transporting pt to questionable place...what would you do?

SamanthaCLE

Forum Ride Along
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On my last shift, my partner and I found ourselves in a bit of an ethical quandary and I was curious how you guys might suggest handling it...

I work for a private ambulance company. My partner and I were dispatched to an ER to transport a 330lb (49yo) woman with polynephritis, right sided weakness s/p previous CVA, mental deficits to her apartment after being discharged. She was in the ED because she called 911 for 'pain in her side'. She's a heavy +2 assist to stand and can only go a step or 2 before becoming SOB and collapsing under her weight.

We transported her home to find that she lives in a dangerous environment for her condition. I opened the door to find a tiny kitchen with a broken office chair next to a broken walker. The office chair was so soiled from her existing in it ALL THE TIME that flies and maggots were emanating from it. There were fly paper strips full of flies and bug spray on the kitchen table next to the chair. It took an incredible amount of effort to get her from the stretcher to the chair. The tiled kitchen area was very small and the rest of the apartment was carpeted. There's no way she can move around in that chair to get to the bathroom or even get a glass of water.

The patient told us that her granddaughter lives there with her but is gone for the weekend and that she has an aide but she will not be coming for a few days. Nothing in the apartment is accessible for her - there's no wheelchair or lift or anything setup for her. The whole situation screams of a patient slipping through the cracks and being taken advantage of. It was obvious to us that she called 911 to go to the ER in the first place because she was unsafe home alone.

It felt awful leaving her in that sitting in that chair but we didn't know what to do for her. I thought about calling the PD to do a wellness check. Is there someone else I can reach out to in order to advocate for her?
 

TransportJockey

Forum Chief
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Call Adult Protective Services for your state. The fact that there's no caretaker to turn her over to and she has mental deficits would make me wary of leaving her there. I can and have returned the patient to the faciltiy we picked up from.
 

DrParasite

The fire extinguisher is not just for show
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Call your agency supervisor and advise them of the situation.

Odds are, you would have been told to return to the ER, and your state's adult services agency would need to be involved, preferably with the assistance of the hospital social worker
 

NomadicMedic

I know a guy who knows a guy.
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I agree with all of the above. Adult protective services exist for cases like this. Best bet would have been to return her to the emergency department and document, document, document. Let a supervisor know, and tell them to bring a camera.

However, if you work for a shady interfacility transport company… All bets are off.
 

hometownmedic5

Forum Asst. Chief
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This is a tough nut to crack. If you refuse to leave every patient in what you consider an inappropriate living situation, your time is going to be short in the IFT world. Many of the living situations our patients are in are inappropriate and your personal threshold may on may not be accurate. On the other hand, there are certainly times when it would be grossly negligent to leave a patient where you are told too. How you handle the situation is going to come down to what your options are. Do you have a field supervisor who can come to the scene and evaluate the situation(or perhaps with facetime and such, do so remotely)? Is there a mandatory reporting system in place for this sort of this? If the situation was as bad as you say it was, we would have returned to the sending facility and filed an abuse/neglect report. Then social services would have been brought in to interview the patient and conduct a site visit. From there, it's out of your hands.

I've been down this exact road. Sometimes your right and sometimes it doesn't matter. I've reported inappropriate living situations and been back to the same house days or weeks later and done it all over again. And again. Patients will surprise you sometimes with their ability to persevere. In overloaded patient advocacy systems, the bar delineating able to care for ones self and not isn't very high.
 

NysEms2117

ex-Parole officer/EMT
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I agree with the above, supervisor, APS, if you have a good reputable PD, call them too. I'd stay with the patient until i hear back from my supervisor on what to do.
 

Bullets

Forum Knucklehead
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Id call my supervisor who would come out and assess along with PD. We would then probably return to the ED and call APS and hospital social work.

We would follow up if/when she does go home with regular home visits and working with the social worker and county APS.

But we are a municipal 3rd service so i think i have more latitude in this area then an IFT EMT would
 
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