Stopping at another scene with a patient on board

[RedZone]

This is something from a review I am working on:

EMS providers work closely with other emergency agencies such as fire and police departments. A coordinated emergency system with good interdepartmental communication and mutual respect among responders is paramount to providing necessary emergency services to a community.

It sounds as if the officer was out of line. I work in a multi-agency EMS system, maybe the largest in the world. I've had my run-ins with other divisions of emergency response.

Thanks... I didn't know where to put that one. It'll be legal issues & ethics!

 

[MMiz]

emt9577,

Amazing story. See, now I'll think twice.

Once I had a flat tire in my rig, pulled over on the shoulder, and hit the truck up. I promptly caused one car to wreck into another. That's what I call job security. :glare:

 

[eggshen]

That is the silliest story I have ever heard. Improper stopping? Whatever. Never again shall I complain about the town I work in, that would never occur to the cops here...EVER. That's just plain madness.

Egg

 

[Jon]

I typed a reply to this and it never went through. Bummer.

Anyway... I've related a story on this topic before...

Several years ago, my partner and I (both EMT-B's) were doing a routine BLS discharge, hospital to SNF. Pt. was stable, and our SOP's REQUIRED us to stop and render aid as long as it was safe to do so, the patient was stable, adn one provider stayed with the patient.

We were driving along when we came upon an MVA with entrapment that happened almost in front of us. We stopped... I was in the back, and my partner asked me to go check the scene while she stayed with the truck and patient. Dispatch was advised, and the goings-on were explained tot he patient. I gained access to the vehicle and held c-spine on the pt, who's face was a bloody pulp after sudden deceleration upon impact with the windshield. As soon as FireRescue showed up, I transferred care to a FF and we left soon after. The patient felt that he was left alone in the rig, and started to complain to staff upon arrivial at SNF. We explained the situation to the SNF staff, as well as our managers.

 

[BossyCow]

Our policy was clearly written out. If you have a patient on board, no stopping. You put the patient with you in the middle of the accident scene just by parking the ambulance. Of course, in the city, there is always another EMS vehicle nearby. I could see where your situation might be different BossyCow.

We don't do non-emergent transports. We are strictly emergency response so I won't be stopping. I think if I had an 'extra' EMT on board and could guarantee that our second out unit was able to respond I might drop that EMT at the scene, but it would have to be very special circumstances. It's one of those slippery slope, gray area judgement calls where no matter what you do, there are those who will point out where and how you :censored: it up by not doing the opposite.

 

[BossyCow]

Wait, how is stopping patient abandonment? I'd never have the person in the back (with the patient) hop out, but I can't see a problem stopping the ambulance and having the driver hop out to check to see if a LEO is okay.

If I had a patient in back who is simply getting a ride to a doctor's appointment, I'd stop for a LEO. If it was an emergency call (even without L/S) I wouldn't stop, but I'd stop otherwise.

My driver is generally a firefighter, not an EMT.

 

[RedZone]

We don't do non-emergent transports. We are strictly emergency response so I won't be stopping.

I don't like to judge, but I want to point out a little ignorance here. I don't know you or your service, but I would assume you've transported a stable patient or two, maybe that probably didn't even need an ambulance. The essence of triage cannot be overstated in EMS.

I think if I had an 'extra' EMT on board and could guarantee that our second out unit was able to respond I might drop that EMT at the scene

So much for that EMT's safety.

It's one of those slippery slope, gray area judgement calls where no matter what you do, there are those who will point out where and how you :censored: it up by not doing the opposite.

You have a few protections here:

- A clearly written policy as was suggested by VentMedic.

- Use of good judgment. I would say a good 25% or more of this job is IMPROVISATION. This is a skill that needs to be honed based on common sense, education, experience, and a clear understanding of your role.

- A supportive interdisciplinary TEAM approach, including a good QA review process that isn't necessarily discipline based. Basically, your "bosses" should "stick up" for their crews unless there is gross negligence.

- Liability insurance.

 

[DT4EMS]

So let's add this to the mix................

You are loaded, en route to the hospital............ when DISPATCH asks you to "check on an unresponsive male" in a ditch you will be coming up on.

What do you do then?

Does dispatch know the resources and your priority?

Now.........do you refuse to stop?

If you stop..... then what?

I can tell you I have worked in different agencies where we picked up more than one patient.............. on different calls.

That doesn't get done as much today as it did 10-15 years ago but not everything is cut and dry. Never and always can't come out of your mouth in EMS.

 

[BossyCow]

I don't like to judge, but I want to point out a little ignorance here. I don't know you or your service, but I would assume ...

Hmmmm.... so who's ignorance are you pointing out?

So much for that EMT's safety. ...

As I stated originally, the most likely scenario is that I do not stop. Everything about this situation is a liability nightmare, no matter which decision you make. But.. regarding safety, we are a volly agency and most often arrive on scene, alone and via POV. Any EMT that I dropped off on a scene would be as safe and prepared as one arriving on scene from their home.

 

[eggshen]

"I might drop that EMT at the scene"

I would leave a pt. on the street corner before I would leave ANY of my partners alone (unless he/she might be getting some Great Wall).

If you have a BS pt. in the back I see no problem with picking up another pt. and another and another. One of my first nights doing the job for real my FI stopped over and over until we had 5 pts, all unrelated (my record is 7). As long as I can manage them all I take no issue with filling up the bus. We use privates, such as AMR, to back us up when we run out of cars and they all seem to have a policy of "one pt. only" regardless of the nature of their current pt. or the one we want to give them. I understand that each agency has it's own policy but that does not preclude me from stating that said policy is WEAK. If I can take some pressure off of the system by filling my pockets with low acuity pts. please, bring 'em on. I would hate to think that a real pt. may go without an ambulance because I am not tight enough to manage my pt. that may have another seizure. So many people get into this job to "help" so my opinion is that one should do just that...help. You are not helping ANYONE by allowing a sick pt. to gasp because you insisted another car check out that "party down". C'est tres mal is all I can say.

Cheers
Eggshen

 

[Epi-do]

When I first started doing this job, it was pretty common in this area to take multiple patients in one truck, but they would all be family members from the same scene or occupants from the same vehicle. We would even do this if they wanted to go to two different ERs, as long as they were relatively close to each other.

Now, it is frowned upon in our local system. Some of the services around here have even gotten trucks that are confugured in a way that you are unable to put a second boarded patient upon the bench seat.

The around here is that you must do what is best for the patient that you are currently with. If you are transporting two patients at the same time that initially appear to be stable and one of them goes south on you, patient #2 is now "suffering" because you are unable to afford them the attention they should be receiving. Also, what happens if you have 3 patients in that back, you are by yourself, and 2 of those patients go south. Now you are definately not doing what is best for your patients.

I have heard all the arguments about how the odds of something like that happening are small, but anyone who has been doing this job for very long has had those patients that caught them off guard, and suddenly crapped out on you with seemingly no warning. It happens - we all know that it does. So, why take the chance that you may have to start CPR on a patient while thier child/spouse/friend/etc. is also in the back of the truck looking on? And it doesn't have to be CPR. Some people just don't handle seeing any of the stuff that we do, whether it be starting an IV, intubating, cardioverting, or working a code. Why risk subjecting someone to the possible psychological trauma of witnessing that on a loved one? It just isn't worth it.

One of my first nights doing the job for real my FI stopped over and over until we had 5 pts, all unrelated (my record is 7). As long as I can manage them all I take no issue with filling up the bus.

I am sorry, but 5 patients in one truck, with one tech is way to much. It is just my opinion, but I just don't believe that each patient is receiving the best care you can give them when your attention is divided in 5 different directions.

 

[eggshen]

5 is no problem as long as one can multitask. No different than an MCI, we are busy and the system comes before the pt. so that we might get ambulances to more pts. This way we can avoid ditching them to privates that have a history of having difficuly managing ONE pt on any given day.

Egg

 

[Epi-do]

Egg, I guess we will just have to agree to disagree on this one. An MCI is one thing, and then, yes mulitple patients per provider is the rule, and not the exception. However, barring and MCI, I can't think of a reason where I would agree that "the system comes before the pt".

I don't think it is really an issue of multitasking either. To some degree, you do that on every shift you work. While my top priorities will always be myself and the rest of the crew onscene, I have never put the system before my patients. Each one gets the best possible care I am able to deliver at the time they are in my care.

I mean no disrespet, nor am I trying to start an arguement. You are most certainly entitled to your opinion, and are the one most familiar with the system you work in. There are qualities of every part of the country that makes each system different. It plays a part in how we view things, and that is what I enjoy about this site. While I disagree with you on this matter, I am sure there are others that we probably agree on, and look forward to reading more of your posts.

 

[VentMedic]

5 is no problem as long as one can multitask. No different than an MCI, we are busy and the system comes before the pt. so that we might get ambulances to more pts. This way we can avoid ditching them to privates that have a history of having difficuly managing ONE pt on any given day.

Egg

So is your company a municipal or county service?
Does your agency still bill or file medicare and insurance claims?
Multilple patients can be a billing nightmare for many companies. Not that it matters to the EMTs or Paramedics...that is until a fraud case happens.

example:

http://www.arkansas.gov/dhs/aging/5-Ambulance.pdf

http://www.merginet.com/index.cfm?pg=legal&fn=ComplianceGuidance-PartIII

 

[Flight-LP]

5 is no problem as long as one can multitask. No different than an MCI, we are busy and the system comes before the pt. so that we might get ambulances to more pts. This way we can avoid ditching them to privates that have a history of having difficuly managing ONE pt on any given day.

Egg

Well hell, why not stop at the nursing home and check to see if anyone needs to go to the hospital......................

What you're describing is ridiculous, unsafe, disrespectful, and flat out stupid. It doesn't matter how trivial of a complaint your patient has, they are still entitled to your best care, not you pushing them off to the side for someone else. Keep it up and I guarantee your EMS career will be short lived. Sometimes you have to roll a call over to someone else, the system SHOULD NEVER COME FIRST! Your responsibility is YOUR PATIENT. If your system is so damn busy that they can't handle the volume, then you need more units. If your service can't effectively perform its needed services for the community, then your service contract needs to be terminated. AMR may suck overall, but at least their SSM program provides for a contractural need. Maybe you and your service could learn something from them before you totally dismiss what may be a valuable resource to you.

Horrible, absolutely horrible................

 

[Ridryder911]

Wow ! This has become interesting that so many opinions and views that represent everything from abandonment to possibly fraud in billing services.


It is common knowledge that once one has made contact to the primary patient that they have made a contract regarding Duty to Act, and anytime that patient is left with lesser and not equal trained individual can be charged with abandonment.

As well, delaying care and transport could be reviewed if there is question that there was excess transport time.

As well, Medicare and many other payers such as insurance companies that the ambulance and EMS providers will not pay for transports devices that transported more than one event. Otherwise, EMS buses would be developed and utilized.

This debate is old and has been talked to death on multiple EMS forums. C'mon folks, really use some common sense. If one is transporting and stops (when they could be transporting a patient) then that EMT is obligated to stay and treat the other patient, thus breaking the initial contract with the first patient.

R/r 911

 

[Emtgirl21]

I think egg just likes to play devils advacate just to see what s/he can get started.

 

[Grady_emt]

Taken 3 from one scene, two boarded, one walking and will never do it again. We were first out on a rollover and the second unit that we called out was wrecked onscene. The tow truck driver wasnt paying attention and pulled the OTV back rightside up into the other unit. Rather than wait for the next available unit (level 0 at the time), I went ahead and took the 2nd backboarded pt on the bench.

As for care, they were all stable, all related family, the walking one refused all c-spine and care other than transport, and the other two were also stable, yet still recieved the full trauma work up of C-spine, LBB, Large bore IV etc...

Wont ever do it again though, two is the max unless as stated earlier, MCI situation.

 

[Emtgirl21]

I have taken two pt from the same vehicle of a MVA. Both patients were stable and BLS. I boarded the first pt w/ FD and went to the ambulance with that pt. My partener and FD boarded the second pt and brought him to the truck. Just trying to get two pt assessments done, vitals, and call report was tough before arriving at the hospital. Adding to the toughness one of my pt starts to have a panic attack and trys to climb off the backboard. I could see how the situation could of gotten nasty quick fast and in a hurry had i not been able to control him.
I've also taken two psych patients at a time. I suggest not doing that personally!

 

[Asclepius]

I'm pretty amazed at the number of people who would put themselves, possibly their patients, and definitely their agencies at risk for liability and all other kinds of legal issues. It's pretty clear that your patient is the one you have made contact with, unless you pass them off to a provider of equal or greater training and certification. Being deferred from one call to another isn't a big deal so long as you haven't already made patient contact. However, once you have that patient...that patient should be your sole focus. You should not stop for any reason until you have reached your destination.