Recommendations to Reduce the Misuse of EMS and Delays in Patient Transfers

The ER is for Emergencies.” – State of Washington

The following recommendations were proposed by the District of Columbia Task Force on Emergency Medical Services in its report released on September 27, 2007.  The Task Force, known as the “Rosenbaum Task Force,” which was created in response to the January 6, 2006 death of New York Times journalist David E. Rosenbaum following an assault on Gramercy Street in Northwest, Washington, D.C., released recommendations almost eight years ago that are just as relevant yesterday, today and tomorrow. The recommendations transcend service-type, geography and demographics. Each has scaled applicability and represents some of the best ideas for reducing the misuse of EMS and delays in patient transfers. The recommendations were as follows:

  1. Develop and implement and outreach program for patients with chronic needs.
  2. Develop and implement a public education program regarding appropriate use of 911 systems.
  3. Improve the 911 dispatch process so that call takers and dispatchers have improved training and enhanced ability to distinguish between emergency and non-emergency calls.
  4. Establish and clarify roles and responsibilities for EMS and police for the treatment of uninjured intoxicated patients and for transport of patients to a detoxification facility.
  5. Medical Director to use authority to require hospitals to accept the transfer of care of a patient or patients within a specified period of time.
  6. Develop standards for drop times, diversion, and closure, and to improve procedures for tracking patient outcomes.
  7. Authorize patients to be transported to a pre-approved clinic or other non-emergency medical facility, appropriate to the patient’s need (or consider the use of remote, i.e. telemedicine, consultation).
  8. Develop and implement a system of alternative transportation options (such as scheduled van service, taxi vouchers, or MetroAccess vouchers).
  9. Develop and implement protocols to refuse transport for non-urgent patients, when appropriate, subject to authorization of a medical supervisor.

Every EMS provider in a busy urban system can appreciate the goals of these recommendations and can think of first hand instances where they would have prevented or reduced unnecessary utilization of EMS resources. Just like EMD became an integrated part of the EMS system, hopefully one day these recommendations will become common practice as well.

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