Proposal aims to head off avoidable 911 calls
Thursday, June 2nd, 2005 at 12:35 am
A Florida county has a new plan to reduce Emergency Department visits:
An elderly diabetic living alone forgets to eat dinner when she takes her insulin.
Hours later, she wakes up on the verge of insulin shock and calls 911. Within minutes, paramedics are at her door. Soon, she's in an ambulance on the way to the hospital.
It's a common scene, according to Volusia County medical officials: an expensive and avoidable emergency room visit. They have a plan they think could help.
Under a new proposal, city and county firefighter paramedics could provide preventive care — like checking in to see whether a forgetful diabetic is taking her medicine and eating her meals. Expensive medical costs could be avoided. Paramedics could get needed patient care training, and their departments might even bring in some cash, county officials said.
Color me skeptical, but I highly doubt this plan will result in a significant decrease in ED usage. Other than the occasional forgetful diabetic, I am having a hard time coming up with reasonable scenarios of EMS workers preventing calls. The original story has these suggestions:
If the assistance is wanted, paramedics might drop by a diabetic's home to do a blood sugar check on the way back from another call; drop in on a homebound patient to make sure he's taking his medicines correctly; perform a cardiac test on someone who recently had heart surgery; or check a home for hazards that could cause an elderly person to fall.
Ok, now let's dissect each suggestion:
- Diabetic: As stated previously: reasonable
- Force feeding a patient their medicines: Don't they already have people to do that? Yeah, their called home health aides. I doubt most highly trained and skilled paramedics would want to sink to the level of pill-pusher. (No offense to HHA… Actually I take that back, I can't count the times that a HHA has called 911 for the most ridiculous reasons. It's like they have no concept of what an emergency is, or what is appropriate, cost-effective medical care. But I digress…)
- Perform a cardiac test on someone: It's true - a great majority of EMS calls are for chest pain, rule out a heart attack/myocardial infarction. But can anyone tell me of any test that can be routinely done in the field that would rule out all major problems with the heart, and prevent a trip to the hospital for definitive diagnosis? Yeah, that's what I thought. If anything, this would likely increase the number of transports to the ED.
- Check on hazards to prevent falls: While I am really too lazy to look up published study data (if there even has been a study), in my experience 90% of elderly people falling is not because they tripped over anything in their path, they just plain fell/rolled out of bed. And you really expect paramedics to inspect every elderly person's home with so little potential benefit?
It would be interesting to see the outcome if the county ever goes through with the plan (and if the Paramedic's Union doesn't boycott it). Paramedics are trained to respond to emergencies, they are not public health workers or home health aides, and I doubt many of them want to be.
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[…] Check on hazards to prevent falls: While I am really too lazy to look up published study data (if there even has been a study), in my experience 90% of elderly people falling is not because they tripped over anything in their path, they just plain fell/rolled out of bed. And you really expect paramedics to inspect every elderly person’s home with so little potential benefit?It would be interesting to see the outcome if the county ever goes through with the plan (and if the Paramedic’s Union doesn’t boycott it). Paramedics are trained to respond to emergencies, they are not public health workers or home health aides, and I doubt many of them want to be.View or post comments on my blog […]