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He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are

He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnapping or entrapment (not hit me up law arguers). To do that we either need implied consent (minor no parent, not A&Ox4, or Law Enforcement). My department, a small rural one with a small tax base which happens to cover a lot of injuries because we have 20 miles of dangerous mountain pass freeway and a ski and mountain bike area, only charge for calls if we transport. I think a transport is around $900. Our minimum transport is 37 miles. We scale it down depending on income and type of event. We're not massive sticklers about it. We're just trying to cover wear and tear on big expensive vehicles for all the non-transports, winter driving, equipment, uniforms, training, etc. Most of our "business" comes from "transients" eg folks who don't live there, eg those skiing, hiking, biking, or driving over the pass. This is also very much not the norm. But should explain a bit about those who do pay are covering those who don't. We don't want a chilling effect on calling 911 for precautionary stuff. We'd rather show up 99 times and check people out and let them go than miss the impending cardiac event. And we get those. It's very interesting just how much going over a 4k foot pass stresses people on the edge. Many of our medica calls are people driving to seattle for deeper care and things exacerbating when they get to 4k feet.

onion2k 2mo ago
I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambulances. Most of the world has accepted that some system to spread the cost among everyone is better than putting people in that situation.
- grogenaut 2mo ago
  Is this the common cost or is this an outlier blog story that hit it off. Talk real data to me. I don't get excited about any individual anecdote (unless it's me personally of course). No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.
  - ChrisMarshallNY 2mo ago
    It’s pretty common. I know that John Oliver is a bit of a “lightning rod,” for many folks, but he (or his staff, really) does his homework. He did a segment on it, some time ago: https://youtube.com/watch?v=Ezv8sdTLxKo https://youtube.com/watch?v=Ezv8sdTLxKo
    - master_crab 2mo ago
      He’s a lightning rod only because some people get unnecessarily triggered by facts that don’t fit their world view.
      - mananaysiempre 2mo ago
        There’s a thin line between satire, which can convince, and sneering, which can only turn off. John Oliver, unfortunately, does end up on the wrong side of it from time to time, and can (together with his core audience) be something of a bully when he does. I’d also be careful about his facts: they’re usually well-researched, but by the nature of the format he only ever presents those which fit his argument, and that’s just not good epistemology. I can think of a few times when the show made me feel safer about my beliefs than I should have been feeling.
        ajuc 2mo ago
        The time for this debate was 100 years ago. Now only people who can't be convinced aren't convinced, so there's no point convincing. So why not make fun of them? There's no downside.
deepsun 2mo ago
> but you make the choice No US doctor would ever tell you how much any procedure would cost (even though they know, at least "in-network" doctors). But if in your EMT you inform the patient of the potential costs of the ride, then yea, I agree they make an informed choice.
- tonyedgecombe 2mo ago
  I’d argue nobody getting into an ambulance is making an informed choice.
  - deepsun 2mo ago
    Under distress, yes. But honestly, I did piloting a little (airplane and various soaring aircrafts), and think that thinking there is also under distress, and that's ok, you still need to make decisions, that's life.
- culopatin 2mo ago
  You’re getting in an ambulance, not calling a cab. You’re probably unconscious, maybe at least disoriented, overwhelmed, concerned about what’s happening more than doing math. Also you’re there on the floor bleeding, what’s your alternative? “Nah don’t worry, I’ll figure out this exposed fracture in the uber, I got points with them so it’s cheaper”?
  - deepsun 2mo ago
    Parent talked about conscious and aware. I had fractures several times, and I did think about the costs. In fact, the last one was pretty bad, andy first thought was "good thing I'm in a country with good medical care, even though expensive".
milleramp 2mo ago
The physician can mandate ambulance transfer.
- sitharus 2mo ago
  Really? Where I live a patient is always able to refuse any medical procedure or treatment, unless they’re unconscious or otherwise mentally unable and the procedure is considered necessary to save their life. They certainly can opt for a non-ambulance transfer, though here it would be free even though a regular ambulance service typically isn’t. Consent for treatment is a core principle of medical practice.
  - true_religion 2mo ago
    I think the idea is that if it's mandated, then the ambulance should be covered by some kind of insurance since it was medically necessary and not just Ol' Bob, the hypochondriac, calling because his tin foil hat fell off.
    - alistairSH 2mo ago
      Except that's not how it works. Ambulances are almost always out-of-network, so subject to MUCH higher OOP expenses. It's spelled out in the article.
- chrisra 2mo ago
  And what would they do if you refuse?
  - criddell 2mo ago
    Who is "they" in your question?
sandworm101 2mo ago
>> We scale it down depending on income and type of event. We're not massive sticklers about it. That touches on another very american problem. The injured person now does not know how much the tansport/treatment will cost. And the only persons on the ground cannot quote a price. If they say yes they enter into that zone of having another random health care bill comming in the mail. Is it 900, or 9000? Will my insurance cover this? Is this outside my deductable? ... this is math that no person should have to do while bleeding beside a highway.
thayne 2mo ago
I had an accident where I had a concussion and other injuries that put me in a lot of, and the people I was with called an ambulance for me, and I wasn't really in a state to decline, but if I had been, and knew how much it would cost, I would have. The ambulance ride was, of course, out of network. As were some of the doctors that treated me once I got to the hospital. It was the first time I dealt with a major medical expense as an adult, and it came as quite a shock when the bills came several months later, that said I was responsible for about $10,000 for the ambulance (plus a lot more for the hospital), and a good chunk of it didn't even count towards my deductible because it was out of network. I later learned I should have contested that since it was an emergency, and insurance is supposed to cover out of network service in an emergency, but I was young and inexperienced with dealing with health insurance companies. Oh, and it was about a 10 minute ambulance ride. I guess my point is, sometimes you don't have a choice, but you still end up with a massive bill. And also, that experience definitely had a chilling effect on me calling 911.
- geoffmunn 2mo ago
  As someone who is not American, $10,000!!!!!! That's hard to conceive where I live. We even have a specifically free ambulance service here.
  - martheen 2mo ago
    I can literally buy a nice house with that just outside the city. And we somehow have universal healthcare despite the average salary is not even one-tenth of American.
- moritzwarhier 2mo ago
  Treating medical care like this, similar to a racketeering scheme, should not be a thing anywhere. Instead of punishing people for seeking medical care (or plainly requiring it), it would be preferable to have a robust protocol for rejecting patients that do not require care, whether at the hospital or before the ambulance ride. For this, people would need to want medical care be a humanitarian right and basic pillar of a functioning society, not a business or a bureaucratic system to perform a selection process decreasing the life expectancy of less-affluent people. Ironically, when there is free medical care and universal insurance, there are also perverse incentives. For example unneeded expensive procedures, prescribing patented, newer drugs where cheaper ones would work, providing ineffective or even detrimental services, etc. But humanitarian values are out of fashion, because they were never achieved globally. So the only right people care about increasingly is their right to own property.
hnthrow10282910 2mo ago
I fainted once and my wife called an ambulance as I was unconcious due to Covid. I was fully aware when the ambulance arrived and refused. They peer pressured me very hard anyways. It was a 1 mile drive and cost me $14,000
- mikeodds 2mo ago
  You do have to question why representatives of the people have not managed to address this
  - hnthrow10282910 2mo ago
    My insurance says ambulance rides are covered 100%. Apparently most are out of network though, which the people have no choice of choosing (obviously). I was sent a post insurance $8000 bill. After months and months of arguing they said it was an error on their side and dropped the charge. Absolutely ridiculous
veunes 2mo ago
I think your department is probably closer to what people imagine ambulance billing looks like
getpokedagain 2mo ago
>> He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. Disagreed. Someone who is cogent and not intoxicated and not a stroke victim can't always make the best choices. Your decision making can be compromised by I dunno the fucking pain of a broken toe bone. Seeking help should not be interpreted as a sign of weakness and made into a maze where only the most rational can escape with minimal bills. The longer we leave this cognitive dissonance where the land of the free roughly translates to land of the free to get fucked we are going to continue to have instability.
- Ferret7446 2mo ago
  By that logic no one can make choices for themselves, because people are never in the absolute theoretical optimal mental state.

onion2k 2mo ago

I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambulances. Most of the world has accepted that some system to spread the cost among everyone is better than putting people in that situation.

grogenaut 2mo ago
Is this the common cost or is this an outlier blog story that hit it off. Talk real data to me. I don't get excited about any individual anecdote (unless it's me personally of course). No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.
- ChrisMarshallNY 2mo ago
  It’s pretty common. I know that John Oliver is a bit of a “lightning rod,” for many folks, but he (or his staff, really) does his homework. He did a segment on it, some time ago: https://youtube.com/watch?v=Ezv8sdTLxKo https://youtube.com/watch?v=Ezv8sdTLxKo
  - master_crab 2mo ago
    He’s a lightning rod only because some people get unnecessarily triggered by facts that don’t fit their world view.
    - mananaysiempre 2mo ago
      There’s a thin line between satire, which can convince, and sneering, which can only turn off. John Oliver, unfortunately, does end up on the wrong side of it from time to time, and can (together with his core audience) be something of a bully when he does. I’d also be careful about his facts: they’re usually well-researched, but by the nature of the format he only ever presents those which fit his argument, and that’s just not good epistemology. I can think of a few times when the show made me feel safer about my beliefs than I should have been feeling.
      - ajuc 2mo ago
        The time for this debate was 100 years ago. Now only people who can't be convinced aren't convinced, so there's no point convincing. So why not make fun of them? There's no downside.

deepsun 2mo ago

> but you make the choice No US doctor would ever tell you how much any procedure would cost (even though they know, at least "in-network" doctors). But if in your EMT you inform the patient of the potential costs of the ride, then yea, I agree they make an informed choice.

tonyedgecombe 2mo ago
I’d argue nobody getting into an ambulance is making an informed choice.
- deepsun 2mo ago
  Under distress, yes. But honestly, I did piloting a little (airplane and various soaring aircrafts), and think that thinking there is also under distress, and that's ok, you still need to make decisions, that's life.
culopatin 2mo ago
You’re getting in an ambulance, not calling a cab. You’re probably unconscious, maybe at least disoriented, overwhelmed, concerned about what’s happening more than doing math. Also you’re there on the floor bleeding, what’s your alternative? “Nah don’t worry, I’ll figure out this exposed fracture in the uber, I got points with them so it’s cheaper”?
- deepsun 2mo ago
  Parent talked about conscious and aware. I had fractures several times, and I did think about the costs. In fact, the last one was pretty bad, andy first thought was "good thing I'm in a country with good medical care, even though expensive".

milleramp 2mo ago

The physician can mandate ambulance transfer.

sitharus 2mo ago
Really? Where I live a patient is always able to refuse any medical procedure or treatment, unless they’re unconscious or otherwise mentally unable and the procedure is considered necessary to save their life. They certainly can opt for a non-ambulance transfer, though here it would be free even though a regular ambulance service typically isn’t. Consent for treatment is a core principle of medical practice.
- true_religion 2mo ago
  I think the idea is that if it's mandated, then the ambulance should be covered by some kind of insurance since it was medically necessary and not just Ol' Bob, the hypochondriac, calling because his tin foil hat fell off.
  - alistairSH 2mo ago
    Except that's not how it works. Ambulances are almost always out-of-network, so subject to MUCH higher OOP expenses. It's spelled out in the article.
chrisra 2mo ago
And what would they do if you refuse?
- criddell 2mo ago
  Who is "they" in your question?

sandworm101 2mo ago

>> We scale it down depending on income and type of event. We're not massive sticklers about it. That touches on another very american problem. The injured person now does not know how much the tansport/treatment will cost. And the only persons on the ground cannot quote a price. If they say yes they enter into that zone of having another random health care bill comming in the mail. Is it 900, or 9000? Will my insurance cover this? Is this outside my deductable? ... this is math that no person should have to do while bleeding beside a highway.

thayne 2mo ago

I had an accident where I had a concussion and other injuries that put me in a lot of, and the people I was with called an ambulance for me, and I wasn't really in a state to decline, but if I had been, and knew how much it would cost, I would have. The ambulance ride was, of course, out of network. As were some of the doctors that treated me once I got to the hospital. It was the first time I dealt with a major medical expense as an adult, and it came as quite a shock when the bills came several months later, that said I was responsible for about $10,000 for the ambulance (plus a lot more for the hospital), and a good chunk of it didn't even count towards my deductible because it was out of network. I later learned I should have contested that since it was an emergency, and insurance is supposed to cover out of network service in an emergency, but I was young and inexperienced with dealing with health insurance companies. Oh, and it was about a 10 minute ambulance ride. I guess my point is, sometimes you don't have a choice, but you still end up with a massive bill. And also, that experience definitely had a chilling effect on me calling 911.

geoffmunn 2mo ago
As someone who is not American, $10,000!!!!!! That's hard to conceive where I live. We even have a specifically free ambulance service here.
- martheen 2mo ago
  I can literally buy a nice house with that just outside the city. And we somehow have universal healthcare despite the average salary is not even one-tenth of American.
moritzwarhier 2mo ago
Treating medical care like this, similar to a racketeering scheme, should not be a thing anywhere. Instead of punishing people for seeking medical care (or plainly requiring it), it would be preferable to have a robust protocol for rejecting patients that do not require care, whether at the hospital or before the ambulance ride. For this, people would need to want medical care be a humanitarian right and basic pillar of a functioning society, not a business or a bureaucratic system to perform a selection process decreasing the life expectancy of less-affluent people. Ironically, when there is free medical care and universal insurance, there are also perverse incentives. For example unneeded expensive procedures, prescribing patented, newer drugs where cheaper ones would work, providing ineffective or even detrimental services, etc. But humanitarian values are out of fashion, because they were never achieved globally. So the only right people care about increasingly is their right to own property.

hnthrow10282910 2mo ago

I fainted once and my wife called an ambulance as I was unconcious due to Covid. I was fully aware when the ambulance arrived and refused. They peer pressured me very hard anyways. It was a 1 mile drive and cost me $14,000

mikeodds 2mo ago
You do have to question why representatives of the people have not managed to address this
- hnthrow10282910 2mo ago
  My insurance says ambulance rides are covered 100%. Apparently most are out of network though, which the people have no choice of choosing (obviously). I was sent a post insurance $8000 bill. After months and months of arguing they said it was an error on their side and dropped the charge. Absolutely ridiculous

veunes 2mo ago

I think your department is probably closer to what people imagine ambulance billing looks like

getpokedagain 2mo ago

>> He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. Disagreed. Someone who is cogent and not intoxicated and not a stroke victim can't always make the best choices. Your decision making can be compromised by I dunno the fucking pain of a broken toe bone. Seeking help should not be interpreted as a sign of weakness and made into a maze where only the most rational can escape with minimal bills. The longer we leave this cognitive dissonance where the land of the free roughly translates to land of the free to get fucked we are going to continue to have instability.

Ferret7446 2mo ago
By that logic no one can make choices for themselves, because people are never in the absolute theoretical optimal mental state.