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Home > Columnists > Arthur Hsieh
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EMS News in Focus
by Arthur Hsieh

3 lessons: When frequent flyers aren't liars

There are three lessons I see coming from this incident

By Arthur Hsieh

I don't know of a single EMS provider who doesn't have a tale of a "frequent flyer" patient. Back in the day we called them "million dollar" patients, because we transported them often.

One person was transported four or five times in a single 24 hour period — pretty much calling for an ambulance the moment he was discharged from the emergency department and got back to his apartment. It's terribly frustrating, and it can be real easy to take it personally.

There are three lessons I see coming from this incident:

1) One can't afford to let one's professional guard down, no matter how frustrating the situation might be. Yes, we're human, but we are being compensated for our work.

There have been simply too many cases where the slip of the tongue results in a lot of hassle, and not the care itself. Look at it another way: is it really worth being suspended or terminated for a lapse in professional judgment?

2) Perform an assessment, each and every time patient contact is made. It's a standard of care, period. Until we evolve as a species and can reliably mind read and remote sense, history taking and a physical examination are kind of necessary to the process.

3) There are better solutions for chronic patients requiring unnecessary, costly ambulance transports to emergency departments.

Several cities have implemented solutions that not only reduce the number of transports, but also get that patient subset to resources that actually help them get out of the EMS system. We have to convince government and private insurance that that is the way to go.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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