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Friday, January 25, 2013 7:14 PM

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Emergency personnel respond to an injury wreck last year north of Ottawa. Franklin County EMS is seeing an increase in the amount of patients refusing transport to medical facilities, regardless of the severity of their conditions.

EMS refusals on the rise

By CRYSTAL HERBER, Herald Staff Writer

What’s more costly to lose: Your money or your health?

Money seems to be the answer for many, based on the number of “refusals to transport” that Franklin County Emergency Medical Services received last year. About 27 percent of the almost 3,000 calls EMS received ended in the patients refusing to be transported to a medical facility, Nick Robbins, ambulance director, said. This is a definite increase in recent years, he said.

“We’re seeing a pretty good increase,” Robbins said. “What we’re seeing is a lot of people don’t want to pay that much or don’t have insurance.”   

In December alone, EMS transported almost as many patients to Ransom Memorial Hospital — 87 — as they had refusals/standbys — 83. Those numbers do not indicate, Robbins said, the number of patients who were taken to the hospital by other means after EMS leaves. The average cost of an ambulance transport is $528. The cost can vary based on the distance traveled and condition of the patient. The Franklin County Board of Commissioners voted in September to increase the ambulance fees, and that increase went into affect Jan. 1.

Even a small car wreck could lead to major injuries, Robbins said, including internal bleeding. There’s numerous underlying causes that could be associated with a car wreck depending on what’s going on, he said.

“There’s a lot of internal injuries that we can’t see, we don’t have X-ray machines and all of that,” Robbins said, “that’s why we try to get them to go.”

In many cases, if people have insurance, that insurance will pay for transportation to a hospital, Robbins said. But with the large number of people without insurance, Robbins said, the threat of a huge medical bill could influence their decision.

“I think a lot of people are scared of the bills that they will see from the hospitals,” Robbins said. “It gives them peace of mind when we come out and tell them ‘well you’re not bad yet, but it’s got the potential for being bad.’”

EMS crews are not medical doctors and they don’t have the capabilities to run diagnostic tests, Robbins said, which is why they usually try to recommend a patient be transported.

In the instance of a refusal, the patient must sign a release form stating their refusal so the county is not held liable should something happen to the patient, Robbins said. No matter how severe the injury or illness, Robbins said, the department cannot force a person to go to the hospital if they refuse.

“We have to explain to them that it’s their decision whether they need to go or not,” he said. “We can’t make them go.”

If a patient is not coherent enough to make a decision for their treatment at the scene, and they don’t have a power of attorney, the EMS crew can make a decision for them, but law enforcement has to be involved at that point, Robbins said.

Another issue the department is running into is people using the ambulance as a quick fix for a medical condition as a cheaper alternative for going to the hospital. The department responded to about 58 diabetic calls last year, Robbins said. In many of those cases, he said the patient was given an insulin shot and then refused to be transported.

“We’re seeing more and more people that are using emergency services as a go-between between primary care and staying at home,” Robbins said, indicating diabetic emergencies or flu-like symptoms.

In most cases, Robbins said, they still recommend the patient go to the hospital, but more often the patient will feel better and refuse to be transported.

In the past, the department didn’t charge for that service, but that may change, Robbins said. The department is looking into possibly charging for those incidents in future. Robbins said he plans to present a more in-depth report to the Franklin County Board of Commissioners, which will break down the refusals versus stand-by calls, and why the patients initially called EMS. 

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