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

[suntan]

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

It's a matter of perceived urgency.

[Buster]

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It's a matter of perceived urgency.

You haven't seen me when I'm hangry

[suntan]

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You haven't seen me when I'm hangry

You don't need more food fatso.

[Buster]

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You don't need more food fatso.

I've been working on something all day for this

Stay tuned

[Tik-Tok]

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

When most of the people requiring the ambulance will never pay a dime from their own pocket, does it really matter?

[killramos]

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When most of the people requiring the ambulance will never pay a dime from their own pocket, does it really matter?

Sounds like we have found the problem

[Misterman]

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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.

So my question still stands. Being that there is some instances where paramedics stay, and times that they don't. What is the protocol that determines that? Maybe that's another system that should be looked in to. Realistically if you're not bleeding out and going to die without some medical professional working on you, there isn't any reason for a paramedic to be there holding your hand while you wait.

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

I know, we just got one. I imagine the collection rate for that bill is pretty low from the FN and homeless drug addict populations. But Ambulance patients are the drastic minority of ER use. There needs to be a usage fee for walk ins.

[kertejud2]

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

We don’t, really. Maybe to a point, but enough heads have rolled and governments toppled when people go hungry that there’s a reason agriculture is the most subsidized and protected industry to ensure stable supply and limit the effects of market pressures as much as possible.

To suggest there’s any true price discovery happening with food is really reaching.

[Buster]

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We don’t, really. Maybe to a point, but enough heads have rolled and governments toppled when people go hungry that there’s a reason agriculture is the most subsidized and protected industry to ensure stable supply and limit the effects of market pressures as much as possible.

To suggest there’s any true price discovery happening with food is really reaching.

Price discovery always happens. It's just whether or not the effects are apparent

Stay in your lane.

[kertejud2]

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Price discovery always happens. It's just whether or not the effects are apparent

Stay in your lane.

Then price discovery happens in healthcare too, the effects just aren’t apparent.

[Buster]

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Then price discovery happens in healthcare too, the effects just aren’t apparent.

You aren't paying attention.

[suntan]

He has a lane?

[TurboMedic]

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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?

Thank you! And what do you mean exactly? Do you have an example?

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

Except that never happens either, so....

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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.

There are private EMS providers. Unsurprisingly the quality of service, and the issues that they have are not so dissimilar. You shouldn't profit drive healthcare, it doesn't necessarily result in better outcomes or service.....

What we do have is people running healthcare that are trying too many square peg round hole solutions, and trying to operate using a blanket policy and standardization, which doesn't work when there are so many regional variances.

And I agree, the simplest solution of all is my favorite.....$$. More resources, more staff, more education, more access, more specialists. I'm guessing that isn't in line with your simple solutions, is to run it like a a business, which I already outlined in another reply why business efficiency doesn't always equate to emergency preparedness properly.

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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'm not sure how I can make it clearer for you, I know we've been down this road before between our posts and we are vastly different in our approach, and you have seemed to have doubted or undermined my first hand account of how things are, for how you "think" things are. So I'll try again...

YES, it takes longer than 5 minutes to check in to triage. Sometimes its 10, sometimes its 20, hell I've even seen it at 40 when there are 6 units showing up at the same time. Its not a simple "hey here's what is going on" and move on. Assessments and information transfer take time, and errors in hand off are highly scrutinized as patient harm potentials. So yes, it takes longer than 5 minutes. Even at urgent care it takes sometimes 15.

Yes, there are cases, many actually rather than specific that Paramedics wait with patients after they are checked in. There are so many scenarios that this is the case, that me listing them because of "variables" would be too long to be worthwhile. Patients are grey, very little is black and white, you like black and white. You can harp about whatever you've witnessed all you want, I could walk into any hospital and take a picture at any time of day and show you 5-20 units that are parked for various reasons. No they are not following protocol, they in fact are, and there is a protocol for a single crew taking multiple patients even.

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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.

Except this has exactly the opposite effect. You, as a comfortable middle or high classer, may think yes, I would absolutely drop $100 for my life. Vulnerable populations, fixed incomers, low incomers, etc, don't do this. Again, I know this because I have these conversations REGULARLY, and see exactly how people react to or feel about the current fee which is much more than $100. People will absolutely not seek health care if it means they won't eat that week. Its absolutely asinine that you think otherwise, aside from being in a position of comfort that cannot possibly empathize with others in compromised situations. Its actually why someone like you "business minded" people should stay far away from health care. You'll just cramp access, say hey people aren't coming, and consider that a win while the health of the general populace deteriorates and contributes to further complicated problems.

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So my question still stands. Being that there is some instances where paramedics stay, and times that they don't. What is the protocol that determines that? Maybe that's another system that should be looked in to. Realistically if you're not bleeding out and going to die without some medical professional working on you, there isn't any reason for a paramedic to be there holding your hand while you wait.
I know, we just got one. I imagine the collection rate for that bill is pretty low from the FN and homeless drug addict populations. But Ambulance patients are the drastic minority of ER use. There needs to be a usage fee for walk ins.

First off, I'm not cut/pasting policies from our internal website to here, so I'll just say you're going to have to take my word for it. If you want me to prove to you who I am or what I do, I'm happy to. There is guidelines that are already in place, you're not breaking ANY new ground here man, I don't know how else to say it.

And FYI, FN do not pay for ambulance services, they are covered under treaty. Neither do 65+ under blue cross. Neither do the majority of AISH clients. Homeless also do not, but not by any sort of budget magic, how do you collect from essentially nothing.....

Are you saying that we should just not take any of these people in? I'm so confused by your stance.....

[Misterman]

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Except that never happens either, so....

And if it did, guess where the money would go? It would follow the same trajectory it does under the current system, top management gets the lions share and a little bit trickles down to where it is actually needed or intended to go.

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I'm not sure how I can make it clearer for you, I know we've been down this road before between our posts and we are vastly different in our approach, and you have seemed to have doubted or undermined my first hand account of how things are, for how you "think" things are. So I'll try again...

No we haven't been this road, ever. If you're unsure how to make this clearer, that's likely why you end up in these debates so frequently. You could start by not painting me as some right wing fanatic in your mind before replying, and then erase the ad hominem driven nonsense you're in the middle of typing, and try genuinely responding to my posts. It'd be a start at least.

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YES, it takes longer than 5 minutes to check in to triage. Sometimes its 10, sometimes its 20, hell I've even seen it at 40 when there are 6 units showing up at the same time. Its not a simple "hey here's what is going on" and move on. Assessments and information transfer take time, and errors in hand off are highly scrutinized as patient harm potentials. So yes, it takes longer than 5 minutes. Even at urgent care it takes sometimes 15.

Yes I'm sure there is cases where it takes longer to check in. Never seen it personally, but I'd be willing to take your word about this particular thing as you have much more exposure than I do, and it is a fairly straight forward observation that shouldn't be twisted by your type of thinking. However, did you notice how this doesn't address what I asked?

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Yes, there are cases, many actually rather than specific that Paramedics wait with patients after they are checked in. There are so many scenarios that this is the case, that me listing them because of "variables" would be too long to be worthwhile. Patients are grey, very little is black and white, you like black and white. You can harp about whatever you've witnessed all you want, I could walk into any hospital and take a picture at any time of day and show you 5-20 units that are parked for various reasons. No they are not following protocol, they in fact are, and there is a protocol for a single crew taking multiple patients even.

Ok, getting somewhere. So there IS specific instances that require a paramedic to wait past check in with a patient. Although it's not every time like is being claimed by a lot of posters here? That seems to be what I'm drawing from your reply. And it sounds like there IS some policy or protocol on it, but it's too vague or complicated for you to comment any specifics about?

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Except this has exactly the opposite effect. You, as a comfortable middle or high classer, may think yes, I would absolutely drop $100 for my life. Vulnerable populations, fixed incomers, low incomers, etc, don't do this. Again, I know this because I have these conversations REGULARLY, and see exactly how people react to or feel about the current fee which is much more than $100. People will absolutely not seek health care if it means they won't eat that week. Its absolutely asinine that you think otherwise, aside from being in a position of comfort that cannot possibly empathize with others in compromised situations. Its actually why someone like you "business minded" people should stay far away from health care. You'll just cramp access, say hey people aren't coming, and consider that a win while the health of the general populace deteriorates and contributes to further complicated problems.

First off, I'm not cut/pasting policies from our internal website to here, so I'll just say you're going to have to take my word for it. If you want me to prove to you who I am or what I do, I'm happy to. There is guidelines that are already in place, you're not breaking ANY new ground here man, I don't know how else to say it.

And FYI, FN do not pay for ambulance services, they are covered under treaty. Neither do 65+ under blue cross. Neither do the majority of AISH clients. Homeless also do not, but not by any sort of budget magic, how do you collect from essentially nothing.....

Are you saying that we should just not take any of these people in? I'm so confused by your stance.....

Not the general populace, just the dredges. I realize that subjectively it might seem asinine to you to focus all our resources on people that don't provide value to society, but it is subjective none the less. Yes I prefer logical thought process to that of feelings and empathy. It leads to more efficient outcomes generally.

I don't need you to "prove" anything to me. You claim you're a paramedic, and I have no reason to doubt that, so I'll take your word for a number things related directly to the paramedic field. But obviously I am going to try and examine the data and follow to it's logical conclusions when you start talking about things outside your pay range. The way you speak is lot like the things we saw during covid. Where people would post things like "Trust me, I'm in healthcare, so I know" When it turns out they are a janitor at the hospital. I'm sure you're knowledgeable about things in your own profession, but I would hope you can agree there is a lot of nuance and ignorance on both our parts when it comes to things outside your profession.

There's nothing confusing about my ideas. It seems like you might just be confused that everyone doesn't think exactly the same as you.

[suntan]

I'm sure TurboMedic is a great guy and does his job well, but he has zero business experience.

[TurboMedic]

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I'm sure TurboMedic is a great guy and does his job well, but he has zero business experience.

You want business efficiency, until you need to use healthcare, then do you want you/your loved ones/friends treated like numbers? Or do you want empathy and care, which is the primary pillar of health care?

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Ok, getting somewhere. So there IS specific instances that require a paramedic to wait past check in with a patient. Although it's not every time like is being claimed by a lot of posters here? That seems to be what I'm drawing from your reply. And it sounds like there IS some policy or protocol on it, but it's too vague or complicated for you to comment any specifics about?

I wrote in an earlier reply, that you're looking for a black and white answer to something that is grey. Lots of hospital and EMS guidelines are written with "at the discretion of", at which time a risk assessment is done. You can't just say we take every single patient presentation X and place them in the waiting room. And every single patient presentation X and place them in the hallway. There is a myriad of information and diagnostics that go into every single decision from treatment to where people go, and each of those is different. You won't put every single syncope or seizure patient in the same place, and some of them end up with EMS, some of them end up in the waiting room, some of them end up in monitored beds, some of them end up in non monitored beds. I'm saying yes, there is a guideline, but for me to parrot the guideline to you is of no use if you're not familiar with the diagnostics and nuances of every patient presentation and the risk factors each person uniquely presents. I'll just say it again, it is not black and white, its not IFTTT. Its also site specific, Rockyview doesn't put anyone in a waiting room, they claim that is beneath them so they force EMS to stay with patients. Foothills puts lots of people in the waiting room. Then there are Urgent Cares, which nobody waits at. Childrens as well is a drop and run site. PLC also is more liberal with their waiting room guidelines. EMS can't just leave because there is still the grey area of patient abandonment, which on paper and in discussions seems to be a non issue, not many people scraping by for a living are willing to stake their livelihoods on it in case of patient deterioration and subsequent blame for being negligent or not seeing the future in black and white.....I would gladly let you see how it works any time, feel free to reach out to me and I can make it happen

[suntan]

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You want business efficiency, until you need to use healthcare, then do you want you/your loved ones/friends treated like numbers? Or do you want empathy and care, which is the primary pillar of health care?

Do you break everything down into two binary choices, that don't even have anything to do with each other?

Not sure you understand this, but rationing is the pillar of socialized healthcare. It can work no other way.

[killramos]

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Do you break everything down into two binary choices, that don't even have anything to do with each other?

Not sure you understand this, but rationing is the pillar of socialized anything. It can work no other way.

ftfy

[suntan]

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ftfy

Yes.

[kertejud2]

If we were making business decisions for EMS the smart business choice would be to prioritize two things: overdoses and FN calls.

Overdoses have quicker turnover and are relatively easy to treat. Low resources and allows higher number of calls means more efficient outcomes.

FN calls are paid for by Health Canada. High payment compliance and doesn’t drain provincial healthcare spending, basically making each call an additional transfer payment.

Yet the supposed business minds here want to do the opposite. Why?