Transporting Multiple Patients

[shfd739]

Mine is 5. 4 kids and a mother after mom rolled the SUV while on pain meds.

2 kids on 2 different boards- 1 board hanging and 1 on the bench. Mom on the stretcher.

Another unit took 4 kids. I think mom was babysitting and that's why so many kids were with her. This was about 5 years ago.

 

[Trashtruck]

I don't understand how you can board more than two people in an ambulance...
One on the stretcher and one on the bench.

Hanging? From and by what?

Folding down the back of the CPR seat?

 

[Trashtruck]

The only time I was faced with the choice was following a nursing home fight.(Quote by Tigger.)

I...I...I, ummm...Jesus, man.

 

[mycrofft]

5 in a Cadillac. One in front eat to be checked out; three big farm boy-brothers on the bench seat with contusons, and one with a fractured arm; and the drunk who caused it unconscious on a spineboard. I crouched on floor near foot of litter.

Brother #1 "Wish I could catch that SOB wh did this!"
Brother #2 (points to litter) "Hey, who's THAT?".
Me: "Just another guy who got hurt". (gulp)

 

[shfd739]

I don't understand how you can board more than two people in an ambulance...
One on the stretcher and one on the bench.

Hanging? From and by what?

Folding down the back of the CPR seat?

Out units have a hooks from the ceiling that allow up to 150lb patient to be hung. Not ideal but it helps.

2 small kids per spine board. They were rolled and placed on the board at the same time. Heads at each end and legs together.

 

[medic417]

Out units have a hooks from the ceiling that allow up to 150lb patient to be hung. Not ideal but it helps.

2 small kids per spine board. They were rolled and placed on the board at the same time. Heads at each end and legs together.

We have 2 sets of hooks. Have left the cot out with law enforcement and placed multiple backboard on floor, on the benches and hanging. Not the best but better than not being able to leave the scene for more than an hour waiting for mutual aid.

 

[mycrofft]

If you used the roof hooks to hang em by their collars....

 

[Tigger]

The only time I was faced with the choice was following a nursing home fight.(Quote by Tigger.)

I...I...I, ummm...Jesus, man.

Male on female too, the female broke his nose and then he slapped her if I recall. We took the male who was also on psych hold and another truck came for the female's "face laceration."

 

[Trashtruck]

Ok. Can somebody please post a picture of these 'hooks' you are hanging a backboard+patient from(<150lbs apparently)
They're strapped to the board, then hung, suspended, from the ceiling of the truck, by hooks? I'm just not seeing this.
Or was this in one of the 'Saw' movies?

Tigger,
I know it happens, but the non-chalant, by-the-way statement made me laugh.

 

[NomadicMedic]

I haven't seen ceiling hooks in a civilian ambulance in at least 20 years.

 

[shfd739]

Ok. Can somebody please post a picture of these 'hooks' you are hanging a backboard+patient from(<150lbs apparently)
They're strapped to the board, then hung, suspended, from the ceiling of the truck, by hooks? I'm just not seeing this.
Or was this in one of the 'Saw' movies?

Tigger,
I know it happens, but the non-chalant, by-the-way statement made me laugh.

I'll snap a pic of the setup when im back at work Monday night.

 

[Trashtruck]

Thank you N7.
I have NO IDEA what people are talking about.

Shfd...please post the pics when you get a chance. How old are these trucks that have them?

When I was in EMT school, I remember being told, briefly, that you could transport up to 3 people on long back boards...one on the stretcher, one on the bench, and one hung from the ceiling. It was basically a one sentence quip and I never thought anything of it since after that, I've never seen them. He said it, I sort of said to myself, 'Wait. Huh?' then he was talking about whatever he was talking about before. Then, I hear people on here talking about it...in this present day and age!

Can't wait to see these contraptions.

 

[NomadicMedic]

Oh, I've seen them. I've never done it, and I haven't seen an ambulance that had the hooks to support a pole stretcher since I started back in the late 80s. I think every fire company in Delaware buys a new ambulance every 18 months, so it's been a while since I've seen em.

 

[medic417]

Oh, I've seen them. I've never done it, and I haven't seen an ambulance that had the hooks to support a pole stretcher since I started back in the late 80s. I think every fire company in Delaware buys a new ambulance every 18 months, so it's been a while since I've seen em.

Ours will hold the true rectangle back boards. Ours are rated more than 150#'s don't recall exactly but mainly if you can lift them they can hang there.:blink: We have fairly new ambulances and a nearby service (about 150 miles away has a 2012 with them ) so it is staill an available option.

 

[Veneficus]

I haven't seen ceiling hooks in a civilian ambulance in at least 20 years.

The only place I have ever seen them is at SH's particular company.

Never used it though. (<150 lbs in southern Louisiana?, maybe only a younger ped...)

I have also seen some boxes at other places with a center mount stretcher and double bench seats set up for supine transport.

I really have my doubts about transporting that many supine patients at once to a hospital. For evacuating facilities useful. For emergencies, not so much.

 

[medic417]

I really have my doubts about transporting that many supine patients at once to a hospital. For evacuating facilities useful. For emergencies, not so much.

Why? Would it be better to just leave everyone else at the scene until you can get back in a few hours? While it is hard to give patient care it is better in my opinion to take them all and get headed to the hospital. Besides technically if we decided we could not transport everyone we would have to stay there for at least an hour waiting for mutual aid as leaving additional patients w/o medical staff on scene would be abandonment. If they don't all fit we get a school bus and place all the patients in there and haul them to the hospital. In a MCI you do whatever it takes to get the patients to the hospital.

 

[Veneficus]

Why? Would it be better to just leave everyone else at the scene until you can get back in a few hours?

It is not transporting multiple patients I have an issue with. It is transporting multiple supine patients. If they are boarded but not critical, realistically they do not need the board.

If they are critical, the lack of providers and equipment is going to be more of an issue.

I have played the game of one patient being monitored by the pulse ox probe and the other on the Nibp and 3 lead. It is certainly not optimal.

Required, sometimes. But there is a difference between doing something in a pinch and actually planning to do it regularly.

While it is hard to give patient care it is better in my opinion to take them all and get headed to the hospital.

I agree. I don't like it, but still agree.

Besides technically if we decided we could not transport everyone we would have to stay there for at least an hour waiting for mutual aid as leaving additional patients w/o medical staff on scene would be 0abandonment.

Sounds like an issue your agency is not properly addressing.

If they don't all fit we get a school bus and place all the patients in there and haul them to the hospital. In a MCI you do whatever it takes to get the patients to the hospital.

This is one of the biggest problems with EMS.

Doing this does not resolve the MCI. It just moves it to where you transport and makes it a problem for somebody else.

Hospitals do not have unlimited resources. They don't even have the ability to pool all of their resources.

EDs, ORs, ect do not shut down for an MCI, that MCI becomes surge and must be managed in addition to normal volumes.

You cannot call staff from other parts of the hospital. When you get a handful of med/surg nurses who never spent a day in their life in acute care, don't have access to equipment, don't know where equipment is, it is worse than having no help at all.

Your normal staff becomes the gophers. Which takes your best players away from patient care.

You cannot conscript ICU staff because then you don't have people for the post surgical post ED management. Other people certainly cannot fill in for them.

Even most doctors become more of a burdon than help.

Diagnostics take time and having 6 or 7 people lined up for CT or filling up ED space waiting for labs creates a patient flow nightmare.

As if that wasn't enough, it is much more difficult to transfer patients from one hospital to another, so you cannot easily get help from outside.

Now add to that a bunch of concerned family showing up and you need to find staff to handle them and start worrying about both visitor, staff, and patient necessities. (otherwise you could have them adding to the patient load)

If EMS wants to be a part of the healthcare team, it has to adopt the concerns of the whole team. Not just think "drive to the hospital and mission accomplished."

 

[medic417]

If EMS wants to be a part of the healthcare team, it has to adopt the concerns of the whole team. Not just think "drive to the hospital and mission accomplished."

This is not just a drive to hospital and let them figure it out. When it occurs the hospital is notified they will have more than an hour before we get there to locate more help. Every flight service in the region (all are more than an hour out as none are in local area) are contacted and asked to send planes and helicopters based on number of patients that need higher level of care than the little level 4 can handle. The neighboring services are contacted and requested to meet us in route to hospital or even meet at the hospital to assist. Then we will stay working at the hospital until things calm or we get another 911. Sucs for the next patient as they have to wait more than an hour for us to get back.

Does the area need some changes, yup. And we have been addressing it. Now there is usually a second crew available to be called in, not always though as many that work the frontier area drive in for their shifts.

 

[DesertMedic66]

That's one thing I do like about how we run MCIs. The closest base hospital is notified and they get bed availablity from all the hospitals in the county as to not overwhelm one hospital.

Example hospital A is our base hospital. They can take 2 immediate (critical), 0 minor and 3 delayed (they will usually go into the waiting room.

Hospital A then goes to the MCI computer system and sees that hospital B can take 0 immediate 3 minor and 2 delayed. Hospital C has no beds. And so on for the whole county.

By the time we leave the MCI scene we already know where our patient/s are going.

 

[Veneficus]

That's one thing I do like about how we run MCIs. The closest base hospital is notified and they get bed availablity from all the hospitals in the county as to not overwhelm one hospital.

Example hospital A is our base hospital. They can take 2 immediate (critical), 0 minor and 3 delayed (they will usually go into the waiting room.

Hospital A then goes to the MCI computer system and sees that hospital B can take 0 immediate 3 minor and 2 delayed. Hospital C has no beds. And so on for the whole county.

By the time we leave the MCI scene we already know where our patient/s are going.

There are a couple things to remember about this.

1. It doesn't stop a critical patient from walking in the front door of the ED.

In most hospital EDs I have come across EMS accounts for 10-15% of patient volume.

In a large incident, some people often transport themselves to the hospital.

2. It only works when EMS transports accordingly. Once you show up with a patient, it is very difficult to move them out. So if EMS transports 4 patients at once, if their triage is inaccurate, (and all triage is to some degree) It can shut down the whole system in 1 shot.

Many of the problems in MCI response are not the fault nor managable by EMS.

Moving patients and beds around in a hospita in a challenge. Mostly because hospitals operate at near maximum capacity normally. There is also considerable work in moving patients from hospital to hospital and not least of the concerns faced is can they pay?

"We are not taking anymore self pay or charity cases" is just as problematic as "we don't have any more critical beds."

My point is EMS must make sure to understand the problems and be a part of the solution in order to be part of the total system.