holding the wall

[Trose34]

Well your in Cali.....lol...thats why. Im from Cali and I would have them fly me to Texas to fix a broken finger....lol..just kidding but you will never get a bed there.
I do know one rule in health care and that means life threts first so grab a wheel chair sit in it and tell your buddy to go up to the desk and say" My buddys chest hurts and they are having trouble breathing.....This now becomes first priority .....lol. You did tell them you had insurance RIGHT...lol...just kidding Have fun holding the wall up.

 

[Trose34]

Sad that most of the time the ones that call for EMS....have waited to the point that it is urgent and willing to pay the extra cost but do not get the extra care once its left up to the ER.

 

[Joe]

Well your in Cali.....lol...thats why. Im from Cali and I would have them fly me to Texas to fix a broken finger....lol..just kidding but you will never get a bed there.
I do know one rule in health care and that means life threts first so grab a wheel chair sit in it and tell your buddy to go up to the desk and say" My buddys chest hurts and they are having trouble breathing.....This now becomes first priority .....lol. You did tell them you had insurance RIGHT...lol...just kidding Have fun holding the wall up.

Ha! The er has gotten smart. They do ecg as soon as we hit the doors. If they deem it normal then we sit for hours. That night we called in to update our status. Dispatch asked if we atleast were buying the wall dinner after fondling it all night

 

[Traumjunk]

In Orlando the average is 30 min for the non critical, even though I have seen codes worked in the hallway due to no beds available.

 

[DrParasite]

on a stable not sick patient, when i'm in no rush, the most i have waited is 20 minutes.

on an unstable sick patient, if I have to wait 10 minutes it's a lot. usually it's just finding a bed and getting the patient registered that takes a few minutes, but none of this BS holding a wall for hours on an ALS patient.

If I were to ever wait more than an hour, I would be on the phone with the DOH, the on call hospital administrator, the nursing director, and every news agency I could think of. If you shout loud enough, soon someone will give you a bed just to shut you up.

Then again, if it's the accepted practice on the west coast, well, I hope I never need to go to the hospital when i visit the west coast.

 

[Hockey]

48 minutes with a patient with chest pains. 12 lead went from good, to eh, to full blown STEMI to...well...we got a room quickly. Patient refused to go to the other hospitals and I knew they had multiple shootings, and other traumas. Poor guy didn't make it.

 

[Sasha]

on a stable not sick patient, when i'm in no rush, the most i have waited is 20 minutes.

on an unstable sick patient, if I have to wait 10 minutes it's a lot. usually it's just finding a bed and getting the patient registered that takes a few minutes, but none of this BS holding a wall for hours on an ALS patient.

If I were to ever wait more than an hour, I would be on the phone with the DOH, the on call hospital administrator, the nursing director, and every news agency I could think of. If you shout loud enough, soon someone will give you a bed just to shut you up.

Then again, if it's the accepted practice on the west coast, well, I hope I never need to go to the hospital when i visit the west coast.

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.

 

[Veneficus]

2 sides of the same coin

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.

But in the end, everyone is trying to do what they think is best for the patient.

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.

Additionally, it is easy to complain things are not moving fast enough when you are basically babysitting one patient.

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.

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.

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.

Even in the busiest hospitals I have been in, EMS accounts for only 10-20% of the total patient load.

But the hospital is not without fault. They often do not see the EMS side.

Like a responsibility to respond. Often to more calls then they can handle. Making unstable or potentially unstable patients wait extended periods of time for help.

They do not understand a handful of crews may really be getting their butts handed to them, which is dangerous for all.

They don't really know the feeling of listening to a radio with a dispatcher nagging at them that calls are waiting. (or a supervisor)

When the EMS and hospital systems cannot function together in a timely manner, it is a sign of misunderstanding on both parts at best, and an ineffective dysfunctional system at worst.

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.

Any idiot can build a wall. It takes a much greater person to build a bridge.

 

[FourLoko]

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.

But in the end, everyone is trying to do what they think is best for the patient.

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.

Additionally, it is easy to complain things are not moving fast enough when you are basically babysitting one patient.

Great points, how dare you be so reasonable? Our longest wait recently was about 1.5 hours. PT from a SNF who requested a trip to the ER, not urgent at all. In fact, he was still on antibiotics from the last ER visit he requested.

As we waited we took vitals countless times, got him water to drink, watched him call family members on his cell phone to tell them he was sitting there waiting, etc.

At least a couple LA City fire calls rolled in while we sat and even they had to wait a bit each time. One was a big dude that evidently "bug bombed" himself. Hook up the pulse ox, 99% on that guy despite his heavy "labored" breathing.

As soon as you leave the ER it's off to another call anyway so just relax and forget about the dispatchers feelings for a while.

At a different hospital this weekend, the "dark corner" scenario. Two patients in one ER room, ours is chillin' but the guy next to her is practically jumping out of bed. He's hooked up to telly, some IV and is about to yank it all out. Asking for food, water and his clothes.

Long story short, thanks to a noob nurse and an unobservant partner we ended up taking this guys belongings/clothes with our patient and had to make a U-Turn to bring them back. I was happy to see him calm down when I returned his property and felt bad that he was being ignored.

So much good stuff all for fast food money. I can't decide if I love it or hate it.

 

[mycrofft]

If Safeway saw backups at a checkout they's open more. If a hospital does they say "That'll slow down those nonpaying suckers" and then they put in more landscaping, buy three lots down the a street, and give the executive board a raise.

 

[Veneficus]

Great points, how dare you be so reasonable?

It is something of a curse it seems.

(especially to people who don't want to hear it)

 

[Joe]

i know its going to be the nature of the beast when you have a population of 300k people and only two hospitals seperated by over 15 miles in a busy metro area. if people didnt call for bs reasons then the people that actually need to go to the hospital would get a bed a lot faster. example, abd pain for last 1 day. htn under control by meds.(+)n/v about 3 hrs ago. vital on scene= 152/90something, 94hr, 18rr, 99%ra. bgl 132. we felt the family could transport to the er and pt family was completely willing to do this. fire decided to keep talking and had us transport bls and hold the wall. once fire says take em, we take em...who can guess what time this call came in?

 

[Fish]

Don't know how common of a term it is but as I sit here with a pt I think...how does everyone else get in and out of the hospital in a timely manner? Maybe its just the abuse of the system or maybe this hospital is really slow. We've been waiting for a bed for the last 2 hours and 12 mins. What's the longest wait for you guys?

1 hour

 

[DrParasite]

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.

 

[JPINFV]

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).

...and here's what you're missing.

A lot of places IFT and 911 isn't strictly separated. You take an IFT unit off the road, you take a unit that could also be responding to 911 units if the 911 units are overloaded (if the 911 units aren't overloaded, then wait time for 911 units is of no concern).

If the IFT company is having response time issues, then the facilities that normally would utilize their IFT service could convert those calls into 911 calls. Thus further burdening the 911 system.

If the IFT ambulance is holding the wall, then that's one less IFT unit that could be used for interhospital transfers or discharges. These calls can either directly reduce the patient load in the ED by transferring out or discharging ED patients, or indirectly reduce the patient load by opening up beds in the hospital which ED patients can be transferred to.

In response to everyone else, what is the 911 service doing to reduce call volume and ensure that only patients who appropriately need ambulance service are being transported?

Finally, why is it that EMS providers are the first to complain if the hospital isn't diverting due to overcrowding, but also the first to complain if the closest open hospital is 30 minutes away, all while often doing nothing to attempt to ensure that their patients are accessing the appropriate level of care, which may often be an urgent care center.

 

[Handsome Robb]

DrParasite I see where you are coming from but from working in a high volume, urban 911 system it doesn't always work the perfect way you want it to work.

We have 4 hospitals in our area and every now and again we end up with the hospitals being overloaded. you can end up with 2 of them on critical care divert so that cuts our options in half if we have a patient who truly is sick.

It's easy to say they need to build a bigger ER but where is that money going to come from to build it and staff it?

Once we are on hospital property the patient is their "problem" if the 911 system gets so busy that we need to be pulled from the ER then so be it but then again it's not fair to the patient to be stuck in a hall bed and I doubt JACHO would be happy with patients being stuck in hall beds without the necessary resources to care for them.

edit: you also seem to be talking about an EMS system that utilizes stations. Where I work we don't, we run system status management, so units posted in outlying areas can be moved inward to cover the central areas.

 

[Sasha]

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.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.
that patient, yes, but what about the patients that no longer have an ambulance in the area since they are stuck holding a wall?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.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.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.yep, it sucks, and it's a headache for the ER. still doesn't justify refusing an EMS patient. yep. doesn't make it right.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.

The patients are less acutely sick? Maybe. But that still doesn't put your acute stuffy nose above my exacerbated chf.

We are important too. If we are holding a wall we are out of service for any stat transfers. (cath labs, strokes, sick pedis, trauma etc. We aren't all dialysis transfers and pulled out PEGs) My company's response area is huge, it can take more than an hour to get from one end to the other. It happens. The hospitals don't enjoy having you sit there staring at them but when there are no beds, there are no beds. If there is no staff to care for the patient then there isn't the staff and they're staying on the stretcher.
Maybe your company needs more ambulances if one being out of service is so devastating.

 

[Epi-do]

I've never waited more than 10-15 minutes for a triage nurse, and that is very rare. Typically, we show up, talk to the triage nurse, and immediately get sent either to a room, or get told to have the pt wait in the waiting room (if that is appropriate).

Now, waiting for a nurse for a bedside report.... I have waited up to 40 minutes before, but, again, that is very rare. Typically, that nurse is there within 5 minutes or so.

I can't imagine waiting over an hour with someone on my cot, just to get a bed. It seems to me, if they are able to wait that long, they can go to the waiting room, and I can get back in service. (Keep in mind, I haven't worked outside of the system I currently work within, so I only have that one example to compare things to. I realize there very well may be systems where patients will wait an hour for a bed, but have something going on that precludes them from being a candidate for going out to the waiting room.)

 

[Joe]

yea we have droped off pts in the waiting room. they look at you like your the antichrist and it makes my day. the other hospital in our area is about 20 mins outside our response area but you can get a bed in 20mins or so. they ift all their pts out once they get seen so there are always open beds. the only downside is we cant transport there if were in our normal area unless the wait at the first hospital is over 2 hrs. (not that uncommon)

 

[rmabrey]

I've never been in an ER for more than 12 minutes, including getting a bed, transferring pt to bed and giving a report.

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