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Science Forum Index » Medicine - Nursing Forum » Delayed Care
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| Mark A. Stewart |
 Posted: Thu Dec 21, 2006 5:45 pm |
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Guest
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I have been a dedicated and frustrated Paramedic for many years. My
frustration stems from the widespread practice of Nursing and Extended Care
facilities within our fine state utilizing "privately owned" ambulances to
respond to "true 911" emergency calls at their facilities.
Many times, these ambulances are dispatched on emergency runs to these
facilities from distant locations, frequently passing local volunteer and
full-time city, township and county EMS stations which are closer and would
have a quicker response time.
The majority of temporary and full-time residents of these facilities are
current and past taxpayers that support(ed) local governmental Fire/EMS
stations whose coverage areas include the facility they live in. So, in an
emergency they are receiving care from a private ambulance company that
typically charges more for their services than a local public EMS system
would charge. Many public EMS systems in Ohio still provide free fire and
EMS services or request a nominal fee, or residents participate in a
subscription based fire/EMS system.
Most of us have been impacted by one of our friends or family members being
"placed" in a nursing home. Usually this placement is near the person's
original residence that is served by a local fire/EMS station. Then, after
becoming a resident of the facility, should they suffer a medical emergency
the local EMS system is often by-passed and the facility calls a private
ambulance.
This practice needs to stop! Facilities should be forced to call EMS
services which are closer in order to provide the quickest emergent care
possible to our senior citizens. These facilities should not be allowed to
sign exclusive contracts with private ambulance services unless the private
service is closer than a local public system and has a crew on station to
handle an emergency run.
Over the years, I have witnessed occasions where an individual in a rest
home had to wait, sometimes with an undesirable complication (in other words
the patient DIED) as a result of delayed response from a privately owned
ambulance that had to travel a long distance and passed one or more local
fire/EMS stations (which have established mutual aid agreements) on it's
journey to the scene of the emergency.
This is not a localized problem. It exists within all of Ohio and probably
most other states and possessions. I was raised by parents who taught me to
respect and honor my elders. Just as I am raising my son with the same
values. When a private ambulance service receives a request to respond to a
known emergency, they should put profits aside and have the facility call
the closest agency to respond. To do otherwise is irresponsible, unethical
and a shame.
In my 20 plus years as a paramedic I have had the unique opportunity to
positively impact the lives of many individuals. At the same time, my life
has been impacted by the dark side of pre-hospital emergency care. I
struggle everyday with haunting memories of death and anguish. At least I
find some solace in exposing this unjust treatment that our seniors
unknowingly receive.
Mark A. Stewart
241 Mulberry Street
Bremen, Ohio 43107
740-438-0299 |
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| Joe |
| Posted: Sat Dec 23, 2006 7:51 pm |
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Guest
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Mark...I am Director of Nursing of a Nursing Home and have long been
involved in my community's EMS program, so I understand both sides of
the situation you present. You may be surprised to know that the use
of private ambulance services for emergency transports may actually be
a requirement of your local community. Many communities have required
nursing homes to contract for ems from private providers because the
number of calls to these facilities would tax the volunteer resources,
or the taxpayer supported professional services of the local community.
I work in a nearly 400 bed facility in the Bronx and we have several
emergency calls a day. I have a contract with a private ambulance
company (who also is a contract provider to the city 911 ems system)
and have arrangements to call them for emergencies. They can respond
with ACLS or BLS depending on the situation. If the call is for an
arrest or near arrest, we call 911 and either get a fire dept unit, or
we may end up getting our private company-- whichever one is closer and
available. For arrests, we used to get a truck and engine response
with an AED in addition to the ACLS and BLS bus response. About a year
ago, FDNY asked us to implement our own AED program internally, and
they no longer send the truck and engine.
In my suburban community where we rely on volunteers, the fire district
asks the nursing homes to use private providers for all but life
threatening situations so the volunteer members are not overtaxed.
I think your concern is that patients deserve an appropriate response
to a medical emergency. My point is that this is most likely planned
by your community as I have described above, and the nursing home
should be able to provide AED enhanced BLS prior to a 911 unit, and
should be able to appropriately triage to a private service if able to
preserve local rescue resources for emergencies in locations without
trained staff.
Mark A. Stewart wrote:
Quote: I have been a dedicated and frustrated Paramedic for many years. My
frustration stems from the widespread practice of Nursing and Extended Care
facilities within our fine state utilizing "privately owned" ambulances to
respond to "true 911" emergency calls at their facilities.
Many times, these ambulances are dispatched on emergency runs to these
facilities from distant locations, frequently passing local volunteer and
full-time city, township and county EMS stations which are closer and would
have a quicker response time.
The majority of temporary and full-time residents of these facilities are
current and past taxpayers that support(ed) local governmental Fire/EMS
stations whose coverage areas include the facility they live in. So, in an
emergency they are receiving care from a private ambulance company that
typically charges more for their services than a local public EMS system
would charge. Many public EMS systems in Ohio still provide free fire and
EMS services or request a nominal fee, or residents participate in a
subscription based fire/EMS system.
Most of us have been impacted by one of our friends or family members being
"placed" in a nursing home. Usually this placement is near the person's
original residence that is served by a local fire/EMS station. Then, after
becoming a resident of the facility, should they suffer a medical emergency
the local EMS system is often by-passed and the facility calls a private
ambulance.
This practice needs to stop! Facilities should be forced to call EMS
services which are closer in order to provide the quickest emergent care
possible to our senior citizens. These facilities should not be allowed to
sign exclusive contracts with private ambulance services unless the private
service is closer than a local public system and has a crew on station to
handle an emergency run.
Over the years, I have witnessed occasions where an individual in a rest
home had to wait, sometimes with an undesirable complication (in other words
the patient DIED) as a result of delayed response from a privately owned
ambulance that had to travel a long distance and passed one or more local
fire/EMS stations (which have established mutual aid agreements) on it's
journey to the scene of the emergency.
This is not a localized problem. It exists within all of Ohio and probably
most other states and possessions. I was raised by parents who taught me to
respect and honor my elders. Just as I am raising my son with the same
values. When a private ambulance service receives a request to respond to a
known emergency, they should put profits aside and have the facility call
the closest agency to respond. To do otherwise is irresponsible, unethical
and a shame.
In my 20 plus years as a paramedic I have had the unique opportunity to
positively impact the lives of many individuals. At the same time, my life
has been impacted by the dark side of pre-hospital emergency care. I
struggle everyday with haunting memories of death and anguish. At least I
find some solace in exposing this unjust treatment that our seniors
unknowingly receive.
Mark A. Stewart
241 Mulberry Street
Bremen, Ohio 43107
740-438-0299 |
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| Dave S |
| Posted: Mon Dec 25, 2006 4:11 am |
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Guest
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I live in the surrounding metropolitan area around the 4th largest city
in the nation. Pretty much throughout the 7 county region that comprises
my area of experience, private ambulance services provide the bulk of
all transports provided to nursing home and long term care facility
patients. 911 is utilized (AS IT SHOULD BE) for only true life
threatening emergencies at these nursing homes... essentially Codes and
Near-Codes.
The folks who work in and with the 911 EMS services in my locale have no
desire (and honestly, dont want to divert the resources) to providing
primary transport to long term care facilities.
You are posting to an international audience about a local problem. If
YOUR local EMS service wants to get in on the $$$/Reimbursement
associated with the nursing home transport industry, then do it the
right way. Dont legislate it. Provide a good service: Market yourself,
guarantee results, with crews that are happy to be there and who
understand that a nursing home isnt a scene call in someone's house, its
a regulated place of business that has obligations it has to meet.
If you are observing that local nursing homes ARENT summoning 911
services when a true life threatening emergency exists (not just a
plugged g-tube, or a fever), then why arent you REPORTING this to your
regional/state healthcare authorities. Nursing homes pretty much survive
on medicare and medicaid funding. If the Feds get involved because of
documented delays in care, I'm sure something will change. Bitching
about it on usenet will do nothing, but waste bandwidth.
Mark A. Stewart wrote:
Quote: I have been a dedicated and frustrated Paramedic for many years. My
frustration stems from the widespread practice of Nursing and Extended Care
facilities within our fine state utilizing "privately owned" ambulances to
respond to "true 911" emergency calls at their facilities.
Many times, these ambulances are dispatched on emergency runs to these
facilities from distant locations, frequently passing local volunteer and
full-time city, township and county EMS stations which are closer and would
have a quicker response time.
The majority of temporary and full-time residents of these facilities are
current and past taxpayers that support(ed) local governmental Fire/EMS
stations whose coverage areas include the facility they live in. So, in an
emergency they are receiving care from a private ambulance company that
typically charges more for their services than a local public EMS system
would charge. Many public EMS systems in Ohio still provide free fire and
EMS services or request a nominal fee, or residents participate in a
subscription based fire/EMS system.
Most of us have been impacted by one of our friends or family members being
"placed" in a nursing home. Usually this placement is near the person's
original residence that is served by a local fire/EMS station. Then, after
becoming a resident of the facility, should they suffer a medical emergency
the local EMS system is often by-passed and the facility calls a private
ambulance.
This practice needs to stop! Facilities should be forced to call EMS
services which are closer in order to provide the quickest emergent care
possible to our senior citizens. These facilities should not be allowed to
sign exclusive contracts with private ambulance services unless the private
service is closer than a local public system and has a crew on station to
handle an emergency run.
Over the years, I have witnessed occasions where an individual in a rest
home had to wait, sometimes with an undesirable complication (in other words
the patient DIED) as a result of delayed response from a privately owned
ambulance that had to travel a long distance and passed one or more local
fire/EMS stations (which have established mutual aid agreements) on it's
journey to the scene of the emergency.
This is not a localized problem. It exists within all of Ohio and probably
most other states and possessions. I was raised by parents who taught me to
respect and honor my elders. Just as I am raising my son with the same
values. When a private ambulance service receives a request to respond to a
known emergency, they should put profits aside and have the facility call
the closest agency to respond. To do otherwise is irresponsible, unethical
and a shame.
In my 20 plus years as a paramedic I have had the unique opportunity to
positively impact the lives of many individuals. At the same time, my life
has been impacted by the dark side of pre-hospital emergency care. I
struggle everyday with haunting memories of death and anguish. At least I
find some solace in exposing this unjust treatment that our seniors
unknowingly receive.
Mark A. Stewart
241 Mulberry Street
Bremen, Ohio 43107
740-438-0299
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| Mark A. Stewart |
| Posted: Mon Dec 25, 2006 11:11 pm |
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Dave, thanks for your response.
As I mentioned in my post this is not a localized problem. Out of the 17
licensed Nursing homes within my county only one calls 911 for emergency
calls.
Ohio department of health currently has no guidlines on how these facilities
should address whom to call for emergencies. Presently, I am working with 2
Ohio Legislatures in creating some sort of policy to be introduced in the
next legislative session.
The last public EMS service I worked at had a 75 bed nursing facility
located less than a mile away. This facility would never call us, instead
they utilized a private service located 19 miles away. If they required
back-up they would call another truck from their same service. If you read
my post closely you would notice that I was referring to true 911 emergency
calls and was not referring to routine transports.
I also realize that city/volunteer services would be overwhelmed if they had
to pick up the extra run volume. You are fortunate that you live in an area
that seems to have a plan that works well. However, if you had a loved one
that resisided in one of these facilities that chose to call a service with
an excessive response time which contributed to their demise you would
probaly be bitching and wasting bandwidth yourself. I have seen several
nursing homes that have contracts or informal agreements with private
services that have an acceptable response time then if for some reason this
service pissed off the facility they would start calling a service that was
farther away.
The system isn't perfect but, I think we could do more to improve the care
of our seniors.
I guess it just sucks to be old.
Mark
Imagine if our public school systems excersied this same judgement when a
young child needed emergent care. In my paticular community the first
private service started in 1977. Prior to that, emergencies runs at these
facilities were handled by city/volunteer services that at the time charged
no fees. After so many frequent calls these public services started
charging the facility itself and not the patient. Thus, was born the
practice of these facilities calling the private companies because they
would bill the patients instead of the facility. This policy continues
today.
"Dave S" <Dastaten@earthlink.net> wrote in message
news:1JLjh.3584$yx6.3149@newsread2.news.pas.earthlink.net...
Quote: I live in the surrounding metropolitan area around the 4th largest city in
the nation. Pretty much throughout the 7 county region that comprises my
area of experience, private ambulance services provide the bulk of all
transports provided to nursing home and long term care facility patients.
911 is utilized (AS IT SHOULD BE) for only true life threatening
emergencies at these nursing homes... essentially Codes and Near-Codes.
The folks who work in and with the 911 EMS services in my locale have no
desire (and honestly, dont want to divert the resources) to providing
primary transport to long term care facilities.
You are posting to an international audience about a local problem. If
YOUR local EMS service wants to get in on the $$$/Reimbursement associated
with the nursing home transport industry, then do it the right way. Dont
legislate it. Provide a good service: Market yourself, guarantee results,
with crews that are happy to be there and who understand that a nursing
home isnt a scene call in someone's house, its a regulated place of
business that has obligations it has to meet.
If you are observing that local nursing homes ARENT summoning 911 services
when a true life threatening emergency exists (not just a plugged g-tube,
or a fever), then why arent you REPORTING this to your regional/state
healthcare authorities. Nursing homes pretty much survive on medicare and
medicaid funding. If the Feds get involved because of documented delays in
care, I'm sure something will change. Bitching about it on usenet will do
nothing, but waste bandwidth.
Mark A. Stewart wrote:
I have been a dedicated and frustrated Paramedic for many years. My
frustration stems from the widespread practice of Nursing and Extended
Care facilities within our fine state utilizing "privately owned"
ambulances to respond to "true 911" emergency calls at their facilities.
Many times, these ambulances are dispatched on emergency runs to these
facilities from distant locations, frequently passing local volunteer and
full-time city, township and county EMS stations which are closer and
would have a quicker response time.
The majority of temporary and full-time residents of these facilities are
current and past taxpayers that support(ed) local governmental Fire/EMS
stations whose coverage areas include the facility they live in. So, in
an emergency they are receiving care from a private ambulance company
that typically charges more for their services than a local public EMS
system would charge. Many public EMS systems in Ohio still provide free
fire and EMS services or request a nominal fee, or residents participate
in a subscription based fire/EMS system.
Most of us have been impacted by one of our friends or family members
being "placed" in a nursing home. Usually this placement is near the
person's original residence that is served by a local fire/EMS station.
Then, after becoming a resident of the facility, should they suffer a
medical emergency the local EMS system is often by-passed and the
facility calls a private ambulance.
This practice needs to stop! Facilities should be forced to call EMS
services which are closer in order to provide the quickest emergent care
possible to our senior citizens. These facilities should not be allowed
to sign exclusive contracts with private ambulance services unless the
private service is closer than a local public system and has a crew on
station to handle an emergency run.
Over the years, I have witnessed occasions where an individual in a rest
home had to wait, sometimes with an undesirable complication (in other
words the patient DIED) as a result of delayed response from a privately
owned ambulance that had to travel a long distance and passed one or more
local fire/EMS stations (which have established mutual aid agreements) on
it's journey to the scene of the emergency.
This is not a localized problem. It exists within all of Ohio and
probably most other states and possessions. I was raised by parents who
taught me to respect and honor my elders. Just as I am raising my son
with the same values. When a private ambulance service receives a
request to respond to a known emergency, they should put profits aside
and have the facility call the closest agency to respond. To do
otherwise is irresponsible, unethical and a shame.
In my 20 plus years as a paramedic I have had the unique opportunity to
positively impact the lives of many individuals. At the same time, my
life has been impacted by the dark side of pre-hospital emergency care.
I struggle everyday with haunting memories of death and anguish. At
least I find some solace in exposing this unjust treatment that our
seniors unknowingly receive.
Mark A. Stewart
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| Dave S |
| Posted: Tue Dec 26, 2006 3:30 am |
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Guest
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Mark A. Stewart wrote:
Quote: The system isn't perfect but, I think we could do more to improve the care
of our seniors.
I guess it just sucks to be old.
Mark
This sums it up nicely.. |
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| Marcus Aurelius |
| Posted: Fri Dec 29, 2006 5:07 pm |
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Guest
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Thank you for the original post with which I agree completely.
Some one who has Acute Coronary Syndrome or other life threatening
emergency needs emergent skilled medical care and assistance,something
which requires the most immediate attention as time is of the essence.
To intentionally dely emergent care amounts not only to negligence, in
my opinion, but to criminal malfeaseance amounting to manslaughter or
murder, in my opinion.
I am an R.N. with an ACLS and a certified legal assistant. |
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| Joe |
| Posted: Fri Dec 29, 2006 8:22 pm |
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Guest
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I don't think that anyone is condoning delaying care for life
threatening emergencies...but I do think that a planned and coordinated
use of private ambulance providers in addition to the paid or volunteer
EMS providers can result in improved response time for the entire
community. If units are tied up with non life threatening emergencies
in nursing homes that could be covered by private units, it can divert
valuable life saving equipment and personnel from a timely response to
the community at large. I just don't see this as an all or nothing
problem....it is something that requires careful and deliberate
planning by both EMS providers and nursing homes.
Marcus Aurelius wrote:
Quote: Thank you for the original post with which I agree completely.
Some one who has Acute Coronary Syndrome or other life threatening
emergency needs emergent skilled medical care and assistance,something
which requires the most immediate attention as time is of the essence.
To intentionally dely emergent care amounts not only to negligence, in
my opinion, but to criminal malfeaseance amounting to manslaughter or
murder, in my opinion.
I am an R.N. with an ACLS and a certified legal assistant. |
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| Guest |
| Posted: Sun Dec 31, 2006 10:41 pm |
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Mark,
I going back to your orginal post, the issue is a regulatory one
imposed by the Centers for Medicare and Medicaid Services (CMS). CMS
requires all long term care facilities to have a contract with an EMS
provider for EMERGENT and NON-emergent calls.
Since Katrina, CMS has directed state survey agencies to enforce this
"tag" more effectively. It may be the private EMS provider will not
contract for just non-emergency transports but wants emergencies also
to keep crew's clinical skills up to date.
This is a mix of regulation and food for thought from an old Paramedic
and current RN.
none.
On 29 Dec 2006 13:07:01 -0800, "Marcus Aurelius"
<alexander26a@hotmail.com> wrote:
Quote: Thank you for the original post with which I agree completely.
Some one who has Acute Coronary Syndrome or other life threatening
emergency needs emergent skilled medical care and assistance,something
which requires the most immediate attention as time is of the essence.
To intentionally dely emergent care amounts not only to negligence, in
my opinion, but to criminal malfeaseance amounting to manslaughter or
murder, in my opinion.
I am an R.N. with an ACLS and a certified legal assistant. |
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