# Stopping at another scene with a patient on board



## VentMedic (Jul 19, 2007)

I have been following this news story on other forums including this one. I had also posted this last week in EMS news. 

http://www.jems.com/news_and_articles/articles/FDNY_EMS_Crew_Acts_Heroic_Under_Fire.html

It has sparked discussions about policy or interpretation of policy regarding the decision to stop at another scene when you have a patient on board. 

Does your company have a *clearly written policy *for stopping or not stopping for another potential patient (accident scene, person down near road, etc) when you already have a patient on board?  

This does not include hearsay, speculation or probably.  

If you stop at an accident scene and determine there are minor or no  injuries then leave to continue transport of the original patient, can you be hit with abandonment if someone deteriorates later at the accident scene?


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## Epi-do (Jul 19, 2007)

I have not seen anything in writing, but I have been told that we are to continue without stopping, and use the radio to contact dispatch and alert them to the incident.  I will be interested to see how many do have a written policy for these types of situations.


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## Asclepius (Jul 19, 2007)

Your legal obligation is to your patient on your bus. Period. You have no legal obligation to anything that you happen upon. Stopping and neglecting your patient puts you and your agency at risk for all kinds of liability issues. The correct thing to do would be to radio in the location of the incident and have them send another truck and/or other rescuers.


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## Asclepius (Jul 19, 2007)

Our protocol clearly states the following:

During the transport of a patient by ambulance, should the EMS crew come across an emergency requiring ambulance assistance; the local EMS system will be activated. Crews involved in the treatment and transportation of an emergency patient are not to stop and render care.

In the event you are transporting the patient with more than two appropriately trained prehospital personnel, you may elect to leave one medical attendant at the scene to render care and the other personnel will continue to transport the patient to the receiving facility.

In the event there is not a patient onboard the ambulance and an emergency situation is encountered requiring ambulance assistance; the crew may stop and render care. However, the local EMS agency should be activated and their jurisdiction respected.


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## BossyCow (Jul 19, 2007)

I agree about the responsibility to the pt in the rig.  When we leave that pt. to assess the damages, injuries of a possible new pt. we have abandoned the pt. already on board. 

Legally, as I understand the issue, once we have a pt. in our care, our responsibility is to that pt. The possible pt's at another scene we may pass on the way by, are only potential pt's.  There was a huge lawsuit in Washington state some years ago about a rig picking up a deceased for transport to the mortuary.  Tones went off for a reported code in progress and they left the deceased and went to the code.  

The agency was sucessfully sued over this.  Partially because they left the deceased in a body bag in his driveway, but also because they had a responsibility to finish out one call before diverting to another.  They were technically in service on one call and so, unavailable to respond to a second call.  


Most agencies will have a policy for doubling up on calls and how those are to be handled. I think this would fall under that catagory

The potential for disaster here is huge.  What if... the scene you respond to become dangerous?  Have you exposed your first patient to those dangers?  Can you be reprimanded for not giving quality care to the second victim because you were distracted by a change in status on the first?


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## daemonicusxx (Jul 20, 2007)

I've stopped before. witnessed a police vehicle spin out and hit the jersey barrier, we had a non emergent patient on board going to a doctors appointment. my partner stayed with the pt, i went to check for injurys. come to find out, not a police officer driving, just the guys from the siren shop returning the cars after putting lights and stuff on them. no injuries on scene, so i notified dispatch and continued txp of the original patient. 

IMO, the condition of the patient you are transporting decides wether you stop or not. stable NH patient going to a doctors office??? VS Possible Police officer injury??? i think i would risk a slap on the wrist to make sure LEO isnt injured.


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## MMiz (Jul 20, 2007)

daemonicusxx said:


> I've stopped before. witnessed a police vehicle spin out and hit the jersey barrier, we had a non emergent patient on board going to a doctors appointment. my partner stayed with the pt, i went to check for injurys. come to find out, not a police officer driving, just the guys from the siren shop returning the cars after putting lights and stuff on them. no injuries on scene, so i notified dispatch and continued txp of the original patient.
> 
> IMO, the condition of the patient you are transporting decides wether you stop or not. stable NH patient going to a doctors office??? VS Possible Police officer injury??? i think i would risk a slap on the wrist to make sure LEO isnt injured.


There are exceptions to every rule.  That's one of them... in my book.


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## firecoins (Jul 20, 2007)

a 9 year old pt having seizures is more important tha an mva, espcially since it turned out to be edp with a gun.


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## VentMedic (Jul 20, 2007)

daemonicusxx said:


> my partner stayed with the pt, i went to check for injurys. come to find out, not a police officer driving, just the guys from the siren shop returning the cars after putting lights and stuff on them. no injuries on scene, so i notified dispatch and continued txp of the original patient.
> 
> 
> 
> ...


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## BossyCow (Jul 20, 2007)

I think transporting someone to a Doctor's appt is different from a pt. you transport after an emergency response are two different situations entirely.


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## Asclepius (Jul 20, 2007)

BossyCow said:


> I think transporting someone to a Doctor's appt is different from a pt. you transport after an emergency response are two different situations entirely.


I tend to agree with you, but the only absolute way to avoid any risk of abandonment is to stay with your patient. However, there is no substitute for good judgment. You'll notice that in the protocol from my system, it states specifically about a patient from an 'emergency' transport.


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## VentMedic (Jul 20, 2007)

Our policy was clearly written out.  If you have a patient on board, no stopping. You put the patient with you in the middle of the accident scene just by parking the ambulance. Of course, in the city, there is always another EMS vehicle nearby.  I could see where your situation might be different BossyCow.


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## firecoins (Jul 20, 2007)

VentMedic said:


> Our policy was clearly written out.  If you have a patient on board, no stopping.


Our policy allows us to stop...at a hospital.


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## RedZone (Jul 20, 2007)

If nobody puts up the NYC policy, I'll try to get a hold of it.  My ops guide is in storage in Fla. and I'm not scheduled for a 911 tour for over a week... but I'll see what I can do.  I never actually knew what it said, we just use our judgment.

I've had situations where I had to stop because running over 50 people would cause too much damage to the ambulance and I've had situations where I just slowed down, rolled down my window and said, "another unit's coming."


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## Grady_emt (Jul 21, 2007)

Our policy as enforced over past QA/QI sessions is as follows:

1: You must have a non-emergent transport patient on-board

2: You are considered a First response unit to;
          Code1 call that is dispatched in your immediate vicinity and you would be the first unit onscene responding non-emergent. ie: call is around the corner/down the street (code 1=C,D,E determinates in med. dispatching)
                   If call is dispatched as an "high mechanism" accident you may stop while transporting, establish command and triage until another unit arrives to relieve you. (high mechanism=rollover, entrapment, motorcycle, ejection, interstate, etc...)

3: If you happen upon a wreck, and can safely pull over, attempt to do so and check for injuries, provide needed care, await another unit.  
                                   DO NOT put your unit and patient in danger attempting to stop for an accident, advise radio of exact location and discription of vehicles for responding units

4: One crewmember must stay with original patient at all times.  If pt is ALS, that crewmember must be the medic.

Personally, unless it comes out as FF/PD down, or I roll up on a serious accident I usually dont stop.


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## eggshen (Jul 21, 2007)

Not sure if we have a policy. We are double Paramedic cars so stopping does no become an abandonment issue. We will often swing buy another call on the way to the hospital to take some pressure off the system. Keep in mind this is only done when your current pt. basically fine. DK head lac, seizure, what ever. When going back emergent there is no stopping be it a crash or anything else.

Egg


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## MMiz (Jul 21, 2007)

Wait, how is stopping patient abandonment?  I'd never have the person in the back (with the patient) hop out, but I can't see a problem stopping the ambulance and having the driver hop out to check to see if a LEO is okay.

If I had a patient in back who is simply getting a ride to a doctor's appointment, I'd stop for a LEO.  If it was an emergency call (even without L/S) I wouldn't stop, but I'd stop otherwise.


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## eggshen (Jul 21, 2007)

Here's how we roll. You're merrily on your way to the ER with your pt. that may or may not need an ambulance. You hear a call go out and you say "9 we're close to that, we'll swing by and see if we can help you out." You stop by, determine if you need another ambulance or if you can double load and save the other car for something else. The airport is another story all together. You often take as many unrelated patients as you can due to the remote location. Saves the system alot of trouble.

Egg


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## RedZone (Jul 21, 2007)

Since I didn't see anybody else say it (my apologies if someone did): I would probably "make arrangements" to stop for another EMS crew needing assistance.


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## emt9577 (Jul 21, 2007)

*Stopping on scene*

I personally have had to deal with some legal repurcutions involving me stopping my buggie for a MVA. I rolled up upon a MVA on the interstate in the far left lane. There was no one else on scene (fire,EMS,Law).  I decided to stop, I was transporting a little old guy, back to the nursing home, my medic was in the back, however it was just a laid back boring BLS call. I signalled my intention to pull off the road, I was watching the road, and also looking at the scene. I pulled my buggy all the way off the road, to the left of the white line.  I then lit the truck up. As I was walking back beside my truck, I hear a loud screeching of breaks, and watch as 3 vehicles all collide behind my truck, fortunately none touched my buggy.  I walk over to the original scene, and a LEO pulled up, claiming that I caused the secondary collision, and that I had to wait on scene to get everything taken care of. He yelled at me to get back in the F____g truck, and wait for him.  No one was injured in either of the collissions. I informed the officer that if my assistance as an EMT wasnt needed, I was loaded, and did have to get my patient back to his nursing home. Well, I went back to the truck, sat in it for about 45 minutes, had the famous phone call with the chief of ops, station manager, dispatcher, and company lawyer.  I got out of the truck to enjoy a smoke or two. The LEO once again yelled at me to get back in my truck.  Well after about 2 more hours on scene, the state trooper that was gonna do the report, called me over to her cruiser, it took about 15 minutes for her to take my report, and then tell me I could leave. She then also cited me for improper stopping of an emergency vehicle. And it wasnt just a ticket you pay a fine for, nope I had to go to court.  I then jumped in the back so the trooper could talk to my partner. When they were done I jumped back up front and carried on the transport. It was kinda touchy there for a minute or two.  About month later, I went to court, fortunately for me the trooper wasnt working that day, and I managed to get the charge dropped. I had never heard of improper stopping of an emergency vehicle.  I was also told that all 3 drivers that were involved in the secondary collision were all cited also, but I wasnt told what for.  

If you do stop, be careful!! Not only do you have the risk of abandonment, you have occassionally have to deal with the risks of a fine from just stopping.

I will admit, I know I should ahve hit my lights before I signalled to turn off.  I was too busy looking at the scene trying to decide if it was safe, I forgot to reach over and hit the lights, until after I was stopped.  

Ive been in fire and EMS since I was 18, and that was the first time I had ever heard of improper stopping.  Oh well, everyone was ok, no fines, and a hard lesson learned.


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## RedZone (Jul 22, 2007)

This is something from a review I am working on:



			
				RedZone said:
			
		

> EMS providers work closely with other emergency agencies such as fire and police departments.  A coordinated emergency system with good interdepartmental communication and mutual respect among responders is paramount to providing necessary emergency services to a community.



It sounds as if the officer was out of line.  I work in a multi-agency EMS system, maybe the largest in the world.  I've had my run-ins with other divisions of emergency response.  

Thanks... I didn't know where to put that one.  It'll be legal issues & ethics!


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## MMiz (Jul 22, 2007)

emt9577,

Amazing story.  See, now I'll think twice.

Once I had a flat tire in my rig, pulled over on the shoulder, and hit the truck up.  I promptly caused one car to wreck into another.  That's what I call job security. :glare:


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## eggshen (Jul 22, 2007)

That is the silliest story I have ever heard. Improper stopping? Whatever. Never again shall I complain about the town I work in, that would never occur to the cops here...EVER. That's just plain madness.

Egg


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## Jon (Jul 22, 2007)

I typed a reply to this and it never went through. Bummer.

Anyway... I've related a story on this topic before...

Several years ago, my partner and I (both EMT-B's) were doing a routine BLS discharge, hospital to SNF. Pt. was stable, and our SOP's REQUIRED us to stop and render aid as long as it was safe to do so, the patient was stable, adn one provider stayed with the patient.

We were driving along when we came upon an MVA with entrapment that happened almost in front of us. We stopped... I was in the back, and my partner asked me to go check the scene while she stayed with the truck and patient.  Dispatch was advised, and the goings-on were explained tot he patient. I gained access to the vehicle and held c-spine on the pt, who's face was a bloody pulp after sudden deceleration upon impact with the windshield. As soon as FireRescue showed up, I transferred care to a FF and we left soon after. The patient felt that he was left alone in the rig, and started to complain to staff upon arrivial at SNF. We explained the situation to the SNF staff, as well as our managers.


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## BossyCow (Jul 23, 2007)

VentMedic said:


> Our policy was clearly written out.  If you have a patient on board, no stopping. You put the patient with you in the middle of the accident scene just by parking the ambulance. Of course, in the city, there is always another EMS vehicle nearby.  I could see where your situation might be different BossyCow.



We don't do non-emergent transports.  We are strictly emergency response so I won't be stopping.  I think if I had an 'extra' EMT on board and could guarantee that our second out unit was able to respond I might drop that EMT at the scene, but it would have to be very special circumstances.  It's one of those slippery slope, gray area judgement calls where no matter what you do, there are those who will point out where and how you :censored: it up by not doing the opposite.


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## BossyCow (Jul 23, 2007)

MMiz said:


> Wait, how is stopping patient abandonment?  I'd never have the person in the back (with the patient) hop out, but I can't see a problem stopping the ambulance and having the driver hop out to check to see if a LEO is okay.
> 
> If I had a patient in back who is simply getting a ride to a doctor's appointment, I'd stop for a LEO.  If it was an emergency call (even without L/S) I wouldn't stop, but I'd stop otherwise.



My driver is generally a firefighter, not an EMT.


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## RedZone (Jul 23, 2007)

BossyCow said:


> We don't do non-emergent transports.  We are strictly emergency response so I won't be stopping.



I don't like to judge, but I want to point out a little ignorance here.  I don't know you or your service, but I would assume you've transported a stable patient or two, maybe that probably didn't even need an ambulance.  The essence of triage cannot be overstated in EMS.



			
				BossyCow said:
			
		

> I think if I had an 'extra' EMT on board and could guarantee that our second out unit was able to respond I might drop that EMT at the scene



So much for that EMT's safety.



			
				BossyCow said:
			
		

> It's one of those slippery slope, gray area judgement calls where no matter what you do, there are those who will point out where and how you :censored: it up by not doing the opposite.



You have a few protections here:

- A clearly written policy as was suggested by VentMedic.

- Use of good judgment.  I would say a good 25% or more of this job is IMPROVISATION.  This is a skill that needs to be honed based on common sense, education, experience, and a clear understanding of your role.

- A supportive interdisciplinary TEAM approach, including a good QA review process that isn't necessarily discipline based.  Basically, your "bosses" should "stick up" for their crews unless there is gross negligence. 

- Liability insurance.


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## DT4EMS (Jul 26, 2007)

So let's add this to the mix................

You are loaded, en route to the hospital............ when DISPATCH asks you to "check on an unresponsive male" in a ditch you will be coming up on.

What do you do then?

Does dispatch know the resources and your priority?

Now.........do you refuse to stop?

If you stop..... then what?

I can tell you I have worked in different agencies where we picked up more than one patient.............. on different calls. 

That doesn't get done as much today as it did 10-15 years ago but not everything is cut and dry. Never and always can't come out of your mouth in EMS.


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## BossyCow (Jul 27, 2007)

RedZone said:


> I don't like to judge, but I want to point out a little ignorance here.  I don't know you or your service, but I would assume ...



Hmmmm.... so who's ignorance are you pointing out?




RedZone said:


> So much for that EMT's safety. ...



As I stated originally, the most likely scenario is that I do not stop.  Everything about this situation is a liability nightmare, no matter which decision you make.  But.. regarding safety, we are a volly agency and most often arrive on scene, alone and via POV.  Any EMT that I dropped off on a scene would be as safe and prepared as one arriving on scene from their home.


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## eggshen (Jul 27, 2007)

"I might drop that EMT at the scene"

I would leave a pt. on the street corner before I would leave ANY of my partners alone (unless he/she might be getting some Great Wall). 

If you have a BS pt. in the back I see no problem with picking up another pt. and another and another. One of my first nights doing the job for real my FI stopped over and over until we had 5 pts, all unrelated (my record is 7). As long as I can manage them all I take no issue with filling up the bus. We use privates, such as AMR, to back us up when we run out of cars and they all seem to have a policy of "one pt. only" regardless of the nature of their current pt. or the one we want to give them. I understand that each agency has it's own policy but that does not preclude me from stating that said policy is WEAK. If I can take some pressure off of the system by filling my pockets with low acuity pts. please, bring 'em on. I would hate to think that a real pt. may go without an ambulance because I am not tight enough to manage my pt. that may have another seizure. So many people get into this job to "help" so my opinion is that one should do just that...help. You are not helping ANYONE by allowing a sick pt. to gasp because you insisted another car check out that "party down". C'est tres mal is all I can say.

Cheers
Eggshen


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## Epi-do (Jul 27, 2007)

When I first started doing this job, it was pretty common in this area to take multiple patients in one truck, but they would all be family members from the same scene or occupants from the same vehicle.  We would even do this if they wanted to go to two different ERs, as long as they were relatively close to each other.

Now, it is frowned upon in our local system.  Some of the services around here have even gotten trucks that are confugured in a way that you are unable to put a second boarded patient upon the bench seat.

The around here is that you must do what is best for the patient that you are currently with.  If you are transporting two patients at the same time that initially appear to be stable and one of them goes south on you, patient #2 is now "suffering" because you are unable to afford them the attention they should be receiving.  Also, what happens if you have 3 patients in that back, you are by yourself, and 2 of those patients go south.  Now you are definately not doing what is best for your patients.  

I have heard all the arguments about how the odds of something like that happening are small, but anyone who has been doing this job for very long has had those patients that caught them off guard, and suddenly crapped out on you with seemingly no warning.  It happens - we all know that it does.  So, why take the chance that you may have to start CPR on a patient while thier child/spouse/friend/etc. is also in the back of the truck looking on?  And it doesn't have to be CPR.  Some people just don't handle seeing any of the stuff that we do, whether it be starting an IV, intubating, cardioverting, or working a code.  Why risk subjecting someone to the possible psychological trauma of witnessing that on a loved one?  It just isn't worth it.  



> One of my first nights doing the job for real my FI stopped over and over until we had 5 pts, all unrelated (my record is 7). As long as I can manage them all I take no issue with filling up the bus.



I am sorry, but 5 patients in one truck, with one tech is way to much.  It is just my opinion, but I just don't believe that each patient is receiving the best care you can give them when your attention is divided in 5 different directions.


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## eggshen (Jul 27, 2007)

5 is no problem as long as one can multitask. No different than an MCI, we are busy and the system comes before the pt. so that we might get ambulances to more pts. This way we can avoid ditching them to privates that have a history of having difficuly managing ONE pt on any given day.

Egg


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## Epi-do (Jul 27, 2007)

Egg, I guess we will just have to agree to disagree on this one.  An MCI is one thing, and then, yes mulitple patients per provider is the rule, and not the exception.  However, barring and MCI, I can't think of a reason where I would agree that "the system comes before the pt".  

I don't think it is really an issue of multitasking either.  To some degree, you do that on every shift you work.  While my top priorities will always be myself and the rest of the crew onscene, I have never put the system before my patients.  Each one gets the best possible care I am able to deliver at the time they are in my care.

I mean no disrespet, nor am I trying to start an arguement.  You are most certainly entitled to your opinion, and are the one most familiar with the system you work in.  There are qualities of every part of the country that makes each system different.  It plays a part in how we view things, and that is what I enjoy about this site.  While I disagree with you on this matter, I am sure there are others that we probably agree on, and look forward to reading more of your posts.


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## VentMedic (Jul 27, 2007)

eggshen said:


> 5 is no problem as long as one can multitask. No different than an MCI, we are busy and the system comes before the pt. so that we might get ambulances to more pts. This way we can avoid ditching them to privates that have a history of having difficuly managing ONE pt on any given day.
> 
> Egg



So is your company a municipal or county service?  
Does your agency still bill or file medicare and insurance claims? 
Multilple patients can be a billing nightmare for many companies. Not that it matters to the EMTs or Paramedics...that is until a fraud case happens.

example:

http://www.arkansas.gov/dhs/aging/5-Ambulance.pdf

http://www.merginet.com/index.cfm?pg=legal&fn=ComplianceGuidance-PartIII


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## Flight-LP (Jul 27, 2007)

eggshen said:


> 5 is no problem as long as one can multitask. No different than an MCI, we are busy and the system comes before the pt. so that we might get ambulances to more pts. This way we can avoid ditching them to privates that have a history of having difficuly managing ONE pt on any given day.
> 
> Egg



Well hell, why not stop at the nursing home and check to see if anyone needs to go to the hospital......................

What you're describing is ridiculous, unsafe, disrespectful, and flat out stupid. It doesn't matter how trivial of a complaint your patient has, they are still entitled to your best care, not you pushing them off to the side for someone else. Keep it up and I guarantee your EMS career will be short lived. Sometimes you have to roll a call over to someone else, the system SHOULD NEVER COME FIRST! Your responsibility is YOUR PATIENT. If your system is so damn busy that they can't handle the volume, then you need more units. If your service can't effectively perform its needed services for the community, then your service contract needs to be terminated. AMR may suck overall, but at least their SSM program provides for a contractural need. Maybe you and your service could learn something from them before you totally dismiss what may be a valuable resource to you.

Horrible, absolutely horrible................


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## Ridryder911 (Jul 27, 2007)

Wow ! This has become interesting that so many opinions and views that represent everything from abandonment to possibly fraud in billing services. 


It is common knowledge that once one has made contact to the primary patient that they have made a contract regarding * Duty to Act*, and anytime that patient is left with *lesser and not equal trained individual*  can be charged with * abandonment*. 

As well, delaying care and transport could be reviewed if there is question that there was excess transport time. 

As well, Medicare and many other payers such as insurance companies that the ambulance and EMS providers will not pay for transports devices that transported more than one event. Otherwise, EMS buses would be developed and utilized. 

This debate is old and has been talked to death on multiple EMS forums. C'mon folks, really use some common sense. If one is transporting and stops (when they could be transporting a patient) then that EMT is obligated to stay and treat the other patient, thus breaking the initial contract with the first patient. 

R/r 911


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## Emtgirl21 (Jul 27, 2007)

I think egg just likes to play devils advacate just to see what s/he can get started.


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## Grady_emt (Jul 27, 2007)

Taken 3 from one scene, two boarded, one walking and will never do it again.  We were first out on a rollover and the second unit that we called out was wrecked onscene.  The tow truck driver wasnt paying attention and pulled the OTV back rightside up into the other unit.  Rather than wait for the next available unit (level 0 at the time), I went ahead and took the 2nd backboarded pt on the bench.

As for care, they were all stable, all related family, the walking one refused all c-spine and care other than transport, and the other two were also stable, yet still recieved the full trauma work up of C-spine, LBB, Large bore IV etc...

Wont ever do it again though, two is the max unless as stated earlier, MCI situation.


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## Emtgirl21 (Jul 27, 2007)

I have taken two pt from the same vehicle of a MVA. Both patients were stable and BLS. I boarded the first pt w/ FD and went to the ambulance with that pt. My partener and FD boarded the second pt and brought him to the truck. Just trying to get two pt assessments done, vitals, and call report was tough before arriving at the hospital. Adding to the toughness one of my pt starts to have a panic attack and trys to climb off the backboard. I could see how the situation could of gotten nasty quick fast and in a hurry had i not been able to control him.
 I've also taken two psych patients at a time. I suggest not doing that personally!


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## Asclepius (Jul 27, 2007)

I'm pretty amazed at the number of people who would put themselves, possibly their patients, and definitely their agencies at risk for liability and all other kinds of legal issues. It's pretty clear that your patient is the one you have made contact with, unless you pass them off to a provider of equal or greater training and certification. Being deferred from one call to another isn't a big deal so long as you haven't already made patient contact. However, once you have that patient...that patient should be your sole focus. You should not stop for any reason until you have reached your destination.


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## sdadam (Jul 28, 2007)

At our agency, if you have a stable patient and come across an emergency situation you have to stop, the crew member in the back stays with their pt and the driver goes and begins to take care of the emergency, once other crews arrive you go on your way.

Obviously if you have an unstable PT you don't stop.


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## jrm818 (Jul 28, 2007)

eggshen said:


> If you have a BS pt. in the back I see no problem with picking up another pt. and another and another. One of my first nights doing the job for real my FI stopped over and over until we had 5 pts, all unrelated (my record is 7).
> 
> Cheers
> Eggshen



:wacko:Is this even for real?  How exactly would one fit 7 pt's in the back of an ambulance?  What do you have as ambulances - mac trucks?

Our rig has 7 secured (seatblets/straps on the cot) total including the front seats - even with pt's who can sit up this is just preposterous to suggest you crammed 7 people into an ambulance.  

I concur with the rest of the general outcry about this practice if it actually is true - which I serously doubt.


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## BossyCow (Jul 30, 2007)

Okay, I'm confused.  I start out saying that I would not stop, then amended that to say I could see a situation where a case for stopping could be made.  I got bashed for both... hmmmmmmm.  

As to leaving an EMT on scene as being dangerous, that may be the case in a more urban environment.  We are often on scene alone.  I've been alone with a patient (turned out to be a back fx and head injury) On the ground, in the woods with support and extrication equipment ferried in by ATV from over a mile away.  Sitting on a hillside for about 30 minutes while waiting for support from fellow responders.  

Is this an ideal situation?  Of course not.  Is this the best way for this type of incident to be treated?  Absolutely not!  But where I live, it's the best we have.  The reality of the volly system in which I work is that there is no telling how many responders in what kind of vehicles will show up to any call.  We are all prepared to be the only one on scene for an undetermined period of time with up to a 40 minute transport to the ED once we have a rig available to us.  

Would I prefer to have a controlled environment on all calls.. you bet... would I like to be on scene in a fully supplied rig with a partner?  Duh-uh....... but will the lack of either of these ever stop me from responding?  Nope!  

Given the option, the more formal response to a call is always the best one.  But, with an MVA with known injuries and patients ejected ... I'm not going to drive 10 miles out of my way to get an ambulance and a couple of other volunteers.  I'm going to the scene, in my pov and I will attempt to do some triage, stabilize what I can and get bystanders to help with flares and traffic control.  This is rural EMS!


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## fm_emt (Jul 30, 2007)

We've been told that if we see something happen, to go ahead and stop as long as our patient is stable. But nobody leaves the current patient. We're to hop on the radio and contact county communications and at the very least relay some information to them so they can dispatch another rig.


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## eggshen (Jul 31, 2007)

You bet it's true, would I do it again? Nope...I don't work that hard anymore.

Egg


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## RedZone (Jul 31, 2007)

BossyCow said:


> Okay, I'm confused.  I start out saying that I would not stop, then amended that to say I could see a situation where a case for stopping could be made.  I got bashed for both... hmmmmmmm.



I hope my comments to that post weren't taken as bashing.  I have respect for the opinions you have offerred.



BossyCow said:


> As to leaving an EMT on scene as being dangerous...



To make up for my bashing thoughts, I will offer you praise here.  It is important to keep in mind that every EMS system is unique.  I am only familiar with the systems I have worked in.  There may be differences with your system that point out my very own ignorance with certain dynamics I cannot even comprehend.



BossyCow said:


> Would I prefer to have a controlled environment on all calls.. you bet



NICE!!!!  More praise.  A HUGE difference between EMS care and other forms of medical care is that we do not work in a controlled environment.  (Actually, I wouldn't prefer to work in a controlled environment... it wouldn't be EMS, and I enjoy what I do).  This was a point I was trying to make in that post of mine.... we must improvise in virtually every situation.....  that's just what we do.  

And as you point out, maybe EMS systems have to improvise in order to use their limited resources to provide the best service to their community.

As far as liability issues... I stick by my comments:



			
				RedZone said:
			
		

> You have a few protections here:
> 
> - A clearly written policy as was suggested by VentMedic.
> 
> ...


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## Arkymedic (Aug 15, 2007)

VentMedic said:


> So is your company a municipal or county service?
> Does your agency still bill or file medicare and insurance claims?
> Multilple patients can be a billing nightmare for many companies. Not that it matters to the EMTs or Paramedics...that is until a fraud case happens.
> 
> ...



Damn Vent you beat me again with documents from my home state even lol. This is something that has been preached to us a whole lot lately especially involving MVAs. Medicare will only pay for one pt to be transported and if we have multiples we are usually to call for an additional unit. 

Also as an FYI did you know that medicare will not pay for diabetic runs where D-50 or glucagon or any other treatment is given and you get an AMA? Found that out the other day as well. Same for MVAs where Air Evac is used and pt care transfered. If pt isn't placed in unit and moved 3 ft cannot charge for the run

This doesn't change my treatment any way shape or form just thought that was kinda screwed up. Instead medicare would rather tax the ER and increase the bill for the pt and then send them home.


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## Arkymedic (Aug 15, 2007)

Ridryder911 said:


> Wow ! This has become interesting that so many opinions and views that represent everything from abandonment to possibly fraud in billing services.
> 
> 
> It is common knowledge that once one has made contact to the primary patient that they have made a contract regarding * Duty to Act*, and anytime that patient is left with *lesser and not equal trained individual*  can be charged with * abandonment*.
> ...




If I have a patient on board (non-critical) we call for an additional unit and I stay in the back with the first pt while my EMT does triage and scene assessment, size up and initializes TX until the other ALS unit arrives. We have 11 First Responder districts and most respond and work well. The EMT would have been able to take command and utilize them to control the incident prior to ALS arrival. 

I also have witnessed a wreck in another services area (no pt on board) and we called it in to our dispatch which relayed it to the responsible EMS service. Then we did assessment and my partner took c-spine on a pt and we helped the other service backboard and load the pt. They were very appreciative. I think it would have looked terrible for an ALS unit two cars back to just drive right on past and not stop.


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