Stopping at another scene with a patient on board

[sdadam]

At our agency, if you have a stable patient and come across an emergency situation you have to stop, the crew member in the back stays with their pt and the driver goes and begins to take care of the emergency, once other crews arrive you go on your way.

Obviously if you have an unstable PT you don't stop.

 

[jrm818]

If you have a BS pt. in the back I see no problem with picking up another pt. and another and another. One of my first nights doing the job for real my FI stopped over and over until we had 5 pts, all unrelated (my record is 7).

Cheers
Eggshen

:wacko:Is this even for real? How exactly would one fit 7 pt's in the back of an ambulance? What do you have as ambulances - mac trucks?

Our rig has 7 secured (seatblets/straps on the cot) total including the front seats - even with pt's who can sit up this is just preposterous to suggest you crammed 7 people into an ambulance.

I concur with the rest of the general outcry about this practice if it actually is true - which I serously doubt.

 

[BossyCow]

Okay, I'm confused. I start out saying that I would not stop, then amended that to say I could see a situation where a case for stopping could be made. I got bashed for both... hmmmmmmm.

As to leaving an EMT on scene as being dangerous, that may be the case in a more urban environment. We are often on scene alone. I've been alone with a patient (turned out to be a back fx and head injury) On the ground, in the woods with support and extrication equipment ferried in by ATV from over a mile away. Sitting on a hillside for about 30 minutes while waiting for support from fellow responders.

Is this an ideal situation? Of course not. Is this the best way for this type of incident to be treated? Absolutely not! But where I live, it's the best we have. The reality of the volly system in which I work is that there is no telling how many responders in what kind of vehicles will show up to any call. We are all prepared to be the only one on scene for an undetermined period of time with up to a 40 minute transport to the ED once we have a rig available to us.

Would I prefer to have a controlled environment on all calls.. you bet... would I like to be on scene in a fully supplied rig with a partner? Duh-uh....... but will the lack of either of these ever stop me from responding? Nope!

Given the option, the more formal response to a call is always the best one. But, with an MVA with known injuries and patients ejected ... I'm not going to drive 10 miles out of my way to get an ambulance and a couple of other volunteers. I'm going to the scene, in my pov and I will attempt to do some triage, stabilize what I can and get bystanders to help with flares and traffic control. This is rural EMS!

 

[fm_emt]

We've been told that if we see something happen, to go ahead and stop as long as our patient is stable. But nobody leaves the current patient. We're to hop on the radio and contact county communications and at the very least relay some information to them so they can dispatch another rig.

 

[eggshen]

You bet it's true, would I do it again? Nope...I don't work that hard anymore.

Egg

 

[RedZone]

Okay, I'm confused. I start out saying that I would not stop, then amended that to say I could see a situation where a case for stopping could be made. I got bashed for both... hmmmmmmm.

I hope my comments to that post weren't taken as bashing. I have respect for the opinions you have offerred.

As to leaving an EMT on scene as being dangerous...

To make up for my bashing thoughts, I will offer you praise here. It is important to keep in mind that every EMS system is unique. I am only familiar with the systems I have worked in. There may be differences with your system that point out my very own ignorance with certain dynamics I cannot even comprehend.

Would I prefer to have a controlled environment on all calls.. you bet

NICE!!!! More praise. A HUGE difference between EMS care and other forms of medical care is that we do not work in a controlled environment. (Actually, I wouldn't prefer to work in a controlled environment... it wouldn't be EMS, and I enjoy what I do). This was a point I was trying to make in that post of mine.... we must improvise in virtually every situation..... that's just what we do.

And as you point out, maybe EMS systems have to improvise in order to use their limited resources to provide the best service to their community.

As far as liability issues... I stick by my comments:

You have a few protections here:

- A clearly written policy as was suggested by VentMedic.

- Use of good judgment. I would say a good 25% or more of this job is IMPROVISATION. This is a skill that needs to be honed based on common sense, education, experience, and a clear understanding of your role.

- A supportive interdisciplinary TEAM approach, including a good QA review process that isn't necessarily discipline based. Basically, your "bosses" should "stick up" for their crews unless there is gross negligence.

- Liability insurance.

 

[Arkymedic]

So is your company a municipal or county service?
Does your agency still bill or file medicare and insurance claims?
Multilple patients can be a billing nightmare for many companies. Not that it matters to the EMTs or Paramedics...that is until a fraud case happens.

example:

http://www.arkansas.gov/dhs/aging/5-Ambulance.pdf

http://www.merginet.com/index.cfm?pg=legal&fn=ComplianceGuidance-PartIII

Damn Vent you beat me again with documents from my home state even lol. This is something that has been preached to us a whole lot lately especially involving MVAs. Medicare will only pay for one pt to be transported and if we have multiples we are usually to call for an additional unit.

Also as an FYI did you know that medicare will not pay for diabetic runs where D-50 or glucagon or any other treatment is given and you get an AMA? Found that out the other day as well. Same for MVAs where Air Evac is used and pt care transfered. If pt isn't placed in unit and moved 3 ft cannot charge for the run

This doesn't change my treatment any way shape or form just thought that was kinda screwed up. Instead medicare would rather tax the ER and increase the bill for the pt and then send them home.

 

[Arkymedic]

Wow ! This has become interesting that so many opinions and views that represent everything from abandonment to possibly fraud in billing services.


It is common knowledge that once one has made contact to the primary patient that they have made a contract regarding Duty to Act, and anytime that patient is left with lesser and not equal trained individual can be charged with abandonment.

As well, delaying care and transport could be reviewed if there is question that there was excess transport time.

As well, Medicare and many other payers such as insurance companies that the ambulance and EMS providers will not pay for transports devices that transported more than one event. Otherwise, EMS buses would be developed and utilized.

This debate is old and has been talked to death on multiple EMS forums. C'mon folks, really use some common sense. If one is transporting and stops (when they could be transporting a patient) then that EMT is obligated to stay and treat the other patient, thus breaking the initial contract with the first patient.

R/r 911

If I have a patient on board (non-critical) we call for an additional unit and I stay in the back with the first pt while my EMT does triage and scene assessment, size up and initializes TX until the other ALS unit arrives. We have 11 First Responder districts and most respond and work well. The EMT would have been able to take command and utilize them to control the incident prior to ALS arrival.

I also have witnessed a wreck in another services area (no pt on board) and we called it in to our dispatch which relayed it to the responsible EMS service. Then we did assessment and my partner took c-spine on a pt and we helped the other service backboard and load the pt. They were very appreciative. I think it would have looked terrible for an ALS unit two cars back to just drive right on past and not stop.