# Ambulance stopped at border - Canada



## Rattletrap (Nov 18, 2007)

http://www.hfxnews.ca/index.cfm?sid=81157&sc=89

This is a sore subject with me as my partner was driving and we were felony type stopped on way to a call at a NH. Almost ended up in a fight with police as they did not understand we were not part of 911 dispatch for NH calls. 

If I were driving it would have been "let the chase begin"


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## firecoins (Nov 18, 2007)

Rattletrap said:


> http://www.hfxnews.ca/index.cfm?sid=81157&sc=89
> 
> This is a sore subject with me as my partner was driving and we were felony type stopped on way to a call at a NH. Almost ended up in a fight with police as they did not understand we were not part of 911 dispatch for NH calls.
> 
> If I were driving it would have been "let the chase begin"



what or where is NH?


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## Chimpie (Nov 18, 2007)

I sit here, cursor flashing in the Quick Reply box cause I'm not sure how I feel about this.

If I read it correctly, the driver of the ambulance had to go into an office to confirm his identification.  To me, that is too far.  Taking one minute to confirm the occupants of the vehicle, that is okay.


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## Chimpie (Nov 18, 2007)

firecoins said:


> what or where is NH?


 
New Hampshire


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## firecoins (Nov 18, 2007)

Chimpie said:


> New Hampshire



He said he was responding to a call at *A* NH. 

He responded to a call in New Hampshire from Ohio?


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## Chimpie (Nov 18, 2007)

My bad.  Haven't had much caffeine today.

NH - Nursing Homes


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## firecoins (Nov 18, 2007)

Chimpie said:


> My bad.  Haven't had much caffeine today.
> 
> NH - Nursing Homes




Didn't think of that.  That makes alot of sense.


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## Asclepius (Nov 18, 2007)

I didn't read the whole article, but I have to side with the border patrol or customs agents. It seems to me that there would be some sort of system involved where the transporting agencies to call ahead and warn the border patrol. In this day and age of terrorist and political frustration with our nations unwillingness to secure our borders, I have to believe that there is or should be a procedure for stuff like this. Simply having the lights and sirens activated to cross the border is insufficient, because by itself, it is unverifiable.

I also feel like the life of one person does not outweigh the security and protection of all the other people in the country who could be affected by someone trying to smuggle something into or out of the country. If you've worked in EMS for any length of time, you know that ambulances have been considered an item a terrorist might try to commandeer for use. Our agency gets reminders every now and then reminding us to make sure our rigs are locked and secured.


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## Flight-LP (Nov 18, 2007)

Very unfortunate, thankfully transfer of appropriate care was accomplished without negative outcomes. Perhaps air transportation should have been considered. If a hospital does not have basic angioplasty capabilities, then EMS should take that into consideration before taking a patient to that facility. Had this pt. been flown, then he could have gone straight to Detroit without delay. Maybe a thought for future responses.

As far as the original post goes, if you are responding to a nursing home and are not part of the public contracted 911 service, then you may have to explain to law enforcement why you are running hot. And they have every right to ask. It would not be my recommendation to argue and or fight with them. We had a private transport crew here in Houston try that once, both were arrested. If hte call at the nursing home is of dire urgency that requires an emergent response, then the local 911 service should handle it. If that is not the case, then a courtesy call to local PD dispatch would eliminate this ever happening again. 

Oh, and I have yet to see any ambulance outrun a police cruiser. It would be entertaining though, smile for the camera's........


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## Flight-LP (Nov 18, 2007)

Asclepius said:


> I didn't read the whole article, but I have to side with the border patrol or customs agents. It seems to me that there would be some sort of system involved where the transporting agencies to call ahead and warn the border patrol. In this day and age of terrorist and political frustration with our nations unwillingness to secure our borders, I have to believe that there is or should be a procedure for stuff like this. Simply having the lights and sirens activated to cross the border is insufficient, because by itself, it is unverifiable.
> 
> I also feel like the life of one person does not outweigh the security and protection of all the other people in the country who could be affected by someone trying to smuggle something into or out of the country. If you've worked in EMS for any length of time, you know that ambulances have been considered an item a terrorist might try to commandeer for use. Our agency gets reminders every now and then reminding us to make sure our rigs are locked and secured.



An absolutely valid point. Looking at the benefit of a nation definately outweighes an outcome of one individual.


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## medicdan (Nov 18, 2007)

Asclepius said:


> If you've worked in EMS for any length of time, you know that ambulances have been considered an item a terrorist might try to commandeer for use. Our agency gets reminders every now and then reminding us to make sure our rigs are locked and secured.



I am particularly sensitive to this, being involved with MDA. I understand that there used to be weekly attempts for Palestinian ambulances to cross the green line through checkpoints into Israel either "empty", that is, with no patient, but full of explosives, or "full" with a mock patient, and explosives packed everywhere not obviously visible. There is a video on youtube of a robot removing a cot mattress filled with explosives. 
Since these attempts have started, the Israeli army has a policy of not allowing Palestinian ambulances through checkpoints, rather transferring care to an MDA ambulance at the checkpoint. There have been a few high-profile transfers, including an infant being transported for an operation only possible in an Israeli hospital. 
Even in and around Tel-Aviv, whenever we enter a hospital complex, we must stop, and are quickly "searched". That is, the security guard makes sure they know the driver (despite the fact there are dozens of security guards and dozens of drivers, we are making daily trips, and each gets to know the other. The guard opens the side door of the ambulance, makes sure there is a patient, and checks to see that all other MDA staff are in proper uniform. This check only takes a few seconds, and is done several times a day, every time we enter a hospital, but is very necessary to Israeli security. Once we reach the ambulance entrance, there is another guard, who checks to see that we indeed have a patient, and that we are locking our ambulances. 

I think in this post 9/11 world the US has every right to be anal about its borders, and based on the assumption that there is a written policy in place that was not initiated by the ambulance, they are the only to blame. I understand the media's interest in blowing one case out of proportion, but as others have said, USCBP is sacrificing the good of one for the safety of many.


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## Rattletrap (Nov 18, 2007)

Flight-LP said:


> Oh, and I have yet to see any ambulance outrun a police cruiser. It would be entertaining though, smile for the camera's........



A chase does not have to be high speed. In most states, unless there is reckless driving by the driver, the police must follow to the scene or the hospital and may not stop you as long as you are acting due regard.


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## Guardian (Nov 19, 2007)

Asclepius said:


> I didn't read the whole article, but I have to side with the border patrol or customs agents. It seems to me that there would be some sort of system involved where the transporting agencies to call ahead and warn the border patrol. In this day and age of terrorist and political frustration with our nations unwillingness to secure our borders, I have to believe that there is or should be a procedure for stuff like this. Simply having the lights and sirens activated to cross the border is insufficient, because by itself, it is unverifiable.
> 
> I also feel like the life of one person does not outweigh the security and protection of all the other people in the country who could be affected by someone trying to smuggle something into or out of the country. If you've worked in EMS for any length of time, you know that ambulances have been considered an item a terrorist might try to commandeer for use. Our agency gets reminders every now and then reminding us to make sure our rigs are locked and secured.



Why are you looking at the big picture?  Why are you using logic?  That's my job, quit it!


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## bstone (Nov 19, 2007)

emt-student said:


> I am particularly sensitive to this, being involved with MDA. I understand that there used to be weekly attempts for Palestinian ambulances to cross the green line through checkpoints into Israel either "empty", that is, with no patient, but full of explosives, or "full" with a mock patient, and explosives packed everywhere not obviously visible. There is a video on youtube of a robot removing a cot mattress filled with explosives.
> Since these attempts have started, the Israeli army has a policy of not allowing Palestinian ambulances through checkpoints, rather transferring care to an MDA ambulance at the checkpoint. There have been a few high-profile transfers, including an infant being transported for an operation only possible in an Israeli hospital.
> Even in and around Tel-Aviv, whenever we enter a hospital complex, we must stop, and are quickly "searched". That is, the security guard makes sure they know the driver (despite the fact there are dozens of security guards and dozens of drivers, we are making daily trips, and each gets to know the other. The guard opens the side door of the ambulance, makes sure there is a patient, and checks to see that all other MDA staff are in proper uniform. This check only takes a few seconds, and is done several times a day, every time we enter a hospital, but is very necessary to Israeli security. Once we reach the ambulance entrance, there is another guard, who checks to see that we indeed have a patient, and that we are locking our ambulances.
> 
> I think in this post 9/11 world the US has every right to be anal about its borders, and based on the assumption that there is a written policy in place that was not initiated by the ambulance, they are the only to blame. I understand the media's interest in blowing one case out of proportion, but as others have said, USCBP is sacrificing the good of one for the safety of many.



Having lived in Israel for 2 years near the Green Line and there before and during the current intifada, I am acutely aware of this situation. Below are two videos illustrating the ambulance issue with the Palestinians and the Red Crescent.

http://www.youtube.com/watch?v=Avm-9IglHTg
http://www.youtube.com/watch?v=AqGjz7iJTns


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## BossyCow (Nov 19, 2007)

Asclepius said:


> I didn't read the whole article, but I have to side with the border patrol or customs agents. It seems to me that there would be some sort of system involved where the transporting agencies to call ahead and warn the border patrol.




According to the article there is a system in place and it was ignored.


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## bstone (Nov 19, 2007)

Which is really disturbing and frustrating. 

There have been instances of Law Enforcement interferring with EMS. This is another one. Fortunately, no one died.


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## Asclepius (Nov 19, 2007)

Would you say that, by and large, LEO are much more helpful to our profession than a hindrance? I have had frustrating calls when LEO called us to the scene for no reason (lots of those actually), but every time I have needed LEO to assist me in 'persuading' a patient to go to the hospital they have done so. Been in EMS for almost ten years now, and I can't recall a single time that LEO was a problem for me.


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## jmaccauley (Nov 19, 2007)

BossyCow said:


> According to the article there is a system in place and it was ignored.



Actually, from what I read, there is a system in place that was not followed. Much different than ignored. Border security is too serious to just assume that lights and sirens means a genuine emergency. There should have been a call made ahead of the ambulance and officials at the border to assure a safe crossing. Instead, taking the word of the driver just doesn't cut it these days. I'm sure the system has a better protocol than that.


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## jmaccauley (Nov 19, 2007)

Rattletrap said:


> http://www.hfxnews.ca/index.cfm?sid=81157&sc=89
> 
> This is a sore subject with me as my partner was driving and we were felony type stopped on way to a call at a NH. Almost ended up in a fight with police as they did not understand we were not part of 911 dispatch for NH calls.
> 
> If I were driving it would have been "let the chase begin"



Are you saying that you were not on a 911 emergency call but were stopped? Why were you stopped? And what makes you think driving to a non emergency gives you the authority to not stop for the police? I'm sure there is more to your story.


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## JJR512 (Nov 19, 2007)

jmaccauley said:


> Are you saying that you were not on a 911 emergency call but were stopped? Why were you stopped? And what makes you think driving to a non emergency gives you the authority to not stop for the police? I'm sure there is more to your story.


He didn't say he wasn't going to an emergency; he just implied he wasn't dispatched by 911. Not all emergency calls are dispatched by the municipality. Private ambulance companies also run emergency calls; they are called directly, not though 911.


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## BossyCow (Nov 19, 2007)

jmaccauley said:


> Actually, from what I read, there is a system in place that was not followed. Much different than ignored. Border security is too serious to just assume that lights and sirens means a genuine emergency. There should have been a call made ahead of the ambulance and officials at the border to assure a safe crossing. Instead, taking the word of the driver just doesn't cut it these days. I'm sure the system has a better protocol than that.



I thought I read they had a police escort to the border.


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## Rattletrap (Nov 19, 2007)

JJR512 said:


> He didn't say he wasn't going to an emergency; he just implied he wasn't dispatched by 911. Not all emergency calls are dispatched by the municipality. Private ambulance companies also run emergency calls; they are called directly, not though 911.



Thank you.

The authority comes from a direct call to our dispatch center telling me someone is laying on the floor unresponsive with a head injury. 

The rest of story involves the fact that a long term sheriff deputy. chased a blue and white type 2 ambulance saying that there was not an emergency in the county. He was backed up by a higher ranking long term sheriff deputy.

Problem.

They were informed who we were and we were responding to a direct call through our dispatch center and what/where it was. They said we were telling lies. 

Most of the chase was on the interstate. State highway patrol was not informed.

Our phone number in big letters on side of truck. Not called.

They told the owner of company they thought that someone was joy riding in a truck belonging to the VFD that is in the town our station was in. Did I say long term deputies? Our truck blue and white type 2 truck and VFD truck orange and white type 3 truck. VFD has their name on truck, we have our name on truck.


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## Flight-LP (Nov 19, 2007)

Again, you may need to notify county authorities if you are responding emergency in their territory. Since the nursing home failed to notify 911 for this emergency and instead called a private, the sheriff is correct in his assumption as to not knowing that an emergency existed. Regardless, they have every right to pull you over and inquire. Should you fail to stop, you will be held accountable. Communication is everything, remember you are not the 911 provider and are subject to some questioning. It happens all the time.

I do wonder why they would think that someone was "joy riding"..............


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## Rattletrap (Nov 19, 2007)

Flight-LP said:


> Again, you may need to notify county authorities if you are responding emergency in their territory. Since the nursing home failed to notify 911 for this emergency and instead called a private, the sheriff is correct in his assumption as to not knowing that an emergency existed. Regardless, they have every right to pull you over and inquire. Should you fail to stop, you will be held accountable. Communication is everything, remember you are not the 911 provider and are subject to some questioning. It happens all the time.
> 
> I do wonder why they would think that someone was "joy riding"..............



Not trying to sound nasty but none of private companies talk to 911 unless they dispatch us. if there was question, our number is in big letters on side of truck. they could/should have called us. 911 around here does not want to be bothered with that either.

I also mentioned that state highway patrol was not notified. The deputies were acting outside their jurisdiction, per highway patrol. They did not know anything about it until I contacted them later in day. There was an investigation. I don't know outcome.


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## jmaccauley (Nov 20, 2007)

I got ya. An emergency run, but the police couldn't verify it through 911.


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## bstone (Nov 20, 2007)

Not being able to verify through 911 is extremely common. I work for a private ambulance service and we run l/s whenever the situation is an emergency. We alert the receiving hospital but we do not alert 911 as we are not part of their system.

In fact, I don't think we have a way to alert 911 other than calling 911 from our cell phones.


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## VentMedic (Nov 20, 2007)

bstone said:


> Not being able to verify through 911 is extremely common. I work for a private ambulance service and we run l/s whenever the situation is an emergency. We alert the receiving hospital but we do not alert 911 as we are not part of their system.
> 
> In fact, I don't think we have a way to alert 911 other than calling 911 from our cell phones.



It is required in many of our counties, especially in the cities, that the company's dispatcher alert the county 911 center. We have had a few accidents in the past between emergency vehicles meeting unpleasantly at intersections.  Often you will hear the dispatcher advise of other emergency traffic in the area. 

Occasionally a small hospital I am familiar with will send a patient by BLS transfer to the city for diagnostics not available at their facility. There have been times when the Sheriff's office calls the ambulance dispatch and the hospital for emergency run verification when they see the L/S on a private ambulance.  The hospital will confirm BLS nonemergent transport. The S.O. will follow the ambulance until the dispatcher tells them to slow down and knock off the L/S. If the driver is reckless or speed is excessive, that ambulance will be pulled over.  There will also be a report filed by the hospital and the S.O. for the county to review the call for justification of the ambulance crew's decision to run L/S.  The hospital and sending doctor are very concerned about this since they think they released a stable patient to go by BLS on a long transport. There is much liability and responsibility to pass around when something goes wrong.


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## JJR512 (Nov 20, 2007)

VentMedic said:


> It is required in many of our counties, especially in the cities, that the company's dispatcher alert the county 911 center. We have had a few accidents in the past between emergency vehicles meeting unpleasantly at intersections. Often you will hear the dispatcher advise of other emergency traffic in the area.
> 
> Occasionally a small hospital I am familiar with will send a patient by BLS transfer to the city for diagnostics not available at their facility. There have been times when the Sheriff's office calls the ambulance dispatch and the hospital for emergency run verification when they see the L/S on a private ambulance. The hospital will confirm BLS nonemergent transport. The S.O. will follow the ambulance until the dispatcher tells them to slow down and knock off the L/S. If the driver is reckless or speed is excessive, that ambulance will be pulled over. There will also be a report filed by the hospital and the S.O. for the county to review the call for justification of the ambulance crew's decision to run L/S. The hospital and sending doctor are very concerned about this since they think they released a stable patient to go by BLS on a long transport. There is much liability and responsibility to pass around when something goes wrong.


What happens around here (the Greater Baltimore Metropolitan Area, Maryland, USA) is that the private ambulance companies do not allow BLS crews to run L/S without authorization from a supervisor in the company. If a police officer decides to check on a L/S-running ambo, he/she calls the phone number on the ambo and checks with the company. I guess they do that because they know there's no point in checking through the 911 system because they know we don't report to them, but in the arrangement you describe, it does make sense.

Police officers don't usually check up on ambos running L/S, not around here, anyway. If they do, it's more likely to be for a Type 2 ambo (vanbulance) because they (the cops) know that no FDs use those, only private companies.

Personally, I don't really like the concept that someone on a BLS private ambo has to call his/her supervisor for permission to run L/S. I understand the justification--some private ambulance employees can be a little gung-ho and would step up to L/S more often if they could, for the thrill--but when you have a true emergency, it can be difficult to find the time to make that phone call.


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## VentMedic (Nov 20, 2007)

JJR512 said:


> Personally, I don't really like the concept that someone on a BLS private ambo has to call his/her supervisor for permission to run L/S. I understand the justification--some private ambulance employees can be a little gung-ho and would step up to L/S more often if they could, for the thrill--but when you have a true emergency, it can be difficult to find the time to make that phone call.



For some areas it greatly reduced using L/S just to get the truck back in service faster by the ambulance service.  A company running its coverage thin due to economics should be addressed some place other than the streets.

Again, a review may be needed in regards to the facility sending the patient also. Did they request the appropriate level of care or was that patient beyond the scope of BLS and needed more monitoring?  Safety measures are there to protect the EMT and Paramedic as well as the general public.


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## Asclepius (Nov 20, 2007)

My thought is if they can't trust the EMT to make the determination for transport then they need to reevaulte their staff. Although, I can't think of a good reason for BLS to be transporting L/S unless they are responding to the scene, moving towards an ALS intercept, or are in a BLS zone around the hospital. I don't think a qualified EMT should need to seek permission to act in the best interest of the patient.

I also do not agree, generally, with the concept of blowing someone in just to get back in service, with very few exceptions. I understand that the system becomes taxed and sometimes it is necessary, but that should happen very infrequently. I've only seen it done a handful of times in all my years.


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## jmaccauley (Nov 20, 2007)

I guess my thought was this: Why is BLS responding to an emergency? Why not have 911 called, unless it's not that critical and the NH just wanted an ambulance to transport. The problem, from law enforcement's poit of view, is that there are stolen ambulances and there are legitimate EMT's who like the lights and siren just because they have them. Whenever I see an ambulance driving at mach 1, I call and ask where they are going because I might very well be called next. As discussed in another thread, someone's crisis is not always our emergency.


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## jmaccauley (Nov 20, 2007)

BossyCow said:


> I thought I read they had a police escort to the border.



Obviously, the police turned them over to the border escorts without telling them anything about the emergency. A phone call might have saved everyone some unneeded agravation.


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## JJR512 (Nov 20, 2007)

jmaccauley said:


> I guess my thought was this: Why is BLS responding to an emergency? Why not have 911 called, unless it's not that critical and the NH just wanted an ambulance to transport.


The problem is that not all nursing homes are staffed by skilled nurses who care about their patients and can determine when there is a true emergency. Or the staff may not be quite as bad as that, but having so many patients to tend to, they might not be able to pay as much attention to one particular patient as might be needed; so, you might have a situation where a patient has a minor emergency that doesn't warrant calling 911, so they call a private company, but meanwhile, while the private company is on its way, the patient gets worse gradually, which is not noticed by staff.

I was recently called to a particular nursing home for a patient whose chief complaint, according to the staff, was "general lethargy and decreased appetite". (Another common nursing home patient complaint like that is "failure to thrive".) Anyway, I get there and do an assessment; pt. has recently (according to staff) altered mental status and is unable to communicate, and a BP of 72/38. Here's someone that clearly should have been at the hospital already, and probably could have been there quite a bit earlier had they called 911. But the staff based their decision to call us on factors other than BP, which at the last regular twice-daily check was 100/50. So either they weren't monitoring the BP more frequently because it wasn't a problem at the last regular check, or nobody cared enough, or knew enough... Anyway, we didn't run that one L/S, nor request an ALS rendezvous, because that NH happens to be next door to the hospital, so no point. 

I'm sure it's the same all over, but some of the nursing homes around here are really quite deplorable, and it's amazing people ever get out of them alive.


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## Rattletrap (Nov 20, 2007)

JJR512 said:


> The problem is that not all nursing homes are staffed by skilled nurses who care about their patients and can determine when there is a true emergency. Or the staff may not be quite as bad as that, but having so many patients to tend to, they might not be able to pay as much attention to one particular patient as might be needed; so, you might have a situation where a patient has a minor emergency that doesn't warrant calling 911, so they call a private company, but meanwhile, while the private company is on its way, the patient gets worse gradually, which is not noticed by staff.
> 
> I was recently called to a particular nursing home for a patient whose chief complaint, according to the staff, was "general lethargy and decreased appetite". (Another common nursing home patient complaint like that is "failure to thrive".) Anyway, I get there and do an assessment; pt. has recently (according to staff) altered mental status and is unable to communicate, and a BP of 72/38. Here's someone that clearly should have been at the hospital already, and probably could have been there quite a bit earlier had they called 911. But the staff based their decision to call us on factors other than BP, which at the last regular twice-daily check was 100/50. So either they weren't monitoring the BP more frequently because it wasn't a problem at the last regular check, or nobody cared enough, or knew enough... Anyway, we didn't run that one L/S, nor request an ALS rendezvous, because that NH happens to be next door to the hospital, so no point.
> 
> I'm sure it's the same all over, but some of the nursing homes around here are really quite deplorable, and it's amazing people ever get out of them alive.



These decisions are in most cases not made by the staff. They must contact the pt doctor and wait for a call back. The doctor then decides what they want done after waiting several hrs to call back on info he has been given.


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## JJR512 (Nov 20, 2007)

Well that explains why I take so many NH patients to the hospital, patients who have fallen and hit their head or possible fractured something, and have to tell the ED staff why I'm just bringing the patient there now when the fall happened "last night" or "two days ago".


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## Rattletrap (Nov 20, 2007)

Bingo

message must be 10 letters


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## VentMedic (Nov 20, 2007)

JJR512 said:


> I'm sure it's the same all over, but some of the nursing homes around here are really quite deplorable, and it's amazing people ever get out of them alive.



An RN at a NH has got to be one of the worst possible jobs an RN could have. Yet, many RNs love geriatric medicine and think they can make a difference. Soon, they find out that they are in a system that is just not reasonable medicine and good nurses get fried both mentally and legally. The more they care, the more they take the hits. 

One RN may be responsible for easily 30 or more patients with very few unlicensed staff to assist.  They must follow orders by doctors that may not see the patient for weeks if that.  They do not have access to ACLS medications or even a code cart in most cases. If they start an IV they are regulated by the state and the facilty as to what meds they can run.  Even the basic meds come from an outside pharmacy in only the amounts that have been ordered for each patient. Just to give an emergent Albuterol treatment, the RN may have to "borrow" from another patient. 

If the RN bypasses the doctor calling protocol to get help faster and calls 911 ALS for a "fever" even though the RN recognizes the signs of sepsis, he/she may get a scolding from the ALS crew for calling them for a fever. "That's BLS". 

If the RN jumps through all the hoops including being put in the waiting line for a BLS truck, the BLS crew sees a very unstable patient and again the RN is going to get chewed by the crew and by the ED.  And yes, the ED may file a formal complaint. So, the RN will again have to justify his/her actions again in a system that can not be easily changed due to all the local, state and Federal guidelines in place to "_protect the patient_".


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## JJR512 (Nov 20, 2007)

I believe the only difference they can really make is in the attitude of their patients. If the nurse comes into the system knowing and understanding that, and is resigned to it, and puts a smile on and is pleasant with her charges, that can really make a positive impact on the patients. But one who is frustrated with the system, or just tired and burned out, and comes in with a scowl and an uncaring attitude is just going to make her patients sad and lonely.

It takes a really strong constitution of character to make that kind of a positive difference in the face of a system like this.


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## emtwacker710 (Apr 24, 2008)

this aggravates me...it does, there should be no reason for stopping that ambulance (or if you read the article the fire truck also) seriously it is not a matter of national security, if the US or Canada wanted to attack each other they would think of better ways than fire and EMS, lol anyways that cop that stopped them is very lucky that the pt. survived..or else he would be in some deep s*it


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