Yet, look at all of the places that will gleefully ignore otherwise valid DNR orders/requests simply because they aren't on the proper colored paper. Opps, sorry, you're a hospice patient with an otherwise valid DNR order written into the chart and going to a hospice facility? Well, you don't have our DNR form, so we're just going to ignore it. So, which is it. Is a DNR a legal order or is it not. If it's a legal order, than all of the systems that limits ambulance crews to just the out-of-hospital forms must be breaking the law somehow.
I know I am probably in the minority, but if i had a DNR, I would want to make it as accurate as possible. that means using the state DNR form, for out-of-hospital if the patient will be transported out of hospital, and if hospital and hospice if appropriate. but thats just me.
Similarly, I doubt the hospital staff is going to lose sleep over forcing the crew who ignored the divert to hold the wall. I imagine it isn't too hard to find patients in the lobby that are sicker than your patient.
probably right, but when I start calling for the hospital administration to come down and explain to my patient why they are waiting, a bed will be found. and while I haven't had to do that, I know of supervisors who have went to the ER and made that request. it's called advocating for your patient.
You're also missing the entire point of a pattern of ignoring the divert status. There's a difference between one patient and flat out continually ignoring it. I stand by my statement that a crew or company that shows such a pattern will garner the attention of the hospital staff, which will garner the attention of both the company (especially if the company has a contract for that facility) and the local EMS authority. Why is the policy on divert status any less important than all of the other policies out there governing the EMS system?
you can stand by your statement, but your statement is still wrong. maybe an IFT company can get in trouble (since that seems to be where all your experience is), but 911 services don't.
the divert status is a hospital request, it isn't an EMS policy. I could explain it more, but if you don't understand that concept, than it is a moot point.
Comparing someone who hasn't accessed the emergency medical system to someone who is currently in the emergency medical system is comparing apples to oranges. Of course it's ironic to discuss dumping patients in a conversation about trying to justify EMTs dumping patients because they don't want to be a team player.
ahhh, not a team player... yeah, that's me. the guy who wants to get back out there and pick up the next GSW victime, heart attack, or asthma attack, and take them to the hospital, instead of holding a wall for 1-4 hours. yep, not a team player :rofl:
If you're coming into a facility on divert, what makes you think that a bed is available to treat your patient? I've never had a patient be treated on my gurney, but I also haven't ignored diversion status either. Besides, what makes you think that the hospital supervisors care what the ambulance supervisor thinks when the ED is already packed with patients and on divert?
well, when you aren't going to make any noise, they won't care. if you just wait their quietly, hospital supervisors won't care. maybe the hospitals I have dealt with are just more EMS friendly than others, or just practice good customer service whether it be from a patient or a fellow healthcare provider.
Of course out West (since you want to make this a geographical issue) doesn't have a problem with unlicensed providers working on ambulances.
ouch, a zinger!!! you know, with a small percentage of FD ambulances or rural ambulances in the sticks do doesn't represent the majority, so your cheap shot doesn't phase me at all,nor does it even apply to me.
Strange, the same could be said about a crew who thinks that divert status doesn't apply to them. What makes your patient more important than all of the other patients in the saturated ED? Your time is more important than the hospital staff's time dealing with numerous other patients because you want to dump your patient on them instead of following your system's policy regarding divert? A policy that was made in consultation with both the system administrators, the hospitals, and the ambulance services? I'd rather have a lower sense of worth than an over-inflated sense of self worth where I think I know more than everyone else involved with the system combined.
yes, back this the divert thing. if you can't understand that it's a courtesy, not a requirement, than I won't waste any more time wit you.
My patient is more important because I have done my job, and brought them to the ER. if the staff say put him in triage, he goes into triage. if the staff say put him in a bed, he goes in a bed. either way, my job (what I'm paid to do, and what my boss tells me to do) is to pick up sick people and take them to the hospital. Once they are in the hospital, they are the hospital's problem (and yes, overcrowding sucks, but that's a hospital flow problem, not an EMS problem).
I wonder what would happen if EMS providers suddenly had to start regularly treating multiple sick patients for hours at a time instead of one patient for 20 minutes. I'm willing to bet the "I'm the center of the universe" attitude would quickly change.
first off, usually those sick patients are focused 100% by a doctor or nurse until they are stabilized. Then they are consistently monitored by a nurse or by a machine (which is monitored by a nurse) for changes, and if there are any life threatening changes the patient again gets 1:1 care.
if a nurse is handling too many sick patients at the time time, than the hospital needs to hire more nurses. I am pretty sure there are nursing standards that say how many patients can be assigned to a nurse. either way, it's a hospital issue, not an EMS one.
This is a ridiculous statement...we are all on the same team, working towards a common goal, that goal being good patient care.
absolutely right, in theory anyway. we also play different roles, ambulance people pick up the people and drop them off in the ER, while the ER people deal with the people we drop off. but if the ER is preventing you from leaving the ER, then they are preventing you from providing good patient care to the other people who need your help, which is preventing you from doing your job. so how is delaying access to the EMS system considered god patient care? ditto delaying getting a comfy bed for the patient (ambulance cots as a whole generally suck when compared to a hospital bed). We won't even go into the detrimental effects of having a patient on a backboard for an extended period of time.... So again, if the people on your "team" are preventing you from providing good patient care to others who need your help, and are forcing your patients to remain on a ambulance cot and/or long spine board longer than the need to, are they really striving to provide good patient care?
So if I'm reading what you said above correctly your saying by allowing a nurse to pull labs before we get a room in hope to expedite the patient's stay in the ER and eventually clearing a bed more quickly I have no respect for the value of my equipment or myself? If myself and a nurse push a med before the patient is assigned a room because the system, as a whole, is overloaded I have a poor opinion of myself and my job? That's asinine.
so let me ask you this: if the nurse can do all that work with the patient on your cot, why should he or she work on getting you a bed at all? why not just leave the patient on your cot? the patient gets treated, the hospital gets it's tests done, and it doesn't tie up a hospital bed at all. there is absolutely no reason for the hospital to get you a bed at all.
Sure units need to be available to answer calls in the system but even if they are able to answer those calls what good is it if there's nowhere for us to take those patients to? Just some food for thought.
the patients need to go somewhere, and the system (in its current state) has EMS take them to the ER. You can like it, you can hate it, you can disagree with it, or you can think it can be done better; but regardless of what anyone thinks, that's the systems we have to deal with. Are the ER's overworked with non-emergent patients? absolutely. But they can't turn them away, despite that they would like to. They do make them wait, but they do get seen, and if a critical patient walks in the door, they do get to jump the line and get seen.
Maybe I am looking at the issue wrong. Maybe the issue is in other areas the ER staff just doesn't care. Maybe EMS needs to build better relationships with the ER management so they will care what people think?
I can't speak for anyone else, but I have gone out with nurses in a purely social setting. We have all gone drinking after a long shift, and EMS was invited to their christmas party. We treat them with respect, and they treat us with respect. Maybe it's because of this that despite being overworked and understaffed, we still rarely wait more than 20 minutes for a bed (and usually it's because they are actively trying to find a bed for us). We are friends, we work to help them, and they in turn work to help us. We understand their roles in the healthcare system, and they understand ours. maybe that's why we don't have hour+ long waits to turn over a patient.
One last example: I had a run in with an L&D nurse a few years ago. She completely ignored me, ignored everything I had to say, and then sent me down to the ER with my patient (which didn't bother me all that much except that I didn't know the way through the hospital). Anyways, I made it to the ER, and the nurse (who only knew me professionally, I doubt she even remembered my name) saw I was visibly frustrated. After we transferred the patient to a bed, she asked what was bothering me and I told her. She then brought me to the nursing director of the ER, who asked what was wrong, and I told her. She then picked up her cell phone, dialed a number, and told me to repeat what I told her. So I did. I later learned that the person she called was the director of the L&D department who wasn't happy to hear what I had to say. The original nurse was reeducated on interacting with other healthcare providers (she didn't think she did anything wrong), which I didn't care about, but the department policies were changed to be more EMS friendly (and more patient friendly, which me very happy).
and the only reason anything was done was because I said something about it, and the ER staff respected EMS (as a general whole, not an individual provider) to listen to a complaint to make the system better for all involved.
btw, that nursing director has since moved on to another position, but I have met the new ER director, have her name, email and phone number, and she knows me, and has my contact information. and yes, we have communicate issues and they tend to be resolved to everyone's benefit.