# Hospital calls 911 for patient.



## ffemt8978 (Apr 22, 2009)

http://www.vancouversun.com/Health/Hospital+staff+call+ambulance+outside/1517456/story.html


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## Shishkabob (Apr 22, 2009)

I was working a couple of weeks ago, and we are a primarily IFT service that does priority 2's pretty often.  There was a priority 2 called for us in a hospital parking lot that turned out to be an auto-ped.



PS-- who is this "Olsen" guy who thinks it's his civic duty to go on a vendetta for the man hit?  Man, the way he acts in that article makes it seem like the pt was a family member.


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## Mountain Res-Q (Apr 22, 2009)

That hospital's policies suck!!!  Are telling me that EMT's and Paramedics are required to treat patient's on the hospital property?  I do believe that ER Doctors and Nurses can do a pretty good job at treating emrgecnies, after all that is where we transport our patients to, right.  Or maybe it is a transport issue; the Hospital Staff isn't sure on how to get the patient into the Hospital wihtout an Ambulance to bring them their patients.

We have a similar situation out here.  The Propt Care facilities and the Family Medical Clinics occassionaly need to have one of there patients transported to a Hospital for diagnostic services and treatments that they are unable to provide there; things like SOB, chest pain, etc...  These pateints are stable and simply require a continuity of care during their transition from these small offices (all owned/operated by the Hospital Folks) to the Hospital.  Logic would say that you call the Ambulance Dispatch and ask for an Ambulance Code 2 for an ALS transport.  But no, they call 911 and request EMS for there patient.  That usually sends out the Ambulance and 1 or 2 Engines (EMT's and MFR's only) CODE 3.  Honestly, are you telling me that Firefighters are needed to provide a level of care that the DOCTOR cannot.  What are they gonna do?  Verify the vitals that the nurses are taking and continue O2?  personally, I don't understand it.  if this is another matter of policy, then they need to change things.


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## spnx (Apr 23, 2009)

Yeah, this is absolutely stupid.  Things are going to change.  It's caused a big uproar here (this is the city I live in BTW).


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## CAOX3 (Apr 23, 2009)

In my area the hospital staff is not covered by the hospital unless in the physical structure of the hospital.  It may be a lousy policy but it is policy.

This is a little different then in my area they could be on hospital grounds and still be 2 miles from the actual hospital.

I agree to some point, they dont have the portable means to treat someone.

How about an example. Lets say they get to the parking lot and this guy is shot 3 times in the chest. 

When we see someone on the ground bleeding we are weary to approach, we begin to put a picture together that says hang on this dont look right, something isnt right here.  Call PD.  Do they think that way?  Do they have the pre-hospital experience to be able put the pieces together. They probably dont even think that way.  Maybe the shooter is still there?  He probably isn't, but he might be.

Now they need to initiate CPR on a GSW, they dont have gowns and probably no gloves with them, they dont have c-spine equipment.  They dont have suction or a BVM or O2 now what.  Mouth to mouth?  I dont think so.  

So they throw him on a gurney no CPR initiated, no c-spine precautions, no bleeding control.  The guy dies.  We all know he died from the his wounds but a lawyer will say different.  He will say, would the ambulance have had the right equipment?  Why didn't you wait for them?

The policy states even if its outside the door its meant to protect them because it could be 10 blocks away.

This hospital took measure,  all their security are first responders.  In my area the security guards are not even employees of the hospital they are contracted from a security company, so they may not be held to the same policies not sure how that would work.

Common sense would tell you to bring them inside if you can see them from the door, but policy,disciplinary action for breaking policy and safety could have played a role.


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## VentMedic (Apr 23, 2009)

There are several reasons this is done and it is often for the benefit of the patient. 

1. Hospital staff may have to "abandon" their patients in the ED or make for unsafe conditions.

2. Liability coverage off property or outside of the boundaries of the hospital. This includes both their medical practice and injury to the healthcare providers themselves. State Workmen's Comp laws may also define work area. 

3. Activating EMS may assure the patient can be immediately transported to the APPROPRIATE hospital. There is a loophole in EMTALA that an obvious trauma can be taken to a trauma center immediately by the EMS protocols. But, many EMS still transport only to the nearest facility. 

4. If contact is made by hospital medical staff, EMTALA laws may come to play which will eventually get the patient transported to another hospital but there may be a delay while certain obligations are met at a facility that is not prepared with a cath lab or trauma surgeons. If that hospital can handle the patient's needs, then they are right there. However, the word "property" in EMTALA is continuously being revised but again, many will also the EMS service to act by their protocols once they have made contact. 

5. There are also regulations regarding LTC facilities that may be with the hospital building but still must call 911. 

Know your laws for your area before you just speculate about why something is done. Often there are reasons in writing, usually from the state or some government agency, that will explain this. The hospitals must write their policies to reflect other laws.

These situations are also prevalent in HEMS. Some HEMS helicopters are not licensed for IFT so the ground crew can not take the patient to a hospital ED that might be across the street to wait for a helicopter that is still 30 minutes out. The hospital may allow EMS and HEMS to use their landing area but no contact can be made by hospital personnel. On a couple of occasions, this policy has been broken when an airway was needed and EMS was unable to get one. Each time, a lot of paperwork had to be filed to keep both the helicopter and hospital from being penalized.


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## colafdp (Apr 23, 2009)

This one I think i'm going to have to chime in on. First of all, I have to agree with the hospital's policy of calling an ambulance for this patient. The staff didn't know why the man had collapsed. I'm not going to repeat everything Vent has said, because all the points were nailed in the above post. But i do believe what they did was proper for the patient and the patients in the ER. Chances are there was an ambulance at RUH (which is just across the river, maybe 2 minutes?) so he wouldn't have been waiting that long. Also, this "business associate" seems to be dumb, calling an ambulance is not a "waste of taxpayer's money" as each trip is billed to the pt or their insurance company. In the end, i do think that the Saskatoon Health Region will have to defend their policy. I've also seen this happen at other facilities in Saskatchewan, so it seems to be more of a provincial policy, then a city policy.

just my 0.02


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## triemal04 (Apr 23, 2009)

This happens a lot more than people most people would think; there's been several times that I've picked people up from the grounds of various hospitals, or even less than 100' from the ER doors.  (mostly there was good reason for it...sometimes not though)  And, while in some situations it's a lousy policy, overall it tends to make the most sense.  In a perfect world nobody would have to worry about that but hey, that's not what we live in.


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## marineman (Apr 23, 2009)

Same policy here, ER nurses will go for patients that fall inside the hospital or under the overhang outside of the doors but if it's any further than that, policy says they have to call an ambulance.


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## lightsandsirens5 (Apr 23, 2009)

I've been up to the ER to backboard a pt who had come in POV from an MVA. Seems to be standard policy that if it is outside the doors, EMS is called.


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## daedalus (Apr 23, 2009)

spnx said:


> Yeah, this is absolutely stupid.  Things are going to change.  It's caused a big uproar here (this is the city I live in BTW).


Not really that stupid. I got called the other day for a doctor who fell down stairs in a clinic that is connected to the hospital. It was better for this patient that EMS equipment was made available, including a backboard and EMTs who could physically lift the patient out of the stair well. 

These policies are not asinine in my experiences, and are half spawned of legal worries and half spawned of carefully going over possible scenarios.


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## Aidey (Apr 24, 2009)

I'm not sure about the hospitals where I work now, but the hospital I interned at for medic school had the same policy. Like Vent's example above, they also had an physically attached SNF/Rehab facility, and if someone there needed to go to the ED, they had to call 911 and have an ambulance transfer the patient. 

It seems asinine, but I understand the protocol. There is so much liability involved in health care now I don't blame hospital staff for wanting to stay out of a grey area where their insurance may not cover them.


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## EmsPrincess* (Apr 24, 2009)

Okay, if it's the hospital's "policy" then I can understand why they called 911. Does that mean it makes sense? 

Not really. 

But then there are plenty of daily occurrences that don't "make sense".


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## VentMedic (Apr 24, 2009)

EmsPrincess* said:


> Okay, if it's the hospital's "policy" then I can understand why they called 911. Does that mean it makes sense?
> 
> Not really.
> 
> But then there are plenty of daily occurences that don't "make sense".


 
Read my other post as to why hospitals have "policies".  They are usually a reflection of other regulations.  

EMS also has "boundaries".  I gave one example of HEMS not having an IFT license so they must pick up all the patients at scene even if across from the hospital door.  The patient will still have to wait outside for however long for that helicopter if they want to get to the trauma center quicker.  If the patient makes contact with that hospital, another helicopter will have to be called AFTER all IFT transfer arrangements are made.

Also, some of you probably know of ambulance and/or fire stations that sit on the boundary line of another service.   Occasionally  a 911 call will be made for a sick/injured person literally across the street.  But, the call goes to the other service whose station might be  1 -2 miles away.   Do you not think bystanders get a little confused as the ambulance across the street just sits there not responding?


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## EmsPrincess* (Apr 24, 2009)

daedalus said:


> Not really that stupid. I got called the other day for a doctor who fell down stairs in a clinic that is connected to the hospital. It was better for this patient that EMS equipment was made available, including a backboard and EMTs who could physically lift the patient out of the stair well.
> 
> These policies are not asinine in my experiences, and are half spawned of legal worries and half spawned of carefully going over possible scenarios.



In instances like the one above I can understand why hopital staff would call EMS. But, to not even check or offer CPR if someone needs it is kind of - sad.


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## EmsPrincess* (Apr 24, 2009)

VentMedic said:


> Read my other post as to why hospitals have "policies".  They are usually a reflection of other regulations.
> 
> EMS also has "boundaries".  I gave one example of HEMS not having an IFT license so they must pick up all the patients at scene even if across from the hospital door.  The patient will still have to wait outside for however long for that helicopter if they want to get to the trauma center quicker.  If the patient makes contact with that hospital, another helicopter will have to be called AFTER all IFT transfer arrangements are made.
> 
> Also, some of you probably know of ambulance and/or fire stations that sit on the boundary line of another service.   Occasionally  a 911 call will be made for a sick/injured person literally across the street.  But, the call goes to the other service whose station might be  1 -2 miles away.   Do you not think bystanders get a little confused as the ambulance across the street just sits there not responding?



I understand what you are explaining about "boundaries". Of course everything has to be run according to policy or we would have chaos. The only thing I don't understand is why no one can check for responsiveness and begin CPR, if needed, on someone who collapsed on the property.


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## VentMedic (Apr 24, 2009)

EmsPrincess* said:


> In instances like the one above I can understand why hopital staff would call EMS. But, to not even check or offer CPR if someone needs it is kind of - sad.


 
That is incorrect.  Read the article.  The Security Guards were trained as first responders and did attend to the patient.


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## EmsPrincess* (Apr 24, 2009)

VentMedic said:


> That is incorrect.  Read the article.  The Security Guards were trained as first responders and did attend to the patient.



Okay, well then I stand or sit corrected. : ) Happy?


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## VentMedic (Apr 24, 2009)

And as already stated, they don't always have the proper equipment. The ED stretchers don't always go into a very low postion for easier loading. And the stretchers are big, heavy and bulky which are meant for the floors of a hospital. While they may have a back board and C-Collar, they would have to free up enough people to assist in lifting and/or CPR. 

Another example: A little hospital near us (I'm at the trauma center) has a bank ATM machine at the corner of their property. Occasionally someone gets mugged there. PD always responds with EMS to that location. Almost always the patient is brought to the trauma center and NOT the little hospital's ED. 

We've even had people call 911 on our property because it is so large and they couldn't find the ED entrance. EMS will usually just drive them around the property, which can be quite a distance, to get them to the correct entrance.


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## EmsPrincess* (Apr 24, 2009)

VentMedic said:


> And as already stated, they don't always have the proper equipment. The ED stretchers don't always go into a very low postion for easier loading. And the stretchers are big, heavy and bulky which are meant for the floors of a hospital. While they may have a back board and C-Collar, they would have to free up enough people to assist in lifting and/or CPR.
> 
> Another example: A little hospital near us (I'm at the trauma center) has a bank ATM machine at the corner of their property. Occasionally someone gets mugged there. PD always responds with EMS to that location. Almost always the patient is brought to the trauma center and NOT the little hospital's ED.
> 
> We've even had people call 911 on our property because it is so large and they couldn't find the ED entrance. EMS will usually just drive them around the property, which can be quite a distance, to get them to the correct entrance.




You seem to be very knowledgeable and obviously have more experience than I do. I was commenting more on situations as described in someone else's reply that if the patient isn't under the over hang that the hospital staff calls 911. I understand and appreciate the need for protocol in any professional setting.


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## Jon (Apr 24, 2009)

Around here, some hospitals have policies that require them to call 911 for any non-patient having a medical emergency. I think it is silly.
  I can understand if the hospital doesn’t have an internal response system for non-patient medical emergencies on the floors… but the average ER has patients come in POV that need to be helped from a car. How is this any different, if it is only a few feet from the ER?



The hospital I used to work for (and do my clinicals in) uses a concept called "Rapid Response" the idea is two-fold. One is for patients (inpatient or same-day surgery) that are declining (abnormal vital signs, change in responsiveness), but aren't a code yet - it essentially brings a code team to the patient to attempt to resolve the patient's condition. During day shift, there is a CRNP that leads this team, and at night, one of several docs in house is tasked with this responsibility.

This team's other responsibility is responding to on-site emergencies. If it is in hospital or just out front, they'll use a wheelchair or gurney... if it is outside, they'll call 911... But when we arrive, we'll find staff already caring for the patient.

  This system works well for us.


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## VentMedic (Apr 24, 2009)

Jon said:


> Around here, some hospitals have policies that require them to call 911 for any non-patient having a medical emergency. I think it is silly.
> I can understand if the hospital doesn’t have an internal response system for non-patient medical emergencies on the floors… but the average ER has patients come in POV that need to be helped from a car. How is this any different, if it is only a few feet from the ER?
> 
> 
> ...


 
Almost every hospital in the country now has something similar to a Rapid Response Team thanks to this nationwide campaign:
http://www.ihi.org/IHI/Programs/Campaign/

Does anyone know how many emergencies outside of that ED you aren't called for? One call and some in EMS seem to get their panties in a twist. A hospital Rapid Response Team may respond to 1 - 2 call per shift or as many as 10 per shift. You know how many patients that team or the staff of the ED did drag in? I can guarantee you are not called for every patient that can't quite make it through the ED doors. And yes, even the Security Guards will rush a wheel chair through the parking lot to catch a patient before they hit the ground. 

Some hospitals also have lift teams which are a true asset to move just about any patient who is any size including the very large bariatric. In most places, they definitely have the technology for the job. However, little hospitals may not have a lift team and the Rapid Response Team will be RNs/RRTs who also have many other patients as an assignment also. ED RNs may have up to and sometimes over 10 patients each. If two RNs leave their pods to go outside, that is 20 patients that will be without supervision. 

EMTALA still says hospitals are to treat patients that are attempting to make it into their ED. However, the ED also knows its own limits and resources which is something EMS should consider for themselves. If they believe there is a patient that is better served by EMS than by their staff for whatever reason they call you. Sorry if it interrupts your paid to sleep or internet time but the ED may feel you are the best choice for the patient. *You should take it as a compliment* instead of whining about it or trying to say a hospital is wrong for making the decision to call you even if it is just policy.   

EMS may then take the patient immediately to a Cath Lab or Trauma Center, bypassing the little hospital, for appropriate care. This is the loophole in EMTALA that I believe serves the patient well. That beats having the patient lie around in that ED for over 3 hours while an IFT to a trauma center or cath lab is arranged with the appropriate staff. Once blood and other drips are hung, it will probably be beyond the care of a regular ALS truck in most places. The hospital may have to free up an RN anyway to go with the Paramedics for a CCT. 

Jon, only my first comment and link about the Rapid Response Team is directed at you.


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## carpentw (Apr 24, 2009)

Our station is literally right next to the hospital and I had a chest pain walk up the other day.  We told him he could just walk to the ER (as its only 50 yards) but they insisted to be taken by ambulance so they would be seen faster.. :wacko:


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## VentMedic (Apr 24, 2009)

carpentw said:


> Our station is literally right next to the hospital and I had a chest pain walk up the other day. We told him he could just walk to the ER (as its only 50 yards) but they insisted to be taken by ambulance so they would be seen faster.. :wacko:


 
Walking 50 yards with chest pain?   

Were you not going with this patient?


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