Re: EMS operations question

[Guest guest]

Shane,

You say only one ambulance was on scene, but were any more available? If so, I

would have recommended another unit be called out for the adult MC rider.

I personally would never delay transport for a " possible " transport. Another

thought, was the adult confused or just undecided? Was the MOI indicative of

possible head trauma? If so, he really should have his own unit as you never

know if his condition might deteriorate.

Then you also have the possible HIPPA and ethical violations of having a minor

and adult transported together, not both related or from the same vehicle.

Over all, I don't think it was a good idea to take them both, but let's let the

councilors weigh in on this.

Sent from my iPhone

McGee, EMT-P

N5SHY

1982 CB900C

> The scenario:

> 3 vehicle MVC, one of the vehicles is a motorcycle. No critical injuries

reported. One of the occupants of a car would like her minor child transported

to the hospital for evaluation. The rider of the motorcycle is indecisive about

being transported by EMS. The child is packaged and is secured in the ambulance,

ready for transport. Only one ambulance is on scene which is staffed by a Medic

and EMT-I. FD is on scene with multiple EMT-B personnel but the FD does not

perform refusal: this is managed by the provider. Delay of transport secondary

to the indecisive adult.

>

> Question: Is there any state or federal code, statute, or law that is being

violated secondary to a delayed transport? My assumption is that common accepted

standards are not being upheld given this scenario.

>

> The scenario progresses:

> The adult finally decides to go to the hospital and is placed in the same

ambulance as the minor who was in a different vehicle. The parents of the minor

requested they transport their child to one hospital while the adult requested

to be transported to a different hospital.

>

> Questions: Is there any EMTALA violation once both patients arrive on the

property of the first reached destination? Does this set the transport personnel

up for HIPPA violation secondary to " strangers " being assessed in the presence

of each other?

>

> Post scenario management discussion: It's okay to transport them both in the

same ambulance because they were both non-critical in condition plus, that's

what we have always done.

>

> The trap: That's what we have always done!

>

> (In this organization) There is no clear policy or operating guideline to

uphold neither field making decisions nor management's philosophy of their

history when tasked with these scenarios.

> A suggestion of creating a guideline was blown off by management and the medic

was verbally reprimanded for not wanting to delay transport of the minor because

a competent adult could not make a decision. Any advice would be gratefully

appreciated.

>

>

[Guest guest]

Shane,

You say only one ambulance was on scene, but were any more available? If so, I

would have recommended another unit be called out for the adult MC rider.

I personally would never delay transport for a " possible " transport. Another

thought, was the adult confused or just undecided? Was the MOI indicative of

possible head trauma? If so, he really should have his own unit as you never

know if his condition might deteriorate.

Then you also have the possible HIPPA and ethical violations of having a minor

and adult transported together, not both related or from the same vehicle.

Over all, I don't think it was a good idea to take them both, but let's let the

councilors weigh in on this.

Sent from my iPhone

McGee, EMT-P

N5SHY

1982 CB900C

> The scenario:

> 3 vehicle MVC, one of the vehicles is a motorcycle. No critical injuries

reported. One of the occupants of a car would like her minor child transported

to the hospital for evaluation. The rider of the motorcycle is indecisive about

being transported by EMS. The child is packaged and is secured in the ambulance,

ready for transport. Only one ambulance is on scene which is staffed by a Medic

and EMT-I. FD is on scene with multiple EMT-B personnel but the FD does not

perform refusal: this is managed by the provider. Delay of transport secondary

to the indecisive adult.

>

> Question: Is there any state or federal code, statute, or law that is being

violated secondary to a delayed transport? My assumption is that common accepted

standards are not being upheld given this scenario.

>

> The scenario progresses:

> The adult finally decides to go to the hospital and is placed in the same

ambulance as the minor who was in a different vehicle. The parents of the minor

requested they transport their child to one hospital while the adult requested

to be transported to a different hospital.

>

> Questions: Is there any EMTALA violation once both patients arrive on the

property of the first reached destination? Does this set the transport personnel

up for HIPPA violation secondary to " strangers " being assessed in the presence

of each other?

>

> Post scenario management discussion: It's okay to transport them both in the

same ambulance because they were both non-critical in condition plus, that's

what we have always done.

>

> The trap: That's what we have always done!

>

> (In this organization) There is no clear policy or operating guideline to

uphold neither field making decisions nor management's philosophy of their

history when tasked with these scenarios.

> A suggestion of creating a guideline was blown off by management and the medic

was verbally reprimanded for not wanting to delay transport of the minor because

a competent adult could not make a decision. Any advice would be gratefully

appreciated.

>

>

[Guest guest]

A lot of this is going to come down to a " reasonable person " standard, rather

then anything cut and dry. There are a lot of problems with the scenario you

describe, but each one of them can be negated by an outside (and undiscussed)

factor. I can see a lot of situations where I would do something similar, but it

would be out of necessity rather then convenience.

My PRIMARY concern is the concept of transporting two patients to two different

hospitals in the same unit. I cannot conceive of a situation where this is

appropriate: the closest I can imagine would be involving transport of

pediatric/adult to their respective trauma centers. In which case, you probably

shouldn't be transporting two patients. Both patients go to the same hospital;

if the hospital of choice isn't appropriate for one or both, you get them a

separate ride or take them both to an appropriate facility. I wouldn't be

concerned about EMTALA (as it regulates hospitals, not ambulances) but that

doesn't make it less of a dumb idea.

There are a couple other potential hiccups with the scenario as well that you're

ignoring. Is it abandonment for the paramedic to evaluate the M/C rider and then

leave with another patient without a refusal, as s/he's now leaving care in the

hands of EMT-Bs (a lower level of care)? I don't really see a problem with it,

but I'm not a plaintiff's attorney.

Ultimately though, if you're looking for justification for past actions, it

really doesn't matter. I've seen some really piss-poor boneheaded decisions made

by managers, and you're stuck with them. Even in the face of overwhelming

contradictory evidence, they may stick to their guns. Before there was the 99%,

there was the 10%.

Austin

> Shane,

> You say only one ambulance was on scene, but were any more available? If so, I

would have recommended another unit be called out for the adult MC rider.

> I personally would never delay transport for a " possible " transport. Another

thought, was the adult confused or just undecided? Was the MOI indicative of

possible head trauma? If so, he really should have his own unit as you never

know if his condition might deteriorate.

> Then you also have the possible HIPPA and ethical violations of having a minor

and adult transported together, not both related or from the same vehicle.

> Over all, I don't think it was a good idea to take them both, but let's let

the councilors weigh in on this.

>

> Sent from my iPhone

> McGee, EMT-P

> N5SHY

> 1982 CB900C

>

>

>

> > The scenario:

> > 3 vehicle MVC, one of the vehicles is a motorcycle. No critical injuries

reported. One of the occupants of a car would like her minor child transported

to the hospital for evaluation. The rider of the motorcycle is indecisive about

being transported by EMS. The child is packaged and is secured in the ambulance,

ready for transport. Only one ambulance is on scene which is staffed by a Medic

and EMT-I. FD is on scene with multiple EMT-B personnel but the FD does not

perform refusal: this is managed by the provider. Delay of transport secondary

to the indecisive adult.

> >

> > Question: Is there any state or federal code, statute, or law that is being

violated secondary to a delayed transport? My assumption is that common accepted

standards are not being upheld given this scenario.

> >

> > The scenario progresses:

> > The adult finally decides to go to the hospital and is placed in the same

ambulance as the minor who was in a different vehicle. The parents of the minor

requested they transport their child to one hospital while the adult requested

to be transported to a different hospital.

> >

> > Questions: Is there any EMTALA violation once both patients arrive on the

property of the first reached destination? Does this set the transport personnel

up for HIPPA violation secondary to " strangers " being assessed in the presence

of each other?

> >

> > Post scenario management discussion: It's okay to transport them both in the

same ambulance because they were both non-critical in condition plus, that's

what we have always done.

> >

> > The trap: That's what we have always done!

> >

> > (In this organization) There is no clear policy or operating guideline to

uphold neither field making decisions nor management's philosophy of their

history when tasked with these scenarios.

> > A suggestion of creating a guideline was blown off by management and the

medic was verbally reprimanded for not wanting to delay transport of the minor

because a competent adult could not make a decision. Any advice would be

gratefully appreciated.

> >

> >

>

>

[Guest guest]

A lot of this is going to come down to a " reasonable person " standard, rather

then anything cut and dry. There are a lot of problems with the scenario you

describe, but each one of them can be negated by an outside (and undiscussed)

factor. I can see a lot of situations where I would do something similar, but it

would be out of necessity rather then convenience.

My PRIMARY concern is the concept of transporting two patients to two different

hospitals in the same unit. I cannot conceive of a situation where this is

appropriate: the closest I can imagine would be involving transport of

pediatric/adult to their respective trauma centers. In which case, you probably

shouldn't be transporting two patients. Both patients go to the same hospital;

if the hospital of choice isn't appropriate for one or both, you get them a

separate ride or take them both to an appropriate facility. I wouldn't be

concerned about EMTALA (as it regulates hospitals, not ambulances) but that

doesn't make it less of a dumb idea.

There are a couple other potential hiccups with the scenario as well that you're

ignoring. Is it abandonment for the paramedic to evaluate the M/C rider and then

leave with another patient without a refusal, as s/he's now leaving care in the

hands of EMT-Bs (a lower level of care)? I don't really see a problem with it,

but I'm not a plaintiff's attorney.

Ultimately though, if you're looking for justification for past actions, it

really doesn't matter. I've seen some really piss-poor boneheaded decisions made

by managers, and you're stuck with them. Even in the face of overwhelming

contradictory evidence, they may stick to their guns. Before there was the 99%,

there was the 10%.

Austin

> Shane,

> You say only one ambulance was on scene, but were any more available? If so, I

would have recommended another unit be called out for the adult MC rider.

> I personally would never delay transport for a " possible " transport. Another

thought, was the adult confused or just undecided? Was the MOI indicative of

possible head trauma? If so, he really should have his own unit as you never

know if his condition might deteriorate.

> Then you also have the possible HIPPA and ethical violations of having a minor

and adult transported together, not both related or from the same vehicle.

> Over all, I don't think it was a good idea to take them both, but let's let

the councilors weigh in on this.

>

> Sent from my iPhone

> McGee, EMT-P

> N5SHY

> 1982 CB900C

>

>

>

> > The scenario:

> > 3 vehicle MVC, one of the vehicles is a motorcycle. No critical injuries

reported. One of the occupants of a car would like her minor child transported

to the hospital for evaluation. The rider of the motorcycle is indecisive about

being transported by EMS. The child is packaged and is secured in the ambulance,

ready for transport. Only one ambulance is on scene which is staffed by a Medic

and EMT-I. FD is on scene with multiple EMT-B personnel but the FD does not

perform refusal: this is managed by the provider. Delay of transport secondary

to the indecisive adult.

> >

> > Question: Is there any state or federal code, statute, or law that is being

violated secondary to a delayed transport? My assumption is that common accepted

standards are not being upheld given this scenario.

> >

> > The scenario progresses:

> > The adult finally decides to go to the hospital and is placed in the same

ambulance as the minor who was in a different vehicle. The parents of the minor

requested they transport their child to one hospital while the adult requested

to be transported to a different hospital.

> >

> > Questions: Is there any EMTALA violation once both patients arrive on the

property of the first reached destination? Does this set the transport personnel

up for HIPPA violation secondary to " strangers " being assessed in the presence

of each other?

> >

> > Post scenario management discussion: It's okay to transport them both in the

same ambulance because they were both non-critical in condition plus, that's

what we have always done.

> >

> > The trap: That's what we have always done!

> >

> > (In this organization) There is no clear policy or operating guideline to

uphold neither field making decisions nor management's philosophy of their

history when tasked with these scenarios.

> > A suggestion of creating a guideline was blown off by management and the

medic was verbally reprimanded for not wanting to delay transport of the minor

because a competent adult could not make a decision. Any advice would be

gratefully appreciated.

> >

> >

>

>

[Guest guest]

Well, this is something new to me. NEVER came across having to transport to two

diferent facilities, much less, transport patients from two separate vehicles.

Just my opinion: IMMEDIATELY if I know the possibility of more than one patient-

in separate vehicles-  " may "  be transported, I would call the appropriate number

of unit(s) to respond accordingly, and not delay transport. MCI- TRIAGE-whatever

name you want to label it, use your resources available to you.

 

I hope this was helpful..............................................  

 

>

> > The scenario:

> > 3 vehicle MVC, one of the vehicles is a motorcycle. No critical injuries

reported. One of the occupants of a car would like her minor child transported

to the hospital for evaluation. The rider of the motorcycle is indecisive about

being transported by EMS. The child is packaged and is secured in the ambulance,

ready for transport. Only one ambulance is on scene which is staffed by a Medic

and EMT-I. FD is on scene with multiple EMT-B personnel but the FD does not

perform refusal: this is managed by the provider. Delay of transport secondary

to the indecisive adult.

> >

> > Question: Is there any state or federal code, statute, or law that is being

violated secondary to a delayed transport? My assumption is that common accepted

standards are not being upheld given this scenario.

> >

> > The scenario progresses:

> > The adult finally decides to go to the hospital and is placed in the same

ambulance as the minor who was in a different vehicle. The parents of the minor

requested they transport their child to one hospital while the adult requested

to be transported to a different hospital.

> >

> > Questions: Is there any EMTALA violation once both patients arrive on the

property of the first reached destination? Does this set the transport personnel

up for HIPPA violation secondary to " strangers " being assessed in the presence

of each other?

> >

> > Post scenario management discussion: It's okay to transport them both in the

same ambulance because they were both non-critical in condition plus, that's

what we have always done.

> >

> > The trap: That's what we have always done!

> >

> > (In this organization) There is no clear policy or operating guideline to

uphold neither field making decisions nor management's philosophy of their

history when tasked with these scenarios.

> > A suggestion of creating a guideline was blown off by management and the

medic was verbally reprimanded for not wanting to delay transport of the minor

because a competent adult could not make a decision. Any advice would be

gratefully appreciated.

> >

> >

>

>

[Guest guest]

If you live where there is an ambulance or more on every corner, it is good to

have separate ambulances for transports, but in several places that I have

worked another ambulance is >20 minutes away if they are not busy or the weather

is good.  If the next service is busy or there is snow and ice, you will do

what you have to for all of your patients!  And yes I have transported patients

out of 2 different vehicles to the hospitals and had transports of these

patients to separate hospitals.  I currently work in an area where the next

service one way is 20 minutes on a good day and the service the other way is 45

minutes.  Every call and area is different.

________________________________

To: texasems-l

Sent: Friday, November 25, 2011 11:31 PM

Subject: Re: EMS operations question

 

Well, this is something new to me. NEVER came across having to transport to two

diferent facilities, much less, transport patients from two separate vehicles.

Just my opinion: IMMEDIATELY if I know the possibility of more than one patient-

in separate vehicles-  " may "  be transported, I would call the appropriate

number of unit(s) to respond accordingly, and not delay transport. MCI-

TRIAGE-whatever name you want to label it, use your resources available to you.

 

I hope this was helpful..............................................  

 

>

> > The scenario:

> > 3 vehicle MVC, one of the vehicles is a motorcycle. No critical injuries

reported. One of the occupants of a car would like her minor child transported

to the hospital for evaluation. The rider of the motorcycle is indecisive about

being transported by EMS. The child is packaged and is secured in the ambulance,

ready for transport. Only one ambulance is on scene which is staffed by a Medic

and EMT-I. FD is on scene with multiple EMT-B personnel but the FD does not

perform refusal: this is managed by the provider. Delay of transport secondary

to the indecisive adult.

> >

> > Question: Is there any state or federal code, statute, or law that is being

violated secondary to a delayed transport? My assumption is that common accepted

standards are not being upheld given this scenario.

> >

> > The scenario progresses:

> > The adult finally decides to go to the hospital and is placed in the same

ambulance as the minor who was in a different vehicle. The parents of the minor

requested they transport their child to one hospital while the adult requested

to be transported to a different hospital.

> >

> > Questions: Is there any EMTALA violation once both patients arrive on the

property of the first reached destination? Does this set the transport personnel

up for HIPPA violation secondary to " strangers " being assessed in the presence

of each other?

> >

> > Post scenario management discussion: It's okay to transport them both in the

same ambulance because they were both non-critical in condition plus, that's

what we have always done.

> >

> > The trap: That's what we have always done!

> >

> > (In this organization) There is no clear policy or operating guideline to

uphold neither field making decisions nor management's philosophy of their

history when tasked with these scenarios.

> > A suggestion of creating a guideline was blown off by management and the

medic was verbally reprimanded for not wanting to delay transport of the minor

because a competent adult could not make a decision. Any advice would be

gratefully appreciated.

> >

> >

>

>

[Guest guest]

Slightly different and I know you were looking more at the technical

aspects of it but there was uproar here locally (non US - Ireland) a few

years ago when one ambulance transported two from the one MVA. One was the

driver at fault and the other was from the vehicle he collided with. She

was critical and later died, he was walking with minor injuries. Local

politicians etc were in uproar.

Owing to numerous incidents similar all our ambulances are only one

stretcher only. EU CEN requirements state one patient but governments are

not obliged to implement them, however ours has based on the issues like

the above. in MVAs there would be strictly one patient / ambulance but

occasionally walking wounded would be taken as second person from Sports

grounds etc.

> **

>

>

> If you live where there is an ambulance or more on every corner, it is

> good to have separate ambulances for transports, but in several places that

> I have worked another ambulance is >20 minutes away if they are not busy or

> the weather is good. If the next service is busy or there is snow and ice,

> you will do what you have to for all of your patients! And yes I have

> transported patients out of 2 different vehicles to the hospitals and had

> transports of these patients to separate hospitals. I currently work in an

> area where the next service one way is 20 minutes on a good day and the

> service the other way is 45 minutes. Every call and area is different.

>

> ________________________________

>

> To: texasems-l

> Sent: Friday, November 25, 2011 11:31 PM

>

> Subject: Re: EMS operations question

>

>

>

> Well, this is something new to me. NEVER came across having to transport

> to two diferent facilities, much less, transport patients from two separate

> vehicles. Just my opinion: IMMEDIATELY if I know the possibility of more

> than one patient- in separate vehicles- " may " be transported, I would call

> the appropriate number of unit(s) to respond accordingly, and not delay

> transport. MCI- TRIAGE-whatever name you want to label it, use your

> resources available to you.

>

> I hope this was helpful..............................................

>

>

>

>

> >

> > > The scenario:

> > > 3 vehicle MVC, one of the vehicles is a motorcycle. No critical

> injuries reported. One of the occupants of a car would like her minor child

> transported to the hospital for evaluation. The rider of the motorcycle is

> indecisive about being transported by EMS. The child is packaged and is

> secured in the ambulance, ready for transport. Only one ambulance is on

> scene which is staffed by a Medic and EMT-I. FD is on scene with multiple

> EMT-B personnel but the FD does not perform refusal: this is managed by the

> provider. Delay of transport secondary to the indecisive adult.

> > >

> > > Question: Is there any state or federal code, statute, or law that is

> being violated secondary to a delayed transport? My assumption is that

> common accepted standards are not being upheld given this scenario.

> > >

> > > The scenario progresses:

> > > The adult finally decides to go to the hospital and is placed in the

> same ambulance as the minor who was in a different vehicle. The parents of

> the minor requested they transport their child to one hospital while the

> adult requested to be transported to a different hospital.

> > >

> > > Questions: Is there any EMTALA violation once both patients arrive on

> the property of the first reached destination? Does this set the transport

> personnel up for HIPPA violation secondary to " strangers " being assessed in

> the presence of each other?

> > >

> > > Post scenario management discussion: It's okay to transport them both

> in the same ambulance because they were both non-critical in condition

> plus, that's what we have always done.

> > >

> > > The trap: That's what we have always done!

> > >

> > > (In this organization) There is no clear policy or operating guideline

> to uphold neither field making decisions nor management's philosophy of

> their history when tasked with these scenarios.

> > > A suggestion of creating a guideline was blown off by management and

> the medic was verbally reprimanded for not wanting to delay transport of

> the minor because a competent adult could not make a decision. Any advice

> would be gratefully appreciated.

> > >

> > >

> >

> >

[Guest guest]

I would have serious reservations about as the two patient - two hospital - one

ambulance paradigm, even in a situation where the next ambulance is years away..

If something were to occur on the " second " transport (from the first hospital to

the second), it would be a nightmare to defend against. Even if provider's

clinical judgement is 100% (thus the patient has no negative outcome due to the

delay of " definitive care " ), what if you were involved in an MVA en route and

the patient was further (or actually, in the case of a " check up " ) injured?

That's a loser, in my opinion.

One ambulance - one destination. You can load them up like a clown car, for all

I care, because sometimes that is " best practices " depending on your specific

situation, but I can't see any defense for not taking them to the first hospital

that is appropriate for all of them.

Austin

> If you live where there is an ambulance or more on every corner, it is good to

have separate ambulances for transports, but in several places that I have

worked another ambulance is >20 minutes away if they are not busy or the weather

is good. If the next service is busy or there is snow and ice, you will do what

you have to for all of your patients! And yes I have transported patients out

of 2 different vehicles to the hospitals and had transports of these patients to

separate hospitals. I currently work in an area where the next service one way

is 20 minutes on a good day and the service the other way is 45 minutes. Every

call and area is different.

>

>

[Guest guest]

This forum is easy to say a lot of things that may not work when your

supervisors tell you to do something (i.e. load 2 patients and take them to 2

hospitals on transfers) or in a snow storm getting patients from

2 separate vehicles out of the weather. Yes you can say no, but you should be

prepared to seek other employment very soon in a different area without a

recommendation!  

________________________________

To: texasems-l

Sent: Tuesday, November 29, 2011 3:06 AM

Subject: Re: EMS operations question

 

I would have serious reservations about as the two patient - two hospital - one

ambulance paradigm, even in a situation where the next ambulance is years away..

If something were to occur on the " second " transport (from the first hospital to

the second), it would be a nightmare to defend against. Even if provider's

clinical judgement is 100% (thus the patient has no negative outcome due to the

delay of " definitive care " ), what if you were involved in an MVA en route and

the patient was further (or actually, in the case of a " check up " ) injured?

That's a loser, in my opinion.

One ambulance - one destination. You can load them up like a clown car, for all

I care, because sometimes that is " best practices " depending on your specific

situation, but I can't see any defense for not taking them to the first hospital

that is appropriate for all of them.

Austin

> If you live where there is an ambulance or more on every corner, it is good to

have separate ambulances for transports, but in several places that I have

worked another ambulance is >20 minutes away if they are not busy or the weather

is good. If the next service is busy or there is snow and ice, you will do what

you have to for all of your patients! And yes I have transported patients out

of 2 different vehicles to the hospitals and had transports of these patients to

separate hospitals. I currently work in an area where the next service one way

is 20 minutes on a good day and the service the other way is 45 minutes. Every

call and area is different.

>

>