State Border Issues for EMS

[ho hum]

Greetings,

Our hospital is the base for a county that borders another state. The little community that is in the other state is 30 miles away from its county seat and only 4 miles away from the state line. The community sends its children to our state for school, receives its mail, shops, works and so forth in our state. Its 911 calls had been going to our state up until about 6 months ago. Its county seat has written into their policies that if their 3 EMS providers are not available, they will call our dispatch for us to respond.

I am concerned about legal issues in another state if there ever were decisions to sue EMS providers, and our base hospital for not practicing inside of our region. I realize that disaters and large emergencies are one thing, but day-to-day EMS stuff gives me worries.

Have any of you had any experience with this situation?

 

[BossyCow]

There should be a mutual aid agreement in place between the two agencies. Especially if it requires you going outside of the state in which you are certified and providing care that may or may not be protocol in the state you are practicing in.

All of this should be covered in the mutual aid agreement. It should determine which state's protocols are in place on the call, and should give you some sort of status within the other state regarding your licensure.

If there is no legal document addressing these issues and determining who's liable for what, I would not provide care.

 

[ho hum]

We are working on that. However, aren't mutal aid agreements more for dealing with disaster situations rather than day-to-day calls?

 

[triemal04]

We are working on that. However, aren't mutal aid agreements more for dealing with disaster situations rather than day-to-day calls?

Nope. They're for dealing with whatever the people who make the agreement want.

 

[firecoins]

We are working on that. However, aren't mutal aid agreements more for dealing with disaster situations rather than day-to-day calls?

No. Mutual Aid deals deal with when your respources are overworked. If your town has ambulance and 2 calls come in, you can't take both calls. Hence the 2nd call goes mutual aid to whom you have an agreement with.

 

[ho hum]

Does that mean if a community does not have any EMS people available rather than being overwhelmed?

We send our rig there and then leave our side of the line uncovered because they have not got anybody working in their volunteer department.

Does Sally Medic get sued for a bad outcome in a state where she doesn't hold a certification?

Does the Medical Direction and the Physician assume responsiblity in another state when something bad happens or do they cut and say that the medic shouldn't have been there in the first place?

 

[triemal04]

Does that mean if a community does not have any EMS people available rather than being overwhelmed?

We send our rig there and then leave our side of the line uncovered because they have not got anybody working in their volunteer department.

Does Sally Medic get sued for a bad outcome in a state where she doesn't hold a certification?

Does the Medical Direction and the Physician assume responsiblity in another state when something bad happens or do they cut and say that the medic shouldn't have been there in the first place?

Not having people available is being overwhelmed. Just like an MCI doesn't have to be 100+ people; it can be 8 if that's all it takes to exhaust the local resources. Now, if you mean that the other area isn't providing EMS because they can rely on your states service...that's not right. At that point either your states service should be contracted to cover both, or somebody should be having a long talk with someone else.

The supe for your states service should be smart enough not to send all his resources somewhere else, though that may depend on how long it'll take them out of service. If it's on ongoing problem that really is a problem (not something that isn't a real issue) then again, there's at least 2 people who need to have a long talk together.

Very likely yes. But then, she'll get sued in her own state if the patient's family is pissed enough or she screwed up. If she has a cert in state A, and full-standing orders from her medical director in state A, then takes a call in state B, she should still be following her normal protocolls from state A. No difference.

I don't know what your situation is, or anything about the services you're talking about, other than that 1 is a volunteer service. But I'm sort of getting the impression that you're overreacting and this isn't a huge deal. So.

1. What type of service is the one in your state? And it's call volume and daily staffing.

2. Same for the other state.

3. Distance to the other states service area.

4. Number of times this happens.

5. Number of times this happens and it uses up all of your states resources.

6. When that happens, how long till another ambulance is available?

I'm sure I'll think of more, but that should help clear things up.

 

[BossyCow]

A mutual aid agreement should be in place anywhere two agencies have a common border. We have National Park, State Forest Lands, Cities, and unicorporated county areas. We have some EMS and one of two responding ALS agencies that are civil fire departments with EMS response. We have several BLS only fire districts that run EMS and a private ambulance company that runs both BLS and ALS rigs.

The mutual aid isn't just for areas that don't have a particular service or who are understaffed. It's to assure that the citizen gets the fastest help from whoever is closest. It's also used when say the city, has a fire and needs more water during a low water table time of year, or the State Forest people have a fire and one of their wildfire workers are injured. It's just a legal agreement that outlines who is able to help who and under what circumstances and what happens if something goes wrong when we do.

We have provided equipment only to fires, have run water tender shuttles to wildfires, have helped transport pts during an MCI. We've covered the east end of our western border district because of a wreck, tree down or other impediment to access via the highway. (Roads wash out and are often blocked by fallen trees during the winter here)

 

[ho hum]

Here is a scenario from this situation:

The community is 29 miles from its county seat and other ambulances. It has 3 people who live in the community. Two are EMT-I's and one is an EMT-B. They have one ambulance and their hospital that provides medical direction is 72 miles away.

The county ambulance from my state is 4 miles from this community. The nearest hospital in our state is 44 miles and happens to be the one providing medical direction. The crew from my state is a medic and an EMT-B.

We received a call for a two victim MVC. On arrival, the communities own ambulance was caring for one victim and our ambulance took the other.

Both had been drinking. They were in a pickup involved in a one vehicle rollover. Neither were restrained. One had had a +LOC. They both desired to refuse care.

Our ambulance happened to get the patient who had not lost consciouness and they had no problem with letting him refuse. The other crew did not feel good about letting the other refuse because of the LOC issue and the drinking. Our medic said she would have called in a flight. Law enforcement took the patient into custody, took him to the jail where they promptly sent him to their base hospital and found he had a head bleed and flew him to a level one trauma center. They couldn't deal with him and so they flew him to our level on trauma center where he would have gone to in the first place.

 

[triemal04]

Here is a scenario from this situation:

The community is 29 miles from its county seat and other ambulances. It has 3 people who live in the community. Two are EMT-I's and one is an EMT-B. They have one ambulance and their hospital that provides medical direction is 72 miles away.

The county ambulance from my state is 4 miles from this community. The nearest hospital in our state is 44 miles and happens to be the one providing medical direction. The crew from my state is a medic and an EMT-B.

We received a call for a two victim MVC. On arrival, the communities own ambulance was caring for one victim and our ambulance took the other.

Both had been drinking. They were in a pickup involved in a one vehicle rollover. Neither were restrained. One had had a +LOC. They both desired to refuse care.

Our ambulance happened to get the patient who had not lost consciouness and they had no problem with letting him refuse. The other crew did not feel good about letting the other refuse because of the LOC issue and the drinking. Our medic said she would have called in a flight. Law enforcement took the patient into custody, took him to the jail where they promptly sent him to their base hospital and found he had a head bleed and flew him to a level one trauma center. They couldn't deal with him and so they flew him to our level on trauma center where he would have gone to in the first place.

This is probably going to be my last post, since I'm starting to get that hinky feeling in the back of my neck that screams "somebody is not being truthful about something here."

What is your issue? If you are only concerned with service A (the one from your state) helping out service B (the other states), then answers to those 6 questions would be good, and really, you should be clear on it by now. If you are worried about a legal problem due to the care provided by medics from service A and B, then that is another issue and one I will not discuss due to that leeetle feeling in the back of my neck.

 

[Rattletrap]

The only feeling in the back of my head is where I just cracked it getting out of the squad.

I an certified in 3 states for a reason due to location. The trucks I work on are certified in 2 states. I have to act in regards to the state and where I am taking my patient to. I have to know 3 sets of protocols. If I am crossing a state line with a patient, I use the state/company protocols that I am based in. If I am staying in the state the patient is in I have to use that states/local protocol.

To answer your question, you will need to know the laws from both states regarding response in your state and to other states. You will also need to know the laws from the state that you are responding to.

All states are different as to what they require you to do. Your best person to talk to is your medical director.

 

[reaper]

As stated, There should not be much legal issues if you have a MA agreement with that service. The rest is up to your service, if they want to continue servicing that area.

The rest of that scenario I won't even touch the legal aspects of it!!!

 

[ho hum]

Not having people available is being overwhelmed. Just like an MCI doesn't have to be 100+ people; it can be 8 if that's all it takes to exhaust the local resources. Now, if you mean that the other area isn't providing EMS because they can rely on your states service...that's not right. At that point either your states service should be contracted to cover both, or somebody should be having a long talk with someone else.

The supe for your states service should be smart enough not to send all his resources somewhere else, though that may depend on how long it'll take them out of service. If it's on ongoing problem that really is a problem (not something that isn't a real issue) then again, there's at least 2 people who need to have a long talk together.

Very likely yes. But then, she'll get sued in her own state if the patient's family is pissed enough or she screwed up. If she has a cert in state A, and full-standing orders from her medical director in state A, then takes a call in state B, she should still be following her normal protocolls from state A. No difference.

I don't know what your situation is, or anything about the services you're talking about, other than that 1 is a volunteer service. But I'm sort of getting the impression that you're overreacting and this isn't a huge deal. So.

1. What type of service is the one in your state? And it's call volume and daily staffing.

2. Same for the other state.

3. Distance to the other states service area.

4. Number of times this happens.

5. Number of times this happens and it uses up all of your states resources.

6. When that happens, how long till another ambulance is available?

I'm sure I'll think of more, but that should help clear things up.

To avoid being acused of being a troll I'll answer the questions in order. Although, I did provide most of the information in the scenario.

1. Single ambulance in a community of 1500 people staffed with EMT-P and EMT-B on each crew.

2. Single ambulance with three volunteer EMS personnel available. One EMT-B and two EMT-I's (who happen to be husband and wife and usually out of service and the same time).

3. From our service area to their is 4 miles. They are 26 miles from their county seat and 72 miles from their hospital.

4. I would imagine that it happens about 2-3 times per month.

5. Every time they call our rig, that leaves their (our rig's) community uncovered and the next closest rig is 25 miles away in a third community. That then bumps them down to one ride to cover the two communities that are 25 miles apart.

6. Whatever it takes to get one ride the 25 miles to the other community.

 

[ho hum]

This is probably going to be my last post, since I'm starting to get that hinky feeling in the back of my neck that screams "somebody is not being truthful about something here."

What is your issue? If you are only concerned with service A (the one from your state) helping out service B (the other states), then answers to those 6 questions would be good, and really, you should be clear on it by now. If you are worried about a legal problem due to the care provided by medics from service A and B, then that is another issue and one I will not discuss due to that leeetle feeling in the back of my neck.

Well then, scratch your neck. I'm telling the facts as I understand they happened and am preparing to discuss with both counties the MOU. I just wonder what I need to do to protect my base hospital as we are providing medical direction in a state where we do not have medical licenses and have not gotten a clear answer from the other state.

 

[Rattletrap]

Well then, scratch your neck. I'm telling the facts as I understand they happened and am preparing to discuss with both counties the MOU. I just wonder what I need to do to protect my base hospital as we are providing medical direction in a state where we do not have medical licenses and have not gotten a clear answer from the other state.

That happens here. In these cases you are allowed to give orders to a squad transpoprting to your hospital. You need the state/ local protocols for the squads located in the other state. If you give orders exceeding their protocols, by mistake, then they must inform you that they may not do what you are telling them to do due to their protocols. As long as their protocols are not exceeded then you are protected. It is that simple.

You may need to send them a letter or have a meeting with them reminding them of this.

 

[WLSC2008]

Tri-State Area

Everyone,
I live in an area of WV that is only minutes from the Ohio and PA line so we have responded to those states and take transports through those states all the time.
The emergency calls though are initiated by another agency that asks for assistance. Mutual aid is in place. We do the same with them when we need help.

 

[akflightmedic]

they promptly sent him to their base hospital and found he had a head bleed and flew him to a level one trauma center. They couldn't deal with him and so they flew him to our level on trauma center where he would have gone to in the first place.

Was this just a typo or did I miss something? Or is it your wording?

Are you saying he went to a base hospital then a Level 1 then to another Level 1???

Maybe I am tired and not comrpehending well.

 

[Canoeman]

Ho hum

I cannot believe that your EMS state representatives can't answer these questions. My service district borders Canada. We go there from time to time. In our region the opinion is simply "your certification, credentials, protocols, liability, (and your state) go with you when you cross a line on a map because it is an emergency"
This has to happen somewhere in at least 49 states. Call yor EMS guy. I'll bet he has answers.