Getting pt. into ambulance

[Explorer127]

Ambulate
Before
Carry



You only get one back. Don't strain it any more than you have to.

Makes sense to me

When the pt is in the ER they will be doing plenty of walking.

 

[Sasha]

Makes sense to me

When the pt is in the ER they will be doing plenty of walking.

I'm not responsible for the patient in the ER, so if THEY choose to walk them, they are more than welcome. I'm not getting sued. ^_^

 

[Explorer127]

I'm not responsible for the patient in the ER, so if THEY choose to walk them, they are more than welcome. I'm not getting sued. ^_^

what do you think of having someone with something really minor like a toothache walk?

 

[Sasha]

Like someone stated before. They could trip and fall, hit their head getting in, hurt themselves climbing up and EVERYONE is looking for a reason to sue someone. And it ain't gonna be me.

 

[Explorer127]

Like someone stated before. They could trip and fall, hit their head getting in, hurt themselves climbing up and EVERYONE is looking for a reason to sue someone. And it ain't gonna be me.

True......

 

[reaper]

As stated earlier, Use assessment and common sense in your decision. If you use those and can justify your decision, don't worry about being sued. It does not happen as much as the newer people make you think.

It is more dangerous for the pt to be carried on a stretcher. If it is absolutely not needed, make them walk. If you choose not to let them walk the whole way, then place the stretcher on nice even ground and have them walk to there. It is safer then carrying the stretcher down stairs, when there is no reason for it.

There is a reason why back injuries are so big in EMS. Not everyone needs to be carried. If you assist them the whole way, they will not trip and fall. Again, use your own judgement on your decisions.

 

[Scott33]

Like someone stated before. They could trip and fall, hit their head getting in, hurt themselves climbing up and EVERYONE is looking for a reason to sue someone. And it ain't gonna be me.

Yes, and they could be shot dead in a driveby shooting, a light aircraft could land on their head, or they could be struck by lightening...twice.

I think it is a shame that you are basing your entire approach to prehospital care, on fear. Can you actually provide a reference or a link to any EMT who has been successfully sued, after deeming it safe to ambulate a patient to either the stretcher, or the ambulance?

My guess is it has never happened.

 

[Outbac1]

Common sense and assessment. Some pts walk. Lifting is part of the job. If we do it right we can "minimize" the potential for injury to ourselves and pts. Injury potential cannot be eliminated. You can be sued either way. If you drop them while they are on a stretcher the lawyers will turn it around and say. "Wouldn't it have been safer to let them walk?"

My health is # 1, my partners #2, Allied workers #3, patients and bystanders can fight over who is # 4 or 5.

So it comes down to common sense and assessment. Some pts walk.

 

[Sasha]

Yes, and they could be shot dead in a driveby shooting, a light aircraft could land on their head, or they could be struck by lightening...twice.

I think it is a shame that you are basing your entire approach to prehospital care, on fear. Can you actually provide a reference or a link to any EMT who has been successfully sued, after deeming it safe to ambulate a patient to either the stretcher, or the ambulance?

My guess is it has never happened.

People are sued all the time for people slipping and falling. Hospitals get sued for patients hurting themselves. I'm not taking a chance.

I'm not basing my patient care on fear. I'm basing how I am going to get the patient into the ambulance not only on the fact America is sue happy, but the fact that my service does not allow for patients to be walked to the ambulance.

 

[remote_medic]

[QUOTE =The problem with walking a patient is the "What-ifs". What if they trip and fall while walking? What if they hit their head while getting into the truck? What if the stress of the walk gives them chest pain they didnt have before? What if they run away? How would you document any of the above?[/QUOTE]


What if I slip, what if I twist my back, what if I drop them?

A lot of what ifs....

My safety first

 

[Explorer127]

Common sense and assessment. Some pts walk. Lifting is part of the job. If we do it right we can "minimize" the potential for injury to ourselves and pts. Injury potential cannot be eliminated. You can be sued either way. If you drop them while they are on a stretcher the lawyers will turn it around and say. "Wouldn't it have been safer to let them walk?"

My health is # 1, my partners #2, Allied workers #3, patients and bystanders can fight over who is # 4 or 5.

So it comes down to common sense and assessment. Some pts walk.

That's pretty much the reason I asked the question--

I wouldn't want to hurt my back because I attempted to lift someone with a toothache...

 

[dsco77]

Hi all, i'm new hear but i gotta start somewhere, so here goes. I have just spent the last half hour reading this thread in total disbelief. Don't you have "crew & patient safety" over their?, Surely it is safer for both parties to walk, with assistance if necessary, than risk dropping someone during an unnecessary lift. Wouldn't it leave you at more risk of being sued if your perfectly ambulant patient were forced to ride on the stretcher which you then dropped.
I work as a paramedic in the UK where we have hydraulic tail lifts on all our ambulances, Hydraulicly raising stretchers, electric stair climber chairs, pat-slides, slide sheets, transfer boards, transfer turn-tables, patient moving & handling belts & light weight carry chairs, but the most useful tool we have to protect out backs is the ability, autonomy & authority to think for our selves. In practice this means that i probably only lift about 20% of my patients, with another 50% being "carried" by lift free equipment & the remaining 30% getting off their backsides & walking & because of this, i will hopefully have a long & healthy career all the way to retirement age.

 

[mikie]

Jealous!

I work as a paramedic in the UK where we have hydraulic tail lifts on all our ambulances...electric stair climber chairs...

Only in my wildest dreams would my dept have such a vehicle. Not to get off topic...do you have any photos of those?

 

[dsco77]

Assuming i can make this image thing work, this is the kind of thing we use;

 

[dsco77]

Assuming i can make this image thing work, this is the kind of thing we use;

If not, just google uk ambulance tail lift & you'll get the idea

 

[JPINFV]

Assuming i can make this image thing work, this is the kind of thing we use;

To post an image, the URL has to end in .jpg or .png. For Flicker, you have to right click on the picture and select "view picture." You can use the URL from that page after removing the "?v=0" from the end of the URL.

I am curious, though, isn't it just as much work lifting the gurney all the way to the ground, or do you have automatic or crack style gurneys? Also, is there any specific reason that you have the gurney mounted to the wall instead of using a center mount? It seems like the patient would be really far from the seats in a configuration like that.

 

[artman17847]

I'm going to go out on a limb here and say something radical....

"I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"

I know this is a radical departure from some systems but its what I do.

I couldn't have said it better myself.

If the pt's CC is minor most busy ED's will triage them to the waiting room anyway.

 

[KEVD18]

In massachusetts, the rules are quite clearly defined. At no time, under any circumstances, are patients to ambulate under their own power with or without assistance or supervision. Never.

Now, that's the protocol. Do I agree with it? No. does it make sense? No. but that's the rule. Failure to abide by this rule extends individual liability to the provider. Not the municipality. Not the, service. The individual provider.

The what if list is astronomical. What if they trip on that craxk in the sidewalk or the ice? What if you trip while assisting them? What if you exacerbate an unknown cardiac or respiratory issue?

I live and practice in the state in the union where you are most likely to be sued. Every move I make has to be calculated against the liability I face if I screw it up. Not only is it quite clearly spelled out in the treatment protocols, my state issued a separate administrative requirements memo on the matter. There is no room to wiggle on it.

Does that mean that patients never walk? Of course not. Happens all the time. Every provider ive ever met has done it. Does that make it right? Nope. Its still quite clearly against the rules and if/when it goes bad, it can end in disaster for the providers.

Dsco 77: hello and welcome. I don’t know anything about the make up of services in the uk, but here in the states the majority of the ambulances on the road are owned by private for profit companies. It has been my experience that these services rarely spend one penny more than they have to on equipment and supplies, unless the service happens to be owned by someone who likes gadgets and toys. Privates in ma take the list of required equipment the state mandates, may or may not add a few things and call it a day. None of the toys you mentioned are common. It would be great if they were, but its about as likely as prehospital open heart surgery.

I'm not happy with any of this btw, but it’s the way it is.

 

[marineman]

Nice looking rig but I prefer the ones that the rear bumper folds out into a full ramp that comes up to the door. The fancy ones even have a winch up by the head of the cot to save the work of pushing the cot + patient up the hill. Those you can still load/unload in a hurry though on that 1% call.

For the topic at hand depending on our dispatch information and what we see when we arrive on scene we make our decision for what gear to initially bring in. Sometimes that gear includes the cot or a stairchair and sometimes it doesn't. If we bring the cot sometimes it comes all the way to the patient and sometimes it waits outside the door. I haven't been on any calls yet where they have the patient walk all the way into the ambulance, we have the cot sitting on the ground at the back but I have seen a few that have the patient climb all the way in. Usually the only ones that walk all the way in are also sitting on the bench seat for the government funded taxi ride. No sense in messing up our clean sheets on the cot for some patients.

 

[Scott33]

In massachusetts, the rules are quite clearly defined. At no time, under any circumstances, are patients to ambulate under their own power with or without assistance or supervision. Never. Now, that's the protocol. Do I agree with it? No. does it make sense? No. but that's the rule.

You can see the stupidity of this protocol, so the issue isn't with you, but with your system.

It's those who feel the need to defend their county or State's obviously outdates practices (unchanged from the mid 60s) by using a myriad of highly improbable scenarios, which have been spoon-fed to them since EMT school, that I have concerns with. Deep down they know the likes of carrying a "sore thumb" is BS; they just don't want to admit it.

At least the higher-end providers here seem to be on the same page.

Kev, I know you have to abide by the rules, but on those occasions where you walk an obvious non-critical patient, you are using sound clinical judgement, and there is nothing wrong with that. It's the rule that is wrong.