Pt vs Medic knowledge of ER services

[brentoli]

That statement is not always the case, per state protocols. In MS, with the exeption of trauma, a pt has the right to ask to be transported to any hospital they want that is inside the services transport radius, reguardless of the appropriateness of the choice. If you for force a pt to go to a hospital they do not want to, you can be charged with kidnapping. The only way around this is to have online direction telling you to go to a particular hospital. As long as the pt is A/O, you typically won't get those orders though.

I don't have our protocols infront of me to quote, but they read similar. I am sure many places do as well. If you live in a metro area with 5+ hospitals, I can see this being an issue. However, if you are in a town with two hospitals, and your chest pain patient wants to go to hospital A which is 2 miles farther than hospital B what right do you have to tell them no?

As far as the article goes, they are selling magazines, its filler material. Readers Digest isn't the Paramedic Digest, its demo is the 50+ age group. You can't read too much into what its saying. I doubt that one article is going to have a wide spread effect on our care.

[Richard B the EMT]

Sometimes it is NOT the patient or their family. Prior to the EMS FDNY merger, this incident happened. The EMS Lieutenant is a friend of mine. The now former mayor never was.

http://www.nytimes.com/1993/12/16/nyregion/giuliani-challenges-ems-at-accident.html?pagewanted=1

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<h1 class="articleHeadline">Giuliani Challenges E.M.S. at Accident

By STEVEN LEE MYERS

Published: December 16, 1993

Mayor-elect Rudolph W. Giuliani found himself hailed as a hero and assailed as a meddler yesterday over his actions -- and his choice of language -- during an angry confrontation with a lieutenant of the New York City Emergency Medical Service at the scene of a car accident on Tuesday morning.

The confrontation occurred when Mr. Giuliani intervened in a dispute between paramedics and the mother of a teen-age boy who had been hit by a taxi over whether to take the injured boy to Columbia-Presbyterian Medical Center, as the woman wanted, or to New York Hospital, which was closer.

Appearing eager to talk about the incident yesterday, Mr. Giuliani portrayed it as a demonstration of the sort of hands-on, no-nonsense approach that he as Mayor would take to shake up the city's bureaucracies.

He said he challenged the lieutenant, James Ayuso, for resisting the woman's "perfectly reasonable request" and leaving the boy "shivering on the ground" while arguing for 10 minutes before acquiesing.

Criticized by Union

"The E.M.S. worker was not exercising appropriate judgment here, nor was he was he acting in the way you or I would like to see people working for the City of New York act towards its citizens," Mr. Giuliani said. "This was a woman in distress with her child crying next to her. He was making matters worse and arguing with her."

But Eric S. Mitchell, the vice president of the union representing the service's officers, harshly criticized the Mayor-elect's actions, accusing him of interfering with the work of the paramedics when he had no authority or expertise to do so.

"Would he, at a bank robbery, turn around and tell a police lieutenant to do this, this and this?" Mr. Mitchell said. "Would he do it to a fire lieutenant? The answer is no. And he shouldn't do it to an E.M.S. lieutenant."

Mr. Mitchell also said Mr. Giuliani used foul language, cursing the lieutenant and obscenely asked him "to get out of his face." Mr. Giuliani denied cursing, saying his strongest words were "idiot" or "stupid."

The boy, Matthew Spotnitz, 13, remained at Columbia-Presbyterian, where his father, Henry Spotnitz, is a heart surgeon. He was listed in good condition yesterday, with a broken leg, cuts and bruises, a hospital spokeswoman, Susan Parker, said.

Whatever the exact details, the encounter underscored the two views of Mr. Giuliani that emerged in the mayoral campaign. His admirers saw a tough, ordinary guy so fed up that he took matters into his own hands; his detractors saw an impetuous former prosecutor, showing his temper and speaking out of place.

After giving a speech at the Sheraton Hotel yesterday, Mayor David N. Dinkins said, "I think it would have been better if it had been handled differently by the Mayor-elect."

Former Mayor Edward I. Koch disagreed, however, praising the Mayor-elect's willingness to get involved, as he promised he would. "Whether he's a citizen or the mayor, he has a right to express his opinion as long as he doesn't interfere," Mr. Koch said.

The boy was hit by the taxi at 7:40 A.M., as he stepped into East 86th Street at York Avenue, near Mr. Giuliani's apartment building, where the Spotnitz family also lives. Two ambulances, one from E.M.S and another from Lenox Hill Hospital, arrived within minutes, along with Lieutenant Ayuso in a supervisor's car.

'Wasn't Acting Properly'

Cristyne Lategano, Mr. Giuliani's press secretary, said Mr. Giuliani arrived at the scene to find the boy's mother, Sharon, upset over the decision to take him to New York Hospital, the nearest trauma center,rather than to Columbia-Presbyterian. Mr. Giuliani joined the argument, and in the end the lieutenant agreed to the request.

Mr. Giuliani defended his actions and even used the occasion to reiterate his promises to effect change. He said the lieutenant's behavior was an unacceptable example of the "cold, bureaucratic response" New Yorkers often encounter in city workers.

"What I said when I ran for Mayor is that New York City is going to get a different kind of Mayor," he said. "You're going to get a hands-on Mayor, somebody who acts to help the citizens of this city."

Lynn Shulman, the associate executive director for E.M.S., said the paramedics involved acted according to the service's guidelines. Those rules allow paramedics to accommodate requests to be taken to specific hospitals, if medically possible and if the ambulance is less than 10 minutes away from the hospital.

She said that at no time during the confrontation did the boy go untreated. "Whatever the conversation or whatnot, the crew was giving medical attention to the patient," she said.

Lieutenant Ayuso, who has worked at the service for 13 years, could not be reached for comment. "He's not at liberty to talk," said Mr. Mitchell, the union official, adding that an "unusual incident" report would be filed about the confrontation.

Mr. Mitchell called Mr. Giuliani's characterizations "patently absurd" and said the Mayor-elect's actions could have jeopardized the boy's life. "The City of New York is paying our lieutenants and captains to make these decisions," he said.

The Spotnitz telephone number is unlisted. Dr. Spotnitz's office referred all calls to the hospital's spokeswoman or to Mr. Giuliani's transition headquarters, which later released a statement by Dr. Spotnitz. "On behalf of my wife and son, I would like to thank Rudy Giuliani for stepping in yesterday morning to help him," his statement said. "It was a traumatic moment, and his assistance meant a great deal to our family."

A version of this article appeared in print on December 16, 1993, on page B3 of the New York edition.

The proper medical based decision was to take the youth to the nearest Trauma Center, at New York-Cornell Hospital, rather than to Columbia-Presbyterian.

Please note why, in the followup article as to why the mother wanted the youth transported to, which is marked by me.

http://www.nytimes.com/1993/12/27/nyregion/dinkins-faults-giuliani-in-dispute-with-ems.html?pagewanted=1

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<h1 class="articleHeadline">Dinkins Faults Giuliani In Dispute With E.M.S.

By SHAWN G. KENNEDY

Published: December 27, 1993

Responding to a question about Mayor-elect Rudolph W. Giuliani's temperament, Mayor David N. Dinkins criticized the Mayor-elect's behavior during a confrontation earlier this month with an ambulance crew as "inappropriate."

The Mayor's remarks, made during a televison interview taped Dec. 16 but broadcast yesterday, were his most direct criticism of Mr. Giuliani's actions in a dispute with a city Emergency Medical Services ambulance crew over which hospital to take a child hit by a taxi.

Although not asked directly at first about the incident during the WNBC-TV interview on "News Forum," Mr. Dinkins brought up the issue when asked in general about the differences between the personal styles of the two.

"I was concerned recently with the incident involving the E.M.S.," he said, when asked by the interviewer, Gabe Pressman, if he was worried about Mr. Giuliani's temperament. "I thought that he might have handled that differently. I thought it inappropriate for a Mayor-elect to interject himself in that fashion."

After Mr. Dinkins brought the incident into the conversation, Mr. Pressman asked: "Do you think he blew his stack?"

"I think he must have," said Mayor Dinkins, who previously had only indirectly criticized Mr. Giuliani's handling of the E.M.S. incident, "because I'm told that he did use the language that they claim he did." The Mayor then said, "We have different styles."

In the Dec. 14 incident, Mr. Giuliani sided with the mother of the 13-year-old boy, who wanted her son taken to Columbia-Presbyterian Medical Center, where the child's father is a doctor. An E.M.S. lieutenant at the scene said the child should be taken to New York Hospital, which is 16 blocks from the accident scene and has a trauma center. Mr. Giuliani, who was leaving his Upper East Side apartment building at the time, insisted that the boy be taken to Columbia-Presbyterian, about 80 blocks from the scene. His aides later defended his actions by saying that honoring the mother's request was not a violation of E.M.S. guidelines.

Mr. Dinkins said that had he been faced with a similar situation, he might have taken the professional aside to ask why a particular request could not be accommodated. "But the judgment should be made by the professional there," the Mayor said, "certainly where health care is concerned."

Responding yesterday to the Mayor's remarks, Cristyne Lategano, Mr. Giuliani's press secretary, suggested that Mayor Dinkins was "doing some Monday-morning quarterbacking."

"Rudy didn't give an order," said Ms. Lategano, "he was helping a neighbor."

After the incident, Mr. Giuliani did not shy away from the issue, saying his actions reflected the fact that the city was "going to get a hands-on Mayor, somebody who acts to help the citizens of this city."

Until now, Mr. Dinkins has made few remarks about the incident other than to indicate that he felt Mr. Giuliani erred in his handling of the situation. In his farewell address to the City Council, for example, Mr. Dinkins made an oblique reference to the E.M.S. situation when he said: "To be a good hands-on Mayor, you've got to know when to take your hands off."

The Mayor-elect, who is to take office on Saturday, is expected to make two appointments later today, for the commissioner of the Department of Finance, and the director of the Office of Health Services.

The front-runner for the finance post is considered to be Marc V. Shaw, currently director of the City Council's finance division, said an official involved in the transition. He had previously been considered a contender for the budget director's post but that position went to Abraham M. Lackman, the senior fiscal adviser to the Republican-controlled state Senate.

A version of this article appeared in print on December 27, 1993, on page B3 of the New York edition.

[Jeepluv77]

Everyone has presented good reasons for their views. I'm open to talking with a patient about it. But in the instance of an emergency in which the hospital they are requesting doesn't offer what they need, why did they even bother calling 911? If they can't compromise and go to a center that can actually do something for them, what are we there for? I know if I was having a heart attack I'd want to go to a facility with a cath lab. If I had a broken bone, I'd want to go to the nearest place that could ease my pain. Who cares about the name on the placard out front? As far as insurance issues go, that's a whole other situation. That's one of those things that our legislators need to address. Yes, a broken bone may not be life-threatening, but it is still a true emergency. Not like you can just sit around and wait to call the doctor tomorrow and then drive yourself where the insurance company wants you to go. And lets not forget that some broken bones are life- or limb-threatening and that these are often things we can't see in the living room without x-ray. If all other factors are equal and it's simply a matter of insurance then there wouldn't be a problem going to another hospital, but isn't there usually a reason we head for one facility over another?

[Richard B the EMT]

In the case of the Pedestrian struck by a car (NYC EMS call-type PEDSTR), where the Mayor-Elect interfered with the crews, policy and protocols directed that, due to the method of injury, that a Trauma Center be considered the destination for the patient. Where the Mayor eventually had the patient taken to, has never had a Trauma Center, just the patient's father working there as a surgeon.

I don't know if it is just tradition, or written law, but, isn't it wrong for a surgeon to operate on a family member?