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



## CAOX3 (Dec 31, 2009)

"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


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## JPINFV (Dec 31, 2009)

but but but but... national healthcare!


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## FFMedic1911 (Dec 31, 2009)

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.


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## VentMedic (Jan 1, 2010)

FFMedic1911 said:


> 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.


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## FFMedic1911 (Jan 1, 2010)

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.


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## VentMedic (Jan 1, 2010)

FFMedic1911 said:


> 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:



FFMedic1911 said:


> 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.


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## CAOX3 (Jan 1, 2010)

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


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## FFMedic1911 (Jan 1, 2010)

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.


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## VentMedic (Jan 1, 2010)

FFMedic1911 said:


> 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? 



FFMedic1911 said:


> 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.


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## FFMedic1911 (Jan 1, 2010)

VentMedic said:


> 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.


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## VentMedic (Jan 1, 2010)

FFMedic1911 said:


> 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



FFMedic1911 said:


> 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.


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## ffemt8978 (Jan 1, 2010)

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.


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## VentMedic (Jan 1, 2010)

ffemt8978 said:


> 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.


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## ffemt8978 (Jan 1, 2010)

VentMedic said:


> 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.


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## VentMedic (Jan 1, 2010)

ffemt8978 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.


 
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.


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## FFMedic1911 (Jan 1, 2010)

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.


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## VentMedic (Jan 1, 2010)

FFMedic1911 said:


> 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? 



FFMedic1911 said:


> 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?


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## Aidey (Jan 1, 2010)

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.


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## VentMedic (Jan 1, 2010)

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.


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## medichopeful (Jan 1, 2010)

VentMedic said:


> 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.


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## rescue99 (Jan 1, 2010)

JPINFV said:


> but but but but... national healthcare!



Oh Wow! I do love this comment! This is the kind of medicine we had 40 years ago here. I remember it very well! Why any American would want to go back to a taxi-cab healthcare system is beyond me. 

While I don't think the man was in immediate danger, the nastyness of a cab alone makes me want more life insurance... in case we wind up back in the same situation here. <_<


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## VentMedic (Jan 1, 2010)

rescue99 said:


> Why any American would want to go back to a taxi-cab healthcare system is beyond me.


 
But isn't that what Americans in the U.S. have now with some EMS systems?  The only difference is the ambulances might have cots and L&S.  The taxi driver however might be more experienced at driving real fast in traffic.


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## Sasha (Jan 1, 2010)

VentMedic said:


> But isn't that what Americans in the U.S. have now with some EMS systems?  *The only difference is the ambulances might have cots and L&S.*  The taxi driver however might be more experienced at driving real fast in traffic.



And drugs, and medical equipment, and hopefully someone educated to use such.


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## rescue99 (Jan 1, 2010)

VentMedic said:


> But isn't that what Americans in the U.S. have now with some EMS systems?  The only difference is the ambulances might have cots and L&S.  The taxi driver however might be more experienced at driving real fast in traffic.



Umm, NO!


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## VentMedic (Jan 1, 2010)

Sasha said:


> And drugs, and medical equipment, and hopefully someone educated to use such.


 
How many are BLS only or have inadequate ALS protocols, training and oversight?  How many services have attitudes about what they think is BS or just do the minimum regardless?


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## rescue99 (Jan 1, 2010)

VentMedic said:


> How many are BLS only or have inadequate ALS protocols, training and oversight?  How many services have attitudes about what they think is BS or just do the minimum regardless?



How many Taxi's are insured to provide any sort of medical care, period? This is a rediculous reason to argue.


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## VentMedic (Jan 1, 2010)

rescue99 said:


> How many Taxi's are insured to provide any sort of medical care, period? This is a rediculous reason to argue.


 
How many ambulances are insured to provide medical care but only give a real fast ride to the hospital?

Look at the actual care some provide or don't provide and I find it ridiculous that ambulances should be allowed to charge what they do.


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## rescue99 (Jan 1, 2010)

VentMedic said:


> How many ambulances are insured to provide medical care but only give a real fast ride to the hospital?
> 
> Look at the actual care some provide or don't provide and I find it ridiculous that ambulances should be allowed to charge what they do.



Enough! Arguing just to argue is not in anyone's best interest.


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## VentMedic (Jan 1, 2010)

rescue99 said:


> Enough! Arguing just to argue is not in anyone's best interest.


 
Are you really this naive to not see some of the issues in EMS? You've also been on the forums long enough to know that some do just run real fast to the hospital for a variety of reasons be it that is all they can do or their favorite TV show is on.

Let's take the typical routine IFT. Do you know the charge to have an EMT in the back who is not educated in most medical conditions they transport? Do you think $600 - $900 is reasonable for one BP check? 

What about the ALS truck that also only does one set of vitals and dumps the patient in the ED "as is"? What about those who have very limited protocols but are still called ALS? What about those who have very limited education, training and protocols but yet try to pass themselves off as CCT under the SCT code?

Do you even know some of the issues mentioned at state and national meetings?


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## Scott33 (Jan 1, 2010)

The stories are sketchy, but what I believe happened would have been the community hospital in Ayr, would not have been geared up for re-implantation of digits, so had to arrange for transport to a more centralized facility which does. Being that Ayr (pronounced "air") is quite a rural town, and given that his injury was non-life threatening, he would have probably have had a longer wait for an ambulance. The "bag of peas" is journalistic nonsense - he would have been assessed, medicated for pain, and had the finger chilled prior to leaving the facility. 

Ayr to Glasgow is about 30 miles north east, basically on one straight road (A77) with minimal congestion. 

Definitely not the ideal situation, but one similar to which I received a week or so ago. Gent fell through a wooden bridge, got hung up on his ring finger which got yanked clean off. Transported by BLS Volly crew. No pain management of course. Result - not even an attempt at re-attachment due to it being pulled off, rather than sliced off. 

So, not much different than the above story.


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## VentMedic (Jan 1, 2010)

Scott33 said:


> No pain management of course. Result - not even an attempt at re-attachment due to it being pulled off, rather than sliced off.


 
That is going to depend on the skill of the microsurgery center. A clean cut is no longer a requirement although the textbook picture perfect amputation would make things easier.

Thus, don't toss out the possibility that replantation is not possible just because it is not a pretty cut. Treat all patients and body parts as if they can be replanted because they just might be and regain their function again to a large percentage. 

It is also unfortunate when a patient lands in a hospital that offers no microsurgery services and transport to a center is not always an option.

My comments of course pertain to the U.S. and its advancements in microsurgery. Other countries may not have these abilities or put the same value on extremities to offer up the costs.


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## Scott33 (Jan 1, 2010)

VentMedic said:


> That is going to depend on the skill of the microsurgery center. A clean cut is no longer a requirement although the textbook picture perfect amputation would make things easier.
> 
> Thus, don't toss out the possibility that replantation is not possible just because it is not a pretty cut. Treat all patients and body parts as if they can be replanted because they just might be and regain their function again to a large percentage.



Absolutely, it is not our call to make.


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## Scott33 (Jan 1, 2010)

rescue99 said:


> Oh Wow! I do love this comment! This is the kind of medicine we had 40 years ago here. I remember it very well! Why any American would want to go back to a taxi-cab healthcare system is beyond me.



The UK had vollies as EMS providers 40 years ago. These days, like with most of the rest of the western world, they require degrees.

The average US BLS 911 call is little more than a taxi ride anyway, if truth be known.


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## nomofica (Jan 1, 2010)

Is it just me, or does this thread seem to reek of sarcasm?:wacko:


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## VentMedic (Jan 1, 2010)

nomofica said:


> Is it just me, or does this thread seem to reek of sarcasm?:wacko:


 
That depends. If you don't care if you lose a finger or hand, then you can be taken to any medical center for treatment. However, many patients would like to keep their body parts if at all possible. But, if you don't care, then you might consider this a sarcastic thread as to why some might want to do pain management and see the patient has the best chances of saving their body part. There are also  some who probably do think just a finger amputated is nothing more than BS and the person should probably just crawl into a taxi.


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## nomofica (Jan 1, 2010)

VentMedic said:


> That depends. If you don't care if you lose a finger or hand, then you can be taken to any medical center for treatment. However, many patients would like to keep their body parts if at all possible. But, if you don't care, then you might consider this a sarcastic thread as to why some might want to do pain management and see the patient has the best chances of saving their body part. There are also  some who probably do think just a finger amputated is nothing more than BS and the person should probably just crawl into a taxi.




I wasn't entirely referring to the initial subject of the thread. There just seems to be a lot of (unnecessary) attacking going on from where I'm standing.


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## CAOX3 (Jan 1, 2010)

I actually had a patient refuse tansportation who had cut off his finger with a table saw, after some discussion we bandaged his finger placed it in a bag and on ice and sent him on his way.

He wanted his wife to take him, he has the right.


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## VentMedic (Jan 1, 2010)

CAOX3 said:


> I actually had a patient refuse tansportation who had cut off his finger with a table saw, after some discussion we bandaged his finger placed it in a bag and on ice and sent him on his way.
> 
> He wanted his wife to take him, he has the right.


 
Right now in this economy, a lot of people are not taking ambulances. Medical debt is a difficult thing and a concern for many who are unemployed now or under insured.  If you are only a BLS truck, there may not be much you can do for the patient.  However, I hope the wife stayed calm enough to give the patient a smooth and safe ride to the hospital.


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## VentMedic (Jan 1, 2010)

nomofica said:


> I wasn't entirely referring to the initial subject of the thread. There just seems to be a lot of (unnecessary) attacking going on from where I'm standing.


 
So what are you contributing other than another unnecessary post stating some posts are unnecessary?


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## ffemt8978 (Jan 1, 2010)

How about keeping it on topic instead?


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## CAOX3 (Jan 1, 2010)

VentMedic said:


> Right now in this economy, a lot of people are not taking ambulances. Medical debt is a difficult thing and a concern for many who are unemployed now or under insured.  If you are only a BLS truck, there may not be much you can do for the patient.  However, I hope the wife stayed calm enough to give the patient a smooth and safe ride to the hospital.



Actually he explained to me that he felt no pain just a slight ache, it was a clean cut minor bleeding and perfect canidate for replantation.

We have ALS if needed. This guy with his presentation was not a canidate for an ALS truck, minor pain, no bleeding and hemodynamically stable.  He rides with us, he chose not too and that is his right.


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## VentMedic (Jan 1, 2010)

CAOX3 said:


> Actually he explained to me that he felt no pain just a slight ache, it was a clean cut minor bleeding and perfect canidate for replantation.
> 
> We have ALS if needed. This guy with his presentation was not a canidate for an ALS truck, minor pain, no bleeding and hemodynamically stable. He rides with us, he chose not too and that is his right.


 
Depending on how far the hospital is, I can pretty much guarantee he'll be crying like a child in pain very soon.   Besides the pain, when people lose body parts they go through different stages of grief regardless of the success of replantation.   

The first stage they go through is denying it has happened to them and that it is just a small cut.    They may actually see their finger still attached in their mind even when they are looking at it on the ground.  

Talking with patients who have had replantation is quite fascinating.


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## nomofica (Jan 1, 2010)

VentMedic said:


> So what are you contributing other than another unnecessary post stating some posts are unnecessary?



I didn't say that any posts were unnecessary but rather certain content within the posts. But there's no use for me to argue with someone who seems to just want to argue for the sake of it.

Hi ho, hi ho, it's off to work I go.


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## Jeffrey_169 (Jan 12, 2010)

JPINFV said:


> but but but but... national healthcare!



Here's your Obamacare....or Obamascare in which case.


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