Here's a situation for you to ponder.

Shishkabob

Shishkabob

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Say you're the advanced provider (Intermediate or Paramedic, or heck you can be an EMT too) driving. Your EMT is in the back with a BLS patient (for the sake of the thread, let's say it's granny going back to the nursing home following treatment for a UTI).


As you're driving down a suburban / rural road, you see a fairly serious MVC. As you draw closer you see someone ejected.




Do you radio it in and drive on.

Do you stop, tell your partner to stay in the back, and act within the role of a first responder?


Legalities in your state, or policies in your agency governing your decision?
 
Here if its determined that your original patient is stable, you can stop and render care until another ambulance arrives on scene. We are allowed to work to our level, if its a medic unit the they are allowed to initiate ALS interventionsas long as those interventions are not being used by the original patient.

Meaning you can't take your first patient off the monitor and use it on the second patient.

Obviously one provider needs to stay with the original patient.

Seems reasonable, any question on stability of the original patient and you radio in and continue on.

Side not if your en route to an emergency and come upon another emergency, we are not allowed to stop we radio in and continue on are original call.
 
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CAOX3 said:
Here if its determined that your original patient is stable, you can stop and render care until another ambulance arrives on scene. We are allowed to work to our level, if its a medic unit the they are allowed to initiate ALS interventionsas long as those interventions are not being used by the original patient.

Meaning you can't take your first patient off the monitor and use it on the second patient.

Obviously one provider needs to stay with the original patient.

Seems reasonable, any question on stability of the original patient and you radio in and continue on.

Side not if your en route to an emergency and come upon another emergency, we are not allowed to stop we radio in and continue on are original call.
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This is how we'd handle it as well. Also, we've been transporting a non-criticial, basically stable ALS patient when we came upon an MCI MVA that was blocking our path to the hospital (all lanes of interstate blocked, snowstorm nightmare). In that case, we had our original patient plus 3 others in our truck with me, and my partner had 3 more patients in a bus that was also stopped in traffic.

The units that were dispatched had an extended ETA because of the snow and traffic backup, and we were on our own with those and a couple more patients (3 of whom were quite sick) for about 30 minutes. My partner went out and brought all of those patients back to the truck...they were all in cars with windows broken out, one had been ejected from a Lay's delivery truck...it was quite a scene.
 
We had this happen to us a while back. We were doing a nursing home take-back I was in the back (BLS) with the lady. We got slammed with calls and so both of our other trucks were on calls, we were getting mutual aid from 2 neighboring towns/counties already and then there was an accident on the Hwy we were traveling on to take our pt back.

We stopped, called for mutual aid from a third county and the Medic waited on scene with the pt until the other unit arrived. I stayed in back with our original pt. Luckily the woman who got hit (hay bale rolled off of a truck and hit her car on drivers side) was mostly shaken up. The Medic did backboard her with aid from first responders and then transfered care to the medic on the arriving unit.
 
is the ejected guy breathing?

Are there other victims?
 
Veneficus said:
is the ejected guy breathing?

Are there other victims?
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I aspire to be good enough someday to tell if someone is breathing from 100 feet away at 60mph, but I fear I have some ways to go :/
 
Linuss said:
I aspire to be good enough someday to tell if someone is breathing from 100 feet away at 60mph, but I fear I have some ways to go :/
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Must be why they put binoculars in the ambulance
 
Linuss said:
I aspire to be good enough someday to tell if someone is breathing from 100 feet away at 60mph, but I fear I have some ways to go :/
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well work on it ;)

Really though, for some reason I had thought you had stopped and we deciding what to do. My fault.
 
We have a document hanging up from MA OEMS in our base saying that, if we have a PT in the back, reguardless of their level of stability, we are not allowed to stop for any reason- the most we can do is radio for an additional unit. In the state's eyes, anything else constitutes abandonment (even if one EMT stays with the PT in the back)
 
Amycus said:
We have a document hanging up from MA OEMS in our base saying that, if we have a PT in the back, reguardless of their level of stability, we are not allowed to stop for any reason- the most we can do is radio for an additional unit. In the state's eyes, anything else constitutes abandonment (even if one EMT stays with the PT in the back)
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I don't think that would hold up in court as abandonment if you had a provider with the patient. It might be negligence or a lowered standard of care, but with no injury to your primary pt you aren't going to be in trouble legally. Of course OEMS can always get you...mwah ha ha ha

PS: OEMS haunts my dreams
 
jjesusfreak01 said:
I don't think that would hold up in court as abandonment if you had a provider with the patient. It might be negligence or a lowered standard of care, but with no injury to your primary pt you aren't going to be in trouble legally. Of course OEMS can always get you...mwah ha ha ha

PS: OEMS haunts my dreams
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I believe you're right. It was one of those, I just forget which. I'll check it soon.

I once had it explained to me that there's too much potential liability by stopping. Your "stable" PT in the back may become worse while you're stopped, even if you can't see that they are becoming worse. If they do somehow go from stable, to crashing, and you leave your "new" PTs behind, you've definately hit abandonment. It's a sticky situation. We've always been taught, if you're dedicated to another PT, you're dedicated to that one PT and that's it. MCI situations not withstanding
 
jjesusfreak01 said:
I don't think that would hold up in court as abandonment if you had a provider with the patient. It might be negligence or a lowered standard of care, but with no injury to your primary pt you aren't going to be in trouble legally. Of course OEMS can always get you...mwah ha ha ha

PS: OEMS haunts my dreams
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I don't know...with all the idiots out there getting a free ride, I'm not worried about something like stopping at the scene of a wreck wiht a patient who's not going to be effected by the stop.

Legally, there has to be harm done to the patient before negligence has occurred, and if one partner stays with the patient, there's been no abandonment.

There's always the possibility of having the partner who's out of the truck being hit by a car or something, but that's fairly out there, and the risks should be weighed before you stop. All the times I have stopped, I've HAD to because the road was completely blocked by the accident. Other times, I've rolled past, told them help was on the way, and moved on.
 
Save the responding crew some work, accidently run over the poor ejected soul to finish him off, look around and go "Oh, that was a big bump!" and keep going as if nothing happened.
 
Sasha said:
Save the responding crew some work, accidently run over the poor ejected soul to finish him off, look around and go "Oh, that was a big bump!" and keep going as if nothing happened.
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Goodyear therapy?
 
yes, this actually happaned to me. I got out and acted as first responder. my emt never left the rig or it would have been abandonment.
 
So let's play the hypothetical game................

Say you have a stable BLS patient in the back with your EMT-B partner and you roll up on this nasty wreck. Being the awesome Paramedic you are, you get out and start intervening on the trauma patient and realize he requires a little SMR, some bandaging, and an IV to counteract the massive hypovolemia he is suffering from. With the help of the local FD, you start stabilizing this nice individual and eventually the primary EMS unit arrives. 2 EMT-B's jump out and rush to your side and freak out because neither of them can treat or transport your patient as he has an IV. NOW WHAT?????????

You can't leave your first patient as your presence is required to be a legal ambulance (unless you live in one of those jacked up states that actually thinks it's ok to have only 1 EMT on an ambulance). In addition, you can now not leave your second patient as you have provided interventions that you cannot turn over to the 2 EMT-B's.

Personally, I'd make the notification and continue on with my current commitment.
 
Flight-LP said:
So let's play the hypothetical game................

Say you have a stable BLS patient in the back with your EMT-B partner and you roll up on this nasty wreck. Being the awesome Paramedic you are, you get out and start intervening on the trauma patient and realize he requires a little SMR, some bandaging, and an IV to counteract the massive hypovolemia he is suffering from. With the help of the local FD, you start stabilizing this nice individual and eventually the primary EMS unit arrives. 2 EMT-B's jump out and rush to your side and freak out because neither of them can treat or transport your patient as he has an IV. NOW WHAT?????????
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your a paramedic with a radio and or cell phone. Why are you being caught with your pants down on who is showing up? Scene Size up and communications are important.

Your either in your area and know what resources are available. You can request an ALS unit or another BLS unit to get your unit. Or your in an unfamiliar area in which you should be able to contact 911 and find out what resources they have available.
 
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This almost excat situation happen to me when I was on my clinicals for EMT-I. We were transporting a elderly male pt to the hospital, non emergency, and while at a red light our driver watched this woman get hit by a car.

We pulled up, The paramedic, got out while the EMT called it in, then he got out to help. THey held c spine and checked ABC while waiting for the other truck to get there. I, sadly, got stuck in the back with the old man being the lowest person in the pecking order.

The woman sadly had a case of insuranceitis, but other then that was fine.
 
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