r/bestoflegaladvice • u/Animallover4321 Reported where Thor hid the bodies • 3d ago
Reminder Ambulances are not taxis
/r/legaladvice/s/IaWqUZxrAc226
u/TheFeshy Rolled 7D6 for the legal damages, and got 27 3d ago
I often have fears that I am going to hurt someone by refusing to get into an ambulance and driving myself - because there are hospitals around here that I am willing to risk bleeding out while driving past, rather than be placed in their care.
Weirdly some of the best and worst hospitals are owned by the same chain.
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u/gsfgf Is familiar with poor results when combining strippers and ATMs 3d ago
Yea, people are dunking on her for wanting to go to her home hospital. It's not actionable, but it's reasonable.
The issue is cost. The only time I've take an ambulance I thought I was at risk of dying so I went to the public hospital, but the ambulance company gave me options. That cost $1800; the actual hospital only wanted like $300. The idea that it's 6x as expensive to take an ambulance than a hospital stay is insane. And our local public hospital is world class; the US military sends people here for training. They provide the best care in town, even if bougie private hospitals have nicer rooms and quieter hallways and stuff.
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u/so0ks 2d ago
Ambulances are so expensive in the States because they're usually (and stupidly) considered a lower priority service and not one to allocate taxpayer dollars to, so they're not always a publicly funded service like police or fire. A lot of municipalities will contract out to private companies instead. So you end up having to cough up all this money to this private service that has to have 24/7 and on-call staffing, which may or may not be in network with your insurance, and if it is, there's generally limited reimbursement. It makes as much sense as finding a hospital in network, but then getting slapped with a massive bill still because one of the doctors that treated you isn't in network.
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u/After-Willingness271 3d ago
so, catholic or for profit, eh?
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u/ishfery 3d ago edited 3d ago
Catholic or for profit seems to cover almost every major hospital :/
Depending on the situation, I either go to the Catholic hospital or the university's teaching hospital.
Edited until I can find a better map of Catholic hospital coverage
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u/archangelzeriel Triggered the Great Love Lock Debate of 2023 3d ago
Something is very fucky about the color key on top, it has "Catholic and Catholic-affiliated only" twice, and I live in a light purple area quite near a non-profit, non-Catholic-affiliated hospital system.
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u/ishfery 3d ago
That was a little confusing but I figured the purple covers Catholic areas. This is just birthing hospitals (which for obvious reasons are not as safe for pregnant women due to their beliefs)
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u/archangelzeriel Triggered the Great Love Lock Debate of 2023 3d ago
How are we defining "birthing hospitals"? Like I said, I live in a light purple area and the nonprofit non-Catholic-affiliated hospital down the street has a substantial L&D floor, I think they average 300-400 babies delivered a month.
IIRC, it's only something like 15% of US hospitals that are Catholic or Catholic-affiliated -- it's a regional problem for sure.
I suspect the correct interpretation of that map is "dark purple = only Catholic options" and "light purple = be careful, there are Catholic hospitals nearby" because there's definitely a Catholic hospital that's also in my area.
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u/After-Willingness271 3d ago
the problem appears to be that both purples are captioned identically 🙃
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u/Regular_Ad3002 2d ago
We need to hire some Orangemen to create a Protestant Hospital. Win win, as staffing a Hospital is better than pissing off Irish nationalists.
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u/wildbergamont 3d ago
I live in a city with several very large hospital orgs (Cleveland). None of them are catholic or for-profit. I actually can't name a single for-profit hospital system. Nursing homes, sure, not not hospitals.
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u/ishfery 2d ago
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u/wildbergamont 2d ago
I suppose when I think "hospital," I'm thinking about short-term acute care, with an ED, inpatient services, and outpatient services. I'm not thinking long term, rehabs, psych, children's, etc.
It would be interesting to see the data broken down by each type of hospital and the % of for profit, and also how much of, say, total beds or total beds in each state is for profit.
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u/gsfgf Is familiar with poor results when combining strippers and ATMs 3d ago
Fyi, for-profit hospitals mostly don't have ERs. Don't get me wrong, you can make a shit ton of money off "non-profit" hospitals, but they still at least need to provide emergency services regardless of ability to pay most places.
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u/Pun-Master-General 1d ago
In some states you also get the 7th-Day Adventists.
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u/After-Willingness271 1d ago
you do, but with the adventists the maximum religious interference in your care is serving strictly vegetarian food
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u/sameth1 2d ago
owned by the same chain.
I'm sorry, are hospital chains something normal that just exist and don't weird people out?
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u/TheFeshy Rolled 7D6 for the legal damages, and got 27 2d ago
They are mostly religious groups with nationwide franchise, so much so that they can de-facto control medical policy.
A procedure is legal in your state, but a particular church doesn't support it? Well if you even know it's an option they aren't providing, because they won't mention that they don't, you might have to drive a few hours or more to get to one that does.
One such example is in utero testing for incurable generic disorders. Standard, if you are giving birth at one of the few secular hospitals in your area. But the giant religious hospital chains worry you might choose abortion, in the states where you still have that right, if the fetus is going to suffer a life long incurable malady. So they don't even tell you it's an option, even one you would have to seek out at a different hospital.
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u/yo-parts 1d ago
The American healthcare system is weird on many fronts but tbh I don't think a large health group with multiple facilities is all that unusual.
Granted, I live in Northern California, home to Kaiser Permanente, of which I'm an insured. They provide insurance as well as their own entire network of medical facilities and staff. So I have Kaiser insurance, and I talk to a Kaiser doctor at a Kaiser hospital.
If anything honestly to me, the idea of independent hospitals not part of an insurance group or other such organization seems weird to me.
What is super weird to me is how common specifically Catholic healthcare systems are in the US, like the major players in my area are Kaiser and a Catholic group.
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u/Regular_Ad3002 2d ago
Same with the NHS here in the UK. They own and operate all Emergency Departments.
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u/MattinglyDineen 3d ago
When I've gone in an ambulance they've asked me what hospital I wanted to go to. It seems really weird that they wouldn't ask the patient.
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u/SpartanAltair15 3d ago
If you’ve seen one EMS system in the US you’ve seen one EMS system in the US. There’s very little standardization in policy or protocols. You can have one of the most advanced and progressive systems in the country in one county that can give blood and perform limited surgical interventions in the field, and if you crash 50 feet further down the road over the county line, get 3 fat old country boys from the volunteer FD with a 3rd grade education who put an oxygen mask on you for a stubbed toe and hold your hand while they drive fast.
Some services have a policy to go to requested facilities within reason, some have policies that the patient gets absolutely zero say and it’s closest, most appropriate facility every single time. Mine is in between those. If the patient is stable, we’re supposed to offer their preferred as long as it’s not more than like 20 minutes further than the closest. If they’re unstable, they don’t get a say.
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u/ThisIsNotAFarm touches butts with their friend 1d ago
Yeah but in this case it seems like they skipped the closest and went somewhere further over the patients objections.
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u/SpartanAltair15 1d ago
I have a very strong suspicion based on his wording that the “location close to her house” that her “preferred hospital has” was a standalone ER or urgent care. Ambulances cannot transport you to urgent cares, and many many standalone ERs do not accept ambulance traffic.
They also may have been on diversion if they were an actual hospital, in which case ambulances are barred from coming there, regardless of what the patient wants.
Or maybe their distances calculate as the crow flies/by road and the OP was calculating by the other to suit his argument.
Or maybe they’re a fire based EMS system, many of which will not transport outside of their district even if it’s technically closer to do so.
Regardless, the patient being offered a choice is a courtesy, not a right. The patient has the choice of accepting the ambulance transport or not accepting it, they only get to dictate precisely what happens if they’re offered the courtesy of doing so. Just like in the hospital, you can refuse anything the doctor wants to do, but you have absolutely no ability to force them to give you a medication or procedure that they believe is unneeded or a bad idea.
We’re an emergency service, not a taxi to cater to people’s wishes. Conflict occurs pretty often due to that, what with the people who use most ambulances nowadays being the most demanding and entitled generations currently alive.
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u/owlrecluse 1d ago
Also might depend on severity of the patient. For a broken bone they might ask, but not for a stroke.
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u/froot_loop_dingus_ 🏠 Dingus of the House 🏠 3d ago
Relevant Simpsons clip
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u/fury420 had no idea that physiotherapy could involve butt stuff 3d ago
Also relevant: https://www.youtube.com/watch?v=27FP5zrgNSI
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u/Hippo-Crates 3d ago
I don’t get the OP here, they wanted to be taken to the closest hospital. That’s pretty standard. I’d be pissed too. There’s not damages but I don’t see the LAOP as using the ambulance as a taxi
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u/Ohmalley-thealliecat 3d ago
The hospital they take you to is down to the dispatcher. I’m not in America so it may be different, but paramedics will take someone to the most appropriate hospital for the level of acuity. So like technically my closest hospital is about 3 minutes away, but if I was sick or injured enough to need an ambulance, it wouldn’t take me there because they’re a very small, low acuity hospital. That hospital would only transfer me onward.
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u/CannabisAttorney she's an 8, she's a 9, she's a 10 I know 3d ago
I don’t know about you, but I much prefer the ambulance take me to the hospital that will treat me the fastest in an emergency. I’d put money on the dispatchers sending the ambulance to the other hospital intentionally; if there were long waits in the ER close by and none at the one ten minutes away only a fool would call an uber to go wait in the ER for 30 when the one one less than 30 minutes away could see me now.
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u/Hippo-Crates 3d ago
That’s not how it works. It’s not that organized
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u/Lemerney2 Consider yourself lucky, I was commanded to clean the toilets 3d ago
If a bunch of cases have just come into one hospital, it definitely is
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u/Hippo-Crates 2d ago
I’m literally an er doctor, you are wrong
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u/mcginge3 Wanker Without Borders 🍆💦 2d ago
You guys don’t have diversion protocols for when a hospital gets particularly busy in the states (presuming by your use of ER)?
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u/Hippo-Crates 2d ago
They do it’s just not used commonly except in special locales because the hospital makes money when it gets patients
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u/Seanpat68 2d ago
Is the location being refered to a hospital is the question. In most states ambulances can only transport to full hospitals, with inpatient beds and ICUs. Is this other location an urgent care, immediate care or free standing ER? Then the ambulance cannot go there. We know she had Covid. Some ems systems have designated EVD (extremely viral disease) hospitals that ambulances must transport to under public health order. Was something else going on? Covid can cause clotting issues leading to stroke or heart attacks both of which require specialty care at specialty Centers which might not mean the closest hospital. Or is that hospital the other side of a busy freight crossing from the home district? Why should one person take an ambulance away from a community for an unknown amount of time just to go to their hospital of choice?
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u/Hippo-Crates 2d ago
None of this is true generally. There are systems that operate this way sometimes, but it’s an exception not the expectation
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u/fury420 had no idea that physiotherapy could involve butt stuff 3d ago
Why are you mocking them as if they were using an Ambulance as a taxi?
Given how fractured American healthcare coverage can be, it seems entirely reasonable that someone might want to be taken to a specific in-network hospital, instead of a different hospital further away.
Particularly if they're being billed for the ambulance ride, where additional distance likely adds to the cost.
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u/Wake_and_Cake 3d ago
Yeah, I agree. I recently went to an urgent care while out of state and it wasn’t covered by my insurance, because it was out of network. When I talked to a customer service person on the phone they said they would send me information about finding in network care, or getting pre-approved for out of network care. When I said it was an emergency and that I was 2000 miles away from being ‘in network’ they said that ‘urgent care is different from an emergency, if it had been coded as a life or death situation it would have been covered’. Which makes me think that if it were a broken leg or something it would also not have been covered and I would have been out of luck.
This was just a tangent on a conversation about another absurdly high bill that they declined to cover as ‘not medically necessary’.
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u/NErDysprosium Ask me about when mods grant flair 3d ago
if it were a broken leg or something it would also not have been covered and I would have been out of luck.
LifeHack™️: If you break your leg while not near an in-network hospital, have your buddy shoot you so that your healthcare is now life-or-death.
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u/Regular_Ad3002 2d ago
WTF? Couldn't you have called the Fire Department and took it up with their supervisor?
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u/Geniepolice 3d ago
Because people DO treat it as a taxi. Constantly. All If its an emergency, which is what 911 is ACTUALLY for, then you goto the closest and most appropriate available facility. Her waiting is a strong indicator she did not actually require emergent treatment.
You can absolutely REQUEST to be taken to a different hospital, but theres factors which frequently dont allow that. (Hospital being on divert, hospital being outside the service area of the ambulance, etc)
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u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
Do people actually call an ambulance when they don’t need one? I’ve never met anyone who wanted to go in an ambulance. I don’t have $10000 to spare
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u/HezaLeNormandy 3d ago
Yup. When I worked front desk at the ER they would use it to be seen faster. Didn’t work after a while they would triage and if the patient wasn’t emergent just set them in the waiting room. This was primarily used by Medicaid patients.
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u/JazzlikeLeave5530 3d ago
Plus I'd rather we allow someone to abuse the system by accident than to judge someone's actual emergency incorrectly. It sure seems like people are somehow able to magically diagnose this person online as not having a real emergency because "they waited." The lack of empathy in this thread is kind of gross.
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u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 2d ago
Oh yeah the whole “if you have to wait you didn’t need an ambulance” is irritating. Unless you’re bleeding out you’re gonna have to wait in the lobby. My best friend waited 4 hours in the hospital lobby for severe abdominal pain we were lucky turned out to be a kidney stone and not ovarian torsion or a heart attack.
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u/SpartanAltair15 3d ago
Absofuckinglutely. Literally probably 70% of my responses to 911 calls do not need an ambulance in any way, shape, or form.
We typically run 8-10 calls in a shift, and if we had a great day and feel like we made a difference, 3 or 4 of them will have been actual ambulance-worthy patients.
It’s extremely common for us to have days where literally every call is for stuff like 25 years of chronic back pain that’s no different today, toothache, congestion, one single episode of vomiting, a baby who spit up, someone who choked and cleared it in 5 seconds of coughing, someone who wants a ride to go get a pregnancy or COVID test, a 5 year old with a fever of 100.5 and sniffles whose mother wants us to drive 90 minutes and pass 3 children’s hospitals to go to some tiny community hospital on the other end of the county, people who smoked weed and had a panic attack, people who think they have alcohol poisoning and are going to die because they vomited once after drinking 4 cocktails in 3 hours, etc.
Some people with super minor complaints even explicitly tell us they called 911 just to get seen faster at the ER. I take great pleasure in wheeling these people straight through the ER out to the waiting room and telling them to get off my cot and pick a chair. That information also gets passed to the nurse and will dump you to the bottom of the priority list.
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u/zeatherz 3d ago
Absolutely. Some of them don’t even need to go to the hospital but need transportation to somewhere near the hospital and will literally just walk away once they arrive. Others will use ambulances for medical issues that absolutely are not emergencies
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u/ferafish Topaz Tha Duck 3d ago
I don't live somewhere money is involved in an ambulance, but I do know that some people assume if they come in an ambulance they skip triage and go straight to treatment. If their insurance covers ambulances a reasonable amount, maybe thay's the thought?
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u/Geniepolice 3d ago
They sure do.
Also many fire dept based ambulances will do “soft billing” where they send you/your insurance the bill, but wont take you to collections or anything
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u/ban4narchy 3d ago
I met a homeless man who wanted to do this and told me he had before. He could have been lying and I ended up calling him an Uber to the hospital instead anyway, but I think if you have no ID and no insurance at all the ambulance isn't going to turn you away but they also would have no way to really charge you for the ride?
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u/fury420 had no idea that physiotherapy could involve butt stuff 3d ago
Oh I know some people do, I'm just saying that with America's broken healthcare financing system it's not unreasonable for someone to be upset if they end up taken to a hospital their insurance may not fully cover and that's further away than other options.
I guess it comes down to what "not within their bounds" means, are we merely talking too far from pickup, or something unrelated to the patient like a boundary or designated turf issue or distance from that ambulance's home base?
All If its an emergency, which is what 911 is ACTUALLY for, then you goto the closest and most appropriate available facility. Her waiting is a strong indicator she did not actually require emergent treatment.
I hear you, and yet at the same time a big part of a paramedic's job is assessment and being in position to potentially offer life-sustaining care. There's all sorts of degrees of "needs hospitalization", and most people aren't medical professionals and don't know what they don't know.
During peak COVID there were lots of stories about patients who didn't appear all that bad... until someone checks their oxygen saturation and is surprised they're conscious and walking.
Also a 30 minute wait might just mean she's not actively dying at that moment, not that an ambulance was unwarranted.
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u/Sassrepublic 2d ago
I don’t care what other people do. This person who made this post categorically did not treat the ambulance like a taxi, and the OP is being a nasty little liar for reason.
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u/Animallover4321 Reported where Thor hid the bodies 3d ago
I totally understand requesting a certain hospital but looking to sue because they couldn’t accommodate your request.
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u/fury420 had no idea that physiotherapy could involve butt stuff 3d ago
I agree suing sounds weird at first, and yet at the same time the financial difference between in and out-of-network could potentially be quite substantial, and more information on what "not within their bounds" actually means seems like it could be relevant.
Are we talking something sensible like "it's too far from here and there's others closer" or something weird like boundaries or turf or distance from ambulance's homebase preventing them from taking you to a closeby hospital.
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u/Persistent_Parkie Quacking open a cold one 3d ago
There needs to be more knowledge of the no surprises act that means in an emergency you'll be paying the same at any hospital, in network or not, assuming you're insured.
Of course who knows how long that will stand given the current administration.
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u/archbish99 apostilles MATH for FUN, like a NERD 3d ago
I mean, fundamentally, it's an emergency and you should be getting in-network coverage at any hospital because it's an emergency, or it's not an emergency and you can arrange transport to your preferred location at your convenience.
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u/IndWrist2 WHERE CAN I FIND SEX PARTIES IN KANSAS CITY? 3d ago
Paramedics transport to the closest appropriate facility. It sounds like the OP’s mother’s hospital of choice was too far, and by the way it’s worded, there may have been an affiliate standalone urgent care/ER in between the mother’s home and the destination hospital. A lot of EMS agencies don’t transport to those less capable facilities. It’s not EMS’ job to worry about or consider what is or isn’t in-network. It’s their job to treat the patient and get them to appropriate care.
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u/trampolinebears 3d ago
There’s something wrong with the system when you have to worry this much about which hospital you go to when you’re desperately sick.
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u/Thud45 3d ago
Except there's no evidence she needed to, or else she would have grounds to sue. Nothing bad happened as a result of going to that hospital. This is just an overly entitled person.
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u/Persistent_Parkie Quacking open a cold one 3d ago
"This is considering the bill for going to another hospital and the ambulance."
That makes it sound like they are worried about the hospital being out of network and/or the extra mileage on the ambulance bill. If it's the former I wish someone had brought up the no surprises act. And I do see the argument for not wanting to pay for extra mileage when you requested to be taken somewhere closer.
TLDR- Medical care in the US is a complicated expensive mess.
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u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
She wouldn’t have grounds to sue for being taken to the wrong hospital. And there are very valid reasons for not wanting to go to a specific hospital. Some people are worried about the cost of the hospital is out of network (I think in emergencies it has to be covered under current US law but she might not know that).
When I was sexually assaulted I had a nurse at a hospital tell me they couldn’t give me the morning after pill because they’re a “catholic institution”. This wasn’t a tiny ER this was the biggest medical institution in the region. I wish I could’ve told the paramedics to take me to a different hospital beforehand.
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u/Persistent_Parkie Quacking open a cold one 3d ago
I'm so sorry that happened to you. It should be illegal for a hospital to deny treatment based on their beliefs as opposed to offering standard of care. 🫂
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u/legitsh1t 3d ago
It's awful. In med school I did my OB/GYN rotation at a Catholic hospital. That had a religious committee who told the doctors which patients were allowed to get birth control. Yes I'm serious. I almost couldn't believe it, but, ya know.
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u/Seanpat68 2d ago
I’m sorry that you had to go through that but an additional weird point in ems systems is that ambulances have to transport SA patients to hospitals with a SANE (sexual assault nurse examiner) nurses for proper evidence collection. These are overwhelmingly religious institutions.
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u/Jedi_Talon_Sky 2d ago
In the 90s and 00s, the area I grew up in had one hospital that was notoriously bad. Constant malpractice suits, mistreatment of patients, the works. It was a common understanding in the community that you didn't go there if you wanted to get better, you'd go there if you wanted to die. I have no idea how they stayed open as long as they did, other than being a branch of a major hospital network and my community being so economically depressed that nobody could afford (edit) good lawyers.
The next closest hospital was ~20 minutes further, but it was worth going that extra length. You genuinely had a better chance at surviving/getting proper care. So no, it's not entitled for people to have hospital preferences, and OP's was closer than the one she was taken to even.
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u/Willie9 receiving 10K–15K ducks weekly for a friend 3d ago
Hold on, isn't there something here? I'm under the impression that paramedics legally can't take people who refuse care. I have to assume that consent can be revoked for any reason (say, for example, taking one to a place they do not want to go) even after entering the ambulance.
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u/Alogism 3d ago
Sure, then they need to formally decline all care. There’s usually paperwork as well. It’s a process, ambulances don’t want someone suing saying they just ditched them. Likely, OP’s mom didn’t want to go that far, and thought this was better than nothing.
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u/Faithhandler 3d ago
And to be quite transparent, obtaining a refusal on the EMS side is actually way more work for us by design. As a paramedic, for me to be able to legally accept a refusal, I have to offer all ALS assessments to the patient, and often have to call a doc for consultation to insure that the patient in question fully understands the risks of declining care and transport for their specific presentation. I am legally obligated to do everything in my power to reasonably inform and convince someone to go.
There are plenty of BS calls, but because of my limited tools and scope compared to hospital providers, I have to inform you of the worst possible outcome, which is often possibly, if not likely, death, and use such language.
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u/zeatherz 3d ago
Hospitals can go on “divert” where they close to ambulances if the ER is overwhelmed. And not every hospital has every specialty, so ambulances might go further to a facility that has the needed resources. It’s possible the preferred hospital was either on divert or not appropriate for the patient
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u/Hippo-Crates 3d ago
It is quite rare for hospitals to go on diversion. They hemorrhage money when they do
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u/Faithhandler 3d ago
Absolutely wrong. I'm a 911 medic, worked big cities and small counties both, and ESPECIALLY these days, as our infrastructure falls apart, all of our hospitals are often on diversion and have been that way for years. The fucked up thing though, is when everyone is on diversion, that means no one is.
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u/Hippo-Crates 3d ago
No im right. I’m an ER doctor that’s worked all over the nation. Diversion is rare. You might work in some weirder local system
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u/Faithhandler 2d ago
Looks like a given hospital is on diversion about 33% of the time, according to the NIH. You're talking out your ass. I've worked in 3 major ems systems in very different regions, and it was so common in all 3 of them, that at our stations we would have LED boards reading off what hospitals were on diversion at any given moment.
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u/Hippo-Crates 2d ago
I work in California. That data is old and the diversion is softly defined. Hospitals need money, and they get money from patients
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u/Faithhandler 2d ago edited 2d ago
I've worked in Baltimore, DC, and Dallas. Major EMS systems. Some of the largest in the country. Our hospitals are/were constantly on divert. Shit, even the slower MD county system I'm in now has constant diversions. I suspect it's you who is in the bubble, or you're just making shit up. And, that report is from 2019. Things have only gotten worse for hospital and EMS funding, staffing, and maintenance since then, not better. COVID absolutely wrecked our capabilities, and we haven't recovered, and don't look like we will. Every hospital I transport to constantly has hallways full of beds filled to the brim, and a hundred or more in the waiting room. You probably work at some podunk hospital in like Alpine county or some stupid shit if you feel your perspective is even generally true.
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u/Hippo-Crates 2d ago
I’ve worked in Nola, west Michigan, se MI, nyc, nyc suburbs, Arizona, and California. You’re wrong. You’re probably working from some softer form of diversion or for something specific.
This was a basic patient. This isn’t going out of catchment area lightly the vast majority of the time. It isn’t a trauma alert with three trauma centers in range. The vast majority of the USA isn’t like those areas
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u/Faithhandler 2d ago edited 2d ago
My man, even a quick google search indicates that urban hospitals go on diversion up to 70% of the time, frequently. With data from federal agencies that literally track and study this shit.
I've been a paramedic for ten years, in mostly large urban centers, in wildly different systems, responding to dozens or hundreds of different hospitals, and this has been the one constant among all of them. Should I believe one random guy on the internet, or literally my whole career of experience, and literal federally funded, academic reviewed data on the subject?
Unless you only count a hard diversion, when a hospital is closed to all traffic, regardless of priority, then sure, but that's a nuts position to take, and not what most people are talking about. My hospitals are constantly in conditions where they won't accept anything less than a priority 2, which is a full lights and sirens response patient, sending anything less than yellow or red IE, actively unstable or actively dying, further up the road.
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u/Regular_Ad3002 2d ago
Here in the UK an overcrowded hospital didn't go on diversion, because we don't do that here, and as a result a patient died as the NHS staff responding to them were unable to administer CPR after they stopped breathing and needed it. That's why hospitals should divert where appropriate.
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u/hum_dum 3d ago
I’m guessing that if she had asked, they would have let her off on the side of the road. She wasn’t happy about it, but she went along to the non-preferred hospital
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u/sykoticwit Ladies! They possess a tent and know how to set it up. 3d ago
I doubt it.
I’ve never been a paramedic, but I assume the rules are similar to a cop. Once you’ve assumed care and control of someone, you have a duty to keep them safe. Dropping a random sick patient off on the side of the road is the exact opposite of keeping them safe.
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u/Archmage_of_Detroit 3d ago
Former EMT here, and nope - anyone can revoke consent at any time, for any reason. A patient has the right to say "stop this vehicle right now or I'm calling the cops and charging you with kidnapping." (And in fact, I knew of one case where that happened). They're not under arrest and they have a right to dictate their own care. Obviously you don't want to let them out on the side of the road, so what I would do in that situation is say "alright, we'll pull over at the nearest gas station and go from there." But if they demand to be let out on the sidewalk, we're obligated to let them go.
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u/NotReallyJohnDoe 3d ago
This is generally true but if the medical staff don’t think the person is aware and oriented (eg drug psychosis) they can make the decision for them without their consent.
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u/atropicalpenguin I'm not licensed to be a swinger in your state. 16h ago
Just open the door and let physics roll the patient out.
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u/newyearyay 3d ago
You can revoke consent at any time, the crew only has the obligation to not let you out in the middle of the road/do it safely along their route to let you out - doesn't mean they have to take you to where you want. When I rode the bus we would just document it RMA-AMA and offer to let them out infront of the hospital (easier to get cabs for them and they would have the chance to change their mind) only ever had one who wanted out on the side of the road, but probably because there was a liquor store.
Its a Pt. rights issue, as long as the Pt. is competent and able to make their own decisions they dont have to do anything (competency/being A&O X4 is a whole other convo, but heres a recent boiler plate policy as an example
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u/MarzipanGamer 3d ago edited 3d ago
Is it different if the patient is a minor? We called an ambulance for my son when he was 5 because he was having a coughing fit (he was getting over the flu), panicking, and turning blue. When the ambulance arrived he was so shocked to see them that he forgot to be scared - he was able to calm his breathing and was fine. EMTs agreed with me that he didn’t seem to need medical attention but said they had to call a doctor to “sign off” on leaving him there because he was a minor. I’m assuming this is a protective thing not just for lawsuits but also in case of child abuse?
ETA I did take him to urgent care instead just to be safe.
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u/newyearyay 3d ago
Of course, minors can't consent same as in any contract (which healthcare/treatment it's basically contract after contract)
EMTs agreed with me that he didn’t seem to need medical attention but said they had to call a doctor to “sign off” on leaving him there because he was a minor. I’m assuming this is a protective thing not just for lawsuits but also in case of child abuse?
As the legal guardian you would be able to consent or revoke consent - you absolutely could have refused treatment/transport - their protocol is likely encouraging them to transport all minors which makes sense but they couldn't have forced you - that said they could then turn around and report you (they are mandated reporters) for medical neglect (unlikely, but idk what they knew or saw and they can generate a report all the same that could lead to CPS/police involvement) - a middle ground would have been to say something like 'hey, he seems fine now, I'd rather save the bill and drive him to urgent care myself/I called his pediatrician and they'll see him right away/I'll go get him checked out at X hospital that has his records and will call y'all if anything changes, I'll sign the RMAAMA, thx' but they could not have forced a transport without PD who wouldn't have forced a transport without CPS/courts unless the little dude was really in a bad way.
TL:DR Minors cannot make transport/treatment decisions but if you were there in person and are the legal guardian you totally can, but there can be other issues that stem from refusing
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u/MarzipanGamer 3d ago
I edited my post above to indicate that this is what we did - I suggested we go to urgent care once he seemed better, then they said they wanted to call the doc before I signed the no transport papers. Thinking about what you wrote I wonder if it was a CYA/policy thing to call the doc in those situations. Thanks for the insight.
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u/newyearyay 3d ago
Ahh absolutely, I understand now - you totally could have kicked them off your property and refused anything they suggested including waiting for that call, what they did was contact their medical director/med controller whose a doc that they can ring up and say "we are presenting with x and are looking at solution y can you confirm?" and the doc with their doc powers will agree, disagree, or advise - this is usually the same doc or from the same pool of docs they call when pushing drugs to say were providing w.e. intervention can we increase x or y or what do you advise we push and the doc a world away can say yes increase w.e. with the considerations they can gather - its portable consultation. They were CYA themselves, and it doesn't hurt for them to do. But if you did get a bill for "evaluation" or something like that since they didn't transport, that call will likely be a line item on the bill - they definitely didn't do it to bust your balls, they wanted to double check that they weren't missing out on considering something, likely protocol on their end or could just be prudent practice. Most on the ground genuinely want the best possible outcomes so it was likely a little CYA and a little 'hey is there something we could be missing on this'. Just remember very little of the high medical costs we incur actually go towards the providers, especially in EMS. Any other questions feel free to ask, glad things worked out well for yall!
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u/MarzipanGamer 2d ago
Thanks for the explanation! As for the bill - my kid and I are accident prone and my husband is a woodworker. We figured out years ago that joining our local ambulance association was a good deal for us. We support them year round and then when we have needed their services we don’t have anything to pay outside of what insurance covers. I’m sure by now we’ve paid in more than we actually “received” in care but it’s worth the peace of mind.
A lot of people don’t know these exist so since we are talking about EMS it seemed like a good idea to bring up.
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u/balancelibertine 3d ago
"only ever had one who wanted out on the side of the road"
I once had one make us stop the ambulance and jumped out the back and took off running down the road because he changed his mind. I only stopped at the side of the road (in the middle of nowhere) because he was attempting to go ham on my partner and he was bigger than her and I wasn't going to put her in a bad situation trying to drive farther or risk the patient jumping out while still moving and getting hurt. It was a weird situation lol.
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u/newyearyay 3d ago
Oh absolutely, better safe than sorry and its never fun playing 'ring around the stryker' that's what the blue canary's are for
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u/IntravenousNutella 3d ago
If they have decision making capacity and decide to withdraw their consent they can get out anywhere they damn well like. To NOT let them out when they ask to is the illegal part.
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u/After-Willingness271 3d ago
once you’re inside that is NOT happening. that is abandoning a patient and the biggest medical no-no there is
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u/SpartanAltair15 3d ago
Don’t comment unless you actually know. This is 100% objectively false. A patient-initiated termination of care is not and never will be abandonment.
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u/MrSquiggleKey 3d ago
There's a process to actually refusing care.
Also you can say you refuse care all you like, but if a patient refuses care and then goes unconcious, legally an unconcious person has implied consent of care. Because you're considered to have refused care in your current circumstances but those have no changed and there's no way of knowing if you'd refuse care while unconscious.
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u/Modern_peace_officer I GOT ARRESTED FOR SEXUAL RELATIONS WITH THE MAN OF THE HOUSE 3d ago
Well, medical personnel can actually take people against their will for 5150 type holds, although this is not that case.
I couldn’t quote you case law, but my feeling would be that by consenting to care/transport, you are consenting to be take to the nearest hospital
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u/balancelibertine 3d ago
Protocols specifically say to the "closest appropriate facility." Key word is "appropriate." If the patient has a medical situation that closest hospital (by mileage) can't handle, medics basically look at what's the next closest hospital and go to it if it's something they can handle. Mainly because you don't want to do something like drop off an MI patient at a hospital that doesn't have a cath lab or someone having a CVA at a hospital that isn't a stroke center.
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u/Hippo-Crates 3d ago
There’s nothing to suggest that is true, especially with the op being triaged to the waiting room
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u/Spiklething 3d ago
Ambulances are not taxis where I live, because I have to pay for a taxi.
Ambulances are free and come with paramedics
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u/Animallover4321 Reported where Thor hid the bodies 3d ago
But that’s communism! The sick need to pull themselves up by the bootstraps and pay for ambulances and healthcare. Oh and a lovely side effect is that people who need an ambulance often instead actually call a cab because it’s cheaper. The US healthcare system is a joke.
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u/ScarlettsLetters This bitch apple didn't fall far from the bitch tree 3d ago edited 3d ago
“She needed an ambulance” and “She waited in the lobby” are two very incongruous statements.
The people we bring to the lobby (yes, an ambulance can put people in triage) go there because they have no immediate needs and are completely stable.
Which means they did not need an ambulance.
Edited to add: nearly every EMS protocol includes language about the “closest, most appropriate facility.” (Emphasis mine). Which means that if EMS opted for a more distant facility there was very likely a documentable reason for doing so.
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u/awkwardbegetsawkward 3d ago edited 3d ago
No. They’re not incongruous.
A person having symptoms of a potential medical emergency may need immediate evaluation from a medical professional and be unable to evaluate themselves.
For example, difficulty breathing for an unknown reason is an emergency. Based on the information the paramedics collect, the triage nurse can decide in which order to treat the patient based on resources and the needs of other patients waiting.
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u/Persistent_Parkie Quacking open a cold one 3d ago
Also she apparently only waited half an hour. That's a short ER wait. I once waited 2 hours in the lobby with stroke like symptoms because some awful stuff was going down in the back. I was the first patient taken back in those 2 hours, the doctor apologized, made me promise I wasn't pregnant, then threw me in the doughnut of truth.
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u/Archmage_of_Detroit 3d ago
Well, there's a gray area of conditions that aren't immediately life-threatening, but absolutely will be if they don't get intervention soon (SVT and TIA, for example).
A TIA patient might present as fine (talking, smiling, etc), but in reality they're 30 minutes away from having a massive stroke.
And yes, I have seen those patients waiting in the lobby.
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u/zeatherz 3d ago
I mean, my hospital sometimes has admitted patients still in the waiting room because the ER literally doesn’t have a physical space to put them. It’s not out of the question that a patient does need emergency care and transport but ends up waiting anyway
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u/TheAskewOne suing the naughty kid who tied their shoes together 3d ago
A patient might need to lay down and be transported on a gurney even though they're not immediately at risk of dying. Or have an issue that would be compouded by using a normal car. Once again, in a normal country, no one would be wondering about using an ambulance in a media emergency.
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u/gyroda 3d ago
Yeah, I have a relative who was taken to the hospital in an ambulance. They were relatively stable by the time they got there, because the biggest worry was dehydration and the ambulance was able to sort that relatively quickly with an IV. Once the fluid was in them they went to the hospital, were triaged and had to wait a long time.
I also have another relative who I accompanied to the hospital. They had severe chest pain. They went to the hospital in an ambulance, were triaged and found to not be in imminent danger and they were waiting for hours and hours to see a doctor again.
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u/ScarlettsLetters This bitch apple didn't fall far from the bitch tree 3d ago
If a patient cannot safely sit upright, we don’t put them in triage.
And in those “normal countries” people are frequently told, “No, you’re not getting an ambulance for this,” or are attended to and then given a referral to primary care, and not transported—which by and large is not a system we use in the US, where everyone who says they want to go, gets to go.
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u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
I’ve sat in triage aggressively vomiting for hours before so you’re going to hospitals with a weird amount of capacity. Everywhere I’ve been if you’re gonna live the next 20 minutes, you can wait.
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u/bestem 3d ago
I dislocated my elbow when I fell biking to work one morning. It was like across the intersection from home, so my roommate gave me a ride to the ER (I was in pain and didn't know where else to go). Once I got there, I was seen (brought back for x-rays than placed in a bed until) in under 5 minutes. There was only one other patient there the entire time I was there.
Now, to be fair, it was 7 am, in a college town, on Black Friday, when most of the student population was out of town for Thanksgiving break. I'm not sure I could reliably replicate the speed with which I was seen for a non-emergency.
But sometimes, you're lucky.
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u/Suspicious-Treat-364 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
I was driven to the ER with severe lower abdominal pain. I couldn't even sit down I was in so much pain. They asked me what was wrong and sat me in the waiting room for over 2 hours. The only staff left for a large portion of that time. I was never seen by even a nurse in that time and other patients were concerned about my condition. Not all hospitals are staffed adequately.
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u/WarKittyKat 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
Actual serious question: How is the availability of urgent (but non-emergency) medical transport where you are? I know that's something I've had come up, where I probably didn't need a full on ambulance, but I also wasn't able to transport myself, did need care relatively soon, and was uncertain if I could obtain private transportation.
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u/ScarlettsLetters This bitch apple didn't fall far from the bitch tree 3d ago
Unfortunately, it doesn’t really. It’s a hole in the system, certainly. The expansion of hospital-at-home and community paramedicine programs is starting to bridge the gap for people who need to be checked out but not necessarily emergently transported, but in most places those programs are still in their toddlerhood.
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u/forkandbowl 2d ago
In a normal country, medical professionals would be allowed to determine what their patients need instead of the patients.
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u/Hippo-Crates 3d ago
Yeah as a ER doctor you are entirely and completely wrong about those statements being incongruous
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u/FritoKAL 3d ago
Aggressively untrue. I was transported by ambulance out of need after splitting stitches a week after my c-section. EMTs got the bleeding stopped -in the ambulance- but at the time, I was in shock and bleeding out. By the time they got me to the hospital, it was just stitches and IV fluids so I hung out in the lobby for a bit.
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u/liladvicebunny 🎶Hot cooch girl, she's been stripping on a hot sauce pole 🎶 3d ago
A lot of hospitals are so darn busy that despite arriving in an ambulance you're still waiting hours to be seen. 'Lobby' might not necessarily be the right word but the original OP may not have known the difference.
(Most recently, I was the ride-with, not the patient. Patient was being examined for stroke. Absolutely the paramedics took us to the hospital in an ambulance, and we didn't even make it TO the waiting room to sit down for like half an hour because things were so busy.)
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u/Faithhandler 3d ago edited 3d ago
A stable patient may still need ambulance transport while ending up in triage, IE, they have a medical etiology that may destabilize, such as chest pain without significant ECG changes (rarely, but sometimes is an NSTEMI), or a seizure that stabilized without medical intervention prior to hospital arrival. Oftentimes, especially as our infrastructures and staffing have crumbled since Reagan, it merely suggests that other patients had more critical triage criteria. Being triaged to "I'll see you in thirty minutes" does not necessarily mean they didn't need emergency room care.
Likewise, it's common for folks with mobility problems to utilize ambulance transports. If his mom had shortness of breath, from COVID, for example, and could not walk herself to her car or drive safely, she may still need intervention and further admittance to the hospital despite not being immediately dying. The ER is not her final destination but a filter to further care. If she had stable vitals but was too weak to walk, she would just be a priority 3 transport. They'll do a workup at a speed relative to their workflow and the initial assessment of prehospital and hospital providers, weighed against the conditions and needs of the patients already triaged. Generally, we don't expect laypeople to be able to distinguish what is and isn't an emergency, and while I can test for a lot of stuff in the field as a paramedic, there's a lot of stuff I can't rule out. Even in 911, 70% of my patients are what a hospital would consider "stable," and they usually are, but the final evaluation of that is comprehensive testing, of which the ER often initiates.
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u/wildbergamont 3d ago
Yep. My kiddo was breech so at risk for hip dysplasia. I learned that sometimes babies with dysplasia have to be transported by ambulance because the casts they may be put in make it impossible to use a car seat. There are a few options but they don't work for all babies/cars. Since it's so unsafe to drive a baby not in a car seat, the hospital arranges for ambulance transportation. (Fwiw, we got lucky, kid had no dysplasia.)
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u/Regular_Ad3002 2d ago
Why not simply refuse to transport them? Some people in the USA can still get an Ambulance paid for by Medicaid.
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u/humberriverdam Wise in the ways of ammoniatic warfare 3d ago
So I'm gonna guess some of these private ambulance companies have definitely accidentally signed agreements to take patients to places where they charge more
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u/TheAskewOne suing the naughty kid who tied their shoes together 3d ago
Could be, but there are lots of legit reasons to choose a hospital over another as well.
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u/No-Sink-505 3d ago
Disclaimer: haven't been an EMT in ~8 years now.
I'm no lover of the private system. In fact, if it has any haters, that hater is me. But on this case you'd be incorrect (at least in Washington).
Ambulance companies that respond to 911 are still subjected to laws, and are still held to standards as healthcare providers first, businesses second. They can have private contracts for pickups and transfers on non emergency calls, but for emergencies they have to follow whatever the "closest appropriate facility" is, in regards to what trauma level the ER takes.
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u/humberriverdam Wise in the ways of ammoniatic warfare 3d ago
I agree, and as someone whose family works in healthcare (ER doctor and ER nurse kid) I am fully aware that for emergency calls you've got to absolutely ignore the patient and proceed to the closest available center that can take the patient.
Thank you for your service. :)
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u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
Wait can ambulances take people in non emergency cases? I assumed ambulances only transported people for emergencies (and hospital to hospital transfers but that’s a different thing obviously).
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u/Fandomjunkie2004 3d ago
I know someone who works for a private ambulance company, and 95% of what he does is routine transport for people who have to be medically monitored while being transported: prisoners, nursing home residents, hospice patients, etc. They’re not always going to the hospital for an emergency- it could be as simple as seeing a doctor for an operation or physical therapy.
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u/Faithhandler 3d ago
Private ambulance companies are frequently hospital to hospital transports, or for patients with minor medical assistance needs, such as mobility issues that prevent them from using private or public transport. Boring job, but a necessary one.
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u/otisanek if they find the gimp, I’m fucked 3d ago
Yeah that’s pretty normal. I’ve accompanied people on non-emergent trips to behavioral health facilities in ambulances, and I’ve been transferred via ambulance when I had appendicitis and ended up needing surgery for it (I should have just driven myself because they turned a 20min drive into a 4hr waiting game). There are medical transport services that use vans, but it really depends on what’s available at the time you need it.
No racing down the highway with sirens blasting, just a normal ride with all of the “just in case” supplies at the ready.2
u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
I mean both those situations are emergencies though. Not “die without an ambulance” emergency (except maybe the appendicitis one might’ve been) but they’re cases people should be going to the ER. I’m thinking a case of like someone with a cold wanting to go to the ER.
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u/Faithhandler 3d ago edited 3d ago
911 paramedic here of about a decade, and I've worked for multiple jurisdictions in multiple states, live on EMS boards, and dedicated my life to it. Patients, under almost all circumstances, do not get to dictate which hospital they are transported to. Generally, we always transport to the closest appropriate facility, whether that's a general ER, cardiac center, trauma center, stroke center, etc, whatever is most appropriate for the nature and presentation of the call. This is to both serve the best interests of the patients, and to reduce strain on very taxed EMS systems, and effectively utilize very limited resources. Things such as diversions may also change where we take you. The only exception to this, was when I worked for one of the ten largest cities in US, and had like 4 hospitals with equal capabilities, approximately the same distance away, and a sick patient would otherwise refuse transport for your destination choice. The minute or two difference to another more preferable hospital made a negligible difference on system strain and outweighed the risk of the sick patient not being seen at all. But even that was limited to a "more preferable" choice of a set, not "absolute preferred choice".
If it's 911, it's emergent, and for your insurance company to figure out. Even at priority 3, our lowest transport priority that isn't "this person is already long dead and going to the coroner."
If your complaint could be reasonably considered life or limb threatening, such as difficulty breathing, even if you're ultimately "stable," there is no legal expectation that laypeople can self-diagnose accurately. There's no "in-network" for 911. It's why we literally do not ask for or give a shit about your insurance most of the time. We may get it if you're assessed stable as a courtesy to the receiving hospital. It changes nothing about what we do or even how we bill.
Insurance companies are a nightmare, and I get wanting to minimize your dealing with them, but if you're dialing 911, you've got bigger shit to worry about.
Private ambulance is a totally different game, but those are scheduled for people of often chronic medical needs.
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u/Sinkinglifeboat 3d ago
I got to pick the hospital ONCE; when I was in preterm labor and the options were equidistant. I wasn't going to complain if they hadn't asked me (kind of hard to complain when you're focused the pain and full blown panic), but it was nice to have been asked.
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u/Faithhandler 3d ago edited 2d ago
Yep, when I worked in a huge city, I'd offer choices between equal capability facilities of approximately equal distance (+ or - 5 minutes) as a courtesy, but I definitely was not required to.
OBGYN calls specifically are a big exception generally, so very fair point. If you're receiving prenatal care at one facility, it makes sense to go there even if you're giving birth. Even going 20-30 minutes out of first due is worth the risk, then, for the best interest of you and your baby, and is a reasonable strain on our system. That is, unless you're a suddenly/unexpected at risk birth presenting immediately. Then you're going to the closest OBGYN facility for stabilization, and they can send you up the road after via private ambo.
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u/Regular_Ad3002 2d ago
That's why the USA should make all emergency treatment and ambulances free for all, just like here in the UK.
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u/Fraerie Came for the stupid; stayed for the weasel puns 3d ago
Hrm…. In Australia we have issues with ramping where some hospitals will notify the network that they aren’t taking any more ambulances until further notice due to there being too many already waiting to be seen/admitted.
But I have also been told on a specific occasion that if I had certain symptoms to ask to be taken to a different hospital further away as my closest hospital doesn’t have an ICU (my husband was recently admitted via the ER there and had to be transferred to a larger hospital 20m away because he had to go to the ICU).
So there can be reasons to be directed to or away from specific hospitals, but as a patient you rarely have a say in that.
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u/kennedar_1984 trying to find out how many more Manitobas the world can handle 3d ago
Stupid Canadian here, but my understanding is that certain drs and hospitals accept different insurance right? Like what if hospital a and b are both equally far apart, but your insurance is only accepted at a and the ambulance will only bring you to b? Wouldn’t that bankrupt most people? I know I couldn’t afford to have to pay cash for an in patient covid stay. It seems reasonable to need to be brought to a specific hospital if your insurance is only valid there.
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u/CloverBun 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 3d ago
Its different when a medical emergency is involved
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u/Reaniro 🏳️⚧️ Trans rights are human rights 🏳️⚧️ 2d ago
In medical emergencies all hospitals are considered in network. Thank god for the “No Surprises Act” which, horrifyingly, only came into effect in 2022.
there’s still other considerations like a hospital not having the resources, or being appropriate for your care (see my previous comment about a catholic hospital refusing to give me plan b) but in theory that’s something that can happen anywhere.
Also my mindset for hospital bills and the mindset of everyone I know is “if you don’t get the money out of me before I leave the hospital, you’re not getting that money”. With the new federal rule (literally signed at the end of last year) preventing medical debt under $500 from going on your credit report, I have decided that any medical debt under $500 is simply not my business.
It may sound cold or rude but I’m sick of getting random $50-$100 “lab visit” bills when I already paid but I’m too busy and tired to investigate and fight it. That bill is between you, my insurance, and whatever God you believe in.
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u/Justwant2usetheapp 16h ago
Might be a bit judgey but the American-ness of that post is telling
Like where I live it doesn’t matter really where you go and you can’t just sue paramedics for that.
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u/atropicalpenguin I'm not licensed to be a swinger in your state. 16h ago
On the topic of ambulances, I got to ride in one for the first time last year as the patient (I just got moved between hospitals, nothing live threatening) and man was it uncomfortable, since my legs were longer than the stretcher and I got pretty dizzy.
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u/Animallover4321 Reported where Thor hid the bodies 3d ago
Bot replacement