Changes won't be easy. California law restricts where ambulances can take 911 patients, and insurance, private and public, reimburses only when they are transported to hospitals. Clinics also would need to have the right hours, staffing and expertise to take the patients.
Then there is the concern about errors in judgment. What happens if a patient is taken to a clinic but really needed to go to an ER? What if a 911 patient is treated at home but really needed to see a doctor?
"It all comes down to liability," said Patrick Hanrahan, an L.A. County firefighter-paramedic. "We don't want to be left on the hook."
Hospital personnel already talk with paramedics in the field, so under a new system, nurses and doctors could help quickly determine the best place for a 911 patient to be treated, said Jim Lott, executive vice president of the Hospital Assn. of Southern California.
"This is long overdue," Lott said. "The communication is there, the technology is there, the expertise is there. There is no reason why this kind of triaging can't be done effectively."
Another problem is that paramedics and ambulances often get stuck with their patients waiting for ER beds to open; creating new protocols could make the process work more smoothly. "If you have ambulances waiting at the emergency room … the people who need the care are not getting it," said Brian Bledsoe, who teaches emergency medicine in Nevada and has written several EMS textbooks.
At Station 41 in Willowbrook, paramedics said they have responded — with lights and sirens — to babies who wouldn't stop crying, people who couldn't sleep and alcoholics who drank too much. "In their eyes it's an emergency," Clayton said. "We know better. But once the call is made, we have to care for them."
On the day Marks called from the urgent-care center, paramedics from a nearby station headed to a Watts motel for a call about a man with a gunshot wound. But the victim, Terrance Montgomery, said he was shot and had been treated nine days earlier. The motel owner said she called 911 because Montgomery owed her money and she wanted him off the property.
As he was loaded into the ambulance, Montgomery, who is uninsured, said he hadn't seen a doctor since leaving the hospital the previous week. "This is going to be my follow-up," he said.
Later in the afternoon, paramedics went to the home of 90-year-old Nathan Shands, who had been vomiting for a few days. His granddaughter said she couldn't get him into the car, so she called 911 to take him to the hospital. She hadn't expected so many people to show up.
"She just wanted transport to the hospital," Clayton said. "She didn't understand 911 response."
