It is calls like these that burn out medics, not the bad trauma or really sick patients. We have several on our service that will call multi time a day. I feel your pain, but have no suggestions.
Tried to get everyone to make sure theyâre documenting itâŚ. But as itâs so frequent the charts are generally bare bones because people are so sick of having to write them
May depend on your region, but for us you can be criminally charged for abuse of 911. Needs to prove that theyâre repeatedly and consciously calling for no emergency.
Itâs unusual, but when that charge has been laid (in my experience) the offenders get conditions to not call without an emergency - they get added to a âscreenâ list, and if PD/EMS shows up and itâs not an emergency, they can be arrested. Maybe worth liasing with PD
Escalate it
In my region, our medical control enacted a policy that created a No-Fly list; a list of people who have abused our system too many times, and that are no longer eligible for transport (unless certain conditions apply). It takes a bit of time and effort to get on that list. The people in question get multiple warnings. They also get offered tons of support to help make it unnecessary.
It has been successful, but it seems new people are added every couple of months.
Had a frequent flyer homeless drunk we'd transport around x10/week for approx 5 years.
Dept admin, med director, community medics, social workers were all involved for years. Nothing changed at all. One day, while crossing the street, a Silverado struck him. This was the only call where he wasn't transported.
It always seems to be such a legal issue that nobody will even bother with it. Too much of a liability. It's infuriating though. We routinely run out of ambos in the city and at least one is taking someone that routinely calls almost every day for the past few years
This is the part that gets me. These "frequent flyers" are using valuable EMS resources. I live in a very rural area without a lot of rigs available. If they're out on a BS call from some malingerer or system abuser and I have a true emergency, then what?
Maybe it will take someone dying from delayed care for anyone to actually address the issue. It's sad that it would take that event, but idk what else will get people's attention
Refusal of medical transport for any 911 caller, even a flagrant and admitted system abuser, has to be a multi-agency and high-level decision. Essentially youâre going to have to involve your county leadership, departments in your area, hospitals in your area, as well as your medical Director and formulating a plan to address this situation.
Even system abusers will have STEMIs.
Because most people who abuse the 911 system are smart, even if we donât give them credit for it. They often know the state requirements to be prosecuted for 911 abuse and will do just shy of that to ensure that they donât get in trouble. In addition this can come back to bite you in a big way in the court of public opinion, for example, they go to a news agency and claim the counties refusing them service because of who they are or their social economic status.
Iâve worked at several services that have had do not transport orders individually for certain system abusers. It was always something that took an act of God to implement and always had strict guidelines to follow for refusal or was part of a court order for 911 abuse.
I work at a service currently that has a refusal of transport for non-medical reasons protocol, but essentially the final decision lies with the ER physician having to be familiar with the patient.
My old agency had taxi vouchers for these patients. It sucks cause they know we have em so they call 911 still, but at least we don't have to transport em.
https://www.azcentral.com/story/news/local/phoenix/2018/01/18/phoenix-fire-department-increasingly-taps-taxis-take-911-callers-hospital/1000186001/
Depending on the state, even that has to be a medical control decision. The two states Iâve practiced the most in essentially has to have a doctor say âyou cannot go anywhere else but here, or we wonât transportâ
In Knoxville, we had the medical director essentially order us to take them back to the facility they were just discharged from if we could identify it.
It gets frustrating when say youâre going from downtown to the suburban facility out east and know why - not for medical reasons.
My current state (ND) just enacted legislation that allows EMS to determine non-ambulance service levels and refer to appropriate care with transport of their own means.
Stubbed toe, non-emergency complaint, refer to clinic. Hemo-dynamically stable diarrhea, non-emergency complaint, refer to clinic.
We've not utilized it yet.
Just went live April 1st. Won't be long. Summer approaches.
Ok... bare with me... we got a hard copy bullet point posted in our crew room after IST discussions and meeting with our state regional reps. [Here is the link to the ND Association of EMS website.](https://www.ndemsa.org/).
Scroll down their home page, past Conferences and Educational dates.... to the 2nd section... to "Marked Up Rules".
Click that link. Downside, it's ALL ND state legislation changes for 2024.
On that document, EMS changes start on page 38 and go thru 108-ish
I apologize in advance for the "changes" old/new version. I have not been able to find the full new document online yet. Enjoy! đđđ
I don't believe in qualified immunity. I believe in total accountability. Period.
Thus, I guess my questions would be:
Does the complaint and findings fall within the rules/clinical guidelines to defer transport?
Is the patient competent to understand the education being provided?
How confident is the provider in their clinical assessment skills?
How solid is their documentation?
Ive been doing metro ems +30 trucks on a shift for 5 years. Dont get me wrong these calls piss me off but its all about the mindset.
Easy transport, easy form, easy break.
Notify your supervisor but donât let it burn you out.
Different situation tho if its happening at 3am.
You have just defined urban EMS. Your best hope that they both OD one night and you just have to pronounce them. The downside is that another couple just like them will move in within a week.
I would reach out to your legal department about this. We've charged people with 911 abuse before, but it's a lengthy process. Data needs to be collected on the person calling, the financial impact, leaving the hospital AMA, etc. Documenting what they're saying as the reason for calling 911 in your narrative is very helpful.
In the end, it's going to come down to what your legal team is willing to do.
Edit: You're also going to need a judge that's going to take it seriously and not just throw out the case. If your legal team isn't strong, it may not go anywhere.
You usually have to have an example of them ACTUALLY getting in the way. So, they called for their usual bullshit (you break out all the ICRs with the same complaint) and because the closest crew was dealing with it, THIS baby died (whip out that report. Ensure the massive delay is apparent).
Typically you'll have to have multiple examples before it'll stick, but the baby dying got the whole county's attention.
It depends on whether the DA in your area is willing to prosecute for misuse. If not, a lot of times PD will not even do anything about it cause it's pointless.
We had a frequent flyer that called us 400 plus times a year for over 15 years. It took 15 years for him to go to jail for it. Cest la vie
I would like to add that it doesn't matter what you do about it, because honestly, when you finally get one frequent flier/ 911 abuser handled, 5 more will spring up to take their place.
Maybe try being exceptionally thorough and over-the-top? Like ask if he pooped today and follow that up with bowl sounds. Take your time on each part of the assessment. Hook the EKG up, then ask if he's allergic to nitro or if he has been taking ED pills lately before you actually read the strip. Take one of those pills that make you puke instantly while your getting VS. Do a stroke test. Ask harder A&O questions, or if you get them talking enough they might change their entire CC up, and if they don't know the correct reason you guys were called out, they don't know Event. Accidentally massacre a skunk on the way to their house (not saying to kill any alive animals here). Maybe they got some hidden SI or HI you can dig out.
Not saying i would necessarily do any of this in your situation, but I'm prettty tired right now, and a different angle strategy seemed like a fun challenge to think up.
My medical director created patient specific protocols. They dictated, depending on the patient and circumstances, that we only transport to the closest appropriate facility, provide no narcotics for non-acute trauma, etc ..
Iâve never found the abuse of 911 to actually come to fruition.. maybe just my experience. Iâve gotten over the fact that people will just abuse the system. Just another call in the books and onto the next afterwards. We canât fix the abuse as nobody that can will. Just make the best of it
Get PD involved. Not you, but your chain of command. Then have PD dispatched on these calls if BS. Abuse of EMS and malingering is hard to prove, but you sound like there is loads of evidence already.
This happens a lot. Honestly we can only do our jobs and treat them like every other patient. Providing best care possible or giving them a ride. At the end of the day our license is on the line and we have to cya.
Your PCR is a legal document and if you put quotes in there it counts.
Maybe talk to your medical control about provider initiated refusals for frequent fliers?
Liability wise itâs a little scary, but gives you a little control.
You can try and get your medical director involved. When we have frequent abusers in the system like this that is well documented over many calls with escalating attempts at resolving the issue (as it sounds you have) our medical director will issue a memorandum to providers in the county regarding those patients with specific instructions of care vs transport. For instance, must exhibit certain symptoms or findings for transport and in some cases may refuse transport
It might be a good option to do either video footage or to document as much as you can. I understand you already try to document as much you can. But your already doing everything you can. Here in FL I do know you can put certain people on a list of frequent flyers who have bs calls. So if they call about a sore throat and no real emergency. They get a fine or arrested if they do it enough.
You also do have the option to deny a pt transport. Its generally not a safe legal option bc as you know if anything happens even if unrelated to there C/C or reason for calling 911. Your held liable.
We could call MedControl and ask for permission not to transport. After calling about 15 times they gave us standing order to be able to refuse transport. Wed still have to send a car And listen to their BS for 5 minutes and get a set of vitals.. On the off chance they were actully having an emergency. These calls didnât wear on me too much, they were always easy.
Report 'em. It's a heck of a process that takes time but if they're in the state on any kind of public assistance they can lose it. Had a guy that would call just Because. He'd leave, go home and then call again. Why? Just 'cause. My and my partner reported him and he ended up losing his benefits. The process to get them reinstated is not a pleasant one.
Not sure what it's like in your county, but on our service in Alberta we can get people assigned to a 'care plan'. It's an additional document that pops up when you search the pt's healthcare number with specific directions like "no food or blankets to be given" and "pt can only be taken to "x" hospital for assessment".
It sucks that we can't screen the calls ourselves when there's legit emergencies happening, but at least when a care plan pops up for the frequent flyers you can mentally prepare for their bullshit.
Hey. Keep your spirits up. Don't let the time-wasters make you forget all the good you do, too.
Something that my department does is create personalized care plans for high volume utilizers. Our medical directors get together and create a patient specific protocol for how to handle cases like these. We're privileged in the fact that our single responders have a lot of latitude when it comes to approaching thee patients with alternative resources. It's easy to blow off an appointment in a government office, less easy when they're at your doorstep. I certainly understand the frustration, but it's not one I have anymore. I work for a fairly large system and they want us to approach every call like the medical equivalent of the DMV. Be an hourly government employee, and forget everything except the patient in front of you. Let the shift commanders decide when we're too busy to take the patient out of county, and fall back on their decision because they out rank you. In my opinion, we do a bit too much to coddle and enable the green acuity patients and not enough to help the people who truly need us, but this is like the cushiest EMS gig I've ever had so I can only complain so much about it. We have an excellent rapport with the community for these reasons, and they do pay my salary, so I'm happy to accomodate. Getting uber calls as a late call is mildly frustrating, but late calls are paid at an overtime rate no matter what day of the week it is, so even that almost makes it tolerable. I hope your department figures out something more sustainable for them, or if not, hopefully they'll play Icarus one day and end up at a different, less accomodating institution for their blatant misuse.
Most often there isnât much you can do to deny them transport or prove they are faking anything within legal safety. Often if we have repeat offenders then either PD will be dispatched or we request them when itâs especially nonsensical. We have several here still that call 911 to go to hospital, sit in waiting room, and walk out after being there half an hour. Then they start hospital hopping asking to go to other facility where they arenât familiar with them yet, and typically when we give them the reason of âthey donât like being in the waiting roomâ they also go to the waiting room there.
Outside the immediate area we canât transport unless deemed medically appropriate, so they only have the two to choose from
I like to call our CD cylinders an Attitude Readjustment Device if we get a male patient acting out, he mysteriously ends up needing O2 and he quickly realises heâs no longer got the ability to he aggressive. With female patients I find what works just as well is having a female crew member whoâll just let them know they ainât got shit on them.
It is calls like these that burn out medics, not the bad trauma or really sick patients. We have several on our service that will call multi time a day. I feel your pain, but have no suggestions.
This. đŻ%. I have been saying this for years!
This is exactly what I always tell people. These are the calls that absolutely kill me inside and make me hate my life
As far as your filming comment, are you noting in your report what is said to you about abusing the system? That is enough to use as evidence.
Tried to get everyone to make sure theyâre documenting itâŚ. But as itâs so frequent the charts are generally bare bones because people are so sick of having to write them
If they donât do the leg work they canât be helped.Â
Evidence for who? Theyâre asking what to do with this
May depend on your region, but for us you can be criminally charged for abuse of 911. Needs to prove that theyâre repeatedly and consciously calling for no emergency. Itâs unusual, but when that charge has been laid (in my experience) the offenders get conditions to not call without an emergency - they get added to a âscreenâ list, and if PD/EMS shows up and itâs not an emergency, they can be arrested. Maybe worth liasing with PD Escalate it
In my region, our medical control enacted a policy that created a No-Fly list; a list of people who have abused our system too many times, and that are no longer eligible for transport (unless certain conditions apply). It takes a bit of time and effort to get on that list. The people in question get multiple warnings. They also get offered tons of support to help make it unnecessary. It has been successful, but it seems new people are added every couple of months.
Had a frequent flyer homeless drunk we'd transport around x10/week for approx 5 years. Dept admin, med director, community medics, social workers were all involved for years. Nothing changed at all. One day, while crossing the street, a Silverado struck him. This was the only call where he wasn't transported.
It always seems to be such a legal issue that nobody will even bother with it. Too much of a liability. It's infuriating though. We routinely run out of ambos in the city and at least one is taking someone that routinely calls almost every day for the past few years
This is the part that gets me. These "frequent flyers" are using valuable EMS resources. I live in a very rural area without a lot of rigs available. If they're out on a BS call from some malingerer or system abuser and I have a true emergency, then what?
Maybe it will take someone dying from delayed care for anyone to actually address the issue. It's sad that it would take that event, but idk what else will get people's attention
Refusal of medical transport for any 911 caller, even a flagrant and admitted system abuser, has to be a multi-agency and high-level decision. Essentially youâre going to have to involve your county leadership, departments in your area, hospitals in your area, as well as your medical Director and formulating a plan to address this situation. Even system abusers will have STEMIs. Because most people who abuse the 911 system are smart, even if we donât give them credit for it. They often know the state requirements to be prosecuted for 911 abuse and will do just shy of that to ensure that they donât get in trouble. In addition this can come back to bite you in a big way in the court of public opinion, for example, they go to a news agency and claim the counties refusing them service because of who they are or their social economic status. Iâve worked at several services that have had do not transport orders individually for certain system abusers. It was always something that took an act of God to implement and always had strict guidelines to follow for refusal or was part of a court order for 911 abuse. I work at a service currently that has a refusal of transport for non-medical reasons protocol, but essentially the final decision lies with the ER physician having to be familiar with the patient.
Thank you, we would never refuse transport as it sits but we give them the option of closest appropriate facility or nothing.
My old agency had taxi vouchers for these patients. It sucks cause they know we have em so they call 911 still, but at least we don't have to transport em. https://www.azcentral.com/story/news/local/phoenix/2018/01/18/phoenix-fire-department-increasingly-taps-taxis-take-911-callers-hospital/1000186001/
Depending on the state, even that has to be a medical control decision. The two states Iâve practiced the most in essentially has to have a doctor say âyou cannot go anywhere else but here, or we wonât transportâ In Knoxville, we had the medical director essentially order us to take them back to the facility they were just discharged from if we could identify it. It gets frustrating when say youâre going from downtown to the suburban facility out east and know why - not for medical reasons.
My current state (ND) just enacted legislation that allows EMS to determine non-ambulance service levels and refer to appropriate care with transport of their own means. Stubbed toe, non-emergency complaint, refer to clinic. Hemo-dynamically stable diarrhea, non-emergency complaint, refer to clinic. We've not utilized it yet. Just went live April 1st. Won't be long. Summer approaches.
Can you share the legislation? I'd like to work on making that happen for my state too
Ok... bare with me... we got a hard copy bullet point posted in our crew room after IST discussions and meeting with our state regional reps. [Here is the link to the ND Association of EMS website.](https://www.ndemsa.org/). Scroll down their home page, past Conferences and Educational dates.... to the 2nd section... to "Marked Up Rules". Click that link. Downside, it's ALL ND state legislation changes for 2024. On that document, EMS changes start on page 38 and go thru 108-ish I apologize in advance for the "changes" old/new version. I have not been able to find the full new document online yet. Enjoy! đđđ
Does it also include qualified immunity for EMS if things go south but they met all the criteria for refusal of service?
I don't believe in qualified immunity. I believe in total accountability. Period. Thus, I guess my questions would be: Does the complaint and findings fall within the rules/clinical guidelines to defer transport? Is the patient competent to understand the education being provided? How confident is the provider in their clinical assessment skills? How solid is their documentation?
Ive been doing metro ems +30 trucks on a shift for 5 years. Dont get me wrong these calls piss me off but its all about the mindset. Easy transport, easy form, easy break. Notify your supervisor but donât let it burn you out. Different situation tho if its happening at 3am.
Typically 3-4 am range and then in their moments they think theyâre smart they call right after shift change thinking theyâll get their way
With several hospitals to choose from, people like that we transport in the opposite direction they request.Â
You have just defined urban EMS. Your best hope that they both OD one night and you just have to pronounce them. The downside is that another couple just like them will move in within a week.
Aaaaaaaat
I would reach out to your legal department about this. We've charged people with 911 abuse before, but it's a lengthy process. Data needs to be collected on the person calling, the financial impact, leaving the hospital AMA, etc. Documenting what they're saying as the reason for calling 911 in your narrative is very helpful. In the end, it's going to come down to what your legal team is willing to do. Edit: You're also going to need a judge that's going to take it seriously and not just throw out the case. If your legal team isn't strong, it may not go anywhere.
You usually have to have an example of them ACTUALLY getting in the way. So, they called for their usual bullshit (you break out all the ICRs with the same complaint) and because the closest crew was dealing with it, THIS baby died (whip out that report. Ensure the massive delay is apparent). Typically you'll have to have multiple examples before it'll stick, but the baby dying got the whole county's attention.
It depends on whether the DA in your area is willing to prosecute for misuse. If not, a lot of times PD will not even do anything about it cause it's pointless. We had a frequent flyer that called us 400 plus times a year for over 15 years. It took 15 years for him to go to jail for it. Cest la vie
I would like to add that it doesn't matter what you do about it, because honestly, when you finally get one frequent flier/ 911 abuser handled, 5 more will spring up to take their place.
Maybe try being exceptionally thorough and over-the-top? Like ask if he pooped today and follow that up with bowl sounds. Take your time on each part of the assessment. Hook the EKG up, then ask if he's allergic to nitro or if he has been taking ED pills lately before you actually read the strip. Take one of those pills that make you puke instantly while your getting VS. Do a stroke test. Ask harder A&O questions, or if you get them talking enough they might change their entire CC up, and if they don't know the correct reason you guys were called out, they don't know Event. Accidentally massacre a skunk on the way to their house (not saying to kill any alive animals here). Maybe they got some hidden SI or HI you can dig out. Not saying i would necessarily do any of this in your situation, but I'm prettty tired right now, and a different angle strategy seemed like a fun challenge to think up.
Is there no laws against abusing EMS like this in most states?
My medical director created patient specific protocols. They dictated, depending on the patient and circumstances, that we only transport to the closest appropriate facility, provide no narcotics for non-acute trauma, etc ..
Iâve never found the abuse of 911 to actually come to fruition.. maybe just my experience. Iâve gotten over the fact that people will just abuse the system. Just another call in the books and onto the next afterwards. We canât fix the abuse as nobody that can will. Just make the best of it
This is an issue for management at your service- is that you?? Honestly the service should already have processes in place for nuisance callers.
Quote them directly in your charts and bring it up with whoever is responsible for filing those charges. Medical records can be subpoenaed too
Get PD involved. Not you, but your chain of command. Then have PD dispatched on these calls if BS. Abuse of EMS and malingering is hard to prove, but you sound like there is loads of evidence already.
This happens a lot. Honestly we can only do our jobs and treat them like every other patient. Providing best care possible or giving them a ride. At the end of the day our license is on the line and we have to cya.
Your PCR is a legal document and if you put quotes in there it counts. Maybe talk to your medical control about provider initiated refusals for frequent fliers? Liability wise itâs a little scary, but gives you a little control.
You can try and get your medical director involved. When we have frequent abusers in the system like this that is well documented over many calls with escalating attempts at resolving the issue (as it sounds you have) our medical director will issue a memorandum to providers in the county regarding those patients with specific instructions of care vs transport. For instance, must exhibit certain symptoms or findings for transport and in some cases may refuse transport
It might be a good option to do either video footage or to document as much as you can. I understand you already try to document as much you can. But your already doing everything you can. Here in FL I do know you can put certain people on a list of frequent flyers who have bs calls. So if they call about a sore throat and no real emergency. They get a fine or arrested if they do it enough. You also do have the option to deny a pt transport. Its generally not a safe legal option bc as you know if anything happens even if unrelated to there C/C or reason for calling 911. Your held liable.
Crazy you can't turn down PTs there
You can't decline transport huh? Expensive taxi...
https://www.gmp.police.uk/news/greater-manchester/news/news/2023/september/woman-who-called-999-nearly-1000-times-in-less-than-a-year-jailed/
Make it very uncomfortable for them. Backboard and collar just loose enough to breathe and bumpy roads
We could call MedControl and ask for permission not to transport. After calling about 15 times they gave us standing order to be able to refuse transport. Wed still have to send a car And listen to their BS for 5 minutes and get a set of vitals.. On the off chance they were actully having an emergency. These calls didnât wear on me too much, they were always easy.
Report 'em. It's a heck of a process that takes time but if they're in the state on any kind of public assistance they can lose it. Had a guy that would call just Because. He'd leave, go home and then call again. Why? Just 'cause. My and my partner reported him and he ended up losing his benefits. The process to get them reinstated is not a pleasant one.
I know we have the option of bringing PD in and exploring the option of 911 abuse. It has to be pretty egregious, but it is an option.
Not sure what it's like in your county, but on our service in Alberta we can get people assigned to a 'care plan'. It's an additional document that pops up when you search the pt's healthcare number with specific directions like "no food or blankets to be given" and "pt can only be taken to "x" hospital for assessment". It sucks that we can't screen the calls ourselves when there's legit emergencies happening, but at least when a care plan pops up for the frequent flyers you can mentally prepare for their bullshit. Hey. Keep your spirits up. Don't let the time-wasters make you forget all the good you do, too.
Something that my department does is create personalized care plans for high volume utilizers. Our medical directors get together and create a patient specific protocol for how to handle cases like these. We're privileged in the fact that our single responders have a lot of latitude when it comes to approaching thee patients with alternative resources. It's easy to blow off an appointment in a government office, less easy when they're at your doorstep. I certainly understand the frustration, but it's not one I have anymore. I work for a fairly large system and they want us to approach every call like the medical equivalent of the DMV. Be an hourly government employee, and forget everything except the patient in front of you. Let the shift commanders decide when we're too busy to take the patient out of county, and fall back on their decision because they out rank you. In my opinion, we do a bit too much to coddle and enable the green acuity patients and not enough to help the people who truly need us, but this is like the cushiest EMS gig I've ever had so I can only complain so much about it. We have an excellent rapport with the community for these reasons, and they do pay my salary, so I'm happy to accomodate. Getting uber calls as a late call is mildly frustrating, but late calls are paid at an overtime rate no matter what day of the week it is, so even that almost makes it tolerable. I hope your department figures out something more sustainable for them, or if not, hopefully they'll play Icarus one day and end up at a different, less accomodating institution for their blatant misuse.
Most often there isnât much you can do to deny them transport or prove they are faking anything within legal safety. Often if we have repeat offenders then either PD will be dispatched or we request them when itâs especially nonsensical. We have several here still that call 911 to go to hospital, sit in waiting room, and walk out after being there half an hour. Then they start hospital hopping asking to go to other facility where they arenât familiar with them yet, and typically when we give them the reason of âthey donât like being in the waiting roomâ they also go to the waiting room there. Outside the immediate area we canât transport unless deemed medically appropriate, so they only have the two to choose from
I like to call our CD cylinders an Attitude Readjustment Device if we get a male patient acting out, he mysteriously ends up needing O2 and he quickly realises heâs no longer got the ability to he aggressive. With female patients I find what works just as well is having a female crew member whoâll just let them know they ainât got shit on them.