Putting all patients on stretcher

[usalsfyre]

Usalsfyre,
Please put up a link and enlighten us all.

The point was for you to look it up and perhaps get a wider overview, but...

http://en.m.wikipedia.org/wiki/Crew_resource_management#section_1

The really relevant info...

Cockpit voice recordings of various air disasters tragically reveal first officers and flight engineers attempting to bring critical information to the captain's attention in an indirect and ineffective way. By the time the captain understood what was being said, it was too late to avert the disaster. A CRM expert named Todd Bishop developed a five-step assertive statement process that encompasses inquiry and advocacy steps:[6]

Opening or attention getter - Address the individual. "Hey Chief," or "Captain Smith," or "Bob," or whatever name or title will get the person's attention.
State your concern - Express your analysis of the situation in a direct manner while owning your emotions about it. "I'm concerned that we may not have enough fuel to fly around this storm system," or "I'm worried that the roof might collapse."
State the problem as you see it - "We're only showing 40 minutes of fuel left," or "This building has a lightweight steel truss roof, and we may have fire extension into the roof structure."
State a solution - "Let's divert to another airport and refuel," or "I think we should pull some tiles and take a look with the thermal imaging camera before we commit crews inside."
Obtain agreement (or buy-in) - "Does that sound good to you, Captain?"
These are often difficult skills to master, as they may require significant changes in personal habits, interpersonal dynamics, and organizational culture.

Questioning of these positions happens and is actively encouraged.

Further, I question the comparison. Aviation(the only of the mentioned areas I have any experience in) is far more complex than operating a vehicle.

Again, it's not inappropriate to make people walk or to sit on the bench. It is to do so through a jaded "sick/not sick" mechanism that I've seen misjudge acuity FAR too often.

 

[NomadicMedic]

If we were making a list if EMS laws, like Fatman in HOG, here is my contribution.

Those who shouldn't walk, always try, while those than can, seldom try.

 

[Trashtruck]

Usalsfyre,
I looked up several links on it. I didn't know if you had a specific link you wanted to single out to me.
Crew resource management...yeah, it's a nice concept in theory, but in practice, my officers would tell me to shove it up my &@% sideways.
That's as far as that goes. I don't agree with it, but that's the culture here.

There's no point in going back and forth on what you think I do with pts and how I assess them.

 

[Jon]

OK, here's my take:

If they are going to the ED for something BS-ish, and are ambulatory without assistance, they may ride on the bench, with a seatbelt. The two greatest categories that fit here are college-aged drunks (that are just drunk enough that Campus PD doesn't want them, but not "really" drunk), and psychiatric calls where the patient is being calm. I'll also do that same with anyone that meets me on the curb with a minor complaint - like minor lacerations, stomachaches, and the like.

Everything is on a case-by-case basis, and if I'm uncomfortable, they go on the stretcher. Pretty simple.

 

[abckidsmom]

OK, here's my take:

If they are going to the ED for something BS-ish, and are ambulatory without assistance, they may ride on the bench, with a seatbelt. The two greatest categories that fit here are college-aged drunks (that are just drunk enough that Campus PD doesn't want them, but not "really" drunk), and psychiatric calls where the patient is being calm. I'll also do that same with anyone that meets me on the curb with a minor complaint - like minor lacerations, stomachaches, and the like.

Everything is on a case-by-case basis, and if I'm uncomfortable, they go on the stretcher. Pretty simple.

I got bitten by a "calm" psych patient who eloped and attempted suicide in the woods beside the hospital. I learned then that people with an actual psych issues who are interacting with EMS or law enforcement and are not displaying anxiety symptoms have a plan and we are part of it. So we need to find out what that plan is and stop it.

Not allowing them freedom of movement is the first step and it means five seat belts on the cot.

 

[mycrofft]

You have to leave the hopital on a wheelchair, so you have to ride in my ambulance in the NHTSA-approved, commercially-produced ambulance litter. We'll have fun, make shadow puppets or something so you don't get bored, but I'm putting you on the safest (in a crash that does not deform the box) seat on the bus. Even if you have to climb in under your own power...and slip and fall and really need a LSB and collar.:glare:

USAF uses rear-facing seats with seatbelts on jet transports on the C-5 for a reason. Does that suggest sitting sideways on a bench seat to you (as patient OR responder).

 

[jemt]

Interesting discussion, especially the point of comparing the stretcher to oxygen,immobilization, etc.

I was actually told before, not putting a pt. on a stretcher is considered insurance fraud when it comes to billing.

 

[Tigger]

Even if the patient walked to the ambulance I'm probably going to have them sit on the stretcher. There isn't much room for larger individuals on the bench and it's kind of awkward talking across the stretcher to the patient. I guess I don't really mind cleaning the stretcher either, got to do something while the report is given etc.

Bringing a patient in on the stretcher here does not affect whether they get a bed or not, it's the triage nurse's sole prerogative to decide where they go regardless of how they come in.

 

[DrParasite]

I was actually told before, not putting a pt. on a stretcher is considered insurance fraud when it comes to billing.

you were told wrong.

the only way it's fraud is if you document that you did transport the patient on the stretcher, or that the patient was bed confined, when they actually were not.

 

[jemt]

you were told wrong.

the only way it's fraud is if you document that you did transport the patient on the stretcher, or that the patient was bed confined, when they actually were not.

Good to know, thanks.

 

[WestMetroMedic]

Precisely.
And sometimes when they have their bags in hand, waving, and are waiting on the curb, I do the limo driver, open the side door, take their bags, and help them in. Then, I assess.
Now, I've had some sick people meet me like this, and end up putting them on the stretcher based on my findings.

For those following along at home, this is called a "positive Samsonite sign."

 

[Melclin]

People who will sit in the airway chair: In general pts who do not really need to be going in the first place but who request transport (also frequent fliers) and people who need to go for a procedure but who really aren't that sick. Sutures would be the most common.

The advantage being that you don't have to remove the stretcher (which is tough on the back), find a way of transferring the pt (which for walkers will be to the waiting room and I don't lower the stretcher with people on it, again on account of liking my back). Additionally you don't have to change the sheets on the stretcher.

I'm not a big fan of sitting psychs. I like them on the stretcher wrapped up in seat belts.

Unless there is a second patient or a family member along for the ride, the captains chair is for providers only round these parts.

Is there a reason for that? Is it a culture, policy or person preference?

More then likely followed up by a lawsuit (there is actually a lawyer in my area who advertises that if you were in an ambulance accident and got hurt to contact him).

That fills me homicidal thoughts.

Oh, no, patients who present via ambulance go to the asthma room too

Why is there a need for an asthma room? They must see an incredible amount of asthmatics. Why are their so many? Are COPD exacerbations included?

 

[the_negro_puppy]

People who will sit in the airway chair: In general pts who do not really need to be going in the first place but who request transport (also frequent fliers) and people who need to go for a procedure but who really aren't that sick. Sutures would be the most common.

The advantage being that you don't have to remove the stretcher (which is tough on the back), find a way of transferring the pt (which for walkers will be to the waiting room and I don't lower the stretcher with people on it, again on account of liking my back). Additionally you don't have to change the sheets on the stretcher.

I'm not a big fan of sitting psychs. I like them on the stretcher wrapped up in seat belts.


Is there a reason for that? Is it a culture, policy or person preference?




That fills me homicidal thoughts.



Why is there a need for an asthma room? They must see an incredible amount of asthmatics. Why are their so many? Are COPD exacerbations included?

Much the same. Not everybody needs the stretcher, though most people do get put on it. I'm quite happy to sit people in the airway chair particularly with minor problems including some psych patients. Walking a pt in encourages triage staff to put them where they belong- in the waiting room. Lets face, many patients that can freely walk with no problems often do not need an Ambulance to take them to hospital. Either way its is a judgement call based on the safety of the patient and myself-partner.

Sorry I will not be putting an obese lady with a trivial ailment / complaint on the stretcher and ruin myself and my partners back lowering and raising the stretcher, when she is quite capable of walking into her GP or Family Drs Office.