Suicidal patient refusal?

[MonkeyArrow]

Normally when you mention the words "patient dumping" and "complaint" in an obscure way, they get up off their cans and get YOU out of there, because even if it's not realistic, the terminology scares hospital providers because of the corporate financial implications behind it.

Don't advocate being obnoxious. EDs don't like having people waiting/holding the wall any more than you do. Plus, I don't know where you work, but at my ER, if you brought that up, we would laugh profusely and go on about our day.

 

[DesertMedic66]

Normally when you mention the words "patient dumping" and "complaint" in an obscure way, they get up off their cans and get YOU out of there, because even if it's not realistic, the terminology scares hospital providers because of the corporate financial implications behind it.

If you do that I imagine the hospitals must hate you. If I start lying to the hospital I can easily say I will get complaints filed against me and will be on the hospitals **** list which means they will not help me out in anyway or authorize me to use medications for issues that are out of my protocols.

 

[Jim37F]

Well besides the fact that the problem seems more like there's always 3 times as many people waiting as there are beds at the hospital (because people for some reason prefer to come to the ER for every little scrape, bump, bruise, fever, med refill, stomach ache, etc etc)

Plus the Psych ER in question from the original scenario is not part of the normal ER at that hospital. You go into the main ER, get triaged (and for this patient that included a Physician talking to her) while still on the gurney in the hallway....then they send you down the hall to the Psych ER which is a completely different area, so talking to the ER Charge Nurse would have done precisely squat (for those answers that mentioned that) as it's not part of the ER, oh and the staff inside keeps the door locked, you can't go inside to talk to their charge nurse without knocking and waiting for them to come out (which sometimes takes several minutes....."hurry" is not a concept they employ there)

It's a known phenomenon there that the Psych ER routinely takes an hour+ upon arrival.....no friggin clue why that is, but it is. It's bad enough to the point where all you have to do is say you were sent there and other crews are automatically "Ouch, I'm sorry....how bad?"

 

[Chris07]

My colleagues and I used to have a running joke at one of our area hospitals that the yellower your pants were, the faster you'd get a bed. While it didn't happen all the time, it happened frequently enough that we began to notice some apparent favoritism towards to local city FD when it came to grabbing the next available bed.

Holding the wall in the LA area (and even throughout a lot of CA) for over an hour+, as stated many many times above, is not just common practice, its expected. The pressure for change isn't going to come from the ambulance companies. Yes, they're potentially losing money while their crews wait in the hallways, yet I don't believe ANY LA area company wishes to upset their potential client hospitals by starting noise about wait times. There's a lot of butt kissing involved in LA area ambulance operations, and holding the wall like a good little boy at the expense of your bottom line is all a part of the game.

Psych facilities are in fact among the worse in regards to wait times. Silverlake anyone? If you've worked in LA for a significant amount of time, I'm sure you've heard or experienced a Silverlake psych story.

 

[DesertMedic66]

Silverlake anyone? If you've worked in LA for a significant amount of time, I'm sure you've heard or experienced a Silverlake psych story.

Oh god. That’s a name I haven’t heard in a long time and I am thankful for that. Last time I was there I was holding the wall for only 3 hours.

 

[bakertaylor28]

Don't advocate being obnoxious. EDs don't like having people waiting/holding the wall any more than you do. Plus, I don't know where you work, but at my ER, if you brought that up, we would laugh profusely and go on about our day.

I'm sure you would right up until you had federal agents in the facility over it within a week or two. Patient Dumping is a federal criminal offense that the FBI investigates, and last time I checked hospital administrators don't like people seeing federal agents walking up and down the halls of the facility. Its bad PR.

 

[bakertaylor28]

If you do that I imagine the hospitals must hate you. If I start lying to the hospital I can easily say I will get complaints filed against me and will be on the hospitals **** list which means they will not help me out in anyway or authorize me to use medications for issues that are out of my protocols.

Yep. They all pretty much hate me, because I don't do red tape well. In fact I'm deathly allergic to it. Babysitting a psych patient does NOT fall under the job description of Emergency Medicine. Thats what RNs are for. Now, if they want to pay me RN pay, I'm not going to complain so much, but so far I've yet to see the money. As for double crossing me- probably not something they want to do considering exactly whom it is I'm married to... Unless that is...of course...you like getting traffic tickets...

 

[DesertMedic66]

Yep. They all pretty much hate me, because I don't do red tape well. In fact I'm deathly allergic to it. Babysitting a psych patient does NOT fall under the job description of Emergency Medicine. Thats what RNs are for. Now, if they want to pay me RN pay, I'm not going to complain so much, but so far I've yet to see the money. As for double crossing me- probably not something they want to do considering exactly whom it is I'm married to... Unless that is...of course...you like getting traffic tickets...

And with that attitude I bet you are well liked by everyone you work with. Also the “I’m married to so and so” usually doesn’t work and just makes you sound like an ***.

 

[Jim37F]

Yeah except caring for BLS patients (whether that's a Psych or minor trauma or whatever) until the transfer of care is complete IS in the job description.....

And you're the one saying we should dump patients in the hallways without proper transfer of care because "I'm not getting nurse pay, and I'm entitled because my spouse will hunt down people who annoy me on my whim".....gee which one sounds like it would receive attention from investigators, that or the hospital that simply doesn't have the capacity to take over your patient at that moment and has you wait..? Hmm....

 

[MonkeyArrow]

I'm sure you would right up until you had federal agents in the facility over it within a week or two. Patient Dumping is a federal criminal offense that the FBI investigates, and last time I checked hospital administrators don't like people seeing federal agents walking up and down the halls of the facility. Its bad PR.

Source for the bolded? And federal law simply says that no hospital can intentionally send patients away to another hospital without appropriate stabilization and treatment within that hospital's means. Having you hold the wall to wait for a bed is not "patient dumping" nor a federal crime.

 

[DrParasite]

Normally when you mention the words "patient dumping" and "complaint" in an obscure way, they get up off their cans and get YOU out of there, because even if it's not realistic, the terminology scares hospital providers because of the corporate financial implications behind it.

That might scare the nursing administration, but I can assure you most of the staff nurses aren't intimidated by an EMT or paramedic with an over-inflated ego.

I'm sure you would right up until you had federal agents in the facility over it within a week or two. Patient Dumping is a federal criminal offense that the FBI investigates, and last time I checked hospital administrators don't like people seeing federal agents walking up and down the halls of the facility. Its bad PR.

So call them. Let the FBI investigate, if you indeed believe that a crime has been committed. In fact, I would argue that if you don't call the FBI, you are actually contributing to the problem, because you are knowingly allowing this crime to be committed, and patients are suffering for it.

Yep. They all pretty much hate me, because I don't do red tape well. In fact I'm deathly allergic to it.

Aren't you paid by the hour? so what do you care?

Babysitting a psych patient does NOT fall under the job description of Emergency Medicine. Thats what RNs are for. Now, if they want to pay me RN pay, I'm not going to
complain so much, but so far I've yet to see the money

yes you will. you like to complain. they could double your pay and you would still complain.

As for double crossing me- probably not something they want to do considering exactly whom it is I'm married to... Unless that is...of course...you like getting traffic tickets...

let me guess... your married to a patrolman? I'm sure your spouse has nothing better to do than give tickets to hospital staff because they pissed you off. I would love to know to hear what the Sgt thinks of their actions... as well as the internal affairs officers who receive the complaint that your spouse is targetting and harassing hospital personnel for no good reason....

and newsflash.... Most people in this world aren't scared of traffic tickets.....

Don't get me wrong, I think holding the wall for an hour is absurd, and I have pissed off my share of hospital employees when I notify my supervisor, and the decision is made by my administraion that we can't transport there because they are overwhelmed, but you sound like a royal jackass, and I would hate to work in the same city as you. In fact, I am pretty sure with an attitude like yours, you would be sent do the back of the line, and ever new ambulance would go in front of you (after all, if you have a stable psych patient, it's not like they are going to get crazier....)

If you do that I imagine the hospitals must hate you. If I start lying to the hospital I can easily say I will get complaints filed against me and will be on the hospitals **** list which means they will not help me out in anyway or authorize me to use medications for issues that are out of my protocols.

What does your medical director thing of you using medications that are outside of your protocols?

 

[DesertMedic66]

What does your medical director thing of you using medications that are outside of your protocols?

Not medications that are out of my scope but medications that are not listed as treatment options for a complaint. If we get approval by the base hospital physician then there is no issue.

For example: Mag isn’t listed in the protocols for asthma, glucagon isn’t listed for esophageal obstruction, push dose pressors isn’t listed, pain management for anything aside from an isolated extremity injury isn’t listed. If I get approval from the base hospital’s physician then it is out of the hands of my medical director. Heck, I can’t even tell you what hospital our medical director works at.

 

[bakertaylor28]

Yeah except caring for BLS patients (whether that's a Psych or minor trauma or whatever) until the transfer of care is complete IS in the job description.....

And you're the one saying we should dump patients in the hallways without proper transfer of care because "I'm not getting nurse pay, and I'm entitled because my spouse will hunt down people who annoy me on my whim".....gee which one sounds like it would receive attention from investigators, that or the hospital that simply doesn't have the capacity to take over your patient at that moment and has you wait..? Hmm....

What I'm not clear about in the first place is how a suicidal pt. is a BLS pt. in the first place- Our local protocol and scope of practice designates suicidal / homicidal pts. as ALS pts because of the increased chance of needing chemical restraint, which requires both an EMT-P and also requires MC clearance in certain situations... eh, but I suppose scope of practice is different in every state

That said, Pt. dumping law also states that if a facility is not capable of completing transfer of the pt. within a "reasonable time" that facility must stabilize the pt. transfer the pt. to a facility that is capable of receiving the pt. immediately. Per technicality of DSM-IV a suicidal / homicidal pt. is NEVER considered stable absent the initiation of the appropriate definitive psychiatric medical interventions, which are beyond the skill set of EMS.

 

[bakertaylor28]

Not medications that are out of my scope but medications that are not listed as treatment options for a complaint. If we get approval by the base hospital physician then there is no issue.

For example: Mag isn’t listed in the protocols for asthma, glucagon isn’t listed for esophageal obstruction, push dose pressors isn’t listed, pain management for anything aside from an isolated extremity injury isn’t listed. If I get approval from the base hospital’s physician then it is out of the hands of my medical director. Heck, I can’t even tell you what hospital our medical director works at.

This sort of thing is WHY our MC is separate and distinct from the receiving facility. Our system doesn't allow the receiving facility to dictate treatment UNTIL they have formal custody of the patient. We give them the heads up on what they have coming, but thats about it. Issues involving prehospital treatment always goes through OLMC.

 

[bakertaylor28]

That might scare the nursing administration, but I can assure you most of the staff nurses aren't intimidated by an EMT or paramedic with an over-inflated ego.

So call them. Let the FBI investigate, if you indeed believe that a crime has been committed. In fact, I would argue that if you don't call the FBI, you are actually contributing to the problem, because you are knowingly allowing this crime to be committed, and patients are suffering for it.
Aren't you paid by the hour? so what do you care?
yes you will. you like to complain. they could double your pay and you would still complain.
let me guess... your married to a patrolman? I'm sure your spouse has nothing better to do than give tickets to hospital staff because they pissed you off. I would love to know to hear what the Sgt thinks of their actions... as well as the internal affairs officers who receive the complaint that your spouse is targetting and harassing hospital personnel for no good reason....

and newsflash.... Most people in this world aren't scared of traffic tickets.....

Don't get me wrong, I think holding the wall for an hour is absurd, and I have pissed off my share of hospital employees when I notify my supervisor, and the decision is made by my administraion that we can't transport there because they are overwhelmed, but you sound like a royal jackass, and I would hate to work in the same city as you. In fact, I am pretty sure with an attitude like yours, you would be sent do the back of the line, and ever new ambulance would go in front of you (after all, if you have a stable psych patient, it's not like they are going to get crazier....)

I am a jackass when it comes to that kind of thing, because it most usually means that someone, somewhere, isn't getting up off their can and doing their job, and consequently making my job more difficult than it really needs to be. I take personal offense to that kind of work ethic. Oh, but that's right in this day and age we don't HAVE work ethics anymore that go BEYOND the bare minimal required. I guess I get this personality trait from working in a hen house. :-D

Of course, then again, I'm the kind of guy that will stop in the middle of the street, hit the lights, and block traffic for at least 15 minutes on a mundane run because some "jackass" parked in the fire lane.

 

[GMCmedic]

What I'm not clear about in the first place is how a suicidal pt. is a BLS pt. in the first place- Our local protocol and scope of practice designates suicidal / homicidal pts. as ALS pts because of the increased chance of needing chemical restraint, which requires both an EMT-P .

By this logic, every patient is ALS because of the chance of cardiac arrest requiring a paramedic to intervene.


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[VentMonkey]

Can we just stop with the shenanigans already?

@Chimpie, @MMiz this @bakertaylor28 person clearly seems to be posting solely for the purpose of being spiteful, argumentative, makes absolutely no sense with his random rants, and has contributed nothing useful to this forum.

If this is not trolling, I don't now what is.

-Vent.

 

[bakertaylor28]

By this logic, every patient is ALS because of the chance of cardiac arrest requiring a paramedic to intervene.


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hrmnn, how do you figure- paroxysmal cardiac arrest isn't all that common in the grand scheme of things, as compared to the significant chance that a psych pt. is probably going to become combative. (usually because things like significant EtOH intoxication, etc. tend to be co-morbid in these types of situations.) Of course I'm in favor of training the EMT-I's to use certain drugs that fall in situations that are most usually going to fall outside ACLS implications. This whole business of allowing the intermediates to obtain IV access and then use it for nothing but fluids is, to me, a rather ignorant approach- as it makes the skill substantially less useful under practical scenarios.

 

[GMCmedic]

hrmnn, how do you figure- paroxysmal cardiac arrest isn't all that common in the grand scheme of things, as compared to the significant chance that a psych pt. is probably going to become combative. (usually because things like significant EtOH intoxication, etc. tend to be co-morbid in these types of situations.)

Because any patient that needs an ambulance is at a higher risks for cardiac arrest.

See how anecdotal evidence works?

Id argue that in my experience, more patients have spontaneously coded than those that up and decided to be combative.

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[gonefishing]

Wheres the mods? Usually when im battling a troll place is shut down by now?

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