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Yeah, I truly do get everyone's point. Perhaps I read more into this than anyone in fact, but I was trying to take a devil's advocate, 'what if' stance simply for the mental gymnastics it might provide. Fiz is partially right, that there isn't enough information. Wrong, in my opinion that this thread is useless. I think it's been a very valuable thread if for no other reason than a bunch of hard headed providers have shown enough respect to debate each other. I've learned a lot about the opinions of other providers from different places and levels from their responses here. So for me, this CAN be a no brainer. I show up and there is a gurney with some white coated folks talking to a patient not far from the ER doors. I help them load and strap the patient and away they go. I report a 'no contact, no medical needed' and be glad I got another call that didn't require me to decon the entire truck. I don't see the abandonment here if a higher level of care has already made contact. Now, bump them back 15 seconds, so that I've made contact, have begun my interview, and the level of provider becomes very significant. Is the right thing to do to turn this patient over to whoever is going to get them through the doors fastest the RIGHT thing to do? Of course it is. But what happens when this patient is taken indoors, assessed and found to be having a life threatening MI, he's left with deficits, calls his lawyers and then my boss' lawyer wants to know why I handed an active MI over to two security guards with a gurney at the hospital? We all know how that story will end, right? How far will 'doing the right thing' go in covering my ass? Hopefully most know that I've never been, and continue not to be a cover your ass first provider. The thing that stuck in my craw here, and being a medic instead of an in hospital provider is perhaps the reason that the Doc and I see this differently, is the comment, "you can come in and get the information you need." Though his, "your missing my point' comment certainly comes off as territorial and a bit arrogant, the previous statement seems to say, "Fuck you and your obligations, you're just driving the ambulance." I would not be offended by that as a medic, but would certainly get my back up if I thought that the ER's arrogant attitude would/could lead to me getting jammed up and being unable to provide for my family. It would be nice to have the full story. I've not been offended by any comments, but was disappointed that there seemed to be no effort to try and flesh this issue out for this kid. (I say 'kid' as the presentation sounds younger, though I have no idea how old s/he might be.) Most of the important answers I've ever been given in my career were received because someone was smart enough to know what I needed to hear despite my not being smart enough to know the right questions to ask. Maybe what it boils down to is who actually made contact first? If the OP was dispatched to this call, then s/he had a duty to act. If he in fact made first contact then he had an obligation to transfer care to a higher level of certification. If he was dispatched, and if he made first contact, and if he doesn't have a significant amount of experience, then I can easily see where this call would be confusing for him. Was this a complicated situation? It appears that it may have been for him...so it doesn't really matter how black and white it was to everyone else, does it? I'm back to doing remote/clinical stuff now, which always tends to make me feel like my whole crews mother...it's likely in that spirit that I'm making a much bigger deal out of this than needs be...but that's ok...I can take it... :-) Thanks for your thoughts everyone. Doc, sorry for the snotty tone in my response to you. It was meant to be kind of tongue in cheek aggressiveness but doesn't read that way to me upon review. You are a gift to us here...I certainly had no reason not to take the time to phrase things differently than I did. Have a great day all! I look forward to your thoughts! Dwayne Edited to ad a missing word. No significant changes made.

Obviously, that would be decided by those in power in a local jurisdiction.

Dwayne, I think it's the lack of looking at the bigger picture that bothers me in this case. What the OP wanted was for the ED staff to transfer care to him....then him transfer care right back to the ED. Why does he wish to act as the middle man? Unless they were a couple of blocks from the ED, doing anything would be a waste of time (are you going to sit in the ED driveway and perform interventions?). As far as the respect issue, respect is earned. Actions like the one above don't do anything to earn respect, in fact they do the opposite. Despite our "upside down in a ditch" bluster, there are few experienced ED nurses that wouldn't be able to operate in the average (like this one) EMS environment. Showing respect towards other healthcare providers (even the dreaded nursing home staff) and showing you know your stuff goes alot farther than Eric Cartman style displays.

There are parts of this story missing so assupmtions have been made by many, but that isn't inappropriate. Several people have talked about the OP turning over care to the hospital staff. Why would the OP need to turn over care. The hospital staff were the first ones on the scene so they would need to turn over care to the EMS crew. Dwayne, as for people criticizing the OP and not making this educational, it is probably because of the last comment that he made about getting back into the ambulance and leaving. It doesn't sound as if he came here to have a discussion, rather to bash a situation he didn't like because of an ego issue. Had he asked what was the proper thing to do or just ask what others would do, it might have gone a lot differently. It's all in the presentation. As has been said about writting PCRs, it's about painting a picture and the picture here was not one of looking for advice but more of a bruised ego. I would have no problem with an extra set of hands so I would be more than happy to have the OP help. Yes, I have assumed that the pt is within EMTALA range of the ER. In that case, the federal goverment has decided to put the burdon on the hospital so it just makes since for them to take control. Yes, I have also assumed that we are dealing with nurses going out to get the pt. Sure, it may have just been ER techs but it's pretty irrelevant. The pt needs to get into the ER. Instead of getting offended that things didn't go his way, the OP could have simply said, "Hey, I'll give you a hand getting him into the ER." He could have gone in and simply turned over the pt to the triage nurse by saying, "This guy was outside and your guys were getting him on the strecher before we got there. I don't know much else because I have been with the guy for all of 30 seconds and felt it would be better to get him in here than waste time outside." Once he is on the hospital grounds, according to CMS/EMTALA, he is the hospitals responsibility and as long as you have told someone about him, you have done your job.

And you are presumably a professional healthcare provider that should know how to frame and explain your comments. The bullshit 'holier than thou' comment doesn't really work here brother. What is your point? What was unprofessional? Why do you feel that it is so? What could have been done differently? I'm to assume I guess that your simple comments mean that you're jumping on board with the majority, perhaps that's why you believed that they needed no explanation? I've been in hospitals, as have just about everyone I know, where 'the corner' could have been a quarter mile from the ER doors. I'm willing to bet the ER heard this call, got tired of waiting for an ambulance and ran out to 'do the right thing.' Do you suppose that they had O2 on their cot? ASA? What if the syncope was secondary to an active MI? What do you suppose would be the mental state of a person being dragged across the parking lot on a stretcher as opposed to in an enclosed ambulance? What if the 'syncope' was actually and arrest? Are you still going to allow them to tell you to put the body on the stretcher or are you going to take control and work it in your ambulance? It's easy to be cocky and sure when there are only a few details. And I'm sure that this is going to turn out to be a time when they were a few feet from the ER doors and the OP is off in the ditch. But until that becomes clear, I can see a ton of scenarios where trying to take control of this situation, and this patient, was the right thing to do. (Of course a bunch of wrongs reasons too, but where's the fun in that?) Dwayne