Stopping for an accident w/ unstable pt...

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ErinCooley

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I'm confident that this has been asked, and discussed, so no need to tell me to look it up. I want to discuss it....


Two times this week I've been en route to the hospital w/ unstable pt (1 head bleed, 1 really, really sick baby that ended up having a 106* fever after 17 miles of cooling her and running IV fluids) when I've witnessed an accident.

Both accidents appeared to be minor, and both times my paramedic partner told me to call it in but to continue to the hospital due to pt status.

I've heard varying opinions on this. Do I have a legal obligation to stop when I have a pt loaded? Does my pts condition dictate when I stop? Is it abandonment for my paramedic to leave me in the back of a truck while s/he is first responding to a pt on the side of the road?
 
im betting its spelled out quite clearlt in your protocols.

for reference, this si the mass protocol on the matter:
http://www.mass.gov/Eeohhs2/docs/dph/emergency_services/ambulance_stopping_advisory_20081001.pdf

and just the white meat:

Stopping at the Scene:​
While EMTs owe a duty of care to the patient on board the ambulance, the Department recognizes that there
are certain unique circumstances where EMTs may need to make a judgment as to whether to stop to assess
and render treatment at another emergency scene to a potential patient or patients. The exercise of
reasonable care, judgment, knowledge and skill expected of all EMTs requires that careful weight and
consideration be given to the following factors in all decisions to interrupt the transport of your patient:​
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Scene safety for the EMTs and the patient on board;​

•​
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The stability of the patient on board;​

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The EMS resources visible at the scene of the other medical emergency.
Therefore, if there is a visible need for EMS resources; the patient on board is stable; patient care is not
compromised by a delay in transport and the scene is safe; EMTs may, but are not required, to stop at another
emergency scene. If there is uncertainty regarding any of these factors, the EMTs must continue transport of
the patient on board. Typically, EMTs may appropriately assist the other emergency by contacting their​

dispatchers to direct an available EMS resource.

im not in total agreement with it, but then im rarely in total agreement with anything.
 
Why would you ever stop at an accident with an unstable patient?
 
JPINFV said:
Why would you ever stop at an accident with an unstable patient?
Click to expand...


some people are stupid. remember, there are lost of people out there who try to save the world all by themselves. if they can get a two for one special, they are going to try.
 
Where I am a truck sometimes has a P and I with a B, or P and P with a B (who normally is a vollie). So if the MVA/emergency is bad, we can let off someone with a first in bag and let them first respond, and the ambulance can still operate. That doesn't really happen that much though. I actually have only heard that it has been done and is possible.

Otherwise, a call in to dispatch works.
 
JPINFV said:
Why would you ever stop at an accident with an unstable patient?
Click to expand...
About sums it up.

If I had a STABLE patient, it would be discussed. Unstable patient... no question, call it in and keep going - MAYBE stopping to ask if there are injuries and advise them that you can't stop because you already have a sick patient onboard... and that you've notified dispatch.
 
Ditto to others. Just for the record, the paramedic taking care of the (unstable) patient leaving the back of the truck for any reason is abandonment unless they are replaced by another medic (or higher trained personnel).
If you do decide to stop, its okay for you to asses the patients on the road, but certainly not your paramedic partner.
 
I don't stop with an unstable patient unless the accident blocks the road. Certainly not stopping by choice.

If I have a stable patient and the accident scene has an unstable patient, I might think about it.

If my patient is stable and the injured on the scene are apparently stable, i call it in. I let them know help is on the way and keep going.
 
ErinCooley said:
I'm confident that this has been asked, and discussed, so no need to tell me to look it up. I want to discuss it....


Two times this week I've been en route to the hospital w/ unstable pt (1 head bleed, 1 really, really sick baby that ended up having a 106* fever after 17 miles of cooling her and running IV fluids) when I've witnessed an accident.

Both accidents appeared to be minor, and both times my paramedic partner told me to call it in but to continue to the hospital due to pt status.

I've heard varying opinions on this. Do I have a legal obligation to stop when I have a pt loaded? Does my pts condition dictate when I stop? Is it abandonment for my paramedic to leave me in the back of a truck while s/he is first responding to a pt on the side of the road?
Click to expand...

Yeah, I think that about sums it up.
 
I responded 2nd unit to a freeway MVA. An IFT-only ambulance with an unstable, ALS pt still-alarmed the call, placed a c-collar on the driver of one of the vehicles and walked away. However they did not leave the scene, their patient seized, went into arrest, and died enroute from the scene to the hospital.
 
I definitley would not stop with ustable Pt., Reason is because suppose your UNSTABLE Pt. is stable for the moment and you leave your partner and begin Pt. care on the MVC Pt's stable or unstable and your original UNSTABLE Pt. goes really unstable you've just abandoned your new MVC Pt's.

If I had stable Pt. who was basically a ride I WOULD call dispatch for another unit, I probably would stop to asess the damage/injuries and see if there was need for immediate attention. REMEMBER THE MOMENT YOU LAY YOUR HANDS ON A PT. IT IS YOUR PT. TILL YOU TURN IT OVER TO SOMEONE OF SAME OR HIGHER LEVEL OF CARE.
 
Acutally just had this happen 2 shifts ago.... We had a 30min transport time with a pt I was giving a CPAP trial to while I set up to RSI her. My partner yells back to me that we are coming up on an accident that is blocking the other lane and he planned to stop.

My response to him was something along the lines of "Are you Crazy! You keep driving and call it in!" He responded back something about there not being anybody on scene yet, but in the end there was no misunderstanding my next statement which was something to the effect of Please Keep Driving (or something like that).

We called it in. The truck that responded actually ended up calling a TA on the driver. Either way, the extra 10 minutes we'd have sat there waiting on the next unit in would have caused additional harm to my patient that I already had a responsibility to.

Unstable pt.... call it in. No questions. Clearly stable.... still situation depending.
 
I heard this situation on the radio the other day. They were running to a 911 call and they saw an mva happen where someone pulling out from in front of them got rear ended, they called it in and kept going, even without a patient.
 
I can only respond with my protocols if I witness an accident with or without patient I cannot initiate care until dispatched so I actually have to radio it in and then they would respond with a dispatch, if I have a patient in my care at the time my duty is to that patient until I can either hand then off to another BLS or higher, if I were to abandon the patient in response to the accident my ticket could be pulled and I would be legally responsible for what happened to that patient. Once I have taken them into my care I have to stay with them until care is no longer needed or they have been transfered to another bls or higher.
 
It sounds like a lot of you are out in the middle of nowhere, with long transport/response times - obviously don't stop with an unstable patient, but I would argue that even with a stable patient, you're putting yourself in an awkward situation (practically and possibly legally) since you won't be able to leave until another medical unit shows up (which could be a while).

In my area, I would only stop with a stable patient and a pretty serious looking TA. And this is only because we have direct radio contact with police units in our area and I could have a few police units roll to me code-3 and arrive within 2-3 minutes. One of the officers could then drive my ambulance (with my partner and patient) on to the ER while I tended to the new patients until further medical units arrived.
 
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I don't think I'd ever stop if I already have a patient, regardless to whether or not they are stable.
 
Explorer127 said:
Wouldn't stopping be negligence?
Click to expand...

Not necessarily - negligence requires there to be an actual harm to the patient (as well as a duty to act, a breech of that duty, and proximal cause) - its certainly possible to stop and not cause a harm to your patient.
 
As others have said, this shouldn't even be a question...

Did I/You cause the accident? Nope. Keep going, let dispatch/911 know and continue on. People are most likely going to flip out but still.

There are exceptions to every rule however, and every case is going to be different. Going down a 2 lane road rural back country is going to be a LOT different then I-75 in Detroit...

Now if its a stubbed toe call or something, thats when you can bend the rules a bit. But if you are with something that is SEMI-Serious, then no.
 
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