Alternatives/choices with ambulance or rescue squad

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dm200
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Alternatives/choices with ambulance or rescue squad

Post by dm200 »

Fortunately, we have never needed to call the local rescue squad or ambulance. However, as DW and I get older, the chance that we might need the service is increasing. One example is that I cannot or could not life DW to move her anywhere.

Our locality has an excellent ambulance service - rescue squad if you have a medical emergency. I will do some more checking, but my understanding is that this service will only transport a patient to the nearest hospital/ER. In the case of a life threatening, time critical emergency (loss of blood, strike, heart attack) - that makes sense.

However, our health plan has an excellent (24 hours a day, 7 days a week) urgent care facility that is just like a hospital ER and has full access to all medical records, specialist on call, etc. In certain situations, as we have done, we would drive or be driven there. Especially if older, mobility can be an issue where assistance is needed, such as a non-serious fall or inability to go up or down stairs.

So, in a non-life threatening situation, we are financially and medically better off going to our health plan urgent care facility instead of the local hospital ER.

Any suggestions, experience or knowledge in being prepared for this potential situation? My "guesstimate" is that about 90% of these assistance situations for us would be best (both medically and financially) handled at the health plan urgent care.
runner3081
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Re: Alternatives/choices with ambulance or rescue squad

Post by runner3081 »

Uber. Serious. I had a health scare and needed ambulance transport to the hospital, 4.7 miles, $1.2K with no real medical care needed in transport. That was the biggest financial mistake I have made in a long time.

If you do call 911 (varies by area), the fire department would come out, triage and then ask if you want transport (if not life threatening). There likely won't be a charge for that.

Pay the $15 bucks for Uber to urgent care and be set.
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Watty
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Re: Alternatives/choices with ambulance or rescue squad

Post by Watty »

Living in a typical suburban single family home can be very isolating when you have to give up driving especially if you don't have friends and neighbors that can help you out when needed for things like this.

In addition to an urgent situation doing things like getting to the grocery store or doctor appointments will become more difficult. It might be time to consider moving to some sort of senior community(not a nursing home) where assistance for things like these will be available.
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dm200
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Re: Alternatives/choices with ambulance or rescue squad

Post by dm200 »

runner3081 wrote: Sun Aug 13, 2017 11:31 am Uber. Serious. I had a health scare and needed ambulance transport to the hospital, 4.7 miles, $1.2K with no real medical care needed in transport. That was the biggest financial mistake I have made in a long time.
If you do call 911 (varies by area), the fire department would come out, triage and then ask if you want transport (if not life threatening). There likely won't be a charge for that.
Pay the $15 bucks for Uber to urgent care and be set.
Yes - I did consider Uber for the transportation part.
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dm200
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Re: Alternatives/choices with ambulance or rescue squad

Post by dm200 »

Watty wrote: Sun Aug 13, 2017 11:40 am Living in a typical suburban single family home can be very isolating when you have to give up driving especially if you don't have friends and neighbors that can help you out when needed for things like this.
In addition to an urgent situation doing things like getting to the grocery store or doctor appointments will become more difficult. It might be time to consider moving to some sort of senior community(not a nursing home) where assistance for things like these will be available.
It is more of an urban environment. We are (I hope and plan) a long way from not being able to drive to normal things.
Spirit Rider
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Re: Alternatives/choices with ambulance or rescue squad

Post by Spirit Rider »

Just search for "Non-emergency Medical Transport" in your area. There are usually wheel chair accessible vans available. This can be companies providing this standalone service or many ambulance service companies also provide this as an alternative service. It is transportation only, there will be no medical personal involved.
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ResearchMed
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Re: Alternatives/choices with ambulance or rescue squad

Post by ResearchMed »

dm200 wrote: Sun Aug 13, 2017 11:24 am Fortunately, we have never needed to call the local rescue squad or ambulance. However, as DW and I get older, the chance that we might need the service is increasing. One example is that I cannot or could not life DW to move her anywhere.

Our locality has an excellent ambulance service - rescue squad if you have a medical emergency. I will do some more checking, but my understanding is that this service will only transport a patient to the nearest hospital/ER. In the case of a life threatening, time critical emergency (loss of blood, strike, heart attack) - that makes sense.

However, our health plan has an excellent (24 hours a day, 7 days a week) urgent care facility that is just like a hospital ER and has full access to all medical records, specialist on call, etc. In certain situations, as we have done, we would drive or be driven there. Especially if older, mobility can be an issue where assistance is needed, such as a non-serious fall or inability to go up or down stairs.

So, in a non-life threatening situation, we are financially and medically better off going to our health plan urgent care facility instead of the local hospital ER.

Any suggestions, experience or knowledge in being prepared for this potential situation? My "guesstimate" is that about 90% of these assistance situations for us would be best (both medically and financially) handled at the health plan urgent care.
If you need the services of 911, even if "only" to lift your wife (which is obviously not a minimal situation, as something else would be wrong), then you probably shouldn't go to a "clinic", where they may not be equipped to handle someone needing that level of assistance, or where there might be some really serious condition.

If you/she can walk (even if with assistance), and it's NOT life-threatening, then as mentioned above, Uber (or similar).
Drat... there was just an article about how one health provider (hospital? insurer?) used Uber for even regular visits, and it apparently saved them a lot of money vs. letting things get worse or someone calling 911 just because they didn't have a car (??) or such...

I'm not quite sure if you are asking if you should/could ask 911 (once on the scene) to take you to the urgent care center instead?
Or whether you should take yourselves there?

Here, 911, will bicker before bypassing a small local hospital to go to the major teaching hospital, but they'll let the person being transported make that call (or did, at one time). But on another occasion, it ended up that after being taken to the smaller/closer hospital, that hospital ER needed to call 911 again, to transport that patient to the major hospital. That was something quite predictable, in our minds. :(

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Re: Alternatives/choices with ambulance or rescue squad

Post by neilpilot »

If you really want to save serious money, consider a medical bracelet that says "DO NOT AIRLIFT". I've seen instances where a helicopter was called in, simply because it was available, and an ambulance transport would have been just as fast. I know it's sometimes necessary, based on your location or type of injury, but in many (most?) cases in my area it's unnecessary and a significant profit center.

I experienced an injury in a vehicle accident 5 years ago, and an ambulance responded. After I was stabilized, I decided my condition didn't warrant ambulance transport, refused their offer of transport, and signed a release. My friend drove me to an urgent care facility. Unfortunately, my airplane was totaled. :(
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Re: Alternatives/choices with ambulance or rescue squad

Post by Mudpuppy »

Find out about your local elder/disabled transportation services. It could also be listed as the paratransit service, which is the ADA definition of the service. Every area with a public transportation option is supported to also have an elder/disabled transportation option for those who cannot make it to the public transportation stops. Larger cities might have more than one provider of such services. A fee will be charged for each trip, but it will be closer to the public transportation fee than a cab fee or medical transport fee. Some providers will support scheduling same-day trips, particularly to a medical office. But you have to be signed up and approved to use the services first.

That also gives you a handy metric for determining the severity of the event. If it's mild enough to go to urgent care, then it should be mild enough to take the time to arrange transport through such services. If you can't wait for such services, then it's not mild enough to go to urgent care and you should go to the ER in an ambulance.
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Re: Alternatives/choices with ambulance or rescue squad

Post by dm200 »

If you need the services of 911, even if "only" to lift your wife (which is obviously not a minimal situation, as something else would be wrong), then you probably shouldn't go to a "clinic", where they may not be equipped to handle someone needing that level of assistance, or where there might be some really serious condition.
No, this facility is very capable of handling some very serious conditions and can keep patients up to 24 hours for treatment/observation. DW has been there twice overnight and I was there once. [We drove all three times]
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Re: Alternatives/choices with ambulance or rescue squad

Post by autopeep »

neilpilot wrote: Sun Aug 13, 2017 12:03 pm If you really want to save serious money, consider a medical bracelet that says "DO NOT AIRLIFT". I've seen instances where a helicopter was called in, simply because it was available, and an ambulance transport would have been just as fast. I know it's sometimes necessary, based on your location or type of injury, but in many (most?) cases in my area it's unnecessary and a significant profit center.
As an ICU doctor, I am pretty comfortable saying the above is not great advice.
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Re: Alternatives/choices with ambulance or rescue squad

Post by JBTX »

We had to use emergency transport for a non life threatening situation a couple of times recently (more detail than I'd rather get into). One downside of such transportation is that the providers are typically not under contract with insurance companies so basically they charge you whatever they damn well please. You can get maybe a 20-30% cash discount but we still paid almost $1000 for two short trips. The insurance maybe covered $200 total.
Last edited by JBTX on Sun Aug 13, 2017 3:52 pm, edited 1 time in total.
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Re: Alternatives/choices with ambulance or rescue squad

Post by JBTX »

autopeep wrote: Sun Aug 13, 2017 3:48 pm
neilpilot wrote: Sun Aug 13, 2017 12:03 pm If you really want to save serious money, consider a medical bracelet that says "DO NOT AIRLIFT". I've seen instances where a helicopter was called in, simply because it was available, and an ambulance transport would have been just as fast. I know it's sometimes necessary, based on your location or type of injury, but in many (most?) cases in my area it's unnecessary and a significant profit center.
As an ICU doctor, I am pretty comfortable saying the above is not great advice.
I'm not a doctor but my reaction was the same. God forbid you actually needed an airlift and sometimes you actually do.
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Re: Alternatives/choices with ambulance or rescue squad

Post by btenny »

It has been my experience that if you call 911 and the paramedics think you need to go to the hospital they will force you to ride in the ambulance they order to the nearest hospital that they pick. You will not have any choice on the hospital or any choice on transportation mode. So unless you refuse treatment completely by the paramedics and are fully able to declare you do not need care they will direct everything. I tried to go by car with a friend when I broke my arm after being treated by the paramedics. They refused that option and said that since I let them treat me I had to go where and how they selected.

So I paid about $1.5K for a 2 mile ambulance ride for a broken arm. I was not happy.

And since I live in a small town way away from big hospitals (we have a small hospital) I now buy helicopter insurance. So if I need to be air evacuated the ride is covered.

Good Luck.
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Re: Alternatives/choices with ambulance or rescue squad

Post by Mudpuppy »

JBTX wrote: Sun Aug 13, 2017 3:52 pm
autopeep wrote: Sun Aug 13, 2017 3:48 pm
neilpilot wrote: Sun Aug 13, 2017 12:03 pm If you really want to save serious money, consider a medical bracelet that says "DO NOT AIRLIFT". I've seen instances where a helicopter was called in, simply because it was available, and an ambulance transport would have been just as fast. I know it's sometimes necessary, based on your location or type of injury, but in many (most?) cases in my area it's unnecessary and a significant profit center.
As an ICU doctor, I am pretty comfortable saying the above is not great advice.
I'm not a doctor but my reaction was the same. God forbid you actually needed an airlift and sometimes you actually do.
My practical side says that most emergency responders would ignore such a bracelet, particularly if you were unconscious and actually in need of an airlift. It's not a contractually binding agreement like a DNR order. Same reason why they would ignore your requests to go to Hospital A instead of Hospital B. They're not going to risk getting sued over your personal preferences when your life is on the line.
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Re: Alternatives/choices with ambulance or rescue squad

Post by Watty »

dm200 wrote: Sun Aug 13, 2017 11:44 am
Watty wrote: Sun Aug 13, 2017 11:40 am Living in a typical suburban single family home can be very isolating when you have to give up driving especially if you don't have friends and neighbors that can help you out when needed for things like this.
In addition to an urgent situation doing things like getting to the grocery store or doctor appointments will become more difficult. It might be time to consider moving to some sort of senior community(not a nursing home) where assistance for things like these will be available.
It is more of an urban environment. We are (I hope and plan) a long way from not being able to drive to normal things.
You might call the urgent care center or insurance company ahead of time to see what they can suggest. There may be "in network" ambulance companies that you could call directly to save some money.

If the situation is so bad that the person cannot be transported in your car, a taxi, or uber then you should really consider using an ambulance. Your example of "such as a non-serious fall" is unlikely to find a lot of good alternatives other than an ambulance. The problem is that it could turn out to be something like a broken hip that any medical transportation company could be sued for if they moved you and there was a problem.

That said, if you have a wheelchair there are may be wheelchair accessible taxis available but you would likely need to handle the loading and unloading pretty much on your own. Some buses are also be wheelchair accessible, or the bus system may have some sort of "call a van" service for people in wheelchairs.
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Re: Alternatives/choices with ambulance or rescue squad

Post by Kenkat »

Based on my experience with aging parents in law, the issue with private transport services or Uber is that often the biggest challenges is to get the person up off the floor. These services are really not equipped for that. I would suggest that you call your local EMS / Fire department and ask them what is the right thing to do in these circumstances. They are usually more than willing to provide guidance and help.
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Re: Alternatives/choices with ambulance or rescue squad

Post by dm200 »

So I paid about $1.5K for a 2 mile ambulance ride for a broken arm. I was not happy.
Amazing.
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Re: Alternatives/choices with ambulance or rescue squad

Post by ClevrChico »

I had to call 911 for a family member six years ago. The local fire department responded and there was a $500 charge. Insurance paid.

The cost of transport didn't really matter, because all the hospital charges put them at out of pocket maximum for the year anyway.
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Re: Alternatives/choices with ambulance or rescue squad

Post by Mudpuppy »

Kenkat wrote: Sun Aug 13, 2017 4:10 pm Based on my experience with aging parents in law, the issue with private transport services or Uber is that often the biggest challenges is to get the person up off the floor. These services are really not equipped for that. I would suggest that you call your local EMS / Fire department and ask them what is the right thing to do in these circumstances. They are usually more than willing to provide guidance and help.
Not are they not equipped to lift a person off the floor, it would be a liability for them to do so. Paratransit services or other wheelchair accessible transport services expect you to be able to get to the wheelchair lift with minimal assistance (they might push you out to the lift just to speed things up, but that's about it). They won't risk getting sued by picking you off the floor. They'll call EMS to handle such cases. And if the fall is bad enough you cannot get off the floor, an ambulance is the prudent choice from a medical perspective.
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Re: Alternatives/choices with ambulance or rescue squad

Post by NCPE »

dm200 -

The answer to many of your questions is "it depends".

I am not sure of your exact location (hopefully you are not inside DC) but I am actively involved in Fire / Rescue response here in NC and can only speak based on my 38 years of being a firefighter / EMT. First off I will apologize for the 50 questions that the 911 dispatcher will ask you to determine the nature and severity of the call so they can dispatch the appropriate resources.

The "I've fallen and can't get up" scenario you mention is far more common that we would all like to admit, and in my area the normal response would be the closest ambulance will be dispatched no lights / no siren (routine traffic) to "assist a patient who has fallen and cannot get up". The normal outcome is the patient is first assessed for injuries and then helped back into their bed / chair and the ambulance then goes back in service after the patient signs a refusal of treatment form (used to be on paper but now they are computerized). Just remember as a patient you have the right to refuse service at any time as long as you are coherent / alert / oriented.

As far as transporting to the nearest hospital facility this is a very common protocol due to the heavy call volume that most Emergency Medical Services are seeing across the country. 30 additional minutes to another hospital doesn't seem like much but that is 30 to 60 minutes that the ambulance is not available for another call, and here in NC we can only transport you to a licensed hospital, not to an Urgent Care Type Facility.
If you truly want to be transported to an Urgent Care type facility you might want to check with a local (typically private / for profit) convalescent ambulance service ahead of time to see if they can provide this type service. Just be warned that you may wait hours and hours for this type of non-emergency transport.

Hopefully your insurance covers EMS transport. The modern day ambulance is pretty much now an Emergency Room on wheels, and it is not cheap to buy the ambulance, equipment and staff it 24/7 with EMTs / Paramedics.

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Re: Alternatives/choices with ambulance or rescue squad

Post by dm200 »

NCPE wrote: Sun Aug 13, 2017 6:49 pm dm200 -
The answer to many of your questions is "it depends".
I am not sure of your exact location (hopefully you are not inside DC) but I am actively involved in Fire / Rescue response here in NC and can only speak based on my 38 years of being a firefighter / EMT. First off I will apologize for the 50 questions that the 911 dispatcher will ask you to determine the nature and severity of the call so they can dispatch the appropriate resources.
The "I've fallen and can't get up" scenario you mention is far more common that we would all like to admit, and in my area the normal response would be the closest ambulance will be dispatched no lights / no siren (routine traffic) to "assist a patient who has fallen and cannot get up". The normal outcome is the patient is first assessed for injuries and then helped back into their bed / chair and the ambulance then goes back in service after the patient signs a refusal of treatment form (used to be on paper but now they are computerized). Just remember as a patient you have the right to refuse service at any time as long as you are coherent / alert / oriented.
As far as transporting to the nearest hospital facility this is a very common protocol due to the heavy call volume that most Emergency Medical Services are seeing across the country. 30 additional minutes to another hospital doesn't seem like much but that is 30 to 60 minutes that the ambulance is not available for another call, and here in NC we can only transport you to a licensed hospital, not to an Urgent Care Type Facility.
If you truly want to be transported to an Urgent Care type facility you might want to check with a local (typically private / for profit) convalescent ambulance service ahead of time to see if they can provide this type service. Just be warned that you may wait hours and hours for this type of non-emergency transport.
Hopefully your insurance covers EMS transport. The modern day ambulance is pretty much now an Emergency Room on wheels, and it is not cheap to buy the ambulance, equipment and staff it 24/7 with EMTs / Paramedics.
NCPE
No, not inside DC :)

Thanks for the feedback.

The local fire department/rescue squad folks often have community type events - so I may chat with them about such details, such as the "refusal of treatment". However being transported to the health plan urgent care facility, I am quite sure the folks there can adequately handle getting a patient into the facility.

We are fortunate that we have not needed to use hospital emergency rooms very much over the decades and have never needed to call the EMT/rescue squad to our house. The few times we needed to use a hospital emergency room have not been "life threatening". At those times, we did not have the 24/7 availability of the current health plan Urgent Care facility. The two times I took DW to this facility were situations where most folks would go to a hospital ER. In both cases, her issue(s) were addressed very quickly and competently because all her records were immediately available, physicians were there and had near immediate access to the appropriate specialists. The quality of care was very high and the costs (to us) were very low - compared to starting with a hospital ER.
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Re: Alternatives/choices with ambulance or rescue squad

Post by carolinaman »

This is a good question for all of us seniors who may have these issues in our future. The key seems to anticipate such needs and determine best course of action if (more likely when) they occur. Trying to figure it out after something has happened is too late. Time and proper diagnosis are crucial in these situations and it is not the time to be cheap. Just my opinion.
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Re: Alternatives/choices with ambulance or rescue squad

Post by Rupert »

I don't have any personal experience with this, but every time I visit the pulmonologist, there is an ambulance outside that has transported a patient to the doctor's office for an office visit. Usually, that patient, who is always a child, is still on the ambulance's bed in the waiting room when I go inside, waiting like everyone else. I've always assumed, given the circumstances, that the patient suffers from something like cystic fibrosis and can only be transported by ambulance. But I have often wondered what sort of arrangement has been made with the ambulance company to do these transports for ordinary, non-emergency medical appointments in a doctor's office, not a hospital or even urgent-care facility. Perhaps you should call around to some ambulance companies in your area and ask what services are available.
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Re: Alternatives/choices with ambulance or rescue squad

Post by lm002e »

btenny wrote: Sun Aug 13, 2017 3:54 pm It has been my experience that if you call 911 and the paramedics think you need to go to the hospital they will force you to ride in the ambulance they order to the nearest hospital that they pick. You will not have any choice on the hospital or any choice on transportation mode. So unless you refuse treatment completely by the paramedics and are fully able to declare you do not need care they will direct everything. I tried to go by car with a friend when I broke my arm after being treated by the paramedics. They refused that option and said that since I let them treat me I had to go where and how they selected.

So I paid about $1.5K for a 2 mile ambulance ride for a broken arm. I was not happy.

And since I live in a small town way away from big hospitals (we have a small hospital) I now buy helicopter insurance. So if I need to be air evacuated the ride is covered.

Good Luck.
I've worked for 15 years as a full-time paramedic in both private/for profit ambulance services, fire dept based EMS and a municipal third service EMS agency. I can say that unless you are somehow unable to make decisions for yourself due to a severe illness, injury or intoxication (we refer to this as "present mental capacity") then any adult patient retains the right to refuse any treatment or transport from EMS. That being said, each individual EMS system has their own protocols and some systems may require that you be transported to the closest appropriate facility, if you consent to transport. Where I work, we operate under the "you call, we haul" protocol. You can call an ambulance for any reason at all and be transported to any emergency dept you choose. Sadly, this often leads to abuse of the 911 system and ambulances end up taken far from their district for no valid medical reason.

One thing that many lay persons do not understand, is that for reasons of liability and common sense, once I make contact with the patient I will always offer transport regardless of the severity of the illness or injury and frequently I will recommend it as my diagnostic capabilities are quite limited in the field. I'm not a doctor and despite advances in technology, my ambulance lacks all the capabilities of a full fledged ER. For me to be dismissive and give the patient the old, "I'm sure you'll be fine", would be both unprofessional and poor medical practice on my part.

As far as ambulance billing goes, it is the health insurance company who decides medical necessity. If, after reviewing the EMS provider's documentation, it is determined that the treatment and transport by EMS was not medically necessary, then the patient gets the bill. For medicare and medicaid patients, only a small portion of the entire bill gets reimbursed if deemed medically necessary and the EMS agency is barred by federal law from attempting to collect the difference from the patient.

I agree with others that most large cities have non-emergent medical transport vans to help facilitate getting to and from medical facilities. This may be a good option to consider. However, as others have already said, in the "I've fallen and I can't get up" scenario, these services are not appropriate.
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Re: Alternatives/choices with ambulance or rescue squad

Post by dm200 »

carolinaman wrote: Mon Aug 14, 2017 8:14 am This is a good question for all of us seniors who may have these issues in our future. The key seems to anticipate such needs and determine best course of action if (more likely when) they occur. Trying to figure it out after something has happened is too late. Time and proper diagnosis are crucial in these situations and it is not the time to be cheap. Just my opinion.

Exactly my thoughts.
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