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Your Ambulance Service: Friend or Foe?
One of your workers slips and falls on an oily floor and sprains his ankle. One of your supervisors dials 911 and also calls Plant Medical. Before the Plant Medical staff arrives, EMS arrives on scene with lights and sirens and begins assessing and treating the employee. Paramedics express concern to Plant Medical and Management that the worker needs to go to hospital by stretcher, and, since they are already on scene, they will be the transporting agency. Later, a feeling of dread comes over the Safety Department. What should have been a simple first aid case has now become a recordable lost work day and restricted work day case. Worse yet, the company is self-insured for the first $3,000 of a workers' compensation claim and Accounts Receivable is screaming about paying several thousands of dollars for the EMS ambulance bill and the hospital charges. What happened?
Employee Occupational Health Services, whether on site or contracted through off-site clinics, are charged with providing cost-effective, OSHA-compliant, knowledgeable care to injured and ill employees. One of the many decisions made by the Plant Medical Director (PMD) or Occupational Health Nurse (OHN) involves selecting the most appropriate yet cost-effective means of transportation for an injured or ill worker who needs a higher level of care or diagnostics that can only be provided at an outside medical provider. Utilizing transportation services effectively can save your company thousands of dollars per year and help avoid unnecessary recordable cases on your OSHA Log.
In addition, transporting your worker to an appropriate off-site medical provider that is familiar with workers’ compensation can save you from restricted or lost work day cases and unneeded diagnostic testing and fees.
The Plant Medical Department is best suited toward making the decision to call EMS, a private ambulance service, or a taxi. In large manufacturing corporations, the Corporate Medical Director (CMD) works with his or her staff to publish Standard Operating Procedures (SOP) for the on-site Medical Departments to follow in evaluation and treatment of illness and injury. Working with the PMDs, the CMD can develop a flow chart to help with decision making in transportation. The presence of certain injuries can fall along a decision-making tree, whereas the presence of crucial signs or symptoms associated with the injury dictates the form of transportation.
For example: A head contusion with a laceration that shows no sign of concussion can most often be safely transported by cab. A head contusion and laceration with positive loss of consciousness or signs and symptoms of concussion is automatically red lined to be transported by ambulance.
A similar SOP can be used by the Safety Department or Security in circumstances where the Medical Department might be closed, such as on off shifts or weekends. But bear in mind, under no circumstances should an ambulance be withheld if the worker shows any signs of an acute life-threatening emergency. When Medical is not open, the prevailing rule should be, "If in doubt, send them out."
What Kind of Transportation is Needed?
Once it has been determined that ambulance transportation is needed, the next decision to be made is what level of transportation do we need, and do we need an emergency response? Call 911 for all life-threatening emergencies. For stable patients and non-life threatening emergencies, other options may be utilized.
In many regions of the United States, consumer activation of the 911 system initiates an emergency response usually consisting of trained first responders and an advanced life support rescue squad or ambulance. Often, this may be more resources than you need for your emergency. Plant Medical can often evaluate, treat, and stabilize most injuries before the 911 services arrive. In addition, throughout most of the United States, activation of 911 places the ambulance and its paramedics, whether a public agency or a private company, under the jurisdiction and control of the respective Medical Control Authority (MCA). This can have great importance on where your worker is transported to. MCAs typically will not allow ambulances in the 911 response mode to transport to Urgent Cares or clinics. Additionally, MCAs might not allow the worker to be transported to a hospital outside of the MCA's geographic boundaries. Then there is the issue of non-participating hospitals within the MCAs region; MCAs may dictate to the ambulance crew that they not transport to a smaller community hospital that the employer contracts with, but must transport to a Regional Trauma Center (RTC).
An RTC on its own policies may over-treat the injured worker by providing crutches or a cast boot (recordable) instead of an elastic ankle support (first aid) or run up thousands of dollars in diagnostic charges, such as MRI or cat scan, that are rather unnecessary. Lastly, the physicians and other health care providers at an RTC may not be aware of your type of business and issue work restrictions or time off (recordable) because they do not know that you have a Plant Medical that can provide light duty work to your workers (first aid).
Finally, ambulance bills in general can often top $600 or $800 or more, and most ambulance services tack on an "emergency response charge" that tops $300 on average. Considering that a standard taxi fee is in the neighborhood of $30 to $40, an ambulance response with lights and siren when not needed can send your medical expenses through the roof.
Analyze How Your Emergency Was Handled
Almost all private ambulance companies in the United States can provide the same or higher level of patient care as their compatriots in the public sector. Most operate exclusively with Advanced Life Support (ALS) Units staffed with paramedics and equipped to handle almost any emergency. Larger private ambulance companies have even branched out to providing specialized transportation for neonatal and Mobile Intensive Care Units, Bariatric Transport Units, and even specialized local and international air ambulances.
The Operations Manager at your local private ambulance service is most willing to meet with your Safety and Medical Department representatives in advance to discuss your company’s transportation needs. Information sharing in advance can often lead to a successful partnership, greater safety and health care for your workers, and even reduced rates and fees. In addition, almost all private ambulance companies employ Certified Emergency Medical Dispatchers (EMD). EMDs are specially trained to gather the right information from the caller, triage the nature of the call and the patient's injury, and assign the most appropriate level of transportation via the most appropriate response mode. Ethically, private ambulance companies will also determine whether activating 911 is more appropriate if they anticipate a longer response time or if the patient’s injuries indicate that 911 is needed.
The Plant Safety Department and the Plant Medical Department and Security should meet together and draw up a policy of who is empowered to call for transportation—Safety? Medical? Security?—and when to use 911 or not. Remember to stick to your corporation's flow chart for determining whether you need an ambulance or not. Remember that all life-threatening emergencies require 911. Strive for consistency to avoid confusion when emergencies occur. Debrief and analyze how an emergency was handled and whether the appropriate transport style had been used. Refine your plan as needed and clarify any confusing points or issues. Work with the outside providers; the Fire Chief, the ambulance company’s Operations Manager, the taxi service owner or designate; and revise your plan again if needed.
And always keep those in your company who need to be informed up to date on your operations. You may find yourself suddenly lowering costs, avoiding unnecessary recordables on your OSHA log, and overall improving the health and safety of your workforce.
This article originally appeared in the November 2016 issue of Occupational Health & Safety.
James Dziendziel, RN, COHN, EMT-P (Ret), CSMP, CESCO, RWCS, is a Board Certified Occupational Health Nurse and retired paramedic with more than 33 years of related experience. He is a Board Certified Safety Management Practitioner and a Board Certified Environmental Safety and Compliance Officer. He is also a Behavior Based Safety Specialist and a Registered Workers Compensation Specialist with degrees in Nursing from Excelsior College and Occupational Safety and Health from Columbia Southern University and undergraduate certificates in Emergency Medical Technology from Oakland Community College. He is active in the Emergency Nurses Association, the American Association of Occupational Health Nurses, and the Association for Occupational Health Professionals in Healthcare. He is also a member of the National Association of Safety Professionals, the Institute for Safety and Health Management, the National Registry of Environmental Professionals, and the National Registry of Workers Compensation Specialists. Currently, he is employed full-time by Fiat Chrysler Automobiles and is on permanent assignment to the Medical Department at Fiat Chrysler’s Sterling Stamping Plant in St