AHS Ambulances not available in Calgary, Police and Fire often step in.

[killramos]

Seems to me we should be shunting PT to Ubers

[ZenOps]

Said it before will say it again: Apple cider vinegar with extra floaties. But make sure there is none left on your teeth.

Wait for a year for any scars to heal up before using.

[zechs]

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Maybe I am just noticing, but it feels more now than ever that medical professionals are being treated like trash by their clients. I know this has happened in the past as I have heard this a lot from nurses. It just seems to be more intense than before though.

Again, maybe it's always been this way and I am just starting to see more of it, but society as a whole has gone way downhill in how we treat each other. This fuels further depression, drug addiction, spiraling to make it worse than before. Generally I have a neutral or positive outlook for the future, but it's become negative this past year.

When you've been in a life threatening emergency situation, and the staff candidly ignores you and slooooowly goes about the business of saving people's lives, you might get upset too.

Fuck Alberta healthcare and fuck the majority of the staff who can't be bothered to do their job with one ounce of haste. They get paid to do a job, if they do a shit job, they will get hassled. The only reason they still jave jobs for doing a shit job, as mentioned, they have a monopoly enforced by government.

[jutes]

Call ambulance for headache or back pain. Oh lawd. The problem isn't wait times and lack of staff, it's the population abusing the healthcare system.

[Xtrema]

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Anecdotal (although I’ve got a handful of anecdotal experiences) but there’s definitely not a staffing issue at hospitals. There’s a lot of people who don’t need ER jamming up the ER though, and if they’re coming in from an ambulance, makes it way worse.

I went in myself a couple of weeks ago in unbearable pain, suspected appendicitis but ended up being a small kidney stone slicing up my ureter, I was admitted and into a bed in 10 mins. IV and pain killers within the hour, CT scan another 30 mins later after talking to the doctor, and discharged after doctor finished the analysis with prescriptions in hand. Was absolutely surprised how smooth everything was. In and out in around 4 hours total.

By the time I left some of the same people were still sitting in the waiting area. Lots of sketched out folks in there just zombieing around, fighting with the admitting staff. It’s fucked up.

Maybe @TurboMedic might have some insights on my account to see if it’s the exception or the norm.

I'm 1/2. My dad took ambulance ride twice in his life. The high BP and potential heart attack, he got admitted immediately. The other time for something else, was in hallway with EMTs for like 6 hours before being admitted.

But the time he got admitted quick was during the peak of COVID where people are avoiding emergencies rooms.

[Buster]

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Honestly, in the grand scheme, a pretty insignificant number to #1 vs. the rest of the population, so alter your perception. And #2, depends on the current supply out there, keep in mind that EMS in the city can do 3-400 calls in a day, so overall not a huge number are OD's (the chart says 5%, but that includes just drunk people, as well as regular medication "overdoses", not just opioid). The other thing is that OD's don't tie up ambulances that long, honestly they mostly get up, give you the finger and walk off..Some thank you....So overall its much less impactful than most other calls in terms of resource intensity.

Attachment 107706




This is such a bad take I'm not sure where to start or if I even should. Yes, this is a problem. Yes there is data on this, plenty of it, I've quoted what I could find quickly that was compiled as up to date as I could, which was 2020 I believe (not my data, someone else compiled it via FOIP). The number would be higher, this only goes one direction. No, it does not take 5 minutes to admit someone at emergency, and no its not laziness. Homeless druggies make up a very very small amount of the people that end up in hospitals to begin with, and also a small amount that end up in hallways. The VAST lions share of the hallway waits is elderly falls (hips/heads/etc) because there are so many of them and they are low priority in terms of severity, and then general sickness complaints, nausea/vomiting/abdo pain, and then seizures. They're all low priority as well, and they can't be "left alone" in a waiting room due to various reasons so they get parked.
So you're right, your assessment doesn't add up.

The conclusion I'm reaching based on your data and comments is that we don't need ambulances for much of what ambulances do. We seem to need at least these additions to the healthcare system:

1. An abundant ambulance alternative for the non-severe, non-urgent requests.
2. A superior version of intake which can accept and triage an unlimited number of patients immediately upon arrival by the ambulances. Why do hospitals not have this already is a mystery to me?
3. Immediate move towards using something equivalent to NP or Physicians Assistants to treat shit quickly in the hospitals (assuming that doctor capacity is ultimately the rate limiting step).
4. A fee for the use of emergency services.

It sure would be nice if our public healthcare system could figure out an incentive to get smart people in there to manage it.

[killramos]

Uber solves healthcare

[TurboMedic]

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Call ambulance for headache or back pain. Oh lawd. The problem isn't wait times and lack of staff, it's the population abusing the healthcare system.

I don't disagree, but the empath in me also says that everyone has a different tolerance level for what THEY feel is an emergency, and its a slippery slope to make people attempt to decide what is severe enough to call an ambulance. That is a system that results in really sick people avoiding or not calling for fear of ridicule for doing so. People are too simple in general for that kind of thing. Like I said, what I feel is an emergency and would use an ambulance or ER for is much different than what someone else would, that doesn't necessarily make them wrong.

Plus we have 811, and people like that call 811 and they will get told to head to emergency many times. Or shunted to 911 many times. Giving advice remotely isn't as easy or cut and dried as it seems either, its laden in liability.

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The conclusion I'm reaching based on your data and comments is that we don't need ambulances for much of what ambulances do. We seem to need at least these additions to the healthcare system:

1. An abundant ambulance alternative for the non-severe, non-urgent requests.
2. A superior version of intake which can accept and triage an unlimited number of patients immediately upon arrival by the ambulances. Why do hospitals not have this already is a mystery to me?
3. Immediate move towards using something equivalent to NP or Physicians Assistants to treat shit quickly in the hospitals (assuming that doctor capacity is ultimately the rate limiting step).
4. A fee for the use of emergency services.

It sure would be nice if our public healthcare system could figure out an incentive to get smart people in there to manage it.

At least your posts are easy to reply to.

1: there is, Aaron Paramedical, AHS Community Care Paramedics/Mobile Integrated Health/City Center Team, Genesis Medi-shuttle, Alberta Paramedical Services, etc

2:Triage isn't necessarily inefficient, it can take anywhere from 10-20 min depending on the volume arriving at the hospital at that time. Sometimes is almost immediately because you're the only one there (in the EMS line, not the wait room line), other times there was 4 units arriving at the same time. Its a dynamic system you're trying to apply a static solution to

3:There are NP's. NP program access is a problem for sure, and there could be more of them, but physicians run the hospitals. There are plenty of physicians in the hospitals, its that the entire system runs a bit slow. Discharges take too long. Waiting for radiology to read reports takes too long. Doing labs takes a long time. Doing CT and Xray takes a long time. Its a system of schedules, that needs to be booked in advance enough to serve the inpatients, as well as have enough slack that they can roll in the constant influx of outpatients in the emergency. Its a hard balance, you can't "Plan" that sort of thing, see my above comment. There's specialists, sometimes they're actually doing their specialist thing and aren't available for the emergency right away, like in surgery or ICU. Again, NP's won't treat shit any faster in a department, that isn't the hangup. People go to Urgent Care for that kind of thing and its still 4-5hrs to get in and out. And in hospital people get discharged from the hallway all the time, they don't even make it into a bed in the department, treatments and diagnostics are started and conducted while in our care. Now that's an argument that it is using EMS as capacity which is a sensitive topic that we all want to see eliminated. It could be, if nurses would take over care of patients in a hallway in that transition phase, and I'm not sure why that never started or got traction.

4: It costs to use an ambulance. Its something to the tune of $285 if we show up and don't transport, and I think around $550? if we take you in. That dissuades nobody except the people I'm sitting in their house, they're actually sick, they NEED to go in, and they're stressed about the bill and want to refuse. See my reply to jutes.....I have to plead with people sometimes to make the best decision for themselves so I can start treating them. I can't stress enough, it more often than not has the wrong effect.

I appreciate your suggestions Buster, but you can't huff in as if none of this "simple solution" stuff isn't in place, hasn't been tried or has been discussed as impractical. They just read like Trumpism solutions. Why hasn't anyone tried injecting disinfectant, its so simple, its right there. Disinfectant kills viruses. The Healthcare system is extremely nuanced and HAS to be able to serve the general public, protect vulnerable populations, and not drive people away from seeking care. That is a fundamental basis of the system, and that sometimes means over servicing, and sometimes at the expense of other efficiencies. Can it work better? Absolutely, but that would cost MONEY, which everyone is up in arms about already. You won't get better service or more with less.

[g-m]

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Honestly, in the grand scheme, a pretty insignificant number to #1 vs. the rest of the population, so alter your perception. And #2, depends on the current supply out there, keep in mind that EMS in the city can do 3-400 calls in a day, so overall not a huge number are OD's (the chart says 5%, but that includes just drunk people, as well as regular medication "overdoses", not just opioid). The other thing is that OD's don't tie up ambulances that long, honestly they mostly get up, give you the finger and walk off..Some thank you....So overall its much less impactful than most other calls in terms of resource intensity.

Attachment 107706




This is such a bad take I'm not sure where to start or if I even should. Yes, this is a problem. Yes there is data on this, plenty of it, I've quoted what I could find quickly that was compiled as up to date as I could, which was 2020 I believe (not my data, someone else compiled it via FOIP). The number would be higher, this only goes one direction. No, it does not take 5 minutes to admit someone at emergency, and no its not laziness. Homeless druggies make up a very very small amount of the people that end up in hospitals to begin with, and also a small amount that end up in hallways. The VAST lions share of the hallway waits is elderly falls (hips/heads/etc) because there are so many of them and they are low priority in terms of severity, and then general sickness complaints, nausea/vomiting/abdo pain, and then seizures. They're all low priority as well, and they can't be "left alone" in a waiting room due to various reasons so they get parked.
So you're right, your assessment doesn't add up.

I find your posts very interesting, thanks. Are all of the typical outsider's comments on management correct or is the reality different there too?

[suntan]

Sounds like fixing it is too hard, we should just pay them more and then they will work harder.

[Xtrema]

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Uber solves healthcare

Surge pricing.

[Buster]

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At least your posts are easy to reply to.

1: there is, Aaron Paramedical, AHS Community Care Paramedics/Mobile Integrated Health/City Center Team, Genesis Medi-shuttle, Alberta Paramedical Services, etc

2:Triage isn't necessarily inefficient, it can take anywhere from 10-20 min depending on the volume arriving at the hospital at that time. Sometimes is almost immediately because you're the only one there (in the EMS line, not the wait room line), other times there was 4 units arriving at the same time. Its a dynamic system you're trying to apply a static solution to

3:There are NP's. NP program access is a problem for sure, and there could be more of them, but physicians run the hospitals. There are plenty of physicians in the hospitals, its that the entire system runs a bit slow. Discharges take too long. Waiting for radiology to read reports takes too long. Doing labs takes a long time. Doing CT and Xray takes a long time. Its a system of schedules, that needs to be booked in advance enough to serve the inpatients, as well as have enough slack that they can roll in the constant influx of outpatients in the emergency. Its a hard balance, you can't "Plan" that sort of thing, see my above comment. There's specialists, sometimes they're actually doing their specialist thing and aren't available for the emergency right away, like in surgery or ICU. Again, NP's won't treat shit any faster in a department, that isn't the hangup. People go to Urgent Care for that kind of thing and its still 4-5hrs to get in and out. And in hospital people get discharged from the hallway all the time, they don't even make it into a bed in the department, treatments and diagnostics are started and conducted while in our care. Now that's an argument that it is using EMS as capacity which is a sensitive topic that we all want to see eliminated. It could be, if nurses would take over care of patients in a hallway in that transition phase, and I'm not sure why that never started or got traction.

4: It costs to use an ambulance. Its something to the tune of $285 if we show up and don't transport, and I think around $550? if we take you in. That dissuades nobody except the people I'm sitting in their house, they're actually sick, they NEED to go in, and they're stressed about the bill and want to refuse. See my reply to jutes.....I have to plead with people sometimes to make the best decision for themselves so I can start treating them. I can't stress enough, it more often than not has the wrong effect.

I appreciate your suggestions Buster, but you can't huff in as if none of this "simple solution" stuff isn't in place, hasn't been tried or has been discussed as impractical. They just read like Trumpism solutions. Why hasn't anyone tried injecting disinfectant, its so simple, its right there. Disinfectant kills viruses. The Healthcare system is extremely nuanced and HAS to be able to serve the general public, protect vulnerable populations, and not drive people away from seeking care. That is a fundamental basis of the system, and that sometimes means over servicing, and sometimes at the expense of other efficiencies. Can it work better? Absolutely, but that would cost MONEY, which everyone is up in arms about already. You won't get better service or more with less.

Are you suggesting there aren't problems? Or are you suggesting there aren't solutions?

Because you REALLY wouldn't like my other solution - which is to cut funding and privatize the healthcare system (along with the complications that arise).

As you appreciate my input, I appreciate your answers. However, you are incorrect that I can't "huff in" and suggest some "Trumpism" suggestions. No offense to you, but you have no training in business efficiencies, management, and where/how creating scarcity is a good thing. I'm happy to hear your input on what you observe, but I don't think it's within your expertise to determine how to solve the problems.

Our public health system (and especially the AHS) is not run by adults. The primary problem is the lack of political will to make the changes, and we can blame the public/voters for that. You're incorrect that the solutions aren't simple. They actually ARE simple - but that doesn't mean they are easy to implement.

[killramos]

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Surge pricing.

Great idea

[Misterman]

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This is such a bad take I'm not sure where to start or if I even should. Yes, this is a problem. Yes there is data on this, plenty of it, I've quoted what I could find quickly that was compiled as up to date as I could, which was 2020 I believe (not my data, someone else compiled it via FOIP). The number would be higher, this only goes one direction. No, it does not take 5 minutes to admit someone at emergency, and no its not laziness. Homeless druggies make up a very very small amount of the people that end up in hospitals to begin with, and also a small amount that end up in hallways. The VAST lions share of the hallway waits is elderly falls (hips/heads/etc) because there are so many of them and they are low priority in terms of severity, and then general sickness complaints, nausea/vomiting/abdo pain, and then seizures. They're all low priority as well, and they can't be "left alone" in a waiting room due to various reasons so they get parked.
So you're right, your assessment doesn't add up.

What take? You mean the question I asked to get clarity on?

I've never seen it take longer than maybe 5 minutes to get checked in with the triage nurse. It's the wait AFTER being checked in while you sit in the waiting room that takes longest. So are you saying there is specific cases where paramedics will wait with patients after they are checked in, right up until they are under direct care of a doctor/nurse? That's certainly not the protocol I've ever witnessed. Are the paramedics that just get people checked in and then leave, not following protocol?

[Misterman]

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The conclusion I'm reaching based on your data and comments is that we don't need ambulances for much of what ambulances do. We seem to need at least these additions to the healthcare system:

1. An abundant ambulance alternative for the non-severe, non-urgent requests.
2. A superior version of intake which can accept and triage an unlimited number of patients immediately upon arrival by the ambulances. Why do hospitals not have this already is a mystery to me?
3. Immediate move towards using something equivalent to NP or Physicians Assistants to treat shit quickly in the hospitals (assuming that doctor capacity is ultimately the rate limiting step).
4. A fee for the use of emergency services.

It sure would be nice if our public healthcare system could figure out an incentive to get smart people in there to manage it.

The usage fee is the one I've been horny about for years that seem like it would be the biggest decrease of system stressors. If you have a legit emergency, you're not going to sweat 100$ to deal with it. If your kid has the sniffles, you might just think twice and wait for a walk in clinic to be open.

[jwslam]

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What take? You mean the question I asked to get clarity on?

I've never seen it take longer than maybe 5 minutes to get checked in with the triage nurse. It's the wait AFTER being checked in while you sit in the waiting room that takes longest. So are you saying there is specific cases where paramedics will wait with patients after they are checked in, right up until they are under direct care of a doctor/nurse? That's certainly not the protocol I've ever witnessed. Are the paramedics that just get people checked in and then leave, not following protocol?

I spent 6 hours in the Foothills hallway recently.
Every patient had a paramedic, whether that was the one they came in with, or some other one that is watching two patients because the original paramedic is off shift.
Paramedic did not leave the patient until they were admitted to an ER bed, or the OD guy who was discharged to CPS.

[suntan]

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The usage fee is the one I've been horny about for years that seem like it would be the biggest decrease of system stressors. If you have a legit emergency, you're not going to sweat 100$ to deal with it. If your kid has the sniffles, you might just think twice and wait for a walk in clinic to be open.

Ambulances already have a usage fee that could be considered hefty.

[Buster]

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Ambulances already have a usage fee that could be considered hefty.

Is there a fee structure that we could implement that would provide a dis-incentive for using ambulances frivolously?

[suntan]

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Is there a fee structure that we could implement that would provide a dis-incentive for using ambulances frivolously?

It's already almost $300/ride. Not sure where the marginal price is.

The problem with medical procedures is that they're almost priceless, because most people value being alive above all else.

[Buster]

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It's already almost $300/ride. Not sure where the marginal price is.

The problem with medical procedures is that they're almost priceless, because most people value being alive above all else.

We need food to be alive, and yet find that price discovery in foodstuffs is fine.