I then got an apology from the man who had yelled at me on the phone, and all was well. (There was also a very sweet reunion moment with the elderly couple that brought tears to everyone's eyes--no kidding.)

Long story. My question is, was this abuse of the EMS system? Is this in the same category as the woman who calls 911 at 3 am to be brought in for a pregnancy test? Admittedly, I should have thought to tell the co-worker and neighbor maybe to take a car service, or arrange for a private ambulance, but it was midnight, and these people were already going above and beyond the call of duty, and frankly, I just didn't think of it. I was more worried about the wife and what would happen to her if she were left alone.

Ugh, what a mess. Any opinions would be welcome!

geenaRN
07-06-2007, 03:43 PM
This might be a dumb question, but why couldn't the neighbor/coworker have brought them in themselves? Why the private car or EMS?

GuitarGirlRN
07-08-2007, 12:33 AM
This might be a dumb question, but why couldn't the neighbor/coworker have brought them in themselves? Why the private car or EMS?


The couple lived in a different part of the city from the hospital, and neither the coworker or the neighbor had cars. The wife didn't walk well.

geenaRN
07-08-2007, 12:37 AM
Never having worked in an ER, I don't know what the answer to your question is. It being midnight, I don't know how many other options you would have had... I would think not many.

However, I did want to say that I personally don't think that this situation is anywhere near the person calling 911 at 3am for a pregnancy test. :) I'm not sure it was appropriate (I'm really not - have no idea) but I certainly would not call it an abuse of the system.

I think it's great that they were able to be reunited.

KimRN
07-13-2007, 08:38 AM
I don't think it was an abuse of the EMS system and here is why. The two people who went home to take care of the wife probably thought that the right thing to do was call an ambulance.

The person at fault here is the EMS person who went balistic on scene. Even if it had not been an appropriate use of EMS, in my county they cannot refuse to transport! It would have been a good opportunity to educate the co-worker and then perhaps they would have brought the wife into the hospital.

This is not the same as the 0300 pregnancy test. The woman was frail, elderly and probably seen by the co-worker as "not well" and therefore needed an ambulance.

You did nothing wrong. Nada!

Now that I've answered, I'm going to go see what everyone else has written! : )

kate loving shenk
07-14-2007, 08:59 PM
the ems system wasn't abused but you were abused by the ems responders!!!

BACRNEMTP
08-05-2007, 08:19 PM
I was a Paramedic for 23 years before becoming a nurse and can offer my opinion on the situation. I worked for a private company, not a public 911 ems system. This type of call did not warrant the use of 911, 911 is used for emergency calls, not calls where an elderly ladies needs transported because she is unable to stay alone. Unfortunately the public does not understand this and use 911 inappropriately. I did not see a time that this occured, if it was the middle of the night, possibly one of the friends could have stayed the night with the elderly lady, and arranged wheelchair transport in the am, or even driven the lady in a private vehicle ( you said she was able to walk with assistance). Also, this type of transport would not be covered by Medicare and probably not by private insurance companies, because it met no medical necessity.

Regarding the behavior of the ambulance crew, I think it was unprofessional to act that way in front of the patient. A better choice for the ambulance crew would have been to offer other options to the concerend parties.

As far as refusing to transport someone. You are obligated to respond to a call but private companies can refuse to transport people. I have in the past refused to transport people who I felt were abusing the system. For example, the man calling from a phone booth for a cut finger at 3am needing a ride to the hospital. Having not worked a municipal service, im not sure if you can refuse to transport patients or not. Its the pubics tax base that pays the salaries of public services.

I dont think this was abuse of EMS, maybe misuse. Just my opinion.

GuitarGirlRN
08-17-2007, 03:27 PM
if it was the middle of the night, possibly one of the friends could have stayed the night with the elderly lady, and arranged wheelchair transport in the am, or even driven the lady in a private vehicle ( you said she was able to walk with assistance). [/QUOTE]

It was the middle of the night (by the time we figured out that the husband would be admitted and that he had a demented wife at home. Also, the two people involved were not really friends--one was a coworker and one also lived in the area that the wife was in. To stay overnight with the wife would have been going above and beyond any type of obligation. This is NYC, no one involved had a car. The patient's insurance company ultimately paid for the ambulance ride.

kathypbib
09-15-2007, 10:54 PM
I agree with the well written response by BACRNEMTP. A bit of a misuse, but the response by the ambulance personnell was over the top, and he/she could have handled it much better. I work for a hospital based/county supplemented 24 hr service and have been in an ambulance for 11 years, soon to be an ER nurse. Keep in mind when calling 911 that medicare does not pay for non urgent rides to the hospital. I would find it supprising if an insurance company would pay either. An ambulance should not be used as a taxi service unless someone is absolutely unable to ride in a car for some reason. Most of these crews work 24 hour shifts and getting jerked out of bed by alarms after midnight really gets the adrenaline going. Which is probably why you got the over the top response.
Some cities have bus services that are able to pick up wheelchair bound people and transport them for $4 or $5 as opposed to a $500 ambulance ride.

jojodow
09-16-2007, 02:34 AM
I was a Paramedic for 23 years before becoming a nurse and can offer my opinion on the situation. I worked for a private company, not a public 911 ems system. This type of call did not warrant the use of 911, 911 is used for emergency calls, not calls where an elderly ladies needs transported because she is unable to stay alone. Unfortunately the public does not understand this and use 911 inappropriately. I did not see a time that this occured, if it was the middle of the night, possibly one of the friends could have stayed the night with the elderly lady, and arranged wheelchair transport in the am, or even driven the lady in a private vehicle ( you said she was able to walk with assistance). Also, this type of transport would not be covered by Medicare and probably not by private insurance companies, because it met no medical necessity.

Regarding the behavior of the ambulance crew, I think it was unprofessional to act that way in front of the patient. A better choice for the ambulance crew would have been to offer other options to the concerend parties.

As far as refusing to transport someone. You are obligated to respond to a call but private companies can refuse to transport people. I have in the past refused to transport people who I felt were abusing the system. For example, the man calling from a phone booth for a cut finger at 3am needing a ride to the hospital. Having not worked a municipal service, im not sure if you can refuse to transport patients or not. Its the pubics tax base that pays the salaries of public services.

I dont think this was abuse of EMS, maybe misuse. Just my opinion.


I have to disagree. As she was walking with assist and confused when she walked in the door, she would have probably been more confused waking up later that night without her husband.

I think she was a broken hip or worse waiting to happen and you did absolutely the right thing by encouraging them to do whatever necessary to bring her to the hospital.

As for the neighbor and co-worker staying overnight with her...unless those two people had medical/caregiving backgrounds...how on earth would any HCP expect them to help that poor lady to the bathroom or into a car without any training in fall prevention? That too could have been a disaster! I've taken care of my fair share of confused 90 year old ladies....and that takes training!

Guitargirl...you did absolutely the right thing! Those EMS guys were unprofessional and unethical if you ask me. :swordfight:

KimRN
09-16-2007, 10:30 AM
I agree with the well written response by BACRNEMTP. A bit of a misuse, but the response by the ambulance personnell was over the top, and he/she could have handled it much better. I work for a hospital based/county supplemented 24 hr service and have been in an ambulance for 11 years, soon to be an ER nurse. Keep in mind when calling 911 that medicare does not pay for non urgent rides to the hospital. I would find it supprising if an insurance company would pay either. An ambulance should not be used as a taxi service unless someone is absolutely unable to ride in a car for some reason. Most of these crews work 24 hour shifts and getting jerked out of bed by alarms after midnight really gets the adrenaline going. Which is probably why you got the over the top response.
Some cities have bus services that are able to pick up wheelchair bound people and transport them for $4 or $5 as opposed to a $500 ambulance ride.

This really is a fantatic service and we have them available in my county...but not at night. No w/c van or anything after 9 PM. Usually we get nursing home patients who are non-ambulatory but don't necessarily require medical monitoring on the way home, or are demented and not safe to put in a cab (our other option) but at night a BLS ambulance is all that is available. I wish there were other options around the clock. I see SO much abuse of the system - some of it unintended, some totally intended!

Polaris
09-30-2007, 07:21 PM
I don't think it was abuse of the system but do agree it was a misuse. But if I recall correctly from your original post, you did not tell them to call EMS, they did that on their own. So to them it seemed like an acceptable use.

Unfortunately, we cannot ensure that all people that need it would have a ride to the hospital. We also can't expect friends to be obligated to care for and transport people. Would most of us? Of course - but we don't know the extenuating life circumstances of these people.

I think it's a hard situation all around. One where you know you want to do the right thing, but also know that it would be not financially responsible. It also took a crew away from responding to a potential real emergency call.

Stuck between a rock and a hard place. Sometimes you just have to call a truce and do what you can, ya know?

Regardless - that EMS "professional" (and I use that term loosely) was completely out of line and I'm glad you got an apology.

Mr Ian
11-18-2007, 04:00 PM
I know the thread's old, but I have an opinion and I'm gonna use it. Besides, not slept all night and I start work in an hour. Need to do something....

It's one of those dilemmas where, unfortunately, the poor RN trying to do their best is left with an ethical decision to make and nothing but condemnation whichever way you choose.

Suffice to say, if you'd left her, woe on you.
As it was, you didn't, so woe on you again!

The issue is not whether you should have done so or not, the issue for me is; this is a foreseeable problem and we as nurses are not responsible for making the policies. Elderly couple, the one left at home as frail as the patient, is it that unusual that someone couldn't have thought that scenario out already?

Of course, mon-fri 9-5 it would have been a lot easier. But it wasn't. Family available it would have been a lot easier, but they weren't. Someone had a car.. etc etc....

What you had was an extreme example of a situation that required on the spot ethical decision making. You weighed it all up in your head and made a judgment call. Beaurocrats might not like it; EMS (and I understand their plight) might not like it; but the patient and family needed it and trust me, the newspapers would have crucified anyone who stopped it.

You did fine. Yes there should be better options, but there weren't at that time in that situation. That's not your fault and it sure wasn't Mr & Mrs "paid my taxes a whole life and probably fought a war or two while we did it".

I just get annoyed, when we make ethical decisions, with the lack of professional support received as if you don't think of other peoples issues too.

Stuff the system. Big up to ya gal :o)

I'd have probably made them go back for the cat... ethically speaking.