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Old 07-09-2004, 01:03 AM   #1
ffemt8978
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This question is for those of you that have more than one hospital that you transport to (BTW, we transport to 16 different hospitals. )

Do your protocols allow you to override a patient's decision about what hospital they want to be taken to, or are you allowed to attempt to convince them to change their mind?

The reason I ask this it that I've had two pediatric calls recently, where the family wanted to go to "Hospital A". Now this is the same hospital that I was asked why I had a trauma patient on oxygen as I wheeled them into the ER. This is also the same hospital that even if I coded in the ER, I would want to be transported somewhere else.

In both of my recent calls, I was able to convince the family to go to "Hospital B", which is certified to a higher trauma and pediatric level than "Hospital A".


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Old 07-09-2004, 02:42 AM   #2
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We are given the ultimate decision in my county. In my district(s) we have a Level II trauma center, a VA Hospital, a hospital that technically can't accept traumas, and in the within a similar timeframe (but not in district) two Trauma 2's and a state-run Trauma 1 (a little further away).

I usually let the patient choose as long as there is no medical reason why they should go somewhere else.
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Old 07-09-2004, 12:42 PM   #3
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LA County's general rule is that all 911 patients are transported to the Most Accessible Receiving (MAR) facility. The MAR is usually, but not always, the geographically closest facility. However, there's a few caveats:

1) Hospitals can either divert all ALS units if they're saturated or can divert specific patients based on staffing or equipment issues. This is handled through a computerized system called ReddiNet, which goes to all the dispatch centers. ALS units call dispatch from the scene to request hospital status and are either told which 2 or 3 are closed (on a good day) or which 2 or 3 are open (on a bad day).

2) BLS units can't be diverted except for internal disaster (fire, hazmat, criminal activity, etc.).

3) ALS units operating under Standing Field Treatment Protocols may have specific facilities identified in thise protocols which determine their transport destination.

4) ALS and BLS units can transport to a hospital other than the MAR when requested by the patient or their family if the patient is stable and only requires BLS-level care and the distance doesn't unreasonably affect the unit's response status (in other words, an additional 10-15 minute transport time's OK but 45 minutes wouldn't be).

Because of our volunteer status and limited resources, our Chief has decided that except in rare circumstances, we always transport to the closest hospital, Arcadia Methodist. Any requests to transport elsewhere have to be approved by the senior officer on scene, with the exception of AMH being closed to internal disaster or serious trauma patients, who would be transported to Huntington Memorial, our nearest trauma center (which is the only other hospital we ever transport to anyway).
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Old 07-09-2004, 01:10 PM   #4
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For a high priority call, like a priority 1, we are to bring the patient to the closest most appropriate facility.

For the standard BLS calls, many times patients have a preference. Many like to go where their doctor is, or where they have gone in the past.

We have three main hospitals we transport to. One is a state of the art Level 1 Trauma center. One is that hospital's sister hospital, and they handle minor traumas. I would take a guy that fell off a short ladder there, but a guy that fell off a ladder from the third story, I woulndnt. The last is also another hospital that can handle minor traumas.

We were talking about this yesterday in the rig. For us, we have our choice of hospitals, and it's not a big deal to drive an extra two minutes to the trauma center. Out in rural areas, lots of fire department EMS units are being pressured to take patients to hospitals that otherwise wouldn't be the best choice.
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Old 07-09-2004, 06:30 PM   #5
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Our trauma criteria is the closest, most appropriate (read highest rated) trauma facility within 30 minutes transport time. NOTE: The 30 minute range is greatly increased when using a helicopter to transport your patient.

Based on this criteria, we are allowed to bypass certain hospitals if we can get to a better facility within 30 minutes. Of course, if we have airway control problems, we stop at the nearest hospital first.
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