# Two PT's one ambulance.



## Ryanpfd (Jun 16, 2009)

I know that most of us have had to do it. Tech two pt's in the back of one ambulance. Ive always been the one to tell the truth on PCR's. With that said. is it technically illigal to say you teched two pt's? one pt clearly was in the stretcher the other boarded. and secured to the bench seat. any input?


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## ResTech (Jun 16, 2009)

There is nothing "illegal" about providing care to two patients in a single EMS unit. The only thing that needs to be considered is patient relationship. Unless a dire emergency (ie MCI), I would only transport two patients in the same unit who are related or are friends who wouldn't mind being exposed or providing their medical history out in the open.

Especially for MVC's... its never a good idea to transport patients from seperate autos... a good scenerio for tempers to flare. As long as patients are of a stable priority and one EMS provider can adequately provide the appropriate level of care then its all good. I have "tech'd" two patients on numerous occasions.


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## Epi-do (Jun 16, 2009)

I am guessing the answer to your question most likely depends upon where you are at.  To my knowledge, there is nothing illegal about tending to two patients at the same time.  Hospital staff do it all the time.

That being said, I guess I am not really getting what you mean by this statement:



> With that said. is it technically illigal to say you teched two pt's?



Are you wanting to write in one pt's PCR that you had another pt in your care also?  The only reason I can see a need for that is if you are unable to do parts of your assessment because of it.  Then all I would document is something along the lines of "Unable to obtain XYZ due to transporting second patient at same time."  Of course, if one patient demands enough attention that you can not adequately assess a second one, then you shouldn't be transporting multiple patients.  

Honestly, the only time I will agree to transport more than one patient in my ambulance is if I am taking two "walking wounded" or two patients that tell me something along the lines of "I don't really need an ambulance, I just need a ride there," essentially, just the patients that only need a ride.  Now, that being said, if there are two patients that need more than "just a ride", but aren't critical, _*and there is a second tech available to ride in with me*_, if there are truly no other ambulances available, I will take two in at once.  I will tech one patient and the second tech will be responsible for the second patient.  However, since I work in an urban setting, the odds of not being able to get another ambulance are pretty small.  It has happened before, but it was under extraordinary circumstances, such as a tornado or other mass cas incident.


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## ResTech (Jun 16, 2009)

Epi-do makes a good point regarding documentation... I personally would make sure to document each patient on a seperate PCR (ie two PCR's for one call) and make mention of the second patient onboard in your narrative of each patient. I believe in painting the whole picture and a second patient on-board changes things up a bit and should be noted.


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## Jon (Jun 16, 2009)

Just a side note - I agree that isn't a great idea to transport patients from different autos... HOWEVER, I've had situations where that was the best option... and I've wanted to beat my partner for standing on this argument. it isn't in my protocols as a "don't do"

Recognize that EMS is preformed in a constantly changing environment and we need to do the best we can for the most patients.


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## Ryanpfd (Jun 16, 2009)

Epi-do said:


> I am guessing the answer to your question most likely depends upon where you are at.  To my knowledge, there is nothing illegal about tending to two patients at the same time.  Hospital staff do it all the time.
> 
> That being said, I guess I am not really getting what you mean by this statement:
> 
> ...



yes. they where related. yes they technically where "walking wounded" and yes I did manage to do two PCR's. on the call. It just looked obsene..when instead of right. "ems secured pt x4 straps and side bars secured" I had to put "pt was secured using long board/collar. pt then secured in ambulance on bench seat. secured x4 straps in a15"


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## ffemt8978 (Jun 16, 2009)

The most we ever transported in one rig was 5 patients...two critical and 3 walking wounded.  With 3 EMT's and a FR in the back it was a crowded trip.

Before everyone gets up in arms, this was a MCI MVA with a total of 12 patients and only three ambulances available.  All three rigs transported multiple patients to multiple ALS intercepts.


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## Epi-do (Jun 16, 2009)

ffemt8978 said:


> The most we ever transported in one rig was 5 patients...two critical and 3 walking wounded.  With 3 EMT's and a FR in the back it was a crowded trip.
> 
> Before everyone gets up in arms, this was a MCI MVA with a total of 12 patients and only three ambulances available.  All three rigs transported multiple patients to multiple ALS intercepts.



But those are special circumstances.  We had a tornado a year ago and we took in 7 walking wounded all at once.  We had 3 sitting on the bench, one on the cot, one each in the airway and CPR seats, and one up front.  Since it was a mass casualty situation though, we didn't have to do PCRs on them, just run them in and drop them off.  The only thing we had to do was get name & birthdate and ER transported to.


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## medicdan (Jun 16, 2009)

I have transported 5 patients before. Again, it was special circumstances, in Israel. We were transporting away from a small plane accident, and 4 of them were stable. I was in the back with a FR. While I managed the unstable patient, the FR got vitals and treated the unstable. 

Think, for example, about how many patients you can provide O2 for, safely. At the private I work for (and pursuant to MA DPH OEMS rules/law), we have 2 regulators for the main, and two portable tanks (each with its own regulator), and an additional tank (without a regulator). That means four patients can be receiving O2 at the same time. 

Think, does that change your transport plan? Should you be taking that many patients if they require O2 therapy? What do you do when you get out of the truck? How long can you last if they are on nasals and the main is at 1000psi? Think it through. 

How much material/supply do you have for multiple patients? Start with the basics (bandaging and wound supplies). Then think through boarding. you may carry more then one board, but do you have the straps, blocks, etc for multiple patients? Where are they located on the truck in relation to the boards? How are they accessible? Now think about BVMs (of different sizes), think about pocket masks, think about AED pads, etc. 

Start thinking through different scenarios, and what you would grab, where the important equipment and supplies are located. What about a school bus flipped over? Senior van? Day Care Center? Nursing Home? you get the idea. 

Preperation is not just about having institutional plans, but also about having the supplies, equipment, education, training, personnel, etc in place. Its not just about saying, "We would use X from the truck", but also about taking it out every once in a while, playing with it, using it on patients, etc.

When was the last time you filled out a triage tag?

Sorry, I am asking more questions then I am answering, but consider approaching your management and asking these questions.


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## medic417 (Jun 17, 2009)

I have had as many as 6 patients in the ambulance with me the only medic in the patient compartment.  None of them related.  Not the best thing to do but part of frontier EMS.  You do what has to be done.  2 unrelated are a common part of life out here.  

Document it on each report so no claims of fraud attempts will come your way.  We actually will use same run number and just add a, b, c, d etc to differentiate.


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## Mountain Res-Q (Jun 17, 2009)

Actually, I have been told by Instructors (and correct me if I am wrong, and maybe this is just a CA thing) that all Ambulances must legally be capable of carrying 2 supine pts in order to be called an ambulance.  It has been several years since I have been on an ambo, but all of the type 2 rigs I worked on had those steel retractable hooks in the ceiling that were capable of holding a backboarded pt 3 feet above the gurney.  Treating this pt was obviously impossible, so if we had 2 non-ambulatory pts, the second was secured to the bench seat.

Practically speaking, ya gotta do what ya gotta do!  You take as many pts as you can _adequately and responsibly_ treat properly, continuously evaluate, and safely secure.  I've been on plenty of MCI drills where in order to get all the pts to a hospital with only the few ambos available meant practically stacking them in like cord word.  I believe that a few of the more minor pts got duct taped to the hood of the ambo.  Who need a siren with all that screaming?  J/K


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## djmedic913 (Jun 17, 2009)

Ryanpfd said:


> I know that most of us have had to do it. Tech two pt's in the back of one ambulance. Ive always been the one to tell the truth on PCR's. With that said. is it technically illigal to say you teched two pt's? one pt clearly was in the stretcher the other boarded. and secured to the bench seat. any input?



I have never heard of this being illegal, or wrong, or improper care. I have taken 2 backboarded BLS patients at the same time. In my opinion only 1 ALS Pt to a rig, but as many BLS Patients as you can fit, with in reason, and no MCI related.



ResTech said:


> There is nothing "illegal" about providing care to two patients in a single EMS unit. The only thing that needs to be considered is patient relationship. Unless a dire emergency (ie MCI), I would only transport two patients in the same unit who are related or are friends who wouldn't mind being exposed or providing their medical history out in the open.
> 
> Especially for MVC's... its never a good idea to transport patients from seperate autos... a good scenerio for tempers to flare. As long as patients are of a stable priority and one EMS provider can adequately provide the appropriate level of care then its all good. I have "tech'd" two patients on numerous occasions.



Call in another rig for occupants of the other vehicle. for safety of each Pt and yourself, do NOT put yourself in the middle of an impending argument and possibly violence. same vehicle occupants together only.



ResTech said:


> Epi-do makes a good point regarding documentation... I personally would make sure to document each patient on a seperate PCR (ie two PCR's for one call) and make mention of the second patient onboard in your narrative of each patient. I believe in painting the whole picture and a second patient on-board changes things up a bit and should be noted.



ALWAYS...each Pt gets their own PCR. even if you get an MVA with 8 ppl signing off...8 people...8 PCR's...it sucks, but remember CYA.



ffemt8978 said:


> The most we ever transported in one rig was 5 patients...two critical and 3 walking wounded.  With 3 EMT's and a FR in the back it was a crowded trip.
> 
> Before everyone gets up in arms, this was a MCI MVA with a total of 12 patients and only three ambulances available.  All three rigs transported multiple patients to multiple ALS intercepts.



5 patients...why would someone get up in arms. this happens...often. I have done it myself, with only myself in the back...but all were BLS.



Mountain Res-Q said:


> but all of the type 2 rigs I worked on had those steel retractable hooks in the ceiling that were capable of holding a backboarded pt 3 feet above the gurney.



I never heard of this..who figured this contraption out. the hammock stretcher...lol...All I know is I would not want to be the Pt on the stretcher staring up a the boarded Pt hanging over my head...LMAO


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## medic417 (Jun 17, 2009)

djmedic913 said:


> I never heard of this..who figured this contraption out. the hammock stretcher...lol...All I know is I would not want to be the Pt on the stretcher staring up a the boarded Pt hanging over my head...LMAO



I actually just started working in an ambulance w/o the hanging hooks at one service.  I hate it.  No where to stack up the multiple patients we get.  One crew recently had to leave a patient behind with an EMT and wait for another ambulance because no hooks.  All of the type 1 and 3 I have ever worked in till now had them.  You really need to make sure you have the rectangle back boards rather than the fancy ones that get narrow at the foot.


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## Ridryder911 (Jun 17, 2009)

It is a very common occurence in many places, especially those that have limited resources. It is not wrong, immoral, unethical and again very common. The problem arises in attempting to bill for transfers (IFT) when transporting patients to multiple hospitals but charging as separate units transported the patients. 

R/r 91


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## Foxbat (Jun 17, 2009)

Mountain Res-Q said:


> Actually, I have been told by Instructors (and correct me if I am wrong, and maybe this is just a CA thing) that all Ambulances must legally be capable of carrying 2 supine pts in order to be called an ambulance.


Until recently (January 2009, I believe) KKK-A-1822 standard had this requirement. 
But then again, in 70's they could carry 5 supine pateints in Caddilac-style ambulance.


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## VentMedic (Jun 17, 2009)

Foxbat said:


> But then again, in 70's they could carry 5 supine pateints in Caddilac-style ambulance.


 

But then the ambulance attendant rode up front with the ambulance driver.


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## medic417 (Jun 17, 2009)

VentMedic said:


> But then the ambulance attendant rode up front with the ambulance driver.



You mean we are not supposed to do that any more?:unsure:


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## MSDeltaFlt (Jun 17, 2009)

Ryanpfd said:


> I know that most of us have had to do it. Tech two pt's in the back of one ambulance. Ive always been the one to tell the truth on PCR's. With that said. is it technically illigal to say you teched two pt's? one pt clearly was in the stretcher the other boarded. and secured to the bench seat. any input?


 
Double check your state and local regulations.  But I believe you are legally capable of transporting as many pts are you can appropriately secure, treat, and have access to.

Ex: 1 in capt's chair, 1 on stretcher, and 3 side by side on bench seat, and another one on side jump seat.  So long as they don't need the only resources that another pt might currently be using: O2, cardiac monitor.  You get my point.


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