How would you have dealt with this call???

[CheekyEMT]

I ran a call yesterday for a double pt transfer out of ICU and Cath Lab to an ICU in a hospital 2 hrs away. We were a 3 member crew and I was the only one providing pt care in the back. Pt 1 came out of Cath Lab . Diagnosis was pacemaker insertion. 91 yrs old, alert oriented, 92% spo2 on RA, monitors, IV"s , stable. Pt 2 came out of ICU,94 yrs old, pacemaker,spo2 94% RA, monitors, IV"s , agressive, dementia , CHF etc....vitals stable at initial time of transfer. Approx 30 min's into transfer PT 2 becomes ext agitated, aggressive , attempting to pull IV lines and pacemaker wires. Swearing , removing himself from stretcher harness etc, I got PT 2 calmed down and was relatively uneventful for rest of transfer, upon arrival at receiving facility pt 2 again becomes very aggressive and agitated, ICU staff and 2 member crew ( crew member 3 was transferring care of PT 1) have difficulty calming pt 2 down and getting PT transferred over to ICU staff. If this had been your call, how would you have dealt with this ?? There's a reason why I am asking but want to hear opinions. If you need more info let me know.

Crew member 1 (driver, 1 yr out of medic school), crew member 2 ( seasoned vet, over 25yrs in service) and me 18yrs of experience providing pt care for duration of transfer.

BTW , transfer was successful and both PT's arrived at the receiving facility very stable .

[Kaisu]

We will not transfer any patient with a psych diagnosis and history of aggression or violence without written orders for chemical restraints. Company policy is to refuse the transfer until orders are obtained.

[vs-eh?]

Questions...

1) Where do you work? I assume way north...

2) You normally work a 3 man crew or was this specific to this transfer?

3) Why were you the only one "providing pt. care"?

4) Since when do Ontario municipal 911 services do 2 patient transfers (or have 3 man crews)?

5) You have multiple monitors on your vehicles? Really? If not normally, and you took one from the hospital, why did you also not take an RN with it? Where did you put the second one?

6) Why was there no RN with you?

7) Why didn't another car/Ornge do one/both of these transfers?

Please answer in the same format.

[vs-eh?]

We will not transfer any patient with a psych diagnosis and history of aggression or violence without written orders for chemical restraints. Company policy is to refuse the transfer until orders are obtained.

This paramedic could have administered midazolam/diazapam for patient sedation, if he/she felt it was warranted.

Ontario paramedics don't work in the way you are suggesting Kaisu.

[CheekyEMT]

Questions...

1) Where do you work? I assume way north...

2) You normally work a 3 man crew or was this specific to this transfer?

3) Why were you the only one "providing pt. care"?

4) Since when do Ontario municipal 911 services do 2 patient transfers (or have 3 man crews)?

5) You have multiple monitors on your vehicles? Really? If not normally, and you took one from the hospital, why did you also not take an RN with it? Where did you put the second one?

6) Why was there no RN with you?

7) Why didn't another car/Ornge do one/both of these transfers?

Please answer in the same format.

1. I work in Ontario, north of Toronto.

2. NO, we are not normally a 3 man crew. Yesterday was an acception, there were 2 , 3 man crews for a 10 hr duration.

3. Why, was I the only one providing PT care, well, that has yet to be determined. Other 2 crew members were more interested in shooting the shit and told me if I needed any assistance to just holler....Ya, I was impressed.

4. Company I work for will run 2 pt transfers occasionally. personally this is the first 2 pt transfer I have run and questioned it prior to taking it.

5. We have 1 ambulance that will accommodate 2 pt's at a time. We got the call, dispatch requested a change of unit, we returned to base, changed units to accommodate both pt's.

6. As far as why there was no RN on this transfer, well you'd have to ask the sending facility. I run the calls, I don't arrange them. One monitor came from sending facility, other monitor was on board.

7. as far as Ornge goes, well, again, I can't answer that. I just run the call.....I would assume Ornge was not available at the time.

2 crew members are ACP, driver was PCP, I assume sending facility thought a 3 member crew with 2 ACP"s was acceptable to transfer these PT's without an RN.

[vs-eh?]

Is this how things are run outside of the GTA?

1) Refuse the transfer. Or request Ornge/another car.

2) Your ACP "partner" did not want to come in the back with you on a 2 hour transfer as you described? Hmmmmmm..... Sorry... Either people don't like you at all or..... actually I don't even know what the or is. Either way, why are you putting up with that?

3) The sending hospital gave you a monitor (that you have to return) and not an RN? HUGE NONO! You knew how to use this monitor to its full capacity? Basically all hospitals that I know don't have/use LP12 or Zoll E for their transport monitors. You are setting yourself up for DISASTER!

And the "I just run the call" thing? Sorry.... I'm a pretty liberal paramedic when it comes to patient treatement/scope/doing this that may be "outside the box" but this one has way too many things that would screw you....

It bothers me that you even took this transfer on many levels.

[CheekyEMT]

Is this how things are run outside of the GTA?

1) Refuse the transfer. Or request Ornge/another car.

2) Your ACP "partner" did not want to come in the back with you on a 2 hour transfer as you described? Hmmmmmm..... Sorry... Either people don't like you at all or..... actually I don't even know what the or is. Either way, why are you putting up with that?

3) The sending hospital gave you a monitor (that you have to return) and not an RN? HUGE NONO! You knew how to use this monitor to its full capacity? Basically all hospitals that I know don't have/use LP12 or Zoll E for their transport monitors. You are setting yourself up for DISASTER!

And the "I just run the call" thing? Sorry.... I'm a pretty liberal paramedic when it comes to patient treatement/scope/doing this that may be "outside the box" but this one has way too many things that would screw you....

It bothers me that you even took this transfer on many levels.

When you're dealing with a superior that has been with the company yr's longer then you have, you do what you're told, is expected of you. It's not a matter or whether or not the other crew member "liked" me, he looked at the 3 man crew as his opportunity to kick back and relax. I dealt with all PT's that day by myself, not just this transfer. Also take into consideration there is very limited space with 2 pt's in the back. Sending facility is located in the same city as our base and knew the monitor would be returned. His exact words to me were" document everything". Nevermind this call, the other ACP on this call is a jerk, I don't like him at all or the way he works. However, he was my superior for 10 hrs yesterday and I, like it or not had to do what I was told. If it had just been me and the driver I would not have taken this call, however I had no say in the matter.

I am simply asking how "you" referring to anyone on this board would have dealt with this call....not whether or not they way I treated the pt's during transfer was acceptable or whether or not the company I work for should have taken the call and not referred it to Ornge. IMO , obviously I did something right, both Pt's arrived at the receiving facility in stable condition. The way one company , municipality operates is not necessarily the way another company or municipality will operate. Northern Ontario operations are much more limited then other services, and yes, I do believe as a result are given and take calls that we should not . I do not run calls in the GTA.....I work North of Toronto, over an hour north of Toronto.

for those of you south of the border Ornge is our provincial air ambulance.

[AnthonyM83]

If the problem started unexpectedly once I was en-route, I'd have to judge whether the patient was coherent and oriented and of sound mind to make his own decisions. With an O2 sat that low, recent surgery, and possibly other meds interacting, etc etc, I'd probably say he wasn't. Simple four point restraints if trying to calm how down doesn't work and if leaving him loose would cause more harm to him or others (versus the harm from applying the restraints both exertionally to him and me).

[HellsBells]

When you're dealing with a superior that has been with the company yr's longer then you have, you do what you're told, is expected of you. It's not a matter or whether or not the other crew member "liked" me, he looked at the 3 man crew as his opportunity to kick back and relax. I dealt with all PT's that day by myself, not just this transfer. Also take into consideration there is very limited space with 2 pt's in the back. Sending facility is located in the same city as our base and knew the monitor would be returned. His exact words to me were" document everything". Nevermind this call, the other ACP on this call is a jerk, I don't like him at all or the way he works. However, he was my superior for 10 hrs yesterday and I, like it or not had to do what I was told. If it had just been me and the driver I would not have taken this call, however I had no say in the matter.

I am simply asking how "you" referring to anyone on this board would have dealt with this call....not whether or not they way I treated the pt's during transfer was acceptable or whether or not the company I work for should have taken the call and not referred it to Ornge. IMO , obviously I did something right, both Pt's arrived at the receiving facility in stable condition. The way one company , municipality operates is not necessarily the way another company or municipality will operate. Northern Ontario operations are much more limited then other services, and yes, I do believe as a result are given and take calls that we should not . I do not run calls in the GTA.....I work North of Toronto, over an hour north of Toronto.

It sounds like you did a good job getting the patients to the receiving facility, and that you're proud of that accomplishment (as you should be), so I'm not really sure what the question is that you're asking.

However, it sounds like you are being taken advantage of by the hospital and your "senior" co-worker. Why on earth do you let people treat you in this manner? Taking a dual patient transfer, when one is going to the ICU is a recipe for disaster. I can guarantee that the hospital and your company have guidelines on transporting critical patients, and I highly doubt dual transport is one of them. You also said in your opening post that this guy had a history of dementia and aggressiveness. Are you or either of your patients best served being stuffed into the back of a small ambulance together?

I commend you on the fact that you handled the situation well once the transport was rolling. But why put yourself in that position to begin with?

[CheekyEMT]

I get that most of you would not have taken this transfer. I also get that you wouldn't let another crew member "push" you around. That is just the way this medic is when it comes to women. There are only 4 of us (women) working from this base, rest are all guys and we currently have 6 units on the rd all the time. There is not 1 other female that works there that has anything good to say about this particular medic because of the way he treats the females. He is arrogant and has a big head. He's one of those medic's that thinks he's god. I said my peace after the transfer was done and let him know my position with him and the call. If I complained about the way he worked with me that day I'd be looked at by everyone else at the base as a whining b**ch. And because of his seniority my complaint wouldn't matter. He made a comment the other day about how the "woman are invading our space". Simply put, he doesn't want us there, he doesn't wanna work with us, and if he has to he's gonna bust our asses and save his .