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Going to the ER, Just Because They Can

23 September 2008 No Comment

By Casey Miner —

Less than thirty seconds after the red phone starts ringing, the paramedics from Berkeley’s Fire Station One are on the road. A man has called 911 to say he cannot walk. He wants to go to the hospital.

As it turns out, the 64-year-old man can walk, though not well, notes paramedic Mark Somontan as he helps the man onto a gurney. At approximately 11am Saturday morning, the man has already drunk half a bottle of wine. He wants to go to detox, he tells Somontan. He should have gone last time, he says, when his doctor said to, after he fell down in the street. He took an ambulance ride then, too.

“I didn’t know who to call,” he says.

In this crew’s district on the west side of Berkeley, more calls than not come from people who do not need an ambulance ride to the hospital – if they need to go to the hospital at all.

“My classic is, ‘I chocked on a Pop Tart,” says paramedic Jen Landsberg. “My nose hurts. My teeth hurt. It’s total 911 abuse.”

When the crew arrives at Alta Bates Hospital, nurse Sunny Vijeh debriefs with Somantan about the case. “Have you discussed the inappropriate use of 911?” she asks. Most patients the paramedics bring in, she says, could probably have gotten to the hospital on their own. This patient, she says, was upset that he could not enter detox immediately, and instead would have to wait for several hours.

“Who calls 911 to go to rehab?” she asks. “People think that if you show up in an ambulance, you get seen right away, and that’s not the case.”

A recent study by the New England Healthcare Institute found that approximately 20 percent of all emergency room visits were for non-urgent purposes. According to the Centers for Disease Control, visits to the ER have increased nearly 40 percent over the last decade.

Paramedics cannot refuse a patient transport to the hospital. “If a person really wants to go, we have to take them,” says paramedic supervisor David Brannigan.

That requirement can wear down the paramedics’ patience.

“It’s hard to maintain a sunny disposition when you’ve transported the same person three times in one shift,” says Landsberg.

The Berkeley fire department handles 8000-9000 calls per year, nearly 80 percent of which are medical. Ambulances are equipped to be mobile emergency rooms, and paramedics can perform a variety of advanced procedures.

“Our job is not to figure out what’s going on, but to stabilize them and get them to the doctor,” says Somontan.

In Berkeley, an ambulance ride costs $1300, but many of the patients use the government insurance programs Medicare and Medi-Cal, says paramedic lieutenant Will Billau. These patients are poor, he says, and they are the first to register the effects of hard economic times.

Says paramedic Loren Chase, “We’re the closest thing right now to universal health care.”

According to the most recent Census data, 20 percent of individuals in Berkeley live below poverty level, compared to 13 percent nationally. According to Billau, at least a third of their patients are “uncollectable” – meaning they have no money and cannot be billed – or uninsured.

“We’re the entry level to the medical system for poor people,” says Billau. “The street is our clinic. Education is a significant part of our job.”

Though they joke about hurt noses and repeat calls, the paramedics say they are not completely cynical. The calls can be frustrating, they say, but they feel sympathy for many of their patients.

“In their world, it is an emergency,” says Landsberg. “So you step into the role of social worker. Some people, it’s just as simple as, they’re cold and they’re lonely. We get lots of calls like that.”

Brannigan agrees. “The longer I do this, the more I see how miserable life is for most people. If you want to go to the ER on a Saturday night, fine. Get in. Let’s go.”

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