ALS/BLS Handover

[DrParasite]

https://kernpublichealth.com/wp-content/uploads/2023/09/ALS_BLS_Hosp.pdf

question: why? the people appear stable; can they be "transferred" to the waiting room, with a report given to the triage nurse? You are tying up a BLS resource babysitting a patient, who might be waiting for hours, who doesn't need monitoring. They want to be seen in the ER; ERs have told people for years that patients are see in order of priority, not order of arrival, and EMS shouldn't let you cut the line. Can't you use your clinical judgement that the patient won't benefit from having EMS babysit them?

Let's not forget, once you are on hospital property, the hospital is responsible for patient care, not EMS.

 

[EpiEMS]

question: why? the people appear stable; can they be "transferred" to the waiting room, with a report given to the triage nurse? You are tying up a BLS resource babysitting a patient, who might be waiting for hours, who doesn't need monitoring. They want to be seen in the ER; ERs have told people for years that patients are see in order of priority, not order of arrival, and EMS shouldn't let you cut the line. Can't you use your clinical judgement that the patient won't benefit from having EMS babysit them?

Let's not forget, once you are on hospital property, the hospital is responsible for patient care, not EMS.

Fair point, this. We transport stable people to the waiting room (or the hallway, with dubious levels of care) BLS and transfer care to triage RN.

 

[VentMonkey]

question: why? the people appear stable; can they be "transferred" to the waiting room, with a report given to the triage nurse? You are tying up a BLS resource babysitting a patient, who might be waiting for hours, who doesn't need monitoring. They want to be seen in the ER; ERs have told people for years that patients are see in order of priority, not order of arrival, and EMS shouldn't let you cut the line. Can't you use your clinical judgement that the patient won't benefit from having EMS babysit them?

Let's not forget, once you are on hospital property, the hospital is responsible for patient care, not EMS.

//shrugs shoulders// was simply replying to the OP’s question. It doesn’t really pertain to me. If you care that much ask the county’s medical director.

 

[Tigger]

We get patients assigned to the waiting room when we patch. Holding the wall is not a thing here and I ain’t mad about it.

 

[CCCSD]

We get patients assigned to the waiting room when we patch. Holding the wall is not a thing here and I ain’t mad about it.

Thank God. Common sense. The wall is utter BS.

 

[EpiEMS]

We get patients assigned to the waiting room when we patch. Holding the wall is not a thing here and I ain’t mad about it.

"Are they good to go to triage?" "[Doing the stare of life to a patient with positive cell phone sign and hemodynamically stable] Yup."

 

[DrParasite]

We get patients assigned to the waiting room when we patch. Holding the wall is not a thing here and I ain’t mad about it.

Never heard of it in NJ, NY or NC... esp for hours. Seems to be very common in California, esp SoCal. I think the first time I ever heard of it was on this forum.

I think the longest I have ever been in an ER just waiting was 30 minutes, and that was because the Charge nurse was having a really really bad day

 

[DesertMedic66]

Never heard of it in NJ, NY or NC... esp for hours. Seems to be very common in California, esp SoCal. I think the first time I ever heard of it was on this forum.

I think the longest I have ever been in an ER just waiting was 30 minutes, and that was because the Charge nurse was having a really really bad day

Flu season of 2017 I held the wall with a chest pain patient for my entire shift. Picked him up from his doctors office at 0900 and got to the hospital by 0930. He was discharged from our gurney at 1815.

 

[EpiEMS]

Never heard of it in NJ, NY or NC... esp for hours.

Likewise, not in NY or CT -- I hit 30 minutes a couple of weeks ago and was pretty surprised.

 

[Bullets]

Flu season of 2017 I held the wall with a chest pain patient for my entire shift. Picked him up from his doctors office at 0900 and got to the hospital by 0930. He was discharged from our gurney at 1815.

How does that work? if theyre assessing and treating on your cot inst that an EMTALA violation?

 

[luke_31]

How does that work? if theyre assessing and treating on your cot inst that an EMTALA violation?

If they are at the facility and the staff there is doing all the work it wouldn’t be an EMTLA violation. They are just using your stretcher as a extra bed essentially and tying you up from being able to go available for another call. It’s messed up to be sure, but when there are no appropriate beds at all, you do what you got to do. A EMTLA violation would occur if you showed up and they turned you away without performing an assessment and stabilization of the patient and then appropriately disposed the patient either home with any necessary follow up instructions or arranged a transfer to a more appropriate facility. It’s obviously a little more complicated than that, but the general idea is there.

 

[johnrsemt]

EMTALA violations are understood as well as HIPAA violations

 

[911MedicTraining]

Does your agency have standards or assessment requirements before a patient can be "downgraded" to BLS transport? I've only been in agencies where there is an ALS co-response or ALS resource assigned to all calls, and have seen various practices by various providers.

We have a document titled “ALS Indicators” which are considered a guideline, because obviously every call is different.

If there is an ALS indicator but the call is downgraded, you just have to be able to justify that decision in your documentation as to why the patient did not need ALS care. If the crew is unsure, then they should er on the side of caution and make it ALS.