EMTALA / JCAHO violation?
- Thread starter HawkMedic
- Start date
What did I misread? Explain to me the decision to take the patient to a hospital that may not have been able to take care of them? How was the patient "unstable"?
Closest facility dumps are weak sauce to me. It says "I don't want to take responsibility for this patient".
Christopher
Forum Deputy Chief
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Isn't that our motto though?
I think these are symptoms of treating our profession as a vocation rather than a clinical field.
It's not my decision to make; I have protocols to follow that were assigned by doctors. The Cath lab in the area is new and cannot perform all the proceedures that some of the other individuals were talking about. It's basically exploritory; We usually fly out individuals to other major hospitals. I did what was expected of me and can sleep well at night, but my question was more about the hospital if they need to have the patient transferrred to there facility, given an appropriate assessment, and transported by an appropriately staff crew if this in any way violates EMTALA, or JHACO. Again, I appreciate what your getting at but not sure your reading it right!
Aidey
Community Leader Emeritus
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You're not explaining it very well. You still have not explained why the patient was hemodynamically unstable. You have not explained whether the pt had active IV drips running, or he had only received a bolus of the medications. You have not explained why the hospital the pt was transported to was better than the one with the cath lab, even if the cath lab is limited in what procedures were performed.
socalmedic
Mediocre at best
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back to the OP
to answer your original question if they had contacted the destination hospital and had the patient accepted, AND you are capable of providing the ordered interventions en route (ie, Nitro/heparin IV), AND the necessary paperwork was prepared to be transported with the patient (Physician Order for transport, Upgrade in care, Ect) then no they have not broken EMTALA.
we take unstable transfers regularly from our local bandade center to the trauma, Stemi, Stroke center. we also bypass for the "most appropriate facility". being that your not a paramedic, i feel that you most likely made the right decision to request a RN if you cannot provide ACLS care. I take nurses from time to time if there is a med that is out of my protocol, they are usually very excited to get to ride in the ambulance...
h34r:
to answer your original question if they had contacted the destination hospital and had the patient accepted, AND you are capable of providing the ordered interventions en route (ie, Nitro/heparin IV), AND the necessary paperwork was prepared to be transported with the patient (Physician Order for transport, Upgrade in care, Ect) then no they have not broken EMTALA.
we take unstable transfers regularly from our local bandade center to the trauma, Stemi, Stroke center. we also bypass for the "most appropriate facility". being that your not a paramedic, i feel that you most likely made the right decision to request a RN if you cannot provide ACLS care. I take nurses from time to time if there is a med that is out of my protocol, they are usually very excited to get to ride in the ambulance...
h34r:
truetiger
Forum Asst. Chief
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Why not just fly him to the appropriate hospital?
truetiger
Forum Asst. Chief
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Out of curiosity, what were his vitals? Any EKG?
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any reason you are avoiding questions? you do not have any vitals posted and then state the pt is unstable. you will get better answers to your questions when you supply the info needed or requested.
Aidey
Community Leader Emeritus
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You're kidding right? A google search of EMTALA comes up with tons of information.
I also would like to know why you are avoiding questions.
varying junctional to Accerated junctional w/ RBBB; Initially onscene the ECG showed ST segment changes in Inferior; 15 lead performed without any Right sided involvement; Third ECG and subsequent ECG's show no signs of STEMI. Our protocol states we are unable to call a STEMI with QRS duration greater than 0.12ms. Initial vitals are 40-60 HR; 70/40 BP; 90%SAO2; 28 RR; ETCO2 32.
Aidey
Community Leader Emeritus
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Are there paramedics in your system?
VFlutter
Flight Nurse
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I do not think anyone here is trying to get you to explain what hemodyamics are, I think they want a more detailed description of the patient's condition. Your definition of unstable may be very different then mine.
And just because they were not having a STEMI does not mean they should not be transferred to a Cath lab facility. You said they were in a junctional rhythm, an EP study may be warranted to rule out any dysrhythmia as the cause for the syncopal episode.
Also could you not have called OLMC to ask about the possibility of diverting to the more appropriate facility if your protocols required you to go to the first?
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Christopher
Forum Deputy Chief
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Right Bundle Branch Block does not obscure the ST-segment in a manner which prohibits traditional STEMI criteria from working.
I'm avoiding some of the questions cause I don't need someone monday night quarter-backing a call when they don't understand the area/ resources that are available. And I though someone on hear would have more knowledge than I did about EMTALA, and JHACO. I'm not getting the information I need from a web search thats why I tried blogging.
VFlutter
Flight Nurse
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Did their condition improve before the hospital requested the transfer? I am assuming it did because I do not think they would bolus tridil with that pressure. ETC02, where they intubated or is that off the nasal cannula?
We are not trying to "quarter back" your call, however a very clear description of the patient's condition and situation are required before talking about if there was a violation
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Aidey
Community Leader Emeritus
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How to you expect to get a real answer when you refuse to give us any information on the system or patient. Both of those play into how EMTALA applies. Stable/unstable is a huge part of whether a transfer is appropriate under EMTALA. I also can not understand why you can't find what you need on a web search. There is tons of information on EMTALA out there, including scenarios and court cases that give examples of how EMTALA applies.
On a site note THIS IS NOT BLOGGING! Blog is short for 'web log'. This is not a blog, this is a forum. /petpeeve