Stopping at another scene with a patient on board

[VentMedic]

I have been following this news story on other forums including this one. I had also posted this last week in EMS news.

http://www.jems.com/news_and_articles/articles/FDNY_EMS_Crew_Acts_Heroic_Under_Fire.html

It has sparked discussions about policy or interpretation of policy regarding the decision to stop at another scene when you have a patient on board.

Does your company have a clearly written policy for stopping or not stopping for another potential patient (accident scene, person down near road, etc) when you already have a patient on board?

This does not include hearsay, speculation or probably.

If you stop at an accident scene and determine there are minor or no injuries then leave to continue transport of the original patient, can you be hit with abandonment if someone deteriorates later at the accident scene?

 

[Epi-do]

I have not seen anything in writing, but I have been told that we are to continue without stopping, and use the radio to contact dispatch and alert them to the incident. I will be interested to see how many do have a written policy for these types of situations.

 

[Asclepius]

Your legal obligation is to your patient on your bus. Period. You have no legal obligation to anything that you happen upon. Stopping and neglecting your patient puts you and your agency at risk for all kinds of liability issues. The correct thing to do would be to radio in the location of the incident and have them send another truck and/or other rescuers.

 

[Asclepius]

Our protocol clearly states the following:

During the transport of a patient by ambulance, should the EMS crew come across an emergency requiring ambulance assistance; the local EMS system will be activated. Crews involved in the treatment and transportation of an emergency patient are not to stop and render care.

In the event you are transporting the patient with more than two appropriately trained prehospital personnel, you may elect to leave one medical attendant at the scene to render care and the other personnel will continue to transport the patient to the receiving facility.

In the event there is not a patient onboard the ambulance and an emergency situation is encountered requiring ambulance assistance; the crew may stop and render care. However, the local EMS agency should be activated and their jurisdiction respected.

 

[BossyCow]

I agree about the responsibility to the pt in the rig. When we leave that pt. to assess the damages, injuries of a possible new pt. we have abandoned the pt. already on board.

Legally, as I understand the issue, once we have a pt. in our care, our responsibility is to that pt. The possible pt's at another scene we may pass on the way by, are only potential pt's. There was a huge lawsuit in Washington state some years ago about a rig picking up a deceased for transport to the mortuary. Tones went off for a reported code in progress and they left the deceased and went to the code.

The agency was sucessfully sued over this. Partially because they left the deceased in a body bag in his driveway, but also because they had a responsibility to finish out one call before diverting to another. They were technically in service on one call and so, unavailable to respond to a second call.


Most agencies will have a policy for doubling up on calls and how those are to be handled. I think this would fall under that catagory

The potential for disaster here is huge. What if... the scene you respond to become dangerous? Have you exposed your first patient to those dangers? Can you be reprimanded for not giving quality care to the second victim because you were distracted by a change in status on the first?

 

[daemonicusxx]

I've stopped before. witnessed a police vehicle spin out and hit the jersey barrier, we had a non emergent patient on board going to a doctors appointment. my partner stayed with the pt, i went to check for injurys. come to find out, not a police officer driving, just the guys from the siren shop returning the cars after putting lights and stuff on them. no injuries on scene, so i notified dispatch and continued txp of the original patient.

IMO, the condition of the patient you are transporting decides wether you stop or not. stable NH patient going to a doctors office??? VS Possible Police officer injury??? i think i would risk a slap on the wrist to make sure LEO isnt injured.

 

[MMiz]

I've stopped before. witnessed a police vehicle spin out and hit the jersey barrier, we had a non emergent patient on board going to a doctors appointment. my partner stayed with the pt, i went to check for injurys. come to find out, not a police officer driving, just the guys from the siren shop returning the cars after putting lights and stuff on them. no injuries on scene, so i notified dispatch and continued txp of the original patient.

IMO, the condition of the patient you are transporting decides wether you stop or not. stable NH patient going to a doctors office??? VS Possible Police officer injury??? i think i would risk a slap on the wrist to make sure LEO isnt injured.

There are exceptions to every rule. That's one of them... in my book.

 

[firecoins]

a 9 year old pt having seizures is more important tha an mva, espcially since it turned out to be edp with a gun.

 

[VentMedic]

my partner stayed with the pt, i went to check for injurys. come to find out, not a police officer driving, just the guys from the siren shop returning the cars after putting lights and stuff on them. no injuries on scene, so i notified dispatch and continued txp of the original patient.

This incident actually could have a high probability of something going wrong, especially since it wasn't an actual LEO driving the car. Luckily it was the shop guys.

We were also always told to notify dispatch prior to getting out of our vehicle for any stops at a scene, scheduled or not. Granted, I did work in a city that had its share of safety issues for both the crew and the truck. We also had a written policy about not stopping with a patient on board which we knew would be enforced.

 

[BossyCow]

I think transporting someone to a Doctor's appt is different from a pt. you transport after an emergency response are two different situations entirely.

 

[Asclepius]

I think transporting someone to a Doctor's appt is different from a pt. you transport after an emergency response are two different situations entirely.

I tend to agree with you, but the only absolute way to avoid any risk of abandonment is to stay with your patient. However, there is no substitute for good judgment. You'll notice that in the protocol from my system, it states specifically about a patient from an 'emergency' transport.

 

[VentMedic]

Our policy was clearly written out. If you have a patient on board, no stopping. You put the patient with you in the middle of the accident scene just by parking the ambulance. Of course, in the city, there is always another EMS vehicle nearby. I could see where your situation might be different BossyCow.

 

[firecoins]

Our policy was clearly written out. If you have a patient on board, no stopping.

Our policy allows us to stop...at a hospital.

 

[RedZone]

If nobody puts up the NYC policy, I'll try to get a hold of it. My ops guide is in storage in Fla. and I'm not scheduled for a 911 tour for over a week... but I'll see what I can do. I never actually knew what it said, we just use our judgment.

I've had situations where I had to stop because running over 50 people would cause too much damage to the ambulance and I've had situations where I just slowed down, rolled down my window and said, "another unit's coming."

 

[Grady_emt]

Our policy as enforced over past QA/QI sessions is as follows:

1: You must have a non-emergent transport patient on-board

2: You are considered a First response unit to;
Code1 call that is dispatched in your immediate vicinity and you would be the first unit onscene responding non-emergent. ie: call is around the corner/down the street (code 1=C,D,E determinates in med. dispatching)
If call is dispatched as an "high mechanism" accident you may stop while transporting, establish command and triage until another unit arrives to relieve you. (high mechanism=rollover, entrapment, motorcycle, ejection, interstate, etc...)

3: If you happen upon a wreck, and can safely pull over, attempt to do so and check for injuries, provide needed care, await another unit.
DO NOT put your unit and patient in danger attempting to stop for an accident, advise radio of exact location and discription of vehicles for responding units

4: One crewmember must stay with original patient at all times. If pt is ALS, that crewmember must be the medic.

Personally, unless it comes out as FF/PD down, or I roll up on a serious accident I usually dont stop.

 

[eggshen]

Not sure if we have a policy. We are double Paramedic cars so stopping does no become an abandonment issue. We will often swing buy another call on the way to the hospital to take some pressure off the system. Keep in mind this is only done when your current pt. basically fine. DK head lac, seizure, what ever. When going back emergent there is no stopping be it a crash or anything else.

Egg

 

[MMiz]

Wait, how is stopping patient abandonment? I'd never have the person in the back (with the patient) hop out, but I can't see a problem stopping the ambulance and having the driver hop out to check to see if a LEO is okay.

If I had a patient in back who is simply getting a ride to a doctor's appointment, I'd stop for a LEO. If it was an emergency call (even without L/S) I wouldn't stop, but I'd stop otherwise.

 

[eggshen]

Here's how we roll. You're merrily on your way to the ER with your pt. that may or may not need an ambulance. You hear a call go out and you say "9 we're close to that, we'll swing by and see if we can help you out." You stop by, determine if you need another ambulance or if you can double load and save the other car for something else. The airport is another story all together. You often take as many unrelated patients as you can due to the remote location. Saves the system alot of trouble.

Egg

 

[RedZone]

Since I didn't see anybody else say it (my apologies if someone did): I would probably "make arrangements" to stop for another EMS crew needing assistance.

 

[emt9577]

Stopping on scene

I personally have had to deal with some legal repurcutions involving me stopping my buggie for a MVA. I rolled up upon a MVA on the interstate in the far left lane. There was no one else on scene (fire,EMS,Law). I decided to stop, I was transporting a little old guy, back to the nursing home, my medic was in the back, however it was just a laid back boring BLS call. I signalled my intention to pull off the road, I was watching the road, and also looking at the scene. I pulled my buggy all the way off the road, to the left of the white line. I then lit the truck up. As I was walking back beside my truck, I hear a loud screeching of breaks, and watch as 3 vehicles all collide behind my truck, fortunately none touched my buggy. I walk over to the original scene, and a LEO pulled up, claiming that I caused the secondary collision, and that I had to wait on scene to get everything taken care of. He yelled at me to get back in the F____g truck, and wait for him. No one was injured in either of the collissions. I informed the officer that if my assistance as an EMT wasnt needed, I was loaded, and did have to get my patient back to his nursing home. Well, I went back to the truck, sat in it for about 45 minutes, had the famous phone call with the chief of ops, station manager, dispatcher, and company lawyer. I got out of the truck to enjoy a smoke or two. The LEO once again yelled at me to get back in my truck. Well after about 2 more hours on scene, the state trooper that was gonna do the report, called me over to her cruiser, it took about 15 minutes for her to take my report, and then tell me I could leave. She then also cited me for improper stopping of an emergency vehicle. And it wasnt just a ticket you pay a fine for, nope I had to go to court. I then jumped in the back so the trooper could talk to my partner. When they were done I jumped back up front and carried on the transport. It was kinda touchy there for a minute or two. About month later, I went to court, fortunately for me the trooper wasnt working that day, and I managed to get the charge dropped. I had never heard of improper stopping of an emergency vehicle. I was also told that all 3 drivers that were involved in the secondary collision were all cited also, but I wasnt told what for.

If you do stop, be careful!! Not only do you have the risk of abandonment, you have occassionally have to deal with the risks of a fine from just stopping.

I will admit, I know I should ahve hit my lights before I signalled to turn off. I was too busy looking at the scene trying to decide if it was safe, I forgot to reach over and hit the lights, until after I was stopped.

Ive been in fire and EMS since I was 18, and that was the first time I had ever heard of improper stopping. Oh well, everyone was ok, no fines, and a hard lesson learned.