Code 3 response to hospital

[daedalus]

While we are on the subject of debating the use of lights and sirens, I figure I'd bring up a practice we use in my service to see what y'all think.

Is it ever appropriate to respond code 3 to a hospital for a STAT IFT? Usually, ALS or CCT. Los Angeles hospitals themselves frequently request use of lights and sirens to respond to their hospital, to pick up transplant teams done harvesting organs, for emergency STEMI transfers for rescue angioplasty at another facility, for urgent neurosurgical patients, etc. Please try and remember that code 3 vs no code in the greater LA area can be the difference of the response taking an hour no code or twenty minutes code 3.

 

[firecoins]

that sounds fine.

 

[JPINFV]

Only if directly requested by the transfering hospital for an emergency response. They're going to be less likely to request or expect it then the general public and you KNOW that it will be for a true emergency. If my memory is correct, LA and OC require private ambulance companies to report these responses to the local fire department dispatch (maybe county EMS too?), which should keep hospitals from requesting an emergency response for the simple reason as they want the bed.

 

[VentMedic]

LA may be one of the exceptions.

Often, the time for IFT can be cut down by making the whole process more efficient.

First you have the identification process for a need to transfer.

Then, which facility, who's the doctor on call and making contact for acceptance.

Once acceptance is finalized, a bed must be found for the patient in the receiving hospital or cath time must be confirmed.

OR if none of the above works out, start over at locating an alternative hospital and begin the process again.

Oops, wrong insurance...Kaiser (or whatever) patient. Start over...

Find CCT ambulance with personnel that can handle all the meds and technology. One can do this but not that. This does it all but must call their MICN to accompany. (A hospital having its own CCT is so much easier.)

Now the paperwork.

We (CCT, Flight and Specialty) fax a list of everything (pumps, IVs etc) that will need to be done prior to our arrival.

Arrival at the facility:
Wait for elevator that takes forever.
Chit chat about the family.
Paperwork not quite ready.
Pumps/IVs need to be switched
Stabilize vitals from pump disconnect/switch.
Stabilize on a transport ventilator...more sedation.
Move to stretcher.
Untangle everything.
More chit chat.
Depart unit...wait for elevator that takes forever...unless staff with elevator key accompanies you.

Drive real fast with L&S to the other hospital.

 

[abckidsmom]

I'd say since it so dramatically impacts the time involved, it's fine. Where I've worked, the difference between Code 3 and no Code 3 is less than 5 minutes, except at rush hour or in other special circumstances. Not worth it, IMO.

 

[VentMedic]

Los Angeles hospitals themselves frequently request use of lights and sirens to respond to their hospital, to pick up transplant teams done harvesting organs,

If communication between the organ procurement team and the ambulance service was established by just asking them to add you to their check list, there would be no need for a Code 3 response to the hospital. Organ Procurement takes about 24 hours to set up and an OR time is scheduled so that all the physicians picking up the organs can be present. A simple phone call notifying the ambulance of the time and confirmation when the teams are in the OR would allow for the ambulance service to have a unit waiting for them.

 

[daedalus]

If communication between the organ procurement team and the ambulance service was established by just asking them to add you to their check list, there would be no need for a Code 3 response to the hospital. Organ Procurement takes about 24 hours to set up and an OR time is scheduled so that all the physicians picking up the organs can be present. A simple phone call notifying the ambulance of the time and confirmation when the teams are in the OR would allow for the ambulance service to have a unit waiting for them.

Agreed.
Also, its hilarious reading your other post above. Except add, male CCT nurse flirts with floor nurses while EMTs transfer patient over and wait for help with vents and pumps.

 

[mycrofft]

Crikey, we got there early once and the pt expired while we advertised.

I think the local EMS rules should be observed, unless it is in North Gardena, SE Central/L.A. Strip/Harbor area, or around the Olympic Auditorium, in whch case you go #3 because otherwise bad guys will jack you.

Whenever you do anything besides driving like Granny, mentally rehearse how it will sound explaining to someone why you were doing what you were doing.

Like your boss, the insurance attorney, the assistant D.A....

 

[daedalus]

I think the local EMS rules should be observed, unless it is in North Gardena, SE Central/L.A. Strip/Harbor area, or around the Olympic Auditorium, in whch case you go #3 because otherwise bad guys will jack you.

Whenever you do anything besides driving like Granny, mentally rehearse how it will sound explaining to someone why you were doing what you were doing.

Like your boss, the insurance attorney, the assistant D.A....

Solid advice. I always actually try to explain my actions to the fake jury, DA, and EMSA every time I have to make a difficult controversial decision. Like letting someone AMA.

 

[Hastings]

One of the issues our service is currently dealing with is abuse of this. The hospital is making every transfer stat just to get us there faster. We tried sitting outside with the siren going for awhile to deter them, but it didn't.

We can't go faster than 72 mph in the vehicle anyway, so we never use L&S on transfers. If we do, people just pass us.

 

[BLSBoy]

I do CCT/SCT, in addition to MICU work up here.
While my "main" function is to drive, I set up the vent, get the patient hooked up to monitor, start a second line, backboard the pt if need be, or if done incorrectly, and get the patient prepared to move to the cot, while my MICN partner gets everything else squared away.
We do go emergency traffic to facilities for STEMIs, trauma transfers, and as requested by an MD. It is up to us to keep the emergency traffic, or downgrade to normal traffic.
For routine SCT/CCT transfers, yea, we lollygag (down to first, we lollygag coming off the field) around, but for emergent runs, we are strictly business.

 

[Airwaygoddess]

"Real Time"

LA may be one of the exceptions.

Often, the time for IFT can be cut down by making the whole process more efficient.

First you have the identification process for a need to transfer.

Then, which facility, who's the doctor on call and making contact for acceptance.

Once acceptance is finalized, a bed must be found for the patient in the receiving hospital or cath time must be confirmed.

OR if none of the above works out, start over at locating an alternative hospital and begin the process again.

Oops, wrong insurance...Kaiser (or whatever) patient. Start over...

Find CCT ambulance with personnel that can handle all the meds and technology. One can do this but not that. This does it all but must call their MICN to accompany. (A hospital having its own CCT is so much easier.)

Now the paperwork.

We (CCT, Flight and Specialty) fax a list of everything (pumps, IVs etc) that will need to be done prior to our arrival.

Arrival at the facility:
Wait for elevator that takes forever.
Chit chat about the family.
Paperwork not quite ready.
Pumps/IVs need to be switched
Stabilize vitals from pump disconnect/switch.
Stabilize on a transport ventilator...more sedation.
Move to stretcher.
Untangle everything.
More chit chat.
Depart unit...wait for elevator that takes forever...unless staff with elevator key accompanies you.

Drive real fast with L&S to the other hospital.

^_^^_^^_^ I need Vent to be my partner!

 

[Ridryder911]

With the increase knowledge of not using HEMS, there are specific things for IFT code three or emergency status ( In OKC, code 3 is no l/s). Such patients that are about ready to code such as cardiogenic shock, severe trauma patients, or O.B. patients that are not stabilized, etc,

Most where the surgical team is awaiting for them. Does it make up the time? Yes, in some circumstances reducing anywhere from 15-25 minutes.

It is very seldom such of those occur, but do. As well, we are decreasing our usage of helicopter flights. Usually we will transport our severely trauma patients to the Trauma Center in emergency status. Even though our nearest hospital is over 200 bed, they do not nor do they want to receive trauma patients as they only have general surgeons. We are now exploring by-passing as well, with true cardiac patients that need to be cathed. Yes, local have a cath lab (non-interventional & only 9-5) but is for scheduled ones only.

 

[VentMedic]

While the distant outlying areas have helicopter access, the immediate county areas have relied on taking the patient to the most appropriate facility be it trauma or cardiac for the past 25 years. When hospitals are easily within within an obtainable distance from each other, there should be little reason to take to a hospital that does not have adequate services and then expect another transfer immediately for the patient. Unfortunately, many EMS agencies still have the "take to the nearest facility and dump" policy.

A patient will also not be transferred if unstable except for extreme exceptions. There is no need to put a dead patient into either a helicopter or ambulance.

 

[VentMedic]

One of the issues our service is currently dealing with is abuse of this. The hospital is making every transfer stat just to get us there faster. We tried sitting outside with the siren going for awhile to deter them, but it didn't.

We can't go faster than 72 mph in the vehicle anyway, so we never use L&S on transfers. If we do, people just pass us.

Some hospitals and ambulance services also have a difficult time getting thier "terminology" together. For some, if a hospital doesn't say STAT, the ambulance company will take it to mean they have 2 hours to get there which is standard per some policies for a routine call. What the hospital may actually mean is, "emergent- but don't kill yourself getting here". There just doesn't seem to be a good middle ground in the policies to get all on the same page for "Yes we need you now but not NOW".

 

[medicdan]

My company routinely responds to a hospital L&S. Most recently, we got a call about an organ procurement that several other companies had rejected. By that time, the organ was already harvested, and they were anxious to get it on the road. The hospital was aprox 15 miles from our base, and was being transported by ground another 180 miles. In fact, I think our contract with New England Organ Bank specifies response times depending on when we get the call.

We also routinely respond L&S to a hospital where we have the IFT contract to bring impending STEMI patients from one building to another. In fact, our response time is closely tracked by the hospital.

I see no other reason to respond. No reason for the added liability.

 

[rescuepoppy]

The lights and siren on our trucks are a tool. Like any other tool on the truck we have to use them correctly when used in the proper manner they serve a purpose but when used incorrectly they can be dangerous. The key here is when needed use them but also turn up the common sense factor.

 

[medicdan]

The lights and siren on our trucks are a tool. Like any other tool on the truck we have to use them correctly when used in the proper manner they serve a purpose but when used incorrectly they can be dangerous. The key here is when needed use them but also turn up the common sense factor.

x2! Cant agree more!

 

[VentMedic]

My company routinely responds to a hospital L&S. Most recently, we got a call about an organ procurement that several other companies had rejected. By that time, the organ was already harvested, and they were anxious to get it on the road. The hospital was aprox 15 miles from our base, and was being transported by ground another 180 miles. In fact, I think our contract with New England Organ Bank specifies response times depending on when we get the call.

This is a very grave error on either the hospital or the organ procurement team. They know this is going to happen for at least 24 hours. The OR is SCHEDULED. So there should be no reason why transportation should ever be an issue for organ procurement.

 

[medicdan]

I agree. It was poor planning. Evidently, several other private ambulance companies had refused the transport because of the long distance. My company is known for never rejecting a call. I was in dispatch when the call came in-- it certainly was not scheduled on our end. AFAIK, other organ transports are scheduled, although we often get a narrow window for the arrival of the organ and team by air.