I think the ER stole my patient

[WolfmanHarris]

Wow! Hospital staff helping outside the walls?! I'm impressed given that I delivered a baby on a drive up they sent into the garage and ran a traumatic, entrapped VSA in the parking lot all in the last year.

That being said, depending on the exchange between all involved I may have had my feathers ruffled a bit in the same circumstances. Our working relationship with ED staff is generally good and I'd likely have offered a hand and then cleared off.

[paramedicmike]

I think the point is his not being respected on the street, in 'his' territory. Plus, having been dispatched to the call, he's got a duty to act and to advocate for his patient, right?

Not when staffers from the hospital that's right there are attending to the patient he doesn't. Does he have a duty to respond? Yes. Does he have a duty to act? Yes. That duty to act is made by way of his response and how he handles himself once there. Does he have a duty to get in the way of identifiable hospital staff from the hospital that's right there who are already attending to this individual? No. Nor does he have the right to make a scene by arguing with hospital staff.

I don't see how he shows EMS to be more proficient and competent than usual by taking in stride the hospital telling him his job in his 'world.' Ya think?

No. I don't think so. Why is it "his world"? Simply because it's on the street corner? And what was taken in stride? He argued with them. Arguing hardly defines taking something in stride.

But I am a little surprised with the gazillion years of experience in this thread that no one can conceive of why it would have bothered him.

Because it was 1) outside a hospital and 2) hospital staff were already attending to the patient when he got there. What's he going to do? Push them out of the way, play his game and then walk the patient right into that very same ER? Hospital staff is there and already working with the patient. Why add in a bunch of political "rah rah BS" (I *knew* I'd be able to work that in to this discussion ) just so he can stroke his ego and delay patient care?

Now, if they'd showed up and said, "Hey! You! Put that patient on my stretcher!" Then I get it completely. It would have been met with something to the effect of, "Hey! You! Go fuck yourself!"

But I bet you'd have said it with a smile.

There is nothing wrong, in my opinion, not confusing, about about this kid being upset that the hospital brought a stretcher out to the street and told him what to do with 'his' patient.

That's just it. It wasn't his patient. It never was.

I should probably be better and stronger and more.....something...than that. But then again, what's really the difference here between the curb on the corner on on the interstate?

When you're on the interstate and some individual identifies him/her-self as a physician what do you have to go on? Nothing! That person is in street clothes with little more than, "I'm a doctor!" written on their forehead.

When you're standing on a street corner, outside of a hospital, with employees of that same hospital, in scrubs, with hospital IDs, and hospital equipment, moving to take that very same individual into that very same hospital for treatment, I'd say it's more than just a little different than the highway scenario.

How does the matter of inches change the scenario.

See my comments immediately preceding this one.

[ERDoc]

I cannot believe that this is even an issue. First, this may be an EMTALA issue if the pt is close enough to the hospital. Second, there are people with higher level of training on the scene with the necessary equipment (a strecher) that can take the patient where they need to be, in the hospital. Save the, "It's in the street, it's in his world," for non-medical people because it really comes off as hero syndome. There is no seperate world or territory, there is only what is best for the patient. Dwayne, do you really need O2 and ASA to run a pt a few seconds into the ER?

[DwayneEMTP]

It's not hero syndrome at all. I'm just exploring the question as I think it's an interesing one. This is sometimes a learning forum. It's the majority of the thread that claims that the patient was 'a few seconds from the door', and 'easily identified by their IDs' etc that are allowing it to be just as cloudy as I am.

Something happened that confused this kid, he came here to talk about it and so far everyone's simply told him that he's an ignorant asshole for having this question/issue. I disagree. Or at the very least have to admit my claim to being an ignorant asshole as well. I'm sure that will not come as s shock to many here.

If we, meaning those of us in this thread, assess patients as we've assessed this scenario, then there is not a level of care that has bragging rights here, as each person has told the story from the greatest benefit to themselves. That doesn't really get us anywhere, right?

Doc, as long as you ignore my contention that they could have been a hundred yards from the door, then you win. Mike, as long as people had on white coats with their IDs prominently displayed, you win. But that only works if we pretend that none of you has ever seen a hospital with docs and nurses that would have sent a couple of EMT students, or a couple of ER techs out with a stretcher to pick up a patient..and I refuse to believe that that is true.

I started out just kind of playing devils advocate, but the effort going into making it appear that there were a bunch of white coated, clean shaved, badged professionals with a stretcher laying down a patient just feet from the ER door while this kid tried to swoop in and be superman is really starting to piss me off. I've been to a few hospitals, and down a few dirt roads, and the busy, "good' hospitals I've been to would have never sent a team out onto a street corner to pick up a patient on a gurney. And the more rural that I've been to might have sent anyone including the janitor to do so, but had it been the nursing staff they most likely wouldn't have been wearing scrubs and certainly not wearing badges.

Just a thought. I was arguing this for fun...I'm truly a little bit surprised by everyone's desire to make it a simple, non learning exercise. I don't get that...

And for the record, I wasn't meaning to claim that it was his world, but the world that he works in, compared to the one he doesn't which, in my mind, would explain why he would find this scenario confusing. There was no intent on my part to imply the Docs and nurses don't belong there. Whew, but thank goodness you reminded me that EMS is about the patient too, and not just my ego....But, in this scenario, wouldn't the good medicine imply that learning is also about teaching this kid, and not just making your point in the fewest words possible?

Dwayne

[Timmy]

I’ve never been involved in a situation were we’ve had to respond to a patient outside of the ED car parking area (maybe 50meters from the ED doors) but this thread is starting to sounds very territorial. At the end of the day we should be working as a team in order to provide the patient with the best possible outcome.

As a Nurse or Doctor in Australia we have to pay a yearly fee in order to be registered, within the registration is liability and malpractice insurance which cover us anytime we identity ourselves as healthcare practitioner so we can automatically rule out this ‘out side of hospital grounds’ comments.

I fail to see why any ED staff running half way down the street in order to get to a patient with a bed in tow, maybe someone might head down for a sticky beak until the ambulance arrived. Within a responsible distance to the ED I see no problem with taking the patient on the hospital stretcher, I wouldn’t wait around for an ambulance to arrive, load them onto the ambulance stretcher, let the ambulance reverse into the ambulance bay, unload and so on… Just a waste of time. If things are that direr straight that the patient wont make it in time to get to the resus bay then we can bring the resus trolley out to them. The resus trolley has a monitor/defib, first line drugs, advanced airway equipment, IV/IO/CVC/Art Line access, fluids, anaesthetics equipment and what not. If there’s been an MVA or someone has spinal injuries then an ambulance would be called because we don’t normally stock KEDs and longboards in the ED.

At the end of the day I think its important to assess how everyone is performing, if the ambos are there first and there doing a good job then let them be, offer some assistance, get them into the ED and visversa with ED staff on scene. There’s no need to fix something that isn’t broken but the sooner we can get them into somewhere that has medical imagining, pathology, specialists and specialist treatment I think the better off the patient will be.

[Lone Star]

Dispatched to a street corner a hospital lives on for "syncope" we arrived to find hospital staff with a stretcher. While I was talking to the patient they insisted she be put on there liter and a taken inside. I attempted to interject that we were there and had an obligation to assess her, get her info, and then take her inside. As they sat the patient on the stretcher they said "you can come in and get her info." I said "you miss my point" got in the truck and left.

Following your own logic, you've created a couple other issues:

1. Since you felt you had an 'obligation to assess her', by speaking to her had established 'patient contact'

2. By simply walking off, you abandoned your patient (you established patient contact, and didn't properly transfer her care to an equal or higher licensure).

3. Proper transfer of patient care includes a written report and a verbal report to be given to the recieving facility, neither of which were done (by your own admission, you simply got back in your truck and left the scene).

Brady's "Intermediate Emergency Care: 1985 Curriculum", (Pg 66) defines 'abandonment' as follows:

Abandonment is the termination of the EMT-Intermediate/patient relationship without assuring a mechanism for the continuation of the care. To avoid being guilty of abandonment you should not initiate patient care, then arbitrarily discontinue it. In addition, you should not turn over care of a patient to personnel with less training than yourself.

4. Since you stated that you had an obligation to assess the patient, and then just got back in your truck and left, by your own admission have breeched your duty to act, which constitutes negligence as well...

[uglyEMT]

Hmmmm interesting thread. I see all three sides (now with Lones observations)

My 2 cents for whatever they are worth...

I see the confusion of the OP, he had made pt contact, was doing his interview and was told to just put the person on the cot and wheel them to the ED by staff. What staff that was is unkown by us as the OP did not state and as Dwayne said could be two orderlies, ER Techs, security guards, ect. so in those situations the OP was correct in wanting to keep his patient.

As for just handing over even to trained hospital staff, what is to say she would recieve care once in the ED? Reading into the abondonment issue just giving her to a nurse and not finding out if she will at least be seen is in my mind still abandonment. I already have a thread started on this http://www.emtcity.c...-triage-nurses/ so I wont go deeper in this thread and derail it.

As to the our world their world thing. This isn't high school we don't have cliques. We are all professionals here and are all part of the chain. We need to remember that.

As to what Lone has brought up. Spot on! The "missed my point got back in the rig and left." line is where it went wrong. OP should have went to the ED and got the information and made a proper transfer to a higher medical authority. Again wont derail the thread here I referenced the other thread.

I guess without more information on as to exactly the who and where it is speculation at this point. I do want to thank Dwayne for playing devil's advocate and opening up the discussion from a different perspective which hopefully we can all learn from.

edited for spelling

Edited June 8, 2011 by UGLyEMT

[ERDoc]

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.

[usalsfyre]

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.

Edited June 8, 2011 by usalsfyre

[uglyEMT]

ERDoc excellent post there. He should have helped, I also believe it was offered, by the hospital staff.

When I talked about transfer of care I was thinking along the abandoment lines, yes hospital staff was on scene first but because he initiated patient contact he, in my own opinion, would still need to stay with the patient until triaged. Not in the rig mind you but stay with everyone while they wheel him in.

edited to finish a fragmented thought

Edited June 8, 2011 by UGLyEMT