Duty to Act, Abandonment, and a CCT Pt on board

[LACoGurneyjockey]

From my own perspective, it's not that we're dogpiling on you because we need something to chew on. It's that we see things that you do not yet, and we really want you to broaden your perspective a bit on things.

, consider this a good lesson, so now go forth and have yourself some fun.

Thanks, that's why I post here when I'm unsure, not to prove my infallible correctness, but to learn and make myself a better provider.

 

[DrParasite]

I would have stopped. how would this look in the newspaper:
"ambulance crew drives right by motor vehicle crash; baby dies"

or

"Ambulance drives by MVA, doen't even stop; driver paralyzed"

or any other really bad situation, that while not your fault in any way, the press make you look like the uncaring offspring of the devil.

Not for nothing, but you are transporting this regular (who is on a vent). no lights, no sirens. Also sounds like it was just you and the RT. No medic and no nurse. so how unstable was the patient? how much resucitative care can the RT provide? Was the patient really critical, or did the RT just not want to interrupt the transport? If the patient did crash enroute, would your crew be able to mitigate the problem? if not, why do you not have the crew to handle it?

Now, once you made contact, you should have stayed. what was the ETA of the FD? 1 minute? 5 minutes? 10 minutes? if you had been caught in traffic for 10 minutes, would the RT have been ok?

 

[BF2BC EMT]

Probably look the same as "EMT with patient on board and no room to transport, stops on scene and gets rear ended, killing patient and RT joe smith.

Or "EMT stops at accident , and leaves a patient who is on a vent in the back of the ambulance who unfortunately passed away while the EMT driver was attempting to place a collar on an accident victim"

See what I'm doing its a two way type of deal. He deserves to be treated and transported safely to where ever he needs to go.

I'm sure this is abandonment. You put a collar on someone and take off. Has anyone ever been collared? It's uncomfortable.

Why are you suing the EMT today "well he stopped and put this really uncomfortable thing around my neck and left, it felt really tight and I couldn't breath. So while I was trying to rip it off I felt my neck crack and make weird noises now I can't walk"

Not to mention this is LA Co I'm surprised he wasn't let go for giving a collar away and getting no money for it

 

[DesertMedic66]

Easy answer for me, alert the local 911 system or my dispatch (if it's in my area) and continue with our transport. That also happens to be company policy. If I'm transporting my duty is to the patient/s in the back of my ambulance.

 

[Handsome Robb]

How do you think that would go over with the general public watching an ambulance, without its lights and sirens on, drive right past a traffic collision they just witnessed? This is something you have to take into account. Everyone is talking about facility contracts and losing them but a poor public image of a company can kill one just as quickly. The public doesn't understand IFT vs. 911, private vs. third service vs. FD based vs. PUM, hell they can't even figure out EMT vs. Paramedic.

There may have been something going on with the patient you didn't know about since you were driving. I would have told my partner what happened and told them my intentions, called it in, stopped, told everyone involved help is on the way and explained that I already had an unstable patient onboard and that I could not stay and gone on my way.

I do have a question though. What if a patient on scene of the MVA had an easily correctable life threat and died because the ambulance that called it in didn't stay on scene to correct it? Could the family go after that company and the providers on that truck. I fully understand where the RT is coming from with that type of patient but will 5 minutes of sitting still on an ambulance cot really cause that mechanically ventilated patient who sits in a room, alone, at the LTAC facility for extended periods of time? Let's be realistic here. Again, this is assuming that there wasn't something going on with the patient that the RT didn't communicate to the OP.

Also, as far as morals, he spoke his mind, he said nothing about changing his treatment because of it. Give him a break. I one hundred percent agree with him. I,personally, have made it very clear to my friends and family that I do not want to be kept alive on life support with no chance of recovery.

 

[DesertMedic66]

If the public makes an issue out of the ambulance not stopping the ambulance company can easily prove that they already had a patient on board and thus the providers have a duty to treat and transport that patient in a timely manner.

I don't see how a case (if someone decided to sue) would win. No patient contact was made. Your duty to act is for the patient you are already treating.

Same thing for us if we are responding to a call code 3 and an accident occurs that does not involve us. We contact dispatch and advise them of the accident and we keep responding to our original call.

No telling how long your on scene before someone you can hand off to arrives. Here is a question: you are transporting a stable patient and you come across a MVC. You get out and start treating the patients of the MVC. Now your original patient becomes unstable, what are you going to do?

A: leave the scene and abandon the patient you started treating?
B: stay on scene and possibly have your patient die on you?

How will either of those options look in the media's eyes?

 

[Handsome Robb]

"Stable" patients generally don't randomly deteriorate. Usually would mean someone missed something during the initial and ongoing assessment. With that said, does it happen? Occasionally. Is it common? Absolutely not.

This an assumption, shoot me, but I'm guessing the OP is in LA. I highly doubt he'd be waiting long for someone to show up. Hell with stable patients if PD is there first I'd be fine leaving and I doubt anyone else would have an issue with it either.

We do the same thing when responding emergent. If It looks bad I'll ask if they'd like us to stop or keep going. If the accident we witnessed is a higher priority (read: responding priority 2 and a rollover, motorcycle involved or auto v ped/bicyclist, all priority 1 calls) they generally have us stop.

We all preach that transport times, without reasonable delays, have no impact on patient outcomes. I'm not advocating we sit around for half an hour waiting 5-10 minutes is cool with me. I'll gladly explain myself to anyone who asks me to.

One thing I will add that has been overlooked on this specific scenario because it's a moot point seeing as the patient is unconscious, but if they're conscious asking them if they have an issue with us stopping is high on the priority list as well. Unless they're a total :censored::censored::censored::censored::censored::censored::censored: I doubt they will. Can't speak from experience, I've never run into this situation other than a minor fender bender that I rolled down my window and asked if they were injured or wanted help or me to call it in and both declined.

As far as your question goes, there's no right answer. We get stuck between a rock and a hard place all the time. That's a particularly large rock and diamond-hard place to be stuck between though.

 

[Clipper1]

Many CCTs have driven past MVCs and not stopped. They usually slow down and tell the people help is on the way but they are already caring for a patient. We have done this many times with the NICU, PICU, or flight team while in a "BLS" truck. The others outside do not have to know who we are transporting either but just that we are enroute to a hospital with someone. Sometimes even the contracted EMTs don't know the full situation with our patient in the back especially if we believe it might influence our safety by them sensing an urgency and want to drive fast and with lights and sirens. "Stable" might even be a term we'll toss out although that is debatable about how "stable" a 23 weeker can be overall. "Stable" can mean they are not going to die right now but could 10 minutes from now.

I do have a question though. What if a patient on scene of the MVA had an easily correctable life threat and died because the ambulance that called it in didn't stay on scene to correct it?

This was an EMT responding. The patients on scene were breathing and vocal. If the patient has a life threatening injury, that EMT would be committed to being on scene for a longer period of time than 5 minutes. They would now be committed to that patient while still having a CCT patient on board the ambulance.

Could the family go after that company and the providers on that truck. I fully understand where the RT is coming from with that type of patient but will 5 minutes of sitting still on an ambulance cot really cause that mechanically ventilated patient who sits in a room, alone, at the LTAC facility for extended periods of time? Let's be realistic here. Again, this is assuming that there wasn't something going on with the patient that the RT didn't communicate to the OP.

LTAC is not a nursing home. Most of the patients there are treated as if they are still in an ICU or at least on telemetry and a low nurse to patient ratio. They usually come from an ICU to an LTAC because they still need advanced care (not including the ventilator) but for the long term. Subacute would be a different situation. Most Subacutes will not take a dialysis patient because of the CMS and state regulations and the cost of care.

The OP should already have known this patient was s/p dialysis along with his vent and a GCS of 4. That should be enough said for the "stable" condition of this patient.

Also, as far as morals, he spoke his mind, he said nothing about changing his treatment because of it. Give him a break. I one hundred percent agree with him. I,personally, have made it very clear to my friends and family that I do not want to be kept alive on life support with no chance of recovery.

He did change his course by stopping. He also brought his up so you don't know if it was an actual deciding factor to stop and he may not either if his morals are imbedded in him.

This was not your family member or you and you are not making the decision for him. You also don't know what your decisions would be. Cancer sucks also and is a horrible death most of the time so you would just give up on your wife if she got a new dx of breast cancer or if you or your child needed a heart transplant after contracting some viral infection? Do you think the effort put into Bryan Stow's life was out of line? There were a lot of EMTs also fighting for him with benefits and prayers along with their time even though some did feel life support should have been discontinued. There are too many factors involved to make a blanket statement now.
We also don't know any other details about this patient. It could have been an 18 y/o MVC patient who was just released to the LTAC with a long road ahead but the potential to recover.

 

[LACoGurneyjockey]

Probably look the same as "EMT with patient on board and no room to transport, stops on scene and gets rear ended, killing patient and RT joe smith.

Or "EMT stops at accident , and leaves a patient who is on a vent in the back of the ambulance who unfortunately passed away while the EMT driver was attempting to place a collar on an accident victim"

See what I'm doing its a two way type of deal. He deserves to be treated and transported safely to where ever he needs to go.

I'm sure this is abandonment. You put a collar on someone and take off. Has anyone ever been collared? It's uncomfortable.

Why are you suing the EMT today "well he stopped and put this really uncomfortable thing around my neck and left, it felt really tight and I couldn't breath. So while I was trying to rip it off I felt my neck crack and make weird noises now I can't walk"

Not to mention this is LA Co I'm surprised he wasn't let go for giving a collar away and getting no money for it

I never said I put a collar on anyone, I went back to the truck to get a collar and that's when the RT decided we needed to leave.

 

[LACoGurneyjockey]

No telling how long your on scene before someone you can hand off to arrives.

In LA County, 10 minutes tops, likely closer to 5.

 

[LACoGurneyjockey]

LTAC is not a nursing home. Most of the patients there are treated as if they are still in an ICU or at least on telemetry and a low nurse to patient ratio. They usually come from an ICU to an LTAC because they still need advanced care (not including the ventilator) but for the long term. Subacute would be a different situation. Most Subacutes will not take a dialysis patient because of the CMS and state regulations and the cost of care.

Pt is going to a subacute facility

We also don't know any other details about this patient. It could have been an 18 y/o MVC patient who was just released to the LTAC with a long road ahead but the potential to recover.

Does an 18 y/o frequently require dialysis? Try 78 y/o on dialysis and a vent for several years.

 

[Clipper1]

I never said I put a collar on anyone, I went back to the truck to get a collar and that's when the RT decided we needed to leave.

The RT knew that is the initiation of care which means you are committed now for who knows how long.

Yes 18 y/o pts may need dialysis especially they have been a trauma or cardiac pt.

Which subacute takes dialysis pts? Kindred facilies don't unless it is an LTAC.

 

[LACoGurneyjockey]

I know of 2 subacute facilities in greater LA with vent dependant dialysis patients, not Kindred.