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Wednesday, January 4, 2017

Why Are There So Many Stubbed Toes in Our Ambulances?

You can change the suffering caused by today's ambulance policies.

A recent news story reported that a pickup truck collided with a semi. The pickup truck became so mangled it is a wonder the driver survived. Shockingly, there were no ambulances available to tend to his serious injuries.

Unavailable ambulances are in the news every week. People can’t get this emergency help primarily because of ambulance waste.

“Ambulance waste” refers to people using ambulances who do not medically need them. As an emergency room physician, I see ambulance waste every day.

Ambulances have brought me patients with minor sprains, harmless insect bites, and complaints about things “not looking right.”And I’m not the only one. Scholars and officials estimate that medically unnecessary rides constitute between 11 and 85 percent of US ambulance use (depending on the population). Even the low estimate in that range means that over one in ten ambulance rides are not emergencies.

The stories that comprise those statistics inspire everything from chuckles to face-palms. Across the country, toothaches and stubbed toes are typical in ambulances. Ambulances have brought me patients with minor ankle sprains, harmless insect bites, and even a complaint that someone’s navel “didn’t look right.”

The patient’s navel was perfectly normal, by the way.

“We get called for people with blisters [and] paper cuts … I was called for a guy that walked through tall grass and then called me out to see if he had been bitten by a snake because he had heard snakes were in tall grass,” said Houston Fire Department Senior Captain Andrew Moore.

Most of these people believe they’re suffering an emergency, but not everyone. An alcoholic requested an ambulance everyday for months because my hospital was near his favorite liquor store.

In Fargo, a lonely resident used flimsy reasons to request ambulances so often – up to five times per day – that the city gave him a “care plan.” According to one official, he has resisted it. “He likes his life the way it is. And while that’s great for him, he doesn’t realize the impact that it has on the community.”

And that’s true: ambulance waste has a huge impact. Cities’ unpaid ambulance bills – a portion of which originate from medically unnecessary ambulance rides – are as high as $300 million.

Ambulance misuse also increases risk to EMTs, patients, and the public. Unnecessary rides also escalate emergency room overcrowding.

The Emergency Medical Services personnel who waste training and time on ambulance abusers suffer career burnout, stress, and depression.

I believe the most troubling consequence of ambulance waste is that people who need emergency rides must wait longer for help.

According to South Carolina-based emergency responder Barry McRoy,

We can’t [help] people if we are tied up with people who abuse the system … There have been several occasions where we were transporting one of [the people misusing the ambulance system] and then had a real emergency … it delays response time [to people experiencing emergencies]. The person who is really sick is suffering because these guys are abusing the system.

San Antonio’s “you call, we haul” policy (whereby requested ambulances respond for any reason) left residents without ambulance access for a short period. I am disturbed to consider the calamities that could have occurred during that time or may occur where these policies dominate.

Disturbingly, one report associated a similar ambulance shortage in Washington, D.C. to the death of one five month-old boy.

You can change the suffering caused by today’s ambulance policies.What can be done? Cities are trying several exciting approaches.

The ETHAN project uses tablets to allow doctors to video chat with patients. If doctors find that a patient does not need an ambulance, they schedule an appointment with a nearby clinic.

Under Michigan’s Right Size Response program, 911 dispatchers determine whether to send an ambulance. If they do not dispatch an ambulance, they dispatch firefighters who reevaluate whether an ambulance is required.

Through Stat apphealthcare providers summon the closest ambulance in the same way one calls an Uber. The app’s founders aspire to offer it to the public and use patient-to-paramedic video chat to determine whether an ambulance is necessary.

Other innovations promise to reduce ambulance abuse from certain populations, such as from the elderly and the mentally ill.

If you’re concerned about ambulance waste, remind your friends that ambulances are for emergencies. Tell them that using ambulances as taxis hurts people. Keep an eye out for further-off innovations that will be game changers such as ambulance drones. And support innovations like ETHAN, which many resist because they are unaware of the suffering caused by today’s ambulance policies. You can change that.

  • Dr. Geoffrey Hosta is a board-certified emergency room doctor with over thirty years of experience in emergency medicine.