Emergency responders to ‘assess and refer’ under new EMS order

Ben Irwin

Fresno, Kings, Madera and Tulare County patients will be advised to not use ambulance service to go to the ER if deemed not an emergency

TULARE COUNTY – Increases in non-emergency requests for ambulatory service and non-emergency visits to emergency departments have had a significant impact on the healthcare system. In the latest adjustment to local care the Central California Emergency Medical Services Agency (CCEMSA), has prompted their EMS Medical Director Jim Andrews to issue an “assess and refer” order for all Fresno, Kings, Madera and Tulare Counties EMS providers.

The unprecedented order, which went into effect Monday, requires emergency responders to perform a patient assessment upon responding to requests for EMS services, and if meeting criteria that does not require emergency transport to an ER, advise the patient that transport by ambulance is not required. The patient will be advised to seek care at an urgent care, contacting their primary care physician, or utilizing tele-care that is available through most insurance carriers.

Dale Dotson, EMS coordinator with Central California Emergency Medical Services, says the intent is to relieve some pressure on ambulance crews and overcrowded hospitals.

“The hope is if we’re taking less patients to the hospital that can get treatment by other means,” Dotson said, “that the ambulance crews are not being overly utilized and spending all their time waiting in line at the hospital waiting for a bed, when they could be out providing more care to the people in the system.”

The order is strictly a recommendation to patients as of now, Dotson said, but if the situation worsens, additional hard line measures might be needed.

“If things keep getting worse, then we may have to put the crews in the position of having to take a more hard stance of, ‘I cannot take you to the hospital,’” Dotson said. “We’re sure hoping we don’t ever see that, but it’s possible.”

Currently, patients may choose to not follow the emergency responders recommendation and be transported to the ER. For the emergency responder to request a patient seek alternate care, the following criteria must be met:

Vital signs are within the following limits:

  • HR: 50–120 bpm
  • RR: 12–30 resp/min
  • SBP: 100–180 mm Hg
  • O2 sat: 93–100%
  • GCS: Has a Glasgow Coma Scale (GCS) of 15 or GCS is at patients baseline

Exhibits no clinical evidence of:

  • Altered level of consciousness
  • Alcohol or drug ingestion that impairs decision making capacity
  • Abnormal or labored breathing or shortness of breath
  • Chest pain/discomfort of any kind
  • Hypoxia as indicated by low oxygen saturation
  • Significant tachycardia
  • Serious hemorrhage
  • Exhibits evidence of Decision-Making Capacity sufficient to understand the nature of the medical condition as well as the risks and potential consequences of not seeking additional medical care from the provided recommendation.

The patient would potentially benefit from the provided recommendation.

The patient is likely to successfully navigate the provided recommendation.

General considerations:

  • Does the patient, guardian, or parent have decision making capacity?
  • Are EMS personnel concerned with the patient’s current medical condition?
  • How likely is the patient to successfully navigate the provided referral?

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