Here let me get you a taxi.....and hold on to your finger.

[CAOX3]

"John, 67, was left with blood spurting from the wound as he lay in agony on the pavement outside his home.

But he was denied treatment at his local hospital in Ayr where he was told to take a TAXI to Glasgow"

http://www.thescottishsun.co.uk/scotsol/homepage/news/2789034/OAP-Johns-digit-ripped-off.html?j

 

[JPINFV]

but but but but... national healthcare!

 

[FFMedic1911]

I'am sure the news has embellished the story for more than it is.I really don't see the problem if the pt. was stable and bleeding controlled why couldn't he take a taxi.

 

[VentMedic]

I'am sure the news has embellished the story for more than it is.I really don't see the problem if the pt. was stable and bleeding controlled why couldn't he take a taxi.

Isn't a taxi what some U.S. FireMedics would suggest? Traumatic amputation of a body part sounds like a BS call and who cares about packaging the finger or replantation.

 

[FFMedic1911]

What info do we have to know the hospital didn't do this.The article is to sketchy to make any assumptions.To assume I made my first post because of a simple screen name is unreasonable.I haven't posted in awhile and forgot as a fire based medic I have nothing to contribute as such.Oh well maybe one day us stupid hose humpers will learn.

 

[VentMedic]

What info do we have to know the hospital didn't do this.The article is to sketchy to make any assumptions.To assume I made my first post because of a simple screen name is unreasonable.I haven't posted in awhile and forgot as a fire based medic I have nothing to contribute as such.Oh well maybe one day us stupid hose humpers will learn.

Did you read your own post?

You stated:

I'am sure the news has embellished the story for more than it is.I really don't see the problem if the pt. was stable and bleeding controlled why couldn't he take a taxi.

The picture shows the guy missing a finger. You don't see a problem with the patient going by taxi? Do you not believe in replantation? Do you do anything to preserve amputated body parts for transport with the patient? Or, do you feed them to your dogs as one infamous FF/FD did not to long ago here in the U.S.?

My first post still stands as stated.

 

[CAOX3]

I tend to to be both physically and emotionally attached to my digits so someone better think its an emergency.

 

[FFMedic1911]

Yes i do believe in replantation.Like I said if the bleeding is stopped and no other problems exist what is going to the other hospital in an ambulance going to achieve.Tell me exactly what you would do for this pt on a transfer that would cause a change in the outcome.If by the second part of your post you are referring to the incident where the ff uses a deceased pts. part as training for a cadaver dog thats not really comparing apples to apples in this case.Yes i do believe in replantation.

 

[VentMedic]

If by the second part of your post you are referring to the incident where the ff uses a deceased pts. part as training for a cadaver dog thats not really comparing apples to apples in this case.Yes i do believe in replantation.

That patient was very much alive and wanted to know what happened to his leg. You did hear about what happened to the FF due to that little incident?

Yes i do believe in replantation.Like I said if the bleeding is stopped and no other problems exist what is going to the other hospital in an ambulance going to achieve.Tell me exactly what you would do for this pt on a transfer that would cause a change in the outcome.

Have you never transported an amputation before? Do you have any protocols for it?

I would see that the finger is properly packaged. IV access with pain management would be a necessity. I've been told by patients that an amputated finger really hurts. It also would not be wise to expose the public to the possibility of bleeding in a taxi since there are little arteries in the finger that can be kinda difficult to control. The sending hospital may also hang antibiotics for transport.

We replant fingers, arms and legs everyday at several microsurgery centers throught the U.S. but proper care MUST be done with both the part still attached to the patient, the amputated part and the patient. If the patient becomes unstable during transport due to blood loss, hypo or hypertension or pain, that can delay replantation and the chances of saving the amputated part.

 

[FFMedic1911]

That patient was very much alive and wanted to know what happened to his leg. You did hear about what happened to the FF due to that little incident?

Could you post a link to this story.Am still not convinced that ever pt needs an ambulance from one hospital to the other hospital.Sorry I know in your eyes that makes me a simple minded ffmedic.Am going to go sit in the corner now.

 

[VentMedic]

Could you post a link to this story.

The Port St. Lucie FF was found guilty of misdemeanor theft and left the FD ending her career.

http://www.wpbf.com/news/17607680/detail.html

Am still not convinced that ever pt needs an ambulance from one hospital to the other hospital.Sorry I know in your eyes that makes me a simple minded ffmedic.Am going to go sit in the corner now.

As I asked before, do you have any protocols for amputated parts?

Do you believe in pain management? Are you allowed to do pain management?

How many traumatic amputations have you taken care of?

If the patient states "they're fine and can drive themselves or go by taxi", those are the ones you might want to watch the closest.

 

[ffemt8978]

Actually, it was the hospital that suggested he go by taxi.

John was rushed to Ayr Hospital with his digit wrapped in a bag of frozen peas.
But health chiefs said they had no suitable surgeons and made him take a cab to Glasgow Royal Infirmary.

 

[VentMedic]

Actually, it was the hospital that suggested he go by taxi.

That is in that country. Here in the U.S. we do have the means to save a finger by replantation. Thus, I am rather shocked that in the year 2010 that some may still not have protocols to treat a patient for traumatic amputation and transport to the appropriate hospital as FFMedic1911 is suggesting. It just seems rather rude to tell a patient a take a cab and say bye-bye to their body part if there is a better alternative available. We get replantation candidates from several hours away by ground and flight with the prognosis being good of a success replantation because both the body part and the patient were treated properly.

 

[ffemt8978]

That is in that country. Here in the U.S. we do have the means to save a finger by replantation. Thus, I am rather shocked that in the year 2010 that some may still not have protocols to treat a patient for traumatic amputation and transport to the appropriate hospital as FFMedic1911 is suggesting. It just seems rather rude to tell a patient a take a cab and say bye-bye to their body part if there is a better alternative available. We get replantation candidates from several hours away by ground and flight with the prognosis being good of a success replantation because both the body part and the patient were treated properly.

I agree, I was just clarifying something that FFMedic said.

However, we can point to cases here where every type of EMS agency (fire, 3rd service, private, and even hospitals) have made boneheaded recommendations like this. There is no need to single out one type of service.

 

[VentMedic]

However, we can point to cases here where every type of EMS agency (fire, 3rd service, private, and even hospitals) have made boneheaded recommendations like this. There is no need to single out one type of service.

I definitely agree with that but FFMedic1911 used the word "I" in his post which is what I tossed back at him.

There are also some areas like in CA that can not transport to a microsurgery center which may not be a service of the trauma center. Unfortunately since a finger amputation is considered "trauma" the patient gets stuck at the trauma hospital for up to 12 - 24 hours while transport to the hospital with microsurgery is arranged. In the one area this occurs frequently, the two hospitals are only about 3 miles apart. For this situation I would probably say package my finger to go and I would take a taxi.

 

[FFMedic1911]

For your questions yes for pain managment and protocols.I have transported several pts. such as this.I'am still trying to find in my post where I suggest places here in the US don't have these protocols in place.

 

[VentMedic]

For your questions yes for pain managment and protocols.I have transported several pts. such as this.I'am still trying to find in my post where I suggest places here in the US don't have these protocols in place.

Did you not read your own posts? You stated the patient could go by taxi. How many body parts must be amputated before they get a ride in your ambulance according to your protocols with pain management?

Tell me exactly what you would do for this pt on a transfer that would cause a change in the outcome.

If you have transported patients before with amputations why do you find it surprising that there are things that can be done for the patient and amputated part? In this article, the patient lost his finger. In the U.S. at this time that does not always have to be the outcome. Did all the patients you transported lose the amputated part? No microsurgery center? No ALS/CCT to get the patient and body part to a microsurgery center? Just a "suck it up attitude" in your area and losing a body part is no big deal?

 

[Aidey]

Um, not to change the topic here, but the Sun isn't exactly the most reliable publication in Scotland (I have family over there). They aren't quite as bad as the National Enquirer, but they are not above dramatizing the details to make the story more sensational. I'm not saying that the article is false, just that there should be some skepticism about the details until a more reliable source is found.

For example, this article, from the local paper there, doesn't even mention that he went to the Ayr hospital. All the other articles I found were re-prints from the Sun.

 

[VentMedic]

If the patient chose to ride a taxi instead of taking the time to wait for an ambulance, then that is his choice. Many farmers and other industrial workers may have to drive, walk or crawl great distances to get help of any type if they suffer an injury.

However, I believe it is irresponsible in the U.S. for a Paramedic to tell a patient to take a taxi after a traumatic amputation with or without the amputated part. One never knows how a person will react to their injury once the initial shock wears off. While it may just be a finger, to some that could be a career ender. Even for those in EMS, if it is your dominant hand, you may have to relearn many skills and it may be difficult for you to do your job to where you may have to find another career path. Realizing that can be devastating if one is alone in a taxi without support of any type and can be dangerous if the taxi driver does not know how to react to your emotions. Bleeding can also become an issue again as the spasms may relax. At least with a Paramedic, pain and bleeding control can hopefully be done as well as some support for the emotional issues surrounding these injuries.

If a hospital has properly cleaned stump and determined that another facility is needed to provide more care, few hospitals are going to release a patient to go by taxi (in the U.S.) especially after they have initiated an IV and have given antibiotics and pain medicine. The wound may still be open and at risk for infection or improper healing. They would also probably have to remove the IV catheter and the patient would have to have it restarted at another facility. Yes, there are some injuries that patients are sent home with a splint to wait for a surgical appointment but there are also many that spend their wait in a hospital to reduce risk and further damage until a specialist can be seen.

 

[medichopeful]

However, I believe it is irresponsible in the U.S. for a Paramedic to tell a patient to take a taxi after a traumatic amputation with or without the amputated part.

I couldn't agree more. However, if it is the only option (in other words, the patient refuses), than I would say it is acceptable. But other than that it is completely out of line.