It's an accepted practice in hospitals that are too busy with no beds. Sure they might find you a bed but not have anyone to attend to that patient.
If your patient isn't critical or potentially unstable sit down and take it as a break.
No need to get the media. It's not unlike waiting a few hours out in triage to be seen.
I think I need to clarify my position. I was only referring to 911 services, not IFTs. There is a huge difference, one that I think the IFT crowd isn't seeing.
if a 911 ambulance is holding a wall for an extended period of time, than their primary area doesn't have an ambulance covering it. if another emergency call comes in, than a mutual aid ambulance needs to respond, with a longer eta that should. a 911 ambulance's job is to be in the street, not tied up in the ER waiting for a bed. For those who say ignore the dispatcher, remember, the dispatcher is only passing along the request for emergency service from the caller.
for IFT, it's a little different. the patients are usually less acutely sick, and there isn't a time crunch for anything. it's a scheduling issues, and holding the wall time needs to be built into the schedule. does the delay screw up the schedule? sure, but it's not as big of a problem as a delayed response to an emergency call (chest pain/unconc/diff breathing or major trauma).
btw, an ambulance should never wait a few hours in triage. never ever. the patient might end up waiting, but the ambulance needs to get back in service to answer the next assignment.
In EMS there seems to be this idea that a hospital has unlimited resources or at least enough where they can take whatever EMS brings in.
No one thinks that. however, the hospitals want EMS to bring them patients, and typically say they can handle the load (or they can go on divert, bypass, whatever). Well, admin says they can handle the load, the working staff might disagree. No one is saying you should demand immediate service (well, maybe if you have a sick patient who is circling the drain), but holding a wall because the ER is mismanaged or lacks the resources to do their job properly isn't right.
But in the end, everyone is trying to do what they think is best for the patient.
that patient, yes, but what about the patients that no longer have an ambulance in the area since they are stuck holding a wall?
Having an ALS EMS squad wait with a patient can be much more attentive care than if the patient was put on a hospital bed and shunted to some dark corner of the hospital.
hmmm, having an ALS squad with the patient on an ambulance cot, vs on a hospital bed, with a hospital tele monitor, being assessed and treated by doctor, nurses and techs, who can start the ball rolling on getting the definitive care that the patient needs. Plus it gets the medic out of the ER to answer the next job, and the ER can use it's resources to document any changes in the patient condition. And even patients in the dark corners have hospital staffed assigned to check up on them.
Additionally, it is easy to complain things are not moving fast enough when you are basically babysitting one patient.
repeating what I said, you are babysitting on patient, but then you are unavailable for any other patients who need you. if the patient is sick, they probably need a hospital nurse and doctor, if they are not sick, they need a hospital bed, and the ER staff can look at them when they get around to it. either way, no need to tie up the ambulance.
Most EMS providers consider it a bad day when they have to manage 2 or 3 at once. In a hospital a Dozen or so is not uncommon. With more complex interactions.
ER staffing and resource management is not the problem of EMS. not only that, but if they are are in deed that overwhelmed, than the ER needs to hire more staff, not refuse to accept the patient and leave them on the EM cot.
Most EMS providers simply have to deal with the ED. Try calling an ICU and claim you have a sick patient, to be told it is full, (as in no beds no staff) and the intensivist tells you she will have to downgrade somebody to make room, but has nobody they feel can be downgraded. Now this ICU patient is sucking up ED resources, while the ICU is trying to get a serial measurement or a nursing floor to accept a patient that doesn't meet their normal criteria. On a good day, it can take an hour. On a bad day, many more.
yep, it sucks, and it's a headache for the ER. still doesn't justify refusing an EMS patient.
That also assumes people want to work with you. If any one person decides they want to punt or turf, it can cause even more delay and headache.
yep. doesn't make it right.
Calling in all kinds of authorities will not only cost some friendly cooperation, it usually doesn't actually solve any of the fundamental problems. It just causes somebody to get pissed on, as the powers that be are not going to take responsibility for failures of a system they created.
actually, it does. if EMS is getting pushed around by the hospital, because the hospital knows EMS is small and can be pushed around, then EMS needs to get someone to push back even harder. If the fundamental problems aren't being solved, than maybe having the authorities involved will get the hospital to realize there is a problem, and a solution needs to be found.
If I'm the ambulance person, there is a good change i don't want to get any of the staff nurses in trouble. there is a good chance these people are my friends, drinking buddies, and people that can make my job much easier. But if the nurse is ignoring me, and refusing to acknowledge my presence, than yes, that is a problem, and the proper notification should be made.
I am paid to cover a town/area. if I am stuck in the ER holding a wall, than I am not doing my job. if my area is uncovered, than I am not doing the job my taxpayers pay me for. a private company is contracted to cover a town or an area, so if they are holding a wall, than they are failing to provide the service from.
An ambulance doesn't belong in the ER; it belongs in its primary answering 911 calls. drop the patient off in the ER, and then return to your area of service.
