# Legal question, I was dispatched to transport 2 PT's!!!!!



## strangerdude88 (Nov 26, 2010)

Okay, It was near the end of my shift earlier this week. Our unit got radioed and asked to call dispatch via cell phone. I call dispatch and was sent to pick up a husband and wife from a boarding care with a chief complaint of "flue like symptoms" I immediately question the dispatcher about the legality of transporting two patients. The dispatcher responds with, " oh it's okay we had a meeting about this the other day, it's perfectly legal." I still protest and am advised to call a supervisor.

So, I call my supervisor and let him know that I am not comfortable with attending two patients and will not do it. He then advices to do a complete assessment of both patients and if they're both stable to take them. If assessment reveals that at least one is not stable take one. So me and my partner find any reason not to take both. We took one(tachycardic, HTN, hot to the touch, and vomited earlier that day) and advised dispatch to send another crew for the wife(we waited till the crew got there).

So can someone please let me know what protocols, laws are being broken? This happened in Los Angeles County. I really did lose respect for this company after this, the way I see it is that our company is money oriented not patient oriented. I just really need advise, did I do the right thing?


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## Shishkabob (Nov 26, 2010)

Perfectly, 100% legal to take more than one patient.  They don't even have to be related.


Each box ambulance I've ever seen is built to hold 2 backboarded patients.




How else do you think MCIs are handled, especially in rural areas?


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## strangerdude88 (Nov 26, 2010)

We are an IFT company, MCI's are the last thing we will ever do. There was at least three other rigs available. I do not see how this doesn't violate HIPPA.


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## brentoli (Nov 26, 2010)

Its husband and wife, you had to "search" for a reason to make one "unstable". Sounds like you did a disservice to them. I've taken more than one patient several times, who weren't related. What was your hangup with it? Why did you not want to do it? If you were taking a man from room twelve and a woman from room thirty, that's a better arguement. But it was a husband and wife, take em both.


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## brentoli (Nov 26, 2010)

strangerdude88 said:


> We are an IFT company, MCI's are the last thing we will ever do. There was at least three other rigs available. I do not see how this doesn't violate HIPPA.



HIPAA - Health Insurance Portability and Accountability Act

And don't be so sure about MCIs. If I have a greyhound bus flip ill be calling all the ambulances, including IFTs, hell, they have the best setups to transfer green patients if you don't have a school/commuter bus available.


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## Aidey (Nov 26, 2010)

It is legal, I've done it several times, with MVC patients mostly. 

I honestly don't see why it was such a big deal that you and your partner had to exaggerate how sick a patient was to get out of taking 2 people.

As for HIPAA there are exceptions, how do you think that hospitals get away with having curtains between beds instead of sound proof walls?


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## Epi-do (Nov 26, 2010)

I am in Indiana, so I can't speak about protocol or laws in CA, at least here, there is nothing illegal about transporting two patients.  As long as you have the equipment you need to treat both pts, and there isn't something major going on, it isn't a huge deal.  Also, you would want to take into consideration the circumstances.  For instance, you wouldn't want to transport both drivers from a 2 car MVC, but two family members from the same car would be ok.

It is never ideal to transport 2 pts and I don't know anyone that likes to do it.  However, it does happen.  It's not an ideal situation, but it isn't the end of the world either.


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## Amycus (Nov 26, 2010)

I am not from the LA County, so unfortunately I cannot speak to your laws/regulations, which make my post mostly useless.

However, in my area- transport of up to 2 PT's is perfectly allowed if A.) They are both stable, B.) No HIPAA violations, and C.) Both PT's can be properly secured. In my case, I've transported, multiple times actually, two people in the same motor vehicle during an MVA- both spineboarded, one secured to the main stretcher, and one to the bench seat. Two people from DIFFERENT vehicles would be totally taboo.

That's just one example. We may have different definitions of stable though- without seeing the whole picture, only the given information, I would have considered the male stable enough. Sounds like flu like symptoms. Unless he's VERY tachy and VERY htn, if he's a bit over 100 and say, 140-150ish sys, I'd consider him stable. If he was well above that, I'd be more worried about getting a possible ALS intercept than finding reason not to transport both. Although I do totally understand, the idea of taking 2 people at once seems very dodgy to begin with.


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## Akulahawk (Nov 26, 2010)

Linuss said:


> Perfectly, 100% legal to take more than one patient.  They don't even have to be related.
> 
> 
> Each box ambulance I've ever seen is built to hold 2 backboarded patients.
> ...


Yep. Perfectly legal to transport 2 patients. However, usually, they must be transported to the same destination. Where you take them depends upon who is the sickest or meets a specific transport policy. The exception is MCI events where you are directed to transport your patients to separate destinations. This would, however, be rare. 

All of the ambulances I have ever worked on had the capability to transport 2 patients flat. One ambulance had the ability to transport 4 flat. One on gurney, one on bench, 2 hanging from ceiling. That was interesting, but we never had to take more than 2 in that unit. B)


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## strangerdude88 (Nov 26, 2010)

Aidey said:


> It is legal, I've done it several times, with MVC patients mostly.
> 
> I honestly don't see why it was such a big deal that you and your partner had to exaggerate how sick a patient was to get out of taking 2 people.
> 
> As for HIPAA there are exceptions, how do you think that hospitals get away with having curtains between beds instead of sound proof walls?



The condition of the patients was not exaggerated, it was his real condition.


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## EMT11KDL (Nov 26, 2010)

I am not in Cali.  So I do not know your local or state code for EMS.

Off the top of my head, I believe my agency says if one patient is a Green Patient, and the other is a yellow or green you can.  But if one of the patients is a Red than NO, only transport 1.  

With that being said I have transported 2 patients by myself a few times.  My transport agency that I work for is completely volli, and sometimes we cant get a second unit for 25+ mins.  Each Situation is different, and sometimes we get put into difficult situations where do dont have any other option but to take multiple patients.  If that happens, rondevu (If available) with another unit while en-route to the hospital.

If I remember correctly from my class and the NREMT, they would like to have one provider for each patient.  

I agree with your decision on this particular call, you didnt feel comfortable transporting 2 patients, and you called ur supervisor and advised him of this also. 

Hope this helps


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## JPINFV (Nov 26, 2010)

strangerdude88 said:


> I do not see how this doesn't violate HIPPA.


Did you ask if the husband and wife wanted to be transported together?


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## Shishkabob (Nov 26, 2010)

strangerdude88 said:


> We are an IFT company, MCI's are the last thing we will ever do. There was at least three other rigs available. I do not see how this doesn't violate HIPPA.



IFT doesn't matter, point still stands, you can take more than one at a time.


You also need to look up HIPAA.  Incidental release of PHI while discussing it with a patient, with safeguards taken, is not punishable.


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## JPINFV (Nov 26, 2010)

strangerdude88 said:


> The condition of the patients was not exaggerated, it was his real condition.



If he was hypertensive and tachycardic, what was the pulse and blood pressure?


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## strangerdude88 (Nov 26, 2010)

JPINFV said:


> Did you ask if the husband and wife wanted to be transported together?



Yes they did. But I also didn't want to take both in case they both deteriorated en route. I only have two hands.


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## strangerdude88 (Nov 26, 2010)

JPINFV said:


> If he was hypertensive and tachycardic, what was the pulse and blood pressure?



160/100, 110 strong/irregular


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## Shishkabob (Nov 26, 2010)

strangerdude88 said:


> 160/100, 110 strong/irregular



That's really pushing the limits of "He needs my undivided attention".


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## Amycus (Nov 26, 2010)

strangerdude88 said:


> 160/100, 110 strong/irregular



This still, in my opinion, and please do not take this the wrong way- is something I would be comfortable BLSing in, even 2 PTs at a time. I don't know what you guys run for a setup out there- if all trucks are I/B, I/I, P/I, etc. If it was new onset of irregular pulse, I'd have some concern, but otherwise, those numbers don't worry me enough that I would consider him unstable by any means.


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## JPINFV (Nov 26, 2010)

strangerdude88 said:


> 160/100, 110 strong/irregular



Systolic of 160 and pulse of 110 is squarely in the "meh" column. The diastolic of 100 is a bit concerning, but not a "this patient is going to die" thing. Similarly, what signs and symptoms were leading you to think that the other patient was at significant risk of crashing?


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## Epi-do (Nov 26, 2010)

strangerdude88 said:


> I immediately question the dispatcher about the legality of transporting two patients...
> 
> So, I call my supervisor and let him know that I am not comfortable with attending two patients and will not do it...
> 
> So me and my partner find any reason not to take both.





EMT11KDL said:


> I agree with your decision on this particular call, you didnt feel comfortable transporting 2 patients, and you called ur supervisor and advised him of this also.



I would most likely agree with the decision as well, if it was based on a legitimate pt condition that warranted not taking both pts.  It sounds like this was more about not _wanting_ to transport two pts rather than being uncomfortable with it.  I don't know anyone that wants to take multiple pts, but we have all done it.  It's just part of the job.


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## Amycus (Nov 26, 2010)

Epi-do said:


> strangerdude88 said:
> 
> 
> > I would most likely agree with the decision as well, if it was based on a legitimate pt condition that warranted not taking both pts.  It sounds like this was more about not _wanting_ to transport two pts rather than being uncomfortable with it.  I don't know anyone that wants to take multiple pts, but we have all done it.  It's just part of the job.
> ...


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## EMT11KDL (Nov 26, 2010)

Amycus said:


> Epi-do said:
> 
> 
> > I find taking two stable PT's to be quite fun sometimes, lol. Kneeling on the floor taking vitals, getting them both engaged in conversation about each other, their conditions, etc.
> ...


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## JPINFV (Nov 26, 2010)

Amycus said:


> If it was new onset of irregular pulse, I'd have some concern, but otherwise, those numbers don't worry me enough that I would consider him unstable by any means.



Unless otherwise stated, I just make the assumption in IFT *threads* (in contrast to actual practice where more information is readily available) that an irregular pulse is secondary to diagnosed atrial fib.


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## JPINFV (Nov 26, 2010)

Epi-do said:


> I don't know anyone that wants to take multiple pts, but we have all done it.  It's just part of the job.



I would personally be perfectly happy to take two related patients who wanted to be transported together provided they have the same origination and destination. Similarly, I'm generally very liberal with my rules regarding transporting family members with my patient.


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## Amycus (Nov 26, 2010)

JPINFV said:


> Unless otherwise stated, I just make the assumption in IFT *threads* (in contrast to actual practice where more information is readily available) that an irregular pulse is secondary to diagnosed atrial fib.



Oh snap, I entirely missed the fact this was about IFT altogether haha. Well in that case, the info should be at your fingertips in theory anyways. If they have afib I wouldn't bat an eyelash at those numbers, except the prior mentioned diastolic, but still, not something I'd be like "oh crap" about


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## jrm818 (Nov 26, 2010)

Amycus said:


> Epi-do said:
> 
> 
> > I find taking two stable PT's to be quite fun sometimes, lol. Kneeling on the floor taking vitals, getting them both engaged in conversation about each other, their conditions, etc.
> ...


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## Shishkabob (Nov 26, 2010)

jrm818 said:


> This would be my major problem with taking 2 patients in a non-emergent setting.  There is no possible way for the provider to secure themselves sitting on the freaking floor. :angry: Are we seriously so unconcerned with preserving our lives in an accident that no one bats an eye to a company that is OK with sacrificing safety when there are (apparently) plenty of other ambulances around?



So there's no airway chair?


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## jrm818 (Nov 26, 2010)

While you can usually reach a patient in the stretcher from the airway chair, at least in the ambulances I've been in I don't think I can reach a patient on the bench.  I've only been in a vanbulance a couple of times, and maybe you can reach in those, I can't claim any experience.  I do think the reality is that most people will be on the floor either way.


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## Shishkabob (Nov 26, 2010)

And who says the patient on the bench seat wouldn't be sitting down, seatbelted themselves, with you sitting next to them?


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## JPINFV (Nov 26, 2010)

To clarify the originating facility, a "board and care" in California (also known as "group homes") is a care facility set up in a house that normally cares for patients more of an assisted living nature than skilled nursing. Even though there are usually no nurses on staff (patients shouldn't require nursing care past what can be provided by a visiting nurse), there should still be a medical packet with the pertinent information available. Similarly, I can see it being more common to have a husband and wife together in a group home than in other care facilities.


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## Amycus (Nov 26, 2010)

JPINFV said:


> To clarify the originating facility, a "board and care" in California (also known as "group homes") is a care facility set up in a house that normally cares for patients more of an assisted living nature than skilled nursing. Even though there are usually no nurses on staff (patients shouldn't require nursing care past what can be provided by a visiting nurse), there should still be a medical packet with the pertinent information available. Similarly, I can see it being more common to have a husband and wife together in a group home than in other care facilities.



Thanks for that clarification JPINFV.


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## EMT11KDL (Nov 26, 2010)

jrm818 said:


> Amycus said:
> 
> 
> > This would be my major problem with taking 2 patients in a non-emergent setting.  There is no possible way for the provider to secure themselves sitting on the freaking floor. :angry: Are we seriously so unconcerned with preserving our lives in an accident that no one bats an eye to a company that is OK with sacrificing safety when there are (apparently) plenty of other ambulances around?
> ...


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## Aidey (Nov 26, 2010)

strangerdude88 said:


> The condition of the patients was not exaggerated, it was his real condition.





JPINFV said:


> Systolic of 160 and pulse of 110 is squarely in the  "meh" column. The diastolic of 100 is a bit concerning, but not a "this  patient is going to die" thing. Similarly, what signs and symptoms were  leading you to think that the other patient was at significant risk of  crashing?



That was my point. His actual vitals may be legit, but unless you are leaving something significant out, he wasn't _that _sick.


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## jrm818 (Nov 26, 2010)

Linuss said:


> And who says the patient on the bench seat wouldn't be sitting down, seatbelted themselves, with you sitting next to them?



True, I assumed that both patients were going to be lying down, and that may not be the case.  I think when you hit the level of acuity where you need no care and can sit up then an ambulance may not be the best use of resources, but thats a separate issue....

That said, I think I have a problem with a patient secured only by a lap belt sitting sideways (or even in the airway chair, although that's a bit safer).  I don't like that as employees we have to sit like that, but I'm not OK with putting a patient into that situation, probably without their even realizing the risks.

Obviously this isn't the case everywhere, but where I've worked in the past it's been against policy to have a patient anywhere but in the stretcher with all straps in such a way to prevent movement in all three planes.  I like that policy.


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## JPINFV (Nov 26, 2010)

jrm818 said:


> Obviously this isn't the case everywhere, but where I've worked in the past it's been against policy to have a patient anywhere but in the stretcher with all straps in such a way to prevent movement in all three planes.  I like that policy.


[sarcasm]Hehe, you'll be pleased to know that, at least when I was working in LA and OC, most ambulances weren't outfitted with shoulder straps.[/sarcasm]


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## EMS49393 (Nov 26, 2010)

I worked in an urban arena for a few years and we transported multiple patients often out of need.  I'm not waiting around for 20 or more minutes for another ambulance to come available when I could have long been to the ER.  

The maximum amount of patients I've transported at once was five.  One on the stretcher, three on the bench, one in the captains chair.  I wedged myself down  in the door well during transport.  The ER was five minutes away and they were all walking wounded pre-litigation examination patients.  I'm not taking another ambulance out of service for that when there could be a chance they are truly needed and the only unit available.

It's not a violation.  You really need to read the law and take the training again so you understand the HIPAA laws and regulations.


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## jrm818 (Nov 26, 2010)

EMT11KDL said:


> jrm818 said:
> 
> 
> > So its ok to put our safety at risk in a emergency situation but not in a non emergent situation?
> ...


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## jrm818 (Nov 26, 2010)

JPINFV said:


> [sarcasm]Hehe, you'll be pleased to know that, at least when I was working in LA and OC, most ambulances weren't outfitted with shoulder straps.[/sarcasm]



lovely.  I can't imagine why you chose a different career path.....


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## JPINFV (Nov 26, 2010)

jrm818 said:


> lovely.  I can't imagine why you chose a different career path.....



Multiple reasons, but that honestly wasn't one of them.


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## jrm818 (Nov 26, 2010)

JPINFV said:


> Multiple reasons, but that honestly wasn't one of them.



Admissions: So JPINFV, tell me a bit about yourself.  What motivated you to dedicate the next decade of your life in rigorous training 1000 hours a week without ever seeing the sunlight just to become a highly trained and deeply in debt new doctor who will be compensated at pennies on the dollar and lectured about medicine by a bunch of government bureaucrats.

JP: Well, I heard you guys had some of the best shoulder straps around and...well....that if I work real real hard I might even be able to pick out the color next time you buy new ones...sir.


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## EMT11KDL (Nov 27, 2010)

jrm818 said:


> EMT11KDL said:
> 
> 
> > No, it's not "OK," but in non-ideal situations the reality is you do what needs to be done.  However, if there is a way to avoid multiple pt. transport, I think it should be avoided.  If you're in the sticks with no other ambulances, then you may be stuck.
> ...


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## brentoli (Nov 27, 2010)

strangerdude88 said:


> *So me and my partner find any reason not to take both.* We took one(tachycardic, HTN, hot to the touch, and vomited earlier that day) and advised dispatch to send another crew for the wife(we waited till the crew got there).



The OP lost alot of credibility in my book with that statement. Is there anything in your company policy/protocols/state law saying you cant take 2 pts at a time? If not I am convinced you did a disservice to your patients. 


Husband and Wife
Wants to go together
Not feeling well

The ambulance is a traumatic experience anyways, what was the harm in keeping them together?


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## EMSLaw (Nov 27, 2010)

In an ideal world, I would transport two patients in two ambulances.  This world seldom being ideal, there's no reason an ambulance can't transport two.  I don't know how your rig is set up, but all our ambulances are set up to accomidate that - you can attach the folding stretcher to the bench seat, there is a second Oxygen "christmas tree", and you carry at least two of almost everything.  Yeah, treating the patient on the bench seat if they're on a stretcher is a bit of a pain, but it's not unmanagable. 

Just not seeing this as such a big deal.


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## jrm818 (Nov 27, 2010)

EMT11KDL said:


> jrm818 said:
> 
> 
> > if both patients are stable, or one of the patients is stable and does not need your attention that often but the other patient does.  Why take another rig Out of Service to take the stable patient? Can you not handle two patients in the back by yourself? If you have two critical patients I can understand not transporting 2 if your working IFT.
> ...


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## abckidsmom (Nov 27, 2010)

jrm818 said:


> EMT11KDL said:
> 
> 
> > My problem isn't taking care of more than one patient at once.  My objection is that lying a second patient on the bench means that you as the provider now have no possibility of being restrained unless you have inspector gadget arms and can reach both patients from a belted position in the airway seat.
> ...


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## lightsandsirens5 (Nov 27, 2010)

Linuss said:


> Perfectly, 100% legal to take more than one patient.  They don't even have to be related.
> 
> 
> Each box ambulance I've ever seen is built to hold 2 backboarded patients.
> ...



Exactly. We transport two pts all the time. We will do this on MCIs, IFTs, etc. We are actually set up to carry three backboards "comfortably" and four if we really cram. 

I have personally taken two pts both from the scene and from hospital to hospital. We will sometimes get paged to take a pt from the local hospital to a lvl II in the city and the hospital will have two that need to go when we get there. So we load them both up. 

Another time we went to a fall. This elderly lady had fallen down two stairs and broken a wrist or something. We we are assessing her when she tells us that her husband tried to catch her as she fell, and he fell as well, dislocation his artificial knee. So we ended up taking both. 

Yea, two, three even four pts is 100% legal. As long as you don't distribute each pts SSN to the other three.


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## EMSrush (Nov 27, 2010)

I've transported 4 pts during an MCI... wasn't a huge deal. We can get into legalities and technicalities all day long, but in the end, I think it has a lot to do with the comfort level of the provider.


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## Veneficus (Nov 27, 2010)

The discrepency may not be with transporting multiple patients, but with billing multiple patients. 

An MCI or multicasualty motor vehicle incident is a very different realm than IFT as far as billing may be concerned. 

Especially the "medical need" if one can sit on a bench seat. I can't imagine that anyone put a patient on a cot, trnsfered them to a bench then loaded the other on a cot, went to the hospital and reversed the process. 

However, if the facility is being billed under contract, that might be a different story. There could also be an issue if the patient contests being transported with another in a nonemergent manner. 

One more reason it is better to work at McDs than in IFT. There are very few reputable IFT companies.


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## johnrsemt (Nov 27, 2010)

Epi;   I think you and I transported 2 once;  both were stable,  but had a great chance to destabilize in a hurry.
 Mother and pre mature newborn.  Mom had large hole in diaphragm and newborn was about 6 weeks early.

maybe it wasn't you.

 Transport 2 quite often;  ended up having one help bag another on a long distance transfer, when one crashed.


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## johnrsemt (Nov 27, 2010)

in fact I transported 2 about 2 years ago,  when we had 6 other trucks available,  but they were both stable knee injuries.   it was about 2 hour transport.

  like previous posters said:  bad Idea to take both drivers from 2 car MVA's;  but I have taken up to 6 people from a ECF evacuation;  and 4 from a MVA, (3 were backboarded).


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## firetender (Nov 27, 2010)

Being asked to do a routine transport of two related patients exhibiting zero cause for concerns during the time it takes you to get from "A" to "B" tells me more about your inadequacy as a medic than anything else.

I'd expect you will be watched closely for a while because in the eyes of the company, that would likely be considered major lazy on your part. That's how it reads to me, and you're making the added mistake of showing your choice is based on your own insecurities, NOT the actual call.

As your employer, I would also register your distrust, seeking legal justification for NOT doing your work for them without considering it's highly probably that the family will get a $ break

And no one (of 14 posters!) except *brentoli* (GOOD ON YA!) mentioned the emotional/psychological benefits of keeping the husband and wife TOGETHER during what could be a period of traumatic separation/transition. THAT is a part of looking out for the patient's welfare that the rest of you didn't even considered.

Regardless, OP, here you see reflected a good 10 "holes" in your bucket that need patching before you can even be good at IFT. If you don't think getting good at that is worthwhile, then you're in the wrong business because you can't even see what's in front of you, only your fears and resentment.


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## JPINFV (Nov 27, 2010)

firetender said:


> And no one (of 14 posters!) except *brentoli* (GOOD ON YA!) mentioned the emotional/psychological benefits of keeping the husband and wife TOGETHER during what could be a period of traumatic separation/transition. THAT is a part of looking out for the patient's welfare that the rest of you didn't even considered.


There's been more than one person who's implied that there's benefits in transporting patients with family. 
http://emtlife.com/showpost.php?p=263189&postcount=24


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## Epi-do (Nov 27, 2010)

johnrsemt said:


> Epi;   I think you and I transported 2 once;  both were stable,  but had a great chance to destabilize in a hurry.
> Mother and pre mature newborn.  Mom had large hole in diaphragm and newborn was about 6 weeks early.
> 
> maybe it wasn't you.
> ...



I don't think that was me.  I would think I would remember a run with patients like that.


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## brentoli (Nov 27, 2010)

JPINFV said:


> There's been more than one person who's implied that there's benefits in transporting patients with family.
> http://emtlife.com/showpost.php?p=263189&postcount=24



Get outa here and let me bask for a little bit.


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## Aidey (Nov 27, 2010)

Veneficus said:


> I can't imagine that anyone put a patient on a cot, trnsfered them to a bench then loaded the other on a cot, went to the hospital and reversed the process.



*Raises hand*

Done that.


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## medic417 (Nov 27, 2010)

Aidey said:


> *Raises hand*
> 
> Done that.



Many times and with more than just 2 patients on many occasions.


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## Veneficus (Nov 27, 2010)

medic417 said:


> Many times and with more than just 2 patients on many occasions.



on IFT?


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## str8lacelaci (Nov 27, 2010)

We transport two patient when its needed, but the two patient have to have be at the same place...we just cant stop pick up patient one up and then drive a little while and pick up patient two


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## Akulahawk (Nov 27, 2010)

Aidey said:


> *Raises hand*
> 
> Done that.


As have I. Once on an IFT. Both patients going from the same place to the same place. Once. I've done that several times on scene calls. Those are _usually _different animals.


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## Veneficus (Nov 27, 2010)

I have done up to 5 patients on a scene call, but never more than one in IFT.


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## John E (Nov 27, 2010)

*Hmmm...*

I found it interesting that the OP listed themselves as an EMT-Intermediate working in Los Angeles County, given that L.A. County doesn't recognize the position of EMT-Intermediate. 

Unless they've changed something and are keeping it very well hidden on the County EMS website.


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## CAOX3 (Nov 27, 2010)

johnrsemt said:


> in fact I transported 2 about 2 years ago,  when we had 6 other trucks available,  but they were both stable knee injuries.   it was about 2 hour transport.
> 
> like previous posters said:  bad Idea to take both drivers from 2 car MVA's;  but I have taken up to 6 people from a ECF evacuation;  and 4 from a MVA, (3 were backboarded).



Where do you put three backboarded patients in an ambulance, what do you have bunk beds? 

We can take multiples they just need to be lawfully secured.


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## ffemt8978 (Nov 27, 2010)

CAOX3 said:


> Where do you put three backboarded patients in an ambulance, what do you have bunk beds?
> 
> We can take multiples they just need to be lawfully secured.



I believe the ceiling hangers above the bench seat would qualify as bunk beds.  

Actually, we've got one ambulance that has two bench seats, a cot, and two hangers so theoretically we could transport 5 patients that are backboarded.  The most we've ever transported in that rig was 2 adults on back boards, one peds on a back board, one with minor injuries in the captain's chair and an infant in their own car seat.  NOTE:  we do 911 only, and no IFT.


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## JPINFV (Nov 27, 2010)

John E said:


> I found it interesting that the OP listed themselves as an EMT-Intermediate working in Los Angeles County, given that L.A. County doesn't recognize the position of EMT-Intermediate.
> 
> Unless they've changed something and are keeping it very well hidden on the County EMS website.




I'm giving him the benefit of the doubt that he might be an AEMT (formerly EMT-II) or a transplant from somewhere else. It's listed as training, not current level of licensure.


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## TransportJockey (Nov 27, 2010)

John E said:


> I found it interesting that the OP listed themselves as an EMT-Intermediate working in Los Angeles County, given that L.A. County doesn't recognize the position of EMT-Intermediate.
> 
> Unless they've changed something and are keeping it very well hidden on the County EMS website.


When I was working as an EMT-B in CO, my level still said NREMT-I/85, is that wrong?... Could be he got training somewhere else and the place where he's working just won't recognize it.


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## ffemt8978 (Nov 27, 2010)

Don't place too much faith in what our members claim there certs are in their profile.  We have no way of verifying that information.


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## firecoins (Nov 28, 2010)

strangerdude88 said:


> We are an IFT company, MCI's are the last thing we will ever do. There was at least three other rigs available. I do not see how this doesn't violate HIPPA.



IFTs get brough in to MCIs in NY.  

Taking 2 patients at once does not violate HIPPA.  They have hospital rooms with multiple patients in them.  Does a sheet prevent the spread of medical info? No.

I have put backbparded pts on the cot and bench.  I have taken 5 walking wounded from 1 car of an MVA.


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## looker (Nov 28, 2010)

I have read all the post and it sounds like you're lucky you haven't been fired yet for cause. There is no reason why you could not take 2 stable patients. What were you afraid of, that one of them will code? How far away was the hospital?


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## 18G (Nov 28, 2010)

To echo what everyone else has said... its an accepted practice to transport two patients especially when they are both stable and related. 

As a provider you have to use judgement... I personally would shy away from transporting MVC patients that are unrelated from separate autos unless an MCI situation or some other extenuating circumstance. But occupants from same auto I've done it lots of times. And in your case I definitely would have transported both without reservation. 

Use your case for learning. Everyone makes mistakes and has those moments that make us look back and think, "what the heck was I thinking".... you don't deserve to be fired or reprimanded as long as your able to change your perspective and become comfortable transporting multiple patients. 

Education should take precedence over discipline for employee improvement.


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## SerumK (Nov 28, 2010)

I was asked to take three non-emergent patients to two destinations IFT.


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## Veneficus (Nov 28, 2010)

looker said:


> I have read all the post and it sounds like you're lucky you haven't been fired yet for cause. There is no reason why you could not take 2 stable patients. What were you afraid of, that one of them will code? How far away was the hospital?



Glad you showed up.

How does transporting 2 IFT patients together work in terms of medicare/medicade billing?


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## Cohn (Nov 28, 2010)

Wah Wah Wah take both pts. 

Sounds a bit whiney to me.


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## medic417 (Nov 28, 2010)

Veneficus said:


> on IFT?



Never been an IFT'er.  But it still would not be illegal to transport two IFT patients.  Just document 2 patients transported.  Mileage will only be paid on one.


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## johnrsemt (Nov 28, 2010)

Don't remember who asked;   but I had a 4 y/o and 6 y/o on same board, legs intertwined on bench:  Mom backboarded on cot; dad, signed SOR, and sat in airway chair.

  never hung a LBB from ceiling but some of our trucks were capable of it.
  Did have a cot hanging from ceiling,  but that was a prank


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## Lone Star (Nov 29, 2010)

jrm818 said:


> Amycus said:
> 
> 
> > This would be my major problem with taking 2 patients in a non-emergent setting.  There is no possible way for the provider to secure themselves sitting on the freaking floor. :angry: Are we seriously so unconcerned with preserving our lives in an accident that no one bats an eye to a company that is OK with sacrificing safety when there are (apparently) plenty of other ambulances around?
> ...


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## looker (Nov 29, 2010)

Veneficus said:


> Glad you showed up.
> 
> How does transporting 2 IFT patients together work in terms of medicare/medicade billing?



As long as point a to b is same for both patient, you end up billing as share of ride. Basically you get paid for both patient but it will be less compare if you transported 1 pt at a time.


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## HasTy (Nov 29, 2010)

Lone Star said:


> jrm818 said:
> 
> 
> > One (the worse off of the two) on the cot, the other sitting either in the 'jump seat' or on the squad bench.  You would have the option of either sitting beside the one on the squad bench (where you could easily reach both patients), or sitting in the 'jump seat'.
> ...


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## Hockey (Nov 29, 2010)

Just trying to get out of another report.  Quit being lazy and do it.  I've had 4 patients all in the back of my truck, only two were related.


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## Sam Adams (Nov 29, 2010)

strangerdude88 said:


> Okay, It was near the end of my shift earlier this week.
> 
> *Typically when most mistakes are made, but I digress ...*
> 
> ...



So you believed this person to NOT be stable, yet you remained on scene delaying care for a critical pt? Did you activate ALS?

You were told not once, but twice, by two different people from your company that it was fine to transport two different pt's who are related, and you still didn't believe them. Sounds weird, but it was the end of your shift, I understand. What concerns me is that you're uncomfortable caring for two pt's with what appears to be the flu. I pray for the day you return home from work and your spouse and two kids are sick. What then?


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## Shishkabob (Nov 29, 2010)

Contact FEMA


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## Veneficus (Nov 29, 2010)

looker said:


> As long as point a to b is same for both patient, you end up billing as share of ride. *Basically you get paid for both patient but it will be less compare if you transported 1 pt at a time*.



Thanks,

That would explain why no company that I have been involved with that did IFT ever let that happen.


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## b2dragun (Nov 29, 2010)

Here is my take:  They sent an Intermediate to transport two patients, if they were unstable or sick enough to not take both then they would probably require ALS.  There is no rule about transporting two pt's, I understand if one of them voices concern, I mean it is IFT and they are married.  If the pt is in need of a Medic then it would be understandable, but realistically we are I's...not that much specialty in our line of work.  Go to medic school then talk, cause as long as the company is sending a basic or I the pt is not that bad.  If you were that concerned then you should realize it is out of your comfort zone and call for ALS.  Otherwise it is you trying to get out of doing your job, you had the pt unstable before you got to the facility.  I also remember you saying it was for flu like symptoms, which would prob be an Alpha if it was a 911 call.  I would still take them both.


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## JPINFV (Nov 29, 2010)

b2dragun said:


> Here is my take:  They sent an Intermediate to transport two patients, if they were unstable or sick enough to not take both then they would probably require ALS.  There is no rule about transporting two pt's, I understand if one of them voices concern, I mean it is IFT and they are married.  If the pt is in need of a Medic then it would be understandable, but realistically we are I's...not that much specialty in our line of work.  Go to medic school then talk, cause as long as the company is sending a basic or I the pt is not that bad.  If you were that concerned then you should realize it is out of your comfort zone and call for ALS.  Otherwise it is you trying to get out of doing your job, you had the pt unstable before you got to the facility.  I also remember you saying it was for flu like symptoms, which would prob be an Alpha if it was a 911 call.  I would still take them both.



They didn't send an EMT-I (AEMT technically). They sent an EMT-B who may be trained at the EMT-I level, but cannot operate at that level since Los Angeles LEMSA doesn't recognize AEMTs.


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## Veneficus (Nov 29, 2010)

*perspective check:*

"chief complaint of "flue like symptoms"

What is so special about ALS that they will somehow make any difference with the limited dx aability and treatment they offer?

It sounds like two sick people, who are partners, needed a cab to the doctor. 

Somehow that is translated in EMS speak to: An Ambulance ride to the ED. 

Am I supposed to believe a EMT-B is incapable to drive 2 people who are presenting with "flu like symptoms" to the ED and fill out the paperwork? 

How are Basics supposed to earn any respect under such circumstances?


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## b2dragun (Nov 29, 2010)

JPINFV said:


> They didn't send an EMT-I (AEMT technically). They sent an EMT-B who may be trained at the EMT-I level, but cannot operate at that level since Los Angeles LEMSA doesn't recognize AEMTs.



My bad, forgot it was Cali...B/P system.  That makes it worse, if it is a facility saying a Basic (not that an I has much more in their bag of tricks) can transport then unless you find something really off just do it.  If you don't want to be at the mercy of a corporation who is concerned with money look for another job.  They will always look for a way to maximize their profit.  If you want to go up to medic learn by doing 2 pt IFT's...whats going to happen when you have to do it off of a 911 call?  Learn from this opportunity, you need to manage time and you will be fine.


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## Amycus (Nov 29, 2010)

Veneficus said:


> "chief complaint of "flue like symptoms"
> 
> What is so special about ALS that they will somehow make any difference with the limited dx aability and treatment they offer?
> 
> ...



I am a basic, and I couldn't agree more.

Technically, to splice some information from another poster- technically isn't this better for the PT also cost wise? The IFT company might charge for 2 PTs, but likely can only charge once for the milage, so they really aren't milking the PT for extra money either.


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## looker (Nov 29, 2010)

Amycus said:


> I am a basic, and I couldn't agree more.
> 
> Technically, to splice some information from another poster- technically isn't this better for the PT also cost wise? The IFT company might charge for 2 PTs, but likely can only charge once for the milage, so they really aren't milking the PT for extra money either.



It actually goes both way in terms of billing This people likely have medi/medi so it means that it will cost government less when 2 pt are transported in same ambulance. At the same time it will mean that another unit will be available to transport someone else.


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## HasTy (Nov 30, 2010)

To be honest in my experience with MOST IFT companies in LACo is that they will bill it however they have to in order to make the bills I have seen patients walk out to the rig climb in and lay down so that the ambulance company could collect the money to for the dialysis run. Back to the OP's problem though...there is nothing wrong with taking two patients other than you might have to write a second PCR God forbid. Now you might run into problems at work seeing as the way I read it you were told by dispatch and M-100 to take both patients...and if they were stable enough for you to wait for a second unit then they were at least IMHO stable enough for you to transport at the same time.


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## looker (Nov 30, 2010)

HasTy said:


> To be honest in my experience with MOST IFT companies in LACo is that they will bill it however they have to in order to make the bills I have seen patients walk out to the rig climb in and lay down so that the ambulance company could collect the money to for the dialysis run.



If they can walk, they should be using NEMT.


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## HasTy (Nov 30, 2010)

looker said:


> If they can walk, they should be using NEMT.



your speaking to the choir hence why I no longer work for the company I was working for in LACo after they asked me to change my PCR so they could get paid but that is a topic that need not be discussed on open forum...



With this post I made 100 posts....Yea for being a forum Lieutenant...


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## Lone Star (Dec 6, 2010)

HasTy said:


> Lone Star said:
> 
> 
> > Most of the rigs that I have worked in (even the older ones that I worked in at a IFT company in LACo) had a Squad Bench AND a captains chair at the head of the stretcher, which is where you should be sitting any way if you are transporting stable patients/are not activley performing an intervention that requires access on the side of the patient. If the rig should become involved in a TC, then the place of greatest safety for you in this case would be there; especially if this is a t-bone.
> ...


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## ambman1989 (Dec 26, 2010)

*not legal*

It is NOT legal to transport two IFT patients at the same time. The only time you are allowed to transport two patients at the same time is on a 911 call. A lot of privates do this then bill medicare for two seperate runs which is Medicare fraud or insurance fraud depending on if the patients have medicare or private insurance. This is rampant in L.A. County.


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## looker (Dec 26, 2010)

ambman1989 said:


> It is NOT legal to transport two IFT patients at the same time. The only time you are allowed to transport two patients at the same time is on a 911 call. A lot of privates do this then bill medicare for two seperate runs which is Medicare fraud or insurance fraud depending on if the patients have medicare or private insurance. This is rampant in L.A. County.



Really? Would you like to post some info that show this is not legal? I will wait 
Edit:If you transport 2 patient at the same time, you are required to bill as share of ride. Only time that is not the case if they are going to different place but that would be very rare for ambulance to do.


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## Shishkabob (Dec 26, 2010)

ambman1989 said:


> It is NOT legal to transport two IFT patients at the same time. The only time you are allowed to transport two patients at the same time is on a 911 call. A lot of privates do this then bill medicare for two seperate runs which is Medicare fraud or insurance fraud depending on if the patients have medicare or private insurance. This is rampant in L.A. County.



Have you read any of the first 10 pages?

Yes, yes it is legal.


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## ambman1989 (Dec 26, 2010)

no no it's not legal on ift's


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## ffemt8978 (Dec 26, 2010)

ambman1989 said:


> no no it's not legal on ift's


Care to cite which law says it's illegal?


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## Shishkabob (Dec 26, 2010)

ambman1989 said:


> no no it's not legal on ift's



Yes, yes it is.


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## HotelCo (Dec 26, 2010)

I've been in the middle of an IFT run, come upon an accident, decided that patient needed immediate transport, so we transported. No one has said anything to me yet, so I'm not worried. B)


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## ambman1989 (Dec 26, 2010)

Care to show me where it says it's legal?????????????????no no it's not check out the articles about greybor ambulance and Murfreesboro ambulance and you will see it clearly states they transported multiple patients at once.....Hello!!!!!!MEDICARE FRAUD!!!!!!!!!!!!!!!!!!!!!!


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## ambman1989 (Dec 26, 2010)

Not sure how they do things in Texas or Michigan but in California it's illegal unless it's 911!!!!!!!!!!!


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## ffemt8978 (Dec 26, 2010)

ambman1989 said:


> Care to show me where it says it's legal?????????????????no no it's not check out the articles about greybor ambulance and Murfreesboro ambulance and you will see it clearly states they transported multiple patients at once.....Hello!!!!!!MEDICARE FRAUD!!!!!!!!!!!!!!!!!!!!!!



It's only Medicare Fraud it you charge Medicare mileage for both patients.  If you only charge mileage on one patient, it's not fraud.

Just because you can't find a source that say's it's illegal doesn't mean it is illegal.  The way the laws are supposed to work in this country is that something is presumed legal unless there is a law prohibiting it, not the other way around.


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## EMS49393 (Dec 26, 2010)

ambman1989 said:


> Not sure how they do things in TexAss or Michigan but in California it's illegal unless it's 911!!!!!!!!!!!



Your argument is rendered invalid since you can provide no reference source.  

I've been working on an ambulance for close to two decades and have transported 2 or more patients several times, whether I was working 911 or IFT.  I have also done billing, dispatch, and I am very versed in medicare law.  Our moderator is correct, you are incorrect.  You can not bill mileage for two patients, however you can transport and bill for the transport for multiple patients, IFT or 911.

Isn't there a bridge somewhere missing it's troll?<_<


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## Shishkabob (Dec 26, 2010)

ambman1989 said:


> Care to show me where it says it's legal?????????????????no no it's not check out the articles about greybor ambulance and Murfreesboro ambulance and you will see it clearly states they transported multiple patients at once.....Hello!!!!!!MEDICARE FRAUD!!!!!!!!!!!!!!!!!!!!!!



I looked up your "greybor ambulance" and in the very first article I read it stated exactly what we have been saying:

You can transport multiple patients... you cannot bill them as individual runs. Especially when you fraud the paperwork stating someone is bed-ridden when they aren't.  

Same with your "Murfreesboro ambulance"... again, billing for patients as requiring an ambulance when they did not.



Not once did I see mention of "not being allowed to carry multiple patients".


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## Journey (Dec 26, 2010)

Just quote the CMS source.

https://www.cms.gov/manuals/Downloads/bp102c10.pdf

10.3.10 – Multiple Patient Ambulance Transport


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## ambman1989 (Dec 26, 2010)

O.?k?


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## JPINFV (Dec 26, 2010)

Medicare is a federal program, not a state program. Therefore, if it's medicare fraud, then it would be the same nationwide, not just in specific states.

Additionally,

"At the heart of the indictment are accusations that the Medlocks provided emergency transportation for people who did not need an ambulance, and sometimes transported multiple patients but billed the government as though each patient had received a separate trip."
- http://www.bizjournals.com/nashville/stories/2010/01/11/daily15.html

Just in case anyone missed it. 

"sometimes transported multiple patients *but billed the government as though each patient had received a separate trip.*"

Is it fraud to transport and bill IFT transports where 2 patients are transported at the same time? No. Is it fraud to bill it like each received their own transport? Yes.


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## ffemt8978 (Dec 26, 2010)

From the link Journey posted,



> 10.3.10 - Multiple Patient Ambulance Transport
> (Rev. 103; Issued:  02-20-09; Effective Date:  01-05-09; Implementation Date:  03-20-09)
> Effective April 1, 2002, if two patients are transported to the same destination simultaneously, for each Medicare beneficiary, Medicare will allow 75 percent of the payment allowance for the base rate applicable to the level of care furnished to that beneficiary plus 50 percent of the total mileage payment allowance for the entire trip.
> 
> ...



So it is legal to transport more than one patient on an IFT, as long as you bill correctly for it.


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## rwik123 (Dec 26, 2010)

ambman1989 said:


> Care to show me where it says it's legal?????????????????no no it's not check out the articles about greybor ambulance and Murfreesboro ambulance and you will see it clearly states they transported multiple patients at once.....Hello!!!!!!MEDICARE FRAUD!!!!!!!!!!!!!!!!!!!!!!



hey bro.. how bout you introduce yourself before joining and running your mouth without civility on every thread you've posted on. Seriously, stop being a troll on this thread and the LA-County/Gerber thread


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## looker (Dec 27, 2010)

ambman1989 i really do not know where you're getting your info from, however as been posted before you joined this forum and after, transporting more then one patient at a time is permitted. It rarely happens but it is totally legal.


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## EMSLaw (Dec 27, 2010)

ambman1989 said:


> Care to show me where it says it's legal?????????????????no no it's not check out the articles about greybor ambulance and Murfreesboro ambulance and you will see it clearly states they transported multiple patients at once.....Hello!!!!!!MEDICARE FRAUD!!!!!!!!!!!!!!!!!!!!!!



You know, using multiple exclamation points just makes your point so much stronger.  I'm totally convinced.  

Lawyers have a saying - "If the law is against you, argue the facts; if the facts are against you, argue the law; if the law and the facts are against you, pound on the table."  You, my friend, are pounding on the table.  

Of course it's illegal to bill medicare for services not actually provided.  However, it is not medicare fraud if you TELL THEM you transported two patients at once, and accept the 75% reimbursement for each patient (which, if you think about it, isn't a bad deal.)  

There are public policy reasons why multiple patient transports - even IFT - are not prohibited.  Take, for example, this hypothetical...  There are about 18 inches of snow on the ground where I live right now.  Two patients are going from the same hospital to the same SNF.  Why should the ambulance company risk two trips in the current conditions when one will do?  Or, instead of inclement weather, place the scenario in small-town USA, where there are only, say, two ambulances available for all purposes.  Medicare can't envision every situation, so they don't try to.  They just tell you what is required for you to get paid.


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## Lone Star (Dec 27, 2010)

HotelCo said:


> I've been in the middle of an IFT run, come upon an accident, decided that patient needed immediate transport, so we transported. No one has said anything to me yet, so I'm not worried. B)




If you're 'in the middle of an IFT run', why are you stopping at another call in the first place?

How was this handled?  

Did you have a patient on board?  

Did one crew member evaluate/treat the MVA patient?  

Did both partners leave the IFT patient unattended?

Getting redirected while enroute to the IFT is one thing, to stop and work an MVA AFTER you've made patient contact with the IFT patient is a whole different ball of wax.

In Michigan, if you're responding to a 'cold call' (IFT, or priority 3 call), you cannot pass an accident scene if you have no patient on board.  If you've already made patient contact and are transporting, you don't have to stop for the MVA, as most crews are only two people, and to effectively evaluate treat and load the MVA patient (if they have significant MOI) with only one person.  The other person would HAVE to stay with the patient, or risk facing an abandonment beef with the State licensing board.


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## Lone Star (Dec 27, 2010)

ambman1989 said:


> Not sure how they do things in Texas or Michigan but in California it's illegal unless it's 911!!!!!!!!!!!



What I'm finding amusing is that with all the members chiming in from California, not one has backed your play on this one.  I'm thinking that there has GOT to be at least ONE other California EMT that would corroborate what you're saying IF in fact, it were illegal in California.  Unfortunately, from what I and a host of others are seeing is that our California members are actually DISPROVING your statement.

I suggest that you go back and take a Med/Legal refresher course before you try to spout off about EMS law.  If you do that and STILL decide to keep up this silly nonsense....provide sources to prove your point!


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## HotelCo (Dec 27, 2010)

Lone Star said:


> If you're 'in the middle of an IFT run', why are you stopping at another call in the first place?
> 
> How was this handled?
> 
> ...



Pt was a stable transfer going back to the nursing home. Why wouldn't I stop? My partner was in back with a stable patient.
I got out of the truck, grabbed the jump bag and went to assess the patient. A PSO pulled up, and we C-collared and backboarded the patient. Placed them on the bench seat, and transported. My partner took care of the MVC, and I drove.


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## HotelCo (Dec 27, 2010)

Lone Star said:


> In Michigan, if you're responding to a 'cold call' (IFT, or priority 3 call), you cannot pass an accident scene if you have no patient on board.



Cite please.


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## supergirl534 (Dec 28, 2010)

*i understand*

i compelety understand why you might be uncomfertable not taking to pt's in the ambulance at once but i have to agree with everyone else.  there is othing wrong with taking two pts to the hospital.  i also work for a private company and understand were when you have a problem with something and they dont help dont get dicouraged you did what you thought what you did was best but the only other thing i have to say is if you made the pt unstable you should have never waited for the other ambulance to show up technically now you are delaying transport.  keep all the little things in mind


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## Paratographer (Dec 29, 2010)

*Just help people!*

I work in a rural setting and have had up to four PTs in my ambulance at once. Two critical, two stable. That's four IVs, vitals every 5 min X2 and vitals every 10-15 on the other two. Throw in an intubation, vent set up and treatment of secondary injuries and you will be amazed how quickly the 40 minute code 3 transport time goes. I had to lean through to the front to get the vitals on the fourth PT.
If I'm presented with a chance to help someone, I jump at it. Why didn't you?


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## Hockey (Dec 29, 2010)

Paratographer said:


> I work in a rural setting and have had up to four PTs in my ambulance at once. Two critical, two stable. That's four IVs, vitals every 5 min X2 and vitals every 10-15 on the other two. Throw in an intubation, vent set up and treatment of secondary injuries and you will be amazed how quickly the 40 minute code 3 transport time goes. I had to lean through to the front to get the vitals on the fourth PT.
> If I'm presented with a chance to help someone, I jump at it. Why didn't you?



Wow.  Are you like a Paragod?  Thats flippin impressive


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## Madmedic780 (Dec 31, 2010)

On a 911 call to a nursing home for a hard ground level fall (stable with suspected strain, no deformations), I had the manager try to convince me to take another one of their client's that had a nasty bed sore at the same time. Considering they were both BLS pts  I had no problem with it but to CMA I called my boss who said no.

But being in a rural area I have taken families in before in non-MCI situations.


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