Don't have a heart attack in a hospital parking lot

[VentMedic]

really, so if the patient enters the ER with a potentially cervical spinal injury, the ER doesn't put them on the backboard with C-collar? I know of two ERs in my area that have at least 1 backboard that is owned by the ER itself.

Some do have backboards or could use one left behind by EMS. However, it is generally not the practice. And again, you may only have one RN and one security guard to carry a patient instead of 6 FFs. There is another reason EDs keep a backboard available and that is for IFT by ground or flight. Sometimes a patient is brought in by EMS without packaging or even walks in with a spinal fracture. It may be easier to stabilize, move and transfer the patient to another facility on the backboard. In other words the patient is packaged with the backboard in the ED for a flight or ambulance transport.

In the hospital, patient will be positioned to where their movement is limited, placed on a bed that is designed for accessories attached such as tongs, halos, traction, pad stabilizeres or whatever and they may be taken to the OR for stabilization of the OR. Neuro will also customize or get a specific sized collar to fit the patient's needs. We have slides and specially designed Hoyers and other lifts that also can move patients with different injuries. But, some equipment runs on tracks in the ceilings of the OR, ICU and ortho units since not all beds accomondate the legs of the Hoyer. If a fall occurs inside the hospital, any of this equipment can be utilized and not a back board.

As much as it sucks, falls in the parking lot typically get an EMS response, and maybe a hospital security one. I can recall several times we were called for falls, only to have security cancel us as they already assisted the patient into the ER.

You complain when you are called and you complain if not needed?

 

[RyanMidd]

My girlfriend (RN) and I understand the inherent differences in our jobs and the policies that come with them, but the one scenario we can always depend on for a heated discussion is as follows:

Man with DNR is in a hospital, several floors up. Paramedics are leaving hospital, and do not know this patient or his physician. DNR man jumps out window, lands on sidewalk in front of medics. He is in respiratory arrest, followed by cardiac arrest, but he is alive. Medics are about to begin treatment, nurse runs outside and says, "Stop, this man has a DNR. Don't do anything".

Knowing the Health Act where I live, as well as similar 'Good Samaritan' type acts, I am all for working the guy. Unless I have online or present medical direction in the form of a valid DNR signed by a local MD, I will work it.

RN girlfriend, however, is adamant that they should take the nurse's advice and leave it be, especially since he is still technically at the hospital and under their care.

We both have a few more salient points than this, but this thread reminded me of the one scenario that will guarantee a fight between her & I. =)

 

[EMSLaw]

Please tell me that isn't a real scenario?

Based on the answers above, the patient is now outside the hospital - he's eloped! (I just love that word in the context. ). I guess you work the code until presented with a valid pre-hospital DNR.

 

[VentMedic]

Please tell me that isn't a real scenario?

That has actually happened a few times at a couple of hospitals in my area. In those situations the physcians at the hospital made contact with EMS by radio if physical contact was not possible and assumed responsiblity of the patient. However, one patient survived the fall without coding and had to be transported from scene to a trauma center. In that situation, the patient remained in control of EMS. Another hospital which was not a trauma had a shooting outside of its ED door with the victim being a patient in the ED who stepped outside for a smoke. EMS, already at the hospital, assumed control of the patient and transported the patient to the trauma center just a few blocks away.

 

[EMSLaw]

That has actually happened a few times at a couple of hospitals in my area. In those situations the physcians at the hospital made contact with EMS by radio if physical contact was not possible and assumed responsiblity of the patient. However, one patient survived the fall without coding and had to be transported from scene to a trauma center. In that situation, the patient remained in control of EMS. Another hospital which was not a trauma had a shooting outside of its ED door with the victim being a patient in the ED who stepped outside for a smoke. EMS, already at the hospital, assumed control of the patient and transported the patient to the trauma center just a few blocks away.

If it were a physician coming out and saying to terminate the code, as long as he was willing to take responsiblity for the patient, I'd do what he said. But, depending on local protocols, of course, a nurse generally isn't qualified to give that instruction.

 

[DrParasite]

You complain when you are called and you complain if not needed?

I complain when I am called, we respond and get on scene, and when not finding a patient, are told by dispatch that security brought the patient to the Emergency room 5 minutes ago. If security is going to call us, at least let us get to the patient. or take her directly to the ER and don't bother calling us, since that is what they will end up doing.