Patient Advocate

[ambodriver]

I am the one being attacked here, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly, and we have a policy that does not allow the medic to refuse a call. You can disagree with the company's stance, but that is our policy. And I disgree with most people's answer that a safety concern can be variable and open to interpretation. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways.

So a pt. has to be stuffed in an ambulance on the floor for a taxi ride over to a rehab center? Why not just call appropriate resources and transport them in the safe and logical way.

No syst that was not directed at you. To the group, I do apologize for being rude, I was on the rag last week, and had some other stressors going on, I should not have been so rude with people who disagree.And yes I do understand the concept of risk versus reward and benefit analysis, but I just don't think the "risk" of performing a non-emergent transport a few miles is as great as many of you do, but everyone is welcome to disagree.About our policy, it was actually formed out of concern for our patients and our industry. We had a local busy 911 provider who created a policy where they would not transport any DNR patient for any reason; their logic was that using a 911 ambulance for a DNR patient was a waste of resources. This created a black eye for EMS for all bedridden patients who live at home and not in a nursing home. We had another 911 provider that refused to run nursing home calls, regardless of acuity of the call. And of course, as a private provider we frequently ran into the medic/nurse who would refuse to run a late call, long distance call, or a call because it was below their education (MICU Nurse doing a discharge to nursing home). We also terminate for any founded customer complaint (after investigation). All potential employees are made aware of all of our terminateable offenses before they are hired, so they know where the line is drawn. No one is forced to work for us. And for the record, I am probably a little too sensitive because I am obese, but it is also because we transport alot of these patients because they have been so mistreated by 911 services, that they refuese to call 911 anymore. We do have a wider bariatric stretcher to use, but we have encountered patients that are too large for it's weight rating. I am only aware of two services that have true bariatric ambulances, with wench and ramp. Most services use the tarp. We treat them like we would any other patient, and do not judge/abuse them, or make them feel bad for calling us. Yes, their predicament is of their own making, but most disease processes are of the person's making. Do you lecture people for smoking or having diabetes ?I googled "obese patient killed in ambulance wreck", in a variety of versions, and I did not see one news story regarding this risk. Which is not to say it has never happened, but it is obviously a rare occurence. I would argue that any call involving an MVC in a roadway or down a steep embankment is far more dangerous than this call.

I call BS. Big bad 911...the privates will save the day. Please. You sound way to immature and inexperienced to be a manager...but hey its the privates that doesn't matter does it

[BushyFromOz]

I googled "obese patient killed in ambulance wreck", in a variety of versions, and I did not see one news story regarding this risk. Which is not to say it has never happened, but it is obviously a rare occurence. I would argue that any call involving an MVC in a roadway or down a steep embankment is far more dangerous than this call.

Your google fu is weak. Obese or not is irrelevent in the risk argument. The core issue is whether it is suitable to transport a patient unrestrained, so you should be searching for the incidence of serious injury or death of unrestrained person in motor vehicle accidents compared to those who are resrained

[ambodriver]

Google fu? ROFL +1 sir

[chbare]

Had an almost carbon copy of this situation occur early in my career while third riding. The crew "stuffed" the patient on the floor as has been described earlier in this thread. Unfortunately, there was a minor incident during the transfer and one of the medics was injured, the patient ended up coming out alright however. The medic's injuries turned out to be worse than initially thought. He ended up loosing his job and was briefly disabled. Last I knew, he was working as a phlebotomist. If I have to alter the normal and approved mechanisms that ensure a safely, secured patient, I would choose not to transport given this situation.

[Asysin2leads]

I hate little etc. etc. etc.... Question, if I relayed your company's policy of routinely transporting unrestrained patients to your local EMS governing body, what do you think their response would be? Here's the thing that managers like you in the privates miss from time to time: There are RULES and LAWS that govern the transportation and treatment of patients. Just because you say its safe, and just because you and other managers decided something its okay, does not make it so. While rules do vary from state to state, I can not imagine a State EMS agency that would tolerate shoehorning a hospital bed into the back of an ambulance. Now, if the great State of Georgia really says its a-okay to routinely transport unrestrained patients on hospital beds in the back of ambulances, well, color me surprised. But I don't think thats the case. I think the case is that your organization routinely breaks the law to make a buck.

Edited October 14, 2011 by Asysin2leads

[Lone Star]

First off, since the patient wasn't an emergent transport; there was NO reason (other than the sending facility trying to 'offload' the patient), there was no reason that they couldn't have taken the time to arrange APPROPRIATE transportation.

As for the contacted service, they should have made it clear that they didn't have the appropriate means to transport this patient.

In my opinion, the OP made the appropriate decision in refusing this call. It has NOTHING to do with discriminating against obese patients. It DID however, have EVERYTHING to do with being able to transport this patient safely.

While patient advocacy is paramount in EMS, there are other considerations that MUST be included when deciding patient transport. Not only the safety of the patient, the general public; but the safety of the providers.

It was stated that the patient was approximately 6" too wide for the floor space available. This means that the patient is crammed and cramped into the space available. In the event of a side impact, all of the energy that is transferred from the 'ramming venicle' to the ambulance body/chassis is directly absorbed by the patient's body.

Removing the safety equipment in order to take an IFT transfer only opens not only the responding crew, but the transporting company up for civil litigation. We know that we live in a highly litigatious society. As a memeber of the managerial echelon, one must balance the well-being of the employee against the liability of the company.

Based on the information available, the responding crew made the appropriate decision, and the supervisor should be the one getting 'sacked'!

Those who support the transporting of the patient despite not having the proper equipment and vehicle need to go back to school and learn what 'patient advocacy' REALLY means!

[nypamedic43]

You are unfortunately preaching to the choir Brett. HLPP steadfastly believes that she is in the right and absolutely refuses to have her mind changed, even with presented with facts. I keep telling myself that I am going to stop reading this thread, but its like a train wreck...you know you shouldnt look, but you do it anyway.

[Asysin2leads]

I read back some of ihate's posts, and unfortunately as is all too common when reading what passes for operational standards in EMS, I am horrified. Let me get this straight about your service and apparently your facilities:

1. You transport people unsecured all the time.

2. You bend and break the rules all the time.

3. Your ICU nurses administer a powerful cardiac medication outside of the guidelines that is set.

4. This culture and manner of thinking is so entrenched that have no problem representing yourself as a person in a supervisory position and advertise on the internet that this the way your company does business.

Unfortunately, I have seen this all the time. An ambulance company sets up shop and hires and fires through lists of EMT-B's while getting away with as much as possible when the State isn't looking. And just so you know, if a child is in cardiac arrest removal from a car seat is the proper course of action in that airway and circulatory compromise take precedence over spinal precautions, when necessary. The fact that you compare your taxi service to legitimate emergency response and transportation is pretty sad. Like I said unfortunately for patients supervisors like you and companies like yours are very commonplace and are poster children for increased standards in EMS and medical transport.

[usalsfyre]

Small private service, a young inexperienced provider put in a position of authority and an owner who cares only about the bottom line is a recipie for disaster.

As for dopamine...if your administering vasoactive infusions, yeah, you need to pay to have a pump. Just because "we do it all the time" doesn't mean it's right or safe. If you don't, put the dopamine away and look up push dose pressors.

Small private service, a young inexperienced provider put in a position of authority and an owner who cares only about the bottom line is a recipie for disaster.

As for dopamine...if your administering vasoactive infusions, yeah, you need to pay to have a pump. Just because "we do it all the time" doesn't mean it's right or safe. If you don't, put the dopamine away and look up push dose pressors.

[craig]

I am sorry, but I would have terminated you. First of all, the stretcher bar and antlers are easily removed from the floor. We do this type of transport frequently, we typically roll them to the truck on the hospital bed (fully raised), remove the head board and then just slide the mattress and patient into the back of the truck, then reverse the process at the receiving facility.

You probably pissed off every social worker and nurse in that facility, and showed them exactly how valuable your competitor is. There are very few services that have a bariatric wench and lift for an ambulance, so the other ambulance may not have been any better equiped than you. It is not your job to determine who you will and will not transport. Hopefully you will still have a job when you go back to work, but do not be surprised if you do not.

P.S. You have no idea what the next stage of treatment was, so you may well have delayed definitive care. She may have been scheduled for a procedure of some sort that day or the next day.

And where is the patient care in that lilpeepees. what happens if god forbis the ambulance is involved in an accident? the patient is NOT retrained in the rear of the ambulance by just lying on the floor on a mattress. If there is a suitable transport vehicle available, then why not wait for the best of the patient. If the patient is then loaded into the ambulance then it is the attending emt/paramedics responsiblity of care....who is covered and made responsible if something goes wrong and the law suits then follow...I think he made the CORRECT decision for the well being of the patient...isnt that who we SHOULD be caring about,,,, not the companies revenue?