Dispatched to the ER Waiting Room?

[Riblett]

A few nights ago, one of our County units was dispatched to the waiting room of the local community hospital. I was at another station, so I don't have a lot of details. Apparently someone called 911 from the waiting room and it came through EMD as "breathing problems." The patient was a two month old male according to dispatch. This community hospital is does not really do high acuity pediatrics, cath lab, OB, etc. But they do stabilize and transfer. This was not a transfer orchestrated by ED staff, those are paged out differently and usually go through a contracted agency.

This person apparently called from the waiting room and demanded they and their baby be taken to a hospital in a neighboring county approximately 45 minutes away. The kid must not have been in that bad of shape because they crew marked en route to the other hospital "routine traffic."

I don't really understand why dispatch sent an ambulance to begin with without contacting the charge nurse or something. They were already in the ER. If an emergency transfer was needed, the staff would have called for it.

Should the crew have even transported this patient? It seem to me that unless they patient's guardian signed out AMA this would be an EMTALA violation and open the EMS crew up to liability. But even if they did, suppose the kid really was in bad shape or became that way and died en route to the other hospital? We have rules in place to keep unstable patients from being shifted between hospitals for just this reason. And to be sure if this child had suffered a negative outcome the lawyers would be coming after that EMS crew for negligence.

[Riblett]

And before someone takes away my special points, I am aware of previous discussions of the topic from 2007.

[Timmy]

What was the reason for calling the ambulance? Waiting times?

[crotchitymedic1986]

Everyone probably did as they should. Dispatch SHOULD have sent the ambulance, as they have no way of knowing what is going on, and it is always better to send someone to investigate versus denying a request from a room miles away. I am sure the hospital made them or asked them to sign out AMA before they left. And the crew did the right thing as the child probably would get transferred out later (my experience is that these facilities do not admit peds under any circumstance). The parent was tired of waiting for definitive care, cant blame a mom for that.

[FireMedic65]

This has actually happened to me. The wait in the ER was really long and apparently triage didn't mean anything. A 3yr old with a head wound was waiting an hour to be scene. And I mean the kid was bleeding a lot. The mother called 911 to come help. An emergency is an emergency right? Doesn't really matter where it is at.

[Kaisu]

We were dispatched to an ER. The patient was in a monitored bed and had been seen by a physician. She didn't think her concerns were being addressed in a timely manner by the ER staff and used her cell phone to call 911. This was a level 2 trauma hospital in an urban area. A crew already at the hospital went to the charge nurse and ascertained that the call was bogus. The call was concluded with "cancelled on scene by higher level of care - no patient contact".

I'm pretty sure they took her cell phone away.

[HERBIE1]

Been called to pay phones outside of ERs many times. We tell them we would be happy to transport them- 25 feet back to the waiting room they were just in. In every single case, the person had a very minor, low acuity complaint, which explains their extended wait for care.

We take patients to the closest appropriate ER, and unless that person has a specialty need(stroke, OB, cardiac catheterization center, etc.) they go back where they came from. The fact that the ER is exceptionally busy is not our concern- unless they are on diversion. If the patient has been triaged, then they are that hospital's responsibility. That means unless they are discharged, leave AMA, or leave without being seen by a doctor, or officially transferred for a legit reason, we have no authority to take them away from a higher level of care.

[Richard B the EMT]

This is usually handled by the nice folks in the EMD. They explain that, per FDNY policy, we don't do transfers from an ER unless requested by the ER crew through the EMD. The FDNY attitude is, the patient is at an ER already.

Personally, I have had some call from a block away from the ER, where the patient has removed themselves from the waiting room, and request going to another ER, due to real or perceived delay in being seen. Our field-side stock answer, as my district has 2 hospitals roughly 7 minutes away from each other, is, "You want to go to the other hospital, where they have just as large a wait to be seen, and start over?" We'll still take them, if they insist.

On FDNY EMS Queens East frequency, we have a few famous frequent fliers. We had one that just clicked along, where the ambulance was en-route to him before he got off the phone with the EMD, on scene, evaluated, transported, and arrived at the ER, 2 blocks from the patent's residence, all in under a half hour. HOWEVER...a half hour after the team got him to the ER, EMD got another call from the man, who had walked home, and called again, because he felt he hadn't been seen in a timely enough manner!

Side-note on that patient: One ambulance crewman actually had a call report book of 25 sheets pre-filled with the man's name, address, and past medical history. All that was needed was the date, times, crew's badge numbers, and the current vital signs.

[Riblett]

This hospital typically does not admit peds, but if the child was truly unstable we would have taken them to that hospital to be stabilized anyway. It is the only hospital in our county and sees plenty of pediatric walk-ins. All other hospitals, those with specializations or admissions area minimum of 45 minutes away. It seems almost counterintuitive, because if it was enough of an emergency to need an emergency ambulance then it was enough of an emergency for them to need stabilization. If it wasn't enough of an emergency to really need the ambulance, then sit down and wait your turn.

I respectfully disagree with the assessment of an emergency is an emergency no matter where it is. That is why they are in an EMERGENCY department. As much as we try to think of ourselves as high level care givers we need to realize that our ultimate goal is transportation to definitive care, which may include stabilization at an intermediary facility. If the patient is in the ER already then EMS should not be responding. Quality of care at the hospital, ED and ward, is beyond our level of responsibility. If we allow this sort of thing to take place, then what is to stop anyone is a minor ailment from getting annoyed with waiting too long and calling 911 from the waiting room? ER's do triage for a reason. Also, EMTALA is in place for a reason. If we start transferring patients out of the waiting room, not only to do we open ourselves up to liability, but provide an avenue to EMTALA to be circumvented by hospitals. A patient doesn't have insurance? Well if we leave them in the waiting room long enough they'll call 911 and get taken to another hospital. Skip evaluating them, skip stabilization, and skip facility acceptance or transfer paperwork!

Just my $.02.

Edited April 17, 2011 by Riblett

[FireMedic65]

If I go to the ER with an emergency and I am not being scene, I will make sure I get care I need by whatever means possible, even if that is calling for an ambulance. I do not care if I am in a hospital. I am sitting there not being taken care of. I will call someone who will take care of me.