the 100% directionless thread

[NomadicMedic]

Get two.

 

[Jim37F]

Not the full 13 hours they quoted when we arrived....but we were still forming a vital part of the hospitals structural integrity for 8 hrs from 1115 to 1900....

 

[VentMonkey]

View attachment 3337
Not the full 13 hours they quoted when we arrived....but we were still forming a vital part of the hospitals structural integrity for 8 hrs from 1115 to 1900....

Gold star for the wordplay. If it makes you feel any better Jim, we once nearly hit that 13th hour as well, however, our patient was treated, diagnosed, and discharged from our gurney before we did.

 

[StCEMT]

View attachment 3337
Not the full 13 hours they quoted when we arrived....but we were still forming a vital part of the hospitals structural integrity for 8 hrs from 1115 to 1900....

I can't even fathom this. Do you just binge your patients favorite shows on Netflix while you wait?

 

[exodus]

I can't even fathom this. Do you just binge your patients favorite shows on Netflix while you wait?

We just implemented a new bed-delay policy. If our patient comes in BLS and is triage eligible, after 30 minutes of waiting for a bed (and the system is "low level"), we can place the patient in the waiting area and the ED refuses a verbal report, our printed PCR is allowable to act as a turnover report. The protocol actually says to walk the patient into the ED instead of utilizing the gurney.

http://www.remsa.us/policy/4204.pdf

APOD Unusual Events
The proliferation of APOD that leads to the lack of sufficient ambulances to respond to emergencies are considered
APOD Unusual Events. These events threaten public health and safety by preventing EMS response to emergency
medical incidents. To mitigate the effects of these APOD Unusual Events the following are hereby established:
•
Criteria for an APOD Unusual Event:

APOD exceeding
30 minutes is
occurring, and;

The ambulance provider identifies and documents low EMS system ambulance availability.

APOD Unusual Event Procedures
•
EMS personnel are authorized to inform ED medical personnel that they are transitioning patient care and
immediately offloading a patient on APOD to a hospital bed or other suitable hospital sitting or reclining device as
appropriate for patient condition provided the patient meets the following criteria:

Stable Vital Signs

Alert and oriented

No ALS interventions in place

Is not on a Welfare and Institutions Code (WIC) 5150 hold
•
EMS personnel shall make every attempt to notify ED medical personnel that they must immediately return to
service
•
EMS personnel may use the written EMS report for transfer of care if ED medical personnel are unavailable to take a
verbal report (post ePCR to hospital dashboard)
•
In the event of a major emergency that requires immediate availability of ambulances, the Riverside County Medical
Health Operational Area Coordinator may give direction to EMS personnel to immediately transfer patient care to
ED medical personnel and return to service to support the EMS system resource
needs

 

[DesertMedic66]

We just implemented a new bed-delay policy. If our patient comes in BLS and is triage eligible, after 30 minutes of waiting for a bed (and the system is "low level"), we can place the patient in the waiting area and the ED refuses a verbal report, our printed PCR is allowable to act as a turnover report. The protocol actually says to walk the patient into the ED instead of utilizing the gurney.

http://www.remsa.us/policy/4204.pdf

AMR higher ups and hospital staff have shot not giving a report down. We must give a face to face verbal report. Ops Manager sent out an email about it on Dec 13

 

[VentMonkey]

For anyone who cares, this is actually a fairly accurate depiction of the Los Angeles County EMS/ ED system.

Action shots aside, it's a good documentary. It's just sad that even after having left this system it still hasn't changed one bit. It's definitely a county-wide systematic problem with many cracks in its faultline waiting to erupt, IMO.

 

[StCEMT]

We just implemented a new bed-delay policy. If our patient comes in BLS and is triage eligible, after 30 minutes of waiting for a bed (and the system is "low level"), we can place the patient in the waiting area and the ED refuses a verbal report, our printed PCR is allowable to act as a turnover report. The protocol actually says to walk the patient into the ED instead of utilizing the gurney.

http://www.remsa.us/policy/4204.pdf

That at least is a bit more reasonable. I get hospitals get flooded at once sometimes, rooms gotta be cleaned, etc. I've waited for beds before and completely understand waiting while they catch up. Jims page though? Nah, screw that.

 

[Jim37F]

Yeah apparently there were like 80 people in the waiting room already, plus they said they had zero beds on the floor available...there were patients in the ER admitted to the floor and ICU who were still in the ER because there was no room upstairs for them....and at least one other hospital was calling asking to arrange an ER to ER transfer to the one we were waiting at because they were full up...so yeah..

 

[Jim37F]

Didn't help when literally 2 or 3 Code Strokes came in, on top of 2 or 3 tier 2 trauma activations and a few general ALS runs that came in and snagged beds in front of us.

 

[StCEMT]

How many hospitals do yall have? Sounds like an Urgent Care or 50 is in order for LACo.

 

[VentMonkey]

How many hospitals do yall have? Sounds like an Urgent Care or 50 is in order for LACo.

When I left it was in the 30's. Again, if you can get your hands on that doc, that's pretty much how it still operates.

Everything from super users, lack of education, abuse of the system, densely populated inner-city areas with the emergency service system as their first and only door to healthcare.

It truly is a perfect storm of a broken healthcare system. There's another more recent doc eaiser to find that was "ok", but this one hits the nail on the head exactly how I remember it to be. If one county could benefit from a county-wide CP, and stand-alone ED's it's them, but what do I know? And, yes there are plenty of clinics, but even when I go back, it seems more and more overcrowded each and every time.

 

[Jim37F]

Plus in recent years more than a few local hospitals closed their ERs because apparently they were costing the hospitals too much money.

 

[Jim37F]

I don't know what I did to anger the EMS Gods, buy I need to find a way quick to appease them...just got done holding the wall again at a different hospital for 2 1/2 hours this time, for a pt whose only complaint was too much ETOH -_- (the Resident wanted to agree with us to just send him to the waiting room, but apparently the Attending overruled for.....reasons?)

 

[PotatoMedic]

I love that I can dictate a patient going to the waiting room... "hello RN! I have a triage appropriate patient for ya..." Drop them off in the waiting room, give a report to the triage rn and im on my way! Now if they need a bed im stuck.

 

[EpiEMS]

I don't know what I did to anger the EMS Gods, buy I need to find a way quick to appease them...just got done holding the wall again at a different hospital for 2 1/2 hours this time, for a pt whose only complaint was too much ETOH -_- (the Resident wanted to agree with us to just send him to the waiting room, but apparently the Attending overruled for.....reasons?)

They don't ask you if the patient can go to triage when you patch/contact en route prior to arriving at the ED? LA, man...

 

[Seirende]

Bug is back home.

 

[VentMonkey]

Plus in recent years more than a few local hospitals closed their ERs because apparently they were costing the hospitals too much money.

They've been closing since the mid-2000's. It goes back to the overall system and its problems. I think this falls under a national healthcare issues, though.

They don't ask you if the patient can go to triage when you patch/contact en route prior to arriving at the ED? LA, man...

Nope. BLS providers who respond with non-transport ALS providers get stuck holding the wall until their patient gets a bed even if it is brought in ALS, the medics typically give a report and are then free to bring another patient meeting "ALS criteria" in.

If the patient is downgraded as BLS, like Jim mentioned earlier, oftentimes you'll continuously be pushed back for ALS patients being brought in, not to mention walk-in patients who are acutely ill.

It certainly doesn't help that EMS being such a crutch for many, won't fix its many flaws, nor does it seem to try to work to improve them. Budgets, politics, both? Who knows, either way it is a hot mess down there.

 

[EpiEMS]

@VentMonkey, oof, that's a bad situation for BLS providers. I can't even imagine that near me.

 

[VentMonkey]

@VentMonkey, oof, that's a bad situation for BLS providers. I can't even imagine that near me.

Yes, it's an extremely backwards, convoluted system. To expand on @Jim37F's earlier analogy...you're (at the BLS/ non-fire ALS level) very much the structural foundation for the proverbial "totem pole" as well.