Unneeded stretcher use?

EpiEMS

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Once this happened in Massachusetts, it was all over for OEMS.

Not so surprising, this is what protocols should be preventing (or at least protecting the service from liability from). Of course, one would think that initial education would address how walking the obviously at risk chest pain patient is a bad idea.


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hometownmedic5

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There is one municipality in my companies empire that has a huge problem in this area, but not with EMS. The fire dept doesn't seem to get the idea that sick people dont walk. The medics in that system routinely show up to a SAS patient be walked down the stairs by the FD. Many, many reports from that system begin "assumed patient care of patient at front door/sidewalk from FD".
 

Tigger

Dodges Pucks
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Not so surprising, this is what protocols should be preventing (or at least protecting the service from liability from). Of course, one would think that initial education would address how walking the obviously at risk chest pain patient is a bad idea.


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I see this as having no business in treatment guidelines. There was an issue, it was investigated, and those responsible were punished. If the state felt like there was a larger issue, then all they needed to do was issue a directive. Not place it into a statewide treatment guideline that takes zero account of location challenges.
 

EpiEMS

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I see this as having no business in treatment guidelines. There was an issue, it was investigated, and those responsible were punished. If the state felt like there was a larger issue, then all they needed to do was issue a directive. Not place it into a statewide treatment guideline that takes zero account of location challenges.

That's a very reasonable point - location is all too pertinent here. However, the vast majority of ems calls, i would posit, are in a setting where having a wheeled carrying device for patients is not exactly unreasonable.


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DrParasite

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Once this happened in Massachusetts, it was all over for OEMS. I started working at Brewster not long after the state included phrasing to pretty much insist patients be carried in the state protocols, we had supervisors coming to do spot checks. Woof.
Unfortunately, knee jerk reactions are all too common in EMS. Based on that report, it appears that two providers failed to do their jobs, and a supervisor willfully failed to investigate a valid complaint. Hopefully they all lost their jobs, and the two medics had their certs yanked (and not just suspended).

It does appear the agency had some issues, ones that aren't a sign of systemic issues in EMS
The notice of deficiency lays out a list of serious problems, including failure to ensure personnel meet state regulations, failure to comply with state laws, failure to provide personnel with appropriate policies and failure to maintain an effective quality assurance program.

The ambulance service also was criticized for not ensuring that its paramedics consistently begin advanced life support on first contact with a patient, rather that waiting until he or she is extricated to an ambulance.
If you don't check that your people are doing the right thing on a consistent basis, is there any surprise that people cut corners and do stuff they shouldn't be?
That's a very reasonable point - location is all too pertinent here. However, the vast majority of ems calls, i would posit, are in a setting where having a wheeled carrying device for patients is not exactly unreasonable.
Not sure what you mean by this.... If you mean on the vast majority of EMS calls you should be bringing in a carrying device, then I absolutely agree with you.

If you mean the patient should be carried on the vast majority of EMS calls, when EMS is used as a taxi service for a person who simply needs a ride to the hospital, or the ambulatory patient can walk to the ambulance, or the toothache at 3am on the 3rd floor walk up now wants to go to the hospital, well, I'm going to have to respectfully disagree.

Agencies that mandate that everyone be carried to the ambulance either don't trust their provider's clinical judgement, are written by managers that don't care about the backs of their employees (and the policies don't apply to them, since they don't ride the truck anymore), or are overly concerned about the theoretical threat of greater liability or perception of the public if we don't carry everyone from their location to the ambulance. That all being said, inappropriate walking of patients to the ambulance should be met with progressive discipline, and should be QAed like any other medical procedure.
 

EpiEMS

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Not sure what you mean by this.... If you mean on the vast majority of EMS calls you should be bringing in a carrying device, then I absolutely agree with you.

If you mean the patient should be carried on the vast majority of EMS calls, when EMS is used as a taxi service for a person who simply needs a ride to the hospital, or the ambulatory patient can walk to the ambulance, or the toothache at 3am on the 3rd floor walk up now wants to go to the hospital, well, I'm going to have to respectfully disagree.

Agencies that mandate that everyone be carried to the ambulance either don't trust their provider's clinical judgement, are written by managers that don't care about the backs of their employees (and the policies don't apply to them, since they don't ride the truck anymore), or are overly concerned about the theoretical threat of greater liability or perception of the public if we don't carry everyone from their location to the ambulance. That all being said, inappropriate walking of patients to the ambulance should be met with progressive discipline, and should be QAed like any other medical procedure.

I'm in favor of mandating bringing a carrying device, for sure. And I do see where agencies are coming from with relation to mandating that everybody gets carried - obviously, there are patients that do not need to be, but you have to think about it from both the provider & service/agency perspective (backs vs. liability, to grossly oversimplify things) to arrive at a reasonable solution. QA/QI is a very valid way - if done well - to ensure that providers aren't walking, say, ACS patients.


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Tigger

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I'm in favor of mandating bringing a carrying device, for sure. And I do see where agencies are coming from with relation to mandating that everybody gets carried - obviously, there are patients that do not need to be, but you have to think about it from both the provider & service/agency perspective (backs vs. liability, to grossly oversimplify things) to arrive at a reasonable solution. QA/QI is a very valid way - if done well - to ensure that providers aren't walking, say, ACS patients.


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Why do we need to mandate bringing a carrying device? It is hard enough to get into half the homes in our areas with two bags and a monitor. If the patient needs to be moved, how will you know what the best way to do that is from outside the house?
 

EpiEMS

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@Tigger, perhaps it is something that is area-specific. And perhaps I'm being overbroad with my assertion, I guess it's the number of cases I have seen where not bringing a carrying device has slowed things down.

My primary reason for suggesting that all patients get a carrying device is trying to prevent the least common denominator provider from ambulating a patient who should not be. Of course, maybe it could be solved by QA/QI?
 

DrParasite

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Why do we need to mandate bringing a carrying device? It is hard enough to get into half the homes in our areas with two bags and a monitor. If the patient needs to be moved, how will you know what the best way to do that is from outside the house?
Why not mandate a carrying device? two crew members = 4 hands, two bags + monitor = 1 crew member with a free hand, which would be perfect for a carrying device.

As for a clinical reason, not bringing in a carrying device delays diffinative care on patients who need one. Just because you bring in a carrying device (which can vary based on dispatch, but the old fashioned stairchair is my personal favorite, and we requested (and obtained approval from management) to keep both stairchairs on the truck for just this reason) doesn't mean you are going to use it; however, should you come across a patient who is experiencing a time sensitive emergency (stroke, stemi, etc), you can quickly wheel them outside to the truck, vs wasting time going out to the truck to get the device in questions, further delaying the patient access to definitive care
 

Tigger

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Why not mandate a carrying device? two crew members = 4 hands, two bags + monitor = 1 crew member with a free hand, which would be perfect for a carrying device.

As for a clinical reason, not bringing in a carrying device delays diffinative care on patients who need one. Just because you bring in a carrying device (which can vary based on dispatch, but the old fashioned stairchair is my personal favorite, and we requested (and obtained approval from management) to keep both stairchairs on the truck for just this reason) doesn't mean you are going to use it; however, should you come across a patient who is experiencing a time sensitive emergency (stroke, stemi, etc), you can quickly wheel them outside to the truck, vs wasting time going out to the truck to get the device in questions, further delaying the patient access to definitive care
Mandating something that is best left to critical thought is frankly something that low performing systems need to do. There is zero reason in our district to bring a stair chair in on every call. None. The minute "delay" associated with getting the proper equipment can and is used for assessment. Not to mention that using the right tool instead of the one you have is actually what is good for the patient.
 

StCEMT

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I ran into this exact situation this weekend. The time spent getting the appropriate device to get the patient out (not a stair chair) was used to clear the disaster of a room just to give us enough room to work so we could load her up. Bringing a stair chair still would have meant a trip back out.
 

Summit

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ABCs

Ambulate Before Carry
 

Jason Stopper

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The big issue is reimbursement. Walking to the ambulance is allowed but if a patient ambulates into the ER insurance may or may not reimburse and they won’t reimburse at ALS rates if a medic treated. I like the spirit of your thread and I like for a patient to ambulated if possible. Especially in tight confines and if the patient is on the heavier side and there are no other responders on scene. I think the biggest driver is reimbursement when patient walks into the ER. A plus of my agency is we have power stretchers and the power load system which are huge back savers. I love the Powerload system it’s a back and fatigue saver for sure!


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