EMS and 911 System

[JPINFV]

I'm not sure that this still exists, it's not in the actual protocol book nor have I ever heard of that.

Most of the time there's at least two within ten minutes drive, but the patient always seems to want to go crosstown at rush hour. Oh well, to the Faulkner we will go from southie.

It's still there. I forgot that it only applied to stable patients.

II. Stable patients:

2. The additional time required to transport the patient to the more distant
hospital does not exceed 20 minutes. (Multiple hospitals for which estimated transport time from the patient is less than 10 minutes are considered to be of equal transport distance.)
http://www.mass.gov/eohhs/docs/dph/emergency-services/specific-condition-point-of-entry-plan.pdf

 

[leoemt]

I feel the difference would be that pharmaceutical companies would sway an MD into prescribing or not prescribing drugs that could dramatically affect a patient's health.

Ignoring calls requiring specialty centers, does it really matter which ER the patient goes to? For the most part they will be getting the exact same care.

That isn't necessarily true. In the city limits of Seattle there are 8 hospitals (not including childerens or group health). All 8 hospitals can in theory treat anything we bring them. However there are big differences.

For example, Harborview is the only Level 1 trauma center in 4 states. They love trauma. Bring them a CVA or a OB and they will piss their pants as they aren't equipped for that. On the other hand Swedish First Hill loves OB and Swedish Cherry Hill loves CVA and Cardiac.

Point is just because a hospital CAN treat something doesn't mean they are the best choice. It is your job to know the differences in the hospitals and what hospital is closest and most appropriate for the patient.

 

[Veneficus]

Didn't answer the poll

I work at the hospital

So I never get to choose...

 

[the_negro_puppy]

This is a bit of a grey area. In Aus we have socialised medicine with public hospitals and Ambulances "free". We also have private hospitals that you can attend if you have insurance.

Our protocol is to take patient's to the closest appropriate public or private hospital unless there are extenuating circumstances. Due to be block and "ramping" their is particular focus on hospital load sharing and only taking pt's to hospitals in their catchment areas.

Hospitals also go on "bypass" here which means non L&S cases are diverted to other hospitals. Different hospitals also have different capabilities - i.e cath labs, trauma centre, O&G.

It can be difficult to balance the patient's needs, condition and all the above factors , but I always try to transport the pt to the best facility for their condition. Many Ambos here try and sway patient's to go to certain hospitals because its "closer to their station etc" but in reality its so busy here, and hospitals so full that pt's need to be taken to the closest suitable facility.

We also get abused by triage nurses. We should be taking patient's to the best facility for them, in good faith. Our personal beliefs should not come into it.

 

[Bullets]

/rant

Technically it is in our protocols that we must transport all trauma to the trauma center, however most crews will ignore that rule if they feel that the traumatic injuries are so minor that it won't matter.

It irritates me to no end when someone is involved in a minor MVC and insists on going to the non-trauma center for whatever reason. If you are a trauma patient, you are going to the trauma center, no questions asked if you are my patient. I don't care if it was fender bender and I am positive you have no injuries, if you insist on going to the hospital then I am going to insist you go to the appropriate facility. If you feel that your injuries are so minor that you don't need a trauma facility, then you most likely don't need an ambulance to take you there.

/rant

If the injuries are minor, then its not a Trauma patient. The injury may have been "traumatic" in the broadest sense, it would not meet Trauma criteria so wouldnt need a trauma center.

Hospitals also go on "bypass" here which means non L&S cases are diverted to other hospitals. Different hospitals also have different capabilities - i.e cath labs, trauma centre, O&G.

Hospitals go on byass here too, but there is no law enforcing bypass, its really just the hospital saying they feel they are too busy/arent staffed for the patient load they have and need a break to catch up. Whether the ambulances honor that is up to them. Bypass is a courtesy.

 

[Aidey]

We have only two different ER's that we can transport to and they are about 3 minutes apart from each other. The only difference between them is that one is a trauma center. So for most calls, it is completely up to the patient.

I have one exception though.

/rant

Technically it is in our protocols that we must transport all trauma to the trauma center, however most crews will ignore that rule if they feel that the traumatic injuries are so minor that it won't matter.

It irritates me to no end when someone is involved in a minor MVC and insists on going to the non-trauma center for whatever reason. If you are a trauma patient, you are going to the trauma center, no questions asked if you are my patient. I don't care if it was fender bender and I am positive you have no injuries, if you insist on going to the hospital then I am going to insist you go to the appropriate facility. If you feel that your injuries are so minor that you don't need a trauma facility, then you most likely don't need an ambulance to take you there.

/rant

I want to know if you personally have discussed this with your medical director. I have a feeling you are interpreting the protocols literally when that wasn't the intention. Even if hospital B isn't a "trauma center" they still have an x-ray machine and a doctor trained in reading them. There is a difference between a trauma patient and a patient with a traumatic injury.

 

[the_negro_puppy]

I want to know if you personally have discussed this with your medical director. I have a feeling you are interpreting the protocols literally when that wasn't the intention. Even if hospital B isn't a "trauma center" they still have an x-ray machine and a doctor trained in reading them. There is a difference between a trauma patient and a patient with a traumatic injury.

Indeed. We shouldn't just be transporting everyone to a tertiary facility due to "what ifs". Don't forget that IFTs exist for a reason. If anything unexpected is found hospitals can do the work-up and organise a transfer. Obviously stuff like pt's meting trauma guidelines need to go to trauma centres.

 

[shfd739]

We have only two different ER's that we can transport to and they are about 3 minutes apart from each other. The only difference between them is that one is a trauma center. So for most calls, it is completely up to the patient.

I have one exception though.

/rant

Technically it is in our protocols that we must transport all trauma to the trauma center, however most crews will ignore that rule if they feel that the traumatic injuries are so minor that it won't matter.

It irritates me to no end when someone is involved in a minor MVC and insists on going to the non-trauma center for whatever reason. If you are a trauma patient, you are going to the trauma center, no questions asked if you are my patient. I don't care if it was fender bender and I am positive you have no injuries, if you insist on going to the hospital then I am going to insist you go to the appropriate facility. If you feel that your injuries are so minor that you don't need a trauma facility, then you most likely don't need an ambulance to take you there.

/rant

This doesn't make any sense. Just because it was an mvc if they don't have any serious complaints/injuries and do not meet trauma criteria why force them on a trauma center? Any ER can handle an exam/work up then transfer out if something is found.

We have 2 trauma centers here and patients have to meet certain criteria to be called a trauma patient and taken there. Otherwise they go to one of the other 12 or 13 ERs in our county. No reason to force them into a trauma center if they don't need it.

 

[JDub]

I want to know if you personally have discussed this with your medical director. I have a feeling you are interpreting the protocols literally when that wasn't the intention. Even if hospital B isn't a "trauma center" they still have an x-ray machine and a doctor trained in reading them. There is a difference between a trauma patient and a patient with a traumatic injury.

Yes. It was brought up at CE rounds and was confirmed to be correct.

Example:

About two weeks ago I worked a wreck. A car was going too fast and rear ended another vehicle on the road. A teenager was in the car going to fast. He said he is shoulder hurt, but had no deformity or even swelling noted to it and and as best we could tell had nothing broken. He didn't want to go to the hospital and his father agreed with that. Later that night I heard a STAT transfer go out from the non-trauma hospital to the trauma center. I asked the crew later what it was and it turned out it was the kid I got a refusal on earlier. Apparently his mother insisted that he go to the hospital and once he got there it turned out he had a broken clavicle and was then STAT transferred.

There were no apparent injuries and one could have easily taken him to the other hospital saying that it was a traumatic injury, not a trauma patient and he still would have been STAT transferred.

At least where I live, the non-trauma hospital simply wants nothing to do with trauma and will transfer out anything trauma related. Why not save the hassle and take any patient with a traumatic injury to the appropriate facility?

 

[triemal04]

Yes. It was brought up at CE rounds and was confirmed to be correct.

Example:

About two weeks ago I worked a wreck. A car was going too fast and rear ended another vehicle on the road. A teenager was in the car going to fast. He said he is shoulder hurt, but had no deformity or even swelling noted to it and and as best we could tell had nothing broken. He didn't want to go to the hospital and his father agreed with that. Later that night I heard a STAT transfer go out from the non-trauma hospital to the trauma center. I asked the crew later what it was and it turned out it was the kid I got a refusal on earlier. Apparently his mother insisted that he go to the hospital and once he got there it turned out he had a broken clavicle and was then STAT transferred.

There were no apparent injuries and one could have easily taken him to the other hospital saying that it was a traumatic injury, not a trauma patient and he still would have been STAT transferred.

At least where I live, the non-trauma hospital simply wants nothing to do with trauma and will transfer out anything trauma related. Why not save the hassle and take any patient with a traumatic injury to the appropriate facility?

I really hope that is not an accurate portrayal of the system you work in. If it is then sadly you work in a completely broken system and should get out ASAP. I can think of a lot of reasons why a system would end up like that, and really it reflects poorly on all players.

There are multiple different levels of "trauma hospitals." I've honestly never seen any actual hospital that didn't have some type of designation; not everyone needs to be, or should be, a level 1 or 2.

But every hospital is capable of taking care of minor traumatic injuries to some extent. While the particular case you mentioned may have had extenuating circumstances, if every hospital is sending everyone with a broken bone elsewhere no matter what, then there is a major problem.

 

[Chris07]

Am I missing something...?

Since when do broken clavicles require STAT transfers to other hospitals? :wacko:

 

[shfd739]

Am I missing something...?

Since when do broken clavicles require STAT transfers to other hospitals? :wacko:

Same here.

What is the "trauma" hospital supposed to do with a broken clavicle that the other one couldn't?

 

[Sublime]

Same here.

What is the "trauma" hospital supposed to do with a broken clavicle that the other one couldn't?

If they're a level 3 or 4 they probably don't have a on call orthopedic surgeon. If the injury was substantial enough maybe that was the reason for transfer. Or maybe the hospital was busy and wanted to get rid of him to open a spot??

 

[usalsfyre]

I've worked with the hospitals JDub speaks of. He's spot on. The non-trauma hospital "suggested" we don't go there once with an OD because the state classifies it as "trauma".

 

[CritterNurse]

I volunteer with a rural department. There are 4 hospitals we transport to on a regular basis, and they all take about the same amount of time (about 40-45 minutes) to get to. Usually the patient knows where they would like to go, and we will take them to the hospital of their choice, within reason. I was on a call where the patient wanted to go to a hospital that would involve crossing two state lines and many hours of driving to get to. We told them that was too far away and suggested one that was much closer.

If the patient is unsure, we will ask the family where they would like us to go. If the family is also unsure, or if any ask our opinion, we would suggest which one we think would be better able to handle their case. If its a psychiatric call, we'll suggest the hospital that the other three would just turn around and have them transported to. For major trauma or cardiac, we'd suggest the hospital that is the best equipped to handle it.