Transporting a patient against their will to Trauma Center

[Brandon O]

I actually disagree. Transporting a patient to a facility that can not manage the patient, is just as bad as not transporting. If the patient is having an acute STEMI and they need a cath lab, they need a cath lab. Not a ECG at your local ED with minimal capabilities. If a patient has life/death traumas, they need a trauma surgeon not an ER doc. A patient with a CVA needs a stroke center and TPA, not a IV and saline. There is a window of time and it is not large. Ultimately that patient will have to be transported to that appropriate facility. The only thing you are doing is delaying transport and passing the buck to someone else.

It would be extremely unusual for a sick patient to get NO benefit from going to the "wrong" hospital. I am the first person to advocate for bringing people where they need to go, but it's in comparison to the delays of transporting to the wrong destination, not in comparison to doing nothing.

Just about every accredited ED can administer fibrinolytics to a STEMI patient or to a stroke after a CT. They can stabilize trauma patients non-surgically and may be able to operate as well (it's just not guaranteed in the way it would be with a trauma center). And every ED can transfer the patient elsewhere. Yes, the patient might refuse that, too, but people in white coats are really good at persuasion. And not to be That Guy, but they have better paperwork, lawyers, and malpractice insurance than you as well.

I suppose if you're in the outback and you drive someone two hours in the opposite direction of the hospital so they can visit the local medicine man, that might literally be worse than nothing...

 

[triemal04]

Even on legal holds I let the patient pick the hospital they go to. We're stripping them of most of their rights already why not give them at least something back?

Can you imagine the ambulance personnel and law enforcement coming into your home/life and forcing you to go to the hospital against your will? Then not even being allowed to pick where you go?

They'd have to dart me.

I'm guessing by "legal holds" you mean the patient has some sort of psych issue that needs to be looked into?

Better be sure that each hospital you're going to has the appropriate psychiatric and social services for that particular issue, otherwise you are just doing the patient a disservice while trying to feel good about it. If that person needs a specific type of resource and the situation has gotten to the point that they have been detained/lost the choice to stay or go, bringing them to a place where they can't get it because they don't want to go there isn't right.

 

[mycrofft]

Why isn't it a field provider's responsibility to worry about coverage? Again, we have an obligation to the community and our service. I did not get into this business to help one patient. Look at the big picture besides just one. I work as a street provider, not in management, that does not mean I do not care about the rest of the community and patient, taxpayers and customer. I worry about all my patients receiving fast and quality care. If that means I am not going to take a pateint further or to an innappropriate hospital when they dont need it, I am fine with that. It is more than just one patient. What is your reasoning, that you dont have to tell the other patient's tough luck (because you never reach them) but the one in front of you might be upset if you tell them tough luck?

I have never had a patient that was critically ill and wanting transport to a different hospital outright refuse. Most people smarten up when the situation is explained. I explain it as a life and death. IE, a patient that needs a cath lab for a stemi, I explain to them the consequences that can be created if they refuse to go. They might not be happy with where they are going, but they will get there and have a better chance at survival. If they still want to refuse and are CAOx4, thats their right.

Yes California to NJ is completely unreasonable, but where is the line drawn? Yes that is extreme, others might argue the hospital that is 45 minutes away is extreme compared to the closer appropriate faciltiy that is only 10 minutes away. Where is the line?

Your duty is to yourself and co-workers (safety) and the pt (safety and care IAW protocols). Everthing else is the gravy which can make you an extra-valued employee or a pain in the keester. (or both).

You are in this business to take care of one patient at a time but prepare for every patient all at once.

 

[ZombieEMT]

It would be extremely unusual for a sick patient to get NO benefit from going to the "wrong" hospital. I am the first person to advocate for bringing people where they need to go, but it's in comparison to the delays of transporting to the wrong destination, not in comparison to doing nothing.

Sure they might get some benefit, but is it enough? It it was, a transfer wouldn't be warranted. I work on a CCT for an IFT that handles these transfers for several local hospitals. Sometimes, it is just too late.

I have never been unsuccessful with the act of persuasion when it comes to getting a patient to an appropriate hospital. Wearing a white coat has nothing to do with it. To just say, "okay we will go where you want" and leave it up to the docs/nurses, you are passing the buck onto someone else and delaying care. Make your patient's realize how important it is to go to that facility. Patient advocate, remember? Isn't that what everyone else on this topic is saying. Again, never been unsuccessful with persuasion.

For those that keep mentioning taking a patient against their will and saying its kidnapping, please realize there is a difference. Taking a patient to a hospital that they do not want to go to does not mean it is against their will or kidnapping. Just because someone agreed does not mean thats what they want.

 

[ZombieEMT]

If we are in Cape May County, there is one hospital and they have very limited capabilities. The next closest hospital is 45 minutes. Closest neuro is 1.5hrs by ground. Between response times to the hospital and transport times it can become a long delay to transfer, hence why we need to persuade to go in the first place not just take them where they want and leave it to the docs.

 

[Tigger]

Sure they might get some benefit, but is it enough? It it was, a transfer wouldn't be warranted. I work on a CCT for an IFT that handles these transfers for several local hospitals. Sometimes, it is just too late.

I have never been unsuccessful with the act of persuasion when it comes to getting a patient to an appropriate hospital. Wearing a white coat has nothing to do with it. To just say, "okay we will go where you want" and leave it up to the docs/nurses, you are passing the buck onto someone else and delaying care. Make your patient's realize how important it is to go to that facility. Patient advocate, remember? Isn't that what everyone else on this topic is saying. Again, never been unsuccessful with persuasion.

For those that keep mentioning taking a patient against their will and saying its kidnapping, please realize there is a difference. Taking a patient to a hospital that they do not want to go to does not mean it is against their will or kidnapping. Just because someone agreed does not mean thats what they want.

No one is suggesting that we always leave designation decisions to the patient exclusively. But in the case of a patient that adamantly refuses transport to the proper facility, you cannot possibly serious in saying that it's better to leave the patient on scene. That's a downright terrible idea.

Yes, sometimes a transfer to the proper facility may come too late, but that cannot be your reasoning. You chide us for not being a patient advocate yet you'll let a patient who needs care stay on scene instead of getting some semblance of an increase in care? I don't get it...

 

[CentralCalEMT]

Sure they might get some benefit, but is it enough? It it was, a transfer wouldn't be warranted. I work on a CCT for an IFT that handles these transfers for several local hospitals. Sometimes, it is just too late.

I have never been unsuccessful with the act of persuasion when it comes to getting a patient to an appropriate hospital. Wearing a white coat has nothing to do with it. To just say, "okay we will go where you want" and leave it up to the docs/nurses, you are passing the buck onto someone else and delaying care. Make your patient's realize how important it is to go to that facility. Patient advocate, remember? Isn't that what everyone else on this topic is saying. Again, never been unsuccessful with persuasion.

For those that keep mentioning taking a patient against their will and saying its kidnapping, please realize there is a difference. Taking a patient to a hospital that they do not want to go to does not mean it is against their will or kidnapping. Just because someone agreed does not mean thats what they want.

I am glad you have never had trouble getting a patient to go to the appropriate facility. Most of us haven't had such luck 100% of the time. The original poster was not talking about taking a critically injured trauma patient to a glorified urgent care. He was talking about taking a hemodynamically stable patient with no apparent injuries that needed a trauma center on paper to a closer facility with medical control approval. You also have to look at the context. They county the OP (and myself) work in is larger than your entire state. We have small critical access hospitals (all of which have CT/on site labs etc) scattered across the rural area. Now I love country folk but they can be the most stubborn people you can meet and just convincing them to go and getting them to the hospital can be a feat in and of itself. The big city hospitals are up to 2 1/2 hours away by ground and we aren't gonna fly someone out based on mechanism alone. Therefore getting to some hospital, any hospital that can stabilize and transfer them is better than leaving them at home, at work, at the scene of an MVA, etc. I know for a fact a patient has a better chance at survival by ending up at any hospital rather than left on scene. EMS is and will never be black and white and what works for New Jersey possibly will not work for the mountains and deserts of rural California.

 

[LACoGurneyjockey]