Ambulances held hostage

EpiEMS

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EpiEMS

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No. Larger hospitals.

Got it. Do you think this problem of parking is mainly an urban (academic?) center problem?
I haven’t heard about this as a rural or even suburban issue.
 

Tigger

Dodges Pucks
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Why does that become an EMS problem? PWW make it quite clear that a patient’s percent at the hospital means the hospital has an obligation to follow their EMTALA requirements and cannot use EMS as a crutch.

And that epitomizes everything wrong with California, the only state that has such a law specific to hospital departments.
It is unclear to me what the solution is though, this seems like a very entrenched problem in some areas and you can be sure those facilities don't think they're violating in laws.

Do people really hold the wall with BLS patients? I can't imagine how the hospital could prevent you from taking them to the waiting room.
 

EpiEMS

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It is unclear to me what the solution is though, this seems like a very entrenched problem in some areas and you can be sure those facilities don't think they're violating in laws.

Do people really hold the wall with BLS patients? I can't imagine how the hospital could prevent you from taking them to the waiting room.

No disagreement. It seems like something that requires litigation and possibly additional legislation too.

Re: BLS patients, it would seem pretty silly to keep a crew waiting around for a patient who could go to triage/waiting room - but maybe this is something that system policies prevent?
 

Jim37F

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I've always been told something along the lines that they (the hospital) doesn't have any extra room in the waiting room, or that just because they're BLS doesn't mean we can dump them where there's no nurse assigned beyond the one doing triage and that would be "patient abandonment".

And most every hospital I transported to seemed to think the patient belonged to the ambulance until they had an open bed, with even suggesting to the Charge Nurse that the patient could go to the waiting room in all but the most obvious "no ambulance needed" patients was met with the same look a Medic might give their EMT if they asked their BLS patient if they had any chest pains...
 

Tigger

Dodges Pucks
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Absurd. Charge nurses here will ask over the radio if the patient can just go straight to triage even if there are open beds. We take people out to six hour waits all the time.
 

Jim37F

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I wish our Charge Nurses thought the same way as yours. 20-30 min wait times were short for us, hour long not uncommon, my 8 hours of holding the wall one day wasn't even close to the record of some of my co-workers. Even with 5 minute transport times we knew any call would be minimum 1 hour before we would be available (from time of dispatch) assuming no other delays.

"Something Something Something liability, they called you guys (911) for a reason, if they deteriorate while waiting in the waiting room it's on us, of they're with you, you'll catch it cuz they're still your patient because liability"
 

MonkeyArrow

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I can't imagine how the hospital could prevent you from taking them to the waiting room.
Who would sign your PCR to document handover of care (if you took them out to the waiting room against the ER’s wishes)?
 

FiremanMike

EMS Coordinator
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I had a buddy that worked for Memphis Fire about 10 years ago (subsequently left the FD altogether). He said they'd have 1+ hour waits in the ER to drop their patient, then have runs holding when they cleared..
 
OP
DrParasite

DrParasite

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I don't pretend to be a lawyer, but it's always been my understanding that dropping a patient without a signoff would be considered abandonment..
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It's always been explained to me that if you drop the patient off in the waiting room, you are supposed to transfer care to the triage nurse, who is the person who signs the transfer of care paperwork.
 

Ensihoitaja

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We don't get signatures for transfer of care. If the patient is unable to sign, we'll have a nurse sign for billing purposes. If the patient/family/parent is able to sign, I don't have to have anyone sign for transfer of care.
 

Tigger

Dodges Pucks
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The patient signs for themself. We don’t require a receiving signature nor has any agency I’ve ever worked for unless the patient is altered or otherwise unable to sign.

I’m not suggesting just dumping the patient in the waiting room and dipping out. But where is the burden of giving the charge or triage nurse handoff, them agreeing that the patient can sit out the waiting room, and then clearing?

What if the patient just wants to go sit out there rather than on your cot?

I get it, this is an entrenched system in some places. It just makes no sense to me, even with the mandatory staffing ratios.
 

GMCmedic

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I've never worked anywhere that required a signature from a nurse unless the patient was incapable of signing. Those are billing signatures, nothing more.
 
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DrParasite

DrParasite

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For those that don't require a signature. how do you "prove" that you transferred patient care to another provider, vs simply "just dumping the patient in the waiting room and dipping out"?
 

Tigger

Dodges Pucks
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Is there any need to prove this?

I document who I turned the patient over and what location that occurred at. Not sure how an RN scribbling on the tablet would change anything.
 

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