Question about priority

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medicdan

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Quick personal story:
Again, some background, I have a water rescue history, and am about to start an EMT-B course...
Two weeks ago, I got a call from my grandmother (lol, 95ish, better shape then I am, but DNR) @ ~midnight. She lives in an independent senior facility. They have an RN in the building all the time, mostly indep. living, but a nursing floor. She told me she had hurt her foot/ankle that morning... RN looked at it and recommended she get Xrays... facility called a private BLS ambulance. We asked that the ambulance take her to a hospital that is further away, but private, with her PMD. We asked for the ambulance because we wanted her leg immobilized, and we wanted to get her in the door-- no waiting room bs. Because the EMts were unfarmiluar with the hospital, they did not have the admit phone number, and brought her in back. The nurses, because they had no advanced notice of the ambulance coming in, refused to take my grandmother. The EMTs wheeled her out the back door, into the front door, and signed her in at the waiting room. Despite the ER being empty, we waited about a half hour to be seen.
Was this ethical? This was in no way a life threatening illness, and the EMTs should have called, but I still think the nurses had no right to refuse care.
In the end, all ended up allright, but it was a bit scary. What if (god forbid?) my grandmother decompensated en route? What if it was an un supported fracture? Would the hospital have still not allowed them in?
Thanks a lot!
 
As someone who has transported many routine medical calls that were not urgent, I find nothing wrong with your story. Even with advance notice, we've often had to wheel a patient through the front and send them through triage like all the other patients. Generally it doesn't happen in EMS, because the hospital knows that we have other calls holding, but it has happened.

If you're grandmother decompensated en route I'm confident that she would have been taken through the ambulance entrance. The problem is that some hospitals can't stand when you don't call them ahead of time, and it seems as though this hospital was flexing their power. We have a county protocol that hospitals are not to be contacted for non-emergent patients, but almost every non-L1 trauma center likes to know what's coming their way.

It's unfortunate that the situation didn't work out like you hoped, and I agree that it wasn't the best solution, but that's how EMS and hospitals work sometimes. Even when you take hundreds of patients in and out of a hospital in a week, some hospitals and some nurses like to exert their power by making up absurd rules. I don't always agree with them, but I know it's usually the exception and not the norm.

I hope that helps, and I hope grandma is doing well.

Take care,
 
Did the triage nurse sign for your grandmother? If so, nothing wrong has occurred. He/She agreed to take over responsibility from the ambulance, and it is common practice in most hospitals to put non-emergent patients (per the EMS crew and triage nurse's opinion) in the waiting room under the triage nurse's responsibility.
 
Sounds like a couple of things... one she should had probably been transported to minor clinic, urgent care center instead of an ER. Second, I too would had "wheeled" her to triage, unless I am extremely bored. People still have to be "triaged", paper work has to be filled out and signed....fractures with pulses are not considered "life threatening".

Patients are triaged upon their severity not on whom they are, who their doctor is, and how or what method they arrived. Nothing pisses me off more, to see someone call an ambulance thinking this will buy them a ticket straight back... and it appeared it did the ER staff as well. Now, depending on what your interpretation of what private is (speciality hospital), they cannot refuse treatment. I truly doubt they refused to treat your grandmother everyone that works in ER is quite aware of EMTALA and their violations... something wrong with this scenario and smells fishy.. sounds, like someone got upset on waiting and then refused LWBS or AMA....

R/r 911
 
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I love treating a bs pt and arriving at the hospital, walking through the ED to the waiting room. Nothing makes me happier than when they look at me with a bewildered face and ask why they're in the waiting room with everyone else and I smile and tell them to sign here for your $500 dollar bill.
 
Some other thoughts -

a half hour wait is great! I waited more than a half hour inside the back of the ER as a 27 year old female who suddenly was unable to walk, tender abdomen, tears flowing (subconsciously) due to pain, and a MOS that the ER staff knows very well. (turns out not only had I ruptured a lumbar disc, but I also had a kidney infection - inflammed Rt kidney and fluid in the L).

if your grandmother decompensated en route, they would have taken her into the ER right away - call from the EMS crew or no call.

if it was an unsupported fracture... what does this mean? Not splinted? Complain to the EMS crew's supervisor. If you mean the type of injury, then again to echo Rid - if she has a pulse and is conscious, a broken ankle is not a major concern.
 
they didnt refuse to treat, they triaged to the waiting room. standard operating procedure
 
rescuecpt said:
Some other thoughts -

a half hour wait is great! I waited more than a half hour inside the back of the ER as a 27 year old female who suddenly was unable to walk, tender abdomen, tears flowing (subconsciously) due to pain, and a MOS that the ER staff knows very well. (turns out not only had I ruptured a lumbar disc, but I also had a kidney infection - inflammed Rt kidney and fluid in the L).

if your grandmother decompensated en route, they would have taken her into the ER right away - call from the EMS crew or no call.

if it was an unsupported fracture... what does this mean? Not splinted? Complain to the EMS crew's supervisor. If you mean the type of injury, then again to echo Rid - if she has a pulse and is conscious, a broken ankle is not a major concern.
Click to expand...


Thats my point... that night, the ER was empty, two of fifteen beds were in use-- no traumas, nothing interesting. If anything, the hospital should have taken her just to save the circular trip.
Thanks again for your answers, this is giving me a better picture of how things really work!
DES
 
Maybe they were also short staffed for some reason, or it was close to one of their shift changes, or a whole host of other things...
 
I'm not 100% sure on what you are saying. Are you saying that you got refused completly at the hospital, or that you had to go to triage?

If you were refused completly, then you might have an EMTALA violation issue. If you were just triaged to the waiting room... I'd say there isn't really an issue.

As was said... an ambulance ride isn't always a ticket to the back... depending on patient's condition and ED status... you might go to Triage.

Regarding calling ahead - Around here, everyone expects you to call ahead. Sometimes we forget, sometimes we are too busy. In the city - everyone often just shows up.
 
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