Patient Advocate

[hatelilpeepees]

Paramagic I completely understand risk versus benefit, it is you who does not. Lets try this: there is a loaded gun in your home, do you ever point it at your family, even when you are cleaning it and are 100% sure it is completely unloaded. There is no risk, since there are no bullets and your finger is not pulling the trigger, but you do not take the risk, EVER.

Everyone in here is saying that putting a 1000 lb patient on an ambulance floor is extremely dangerous (although no on can produce any proof that a patient has been injured or killed during one of these transports,, and it happens on a frequent basis.

So if the risk to the patient is death (per you guys), and there is a way to avoid it (pay to play as one of you suggest, and require every service to at least purchase one bariatric ambulance that is centrally located in your service area), why would you continue to take the risk ? Because there is no greater risk with this patient than any other.

Now in the scenario above with the gun, we can point to accidental gun death statistics to prove that pointing a gun at someone is dangerous and risky.

So two questions you still refuse to answer:

If you have no proof that a patient has been injured or killed while riding the ambulance floor, how can you say it is a "RISK" at all ? Using that logic, I could demand that all of you can never use a cell phone again because I believe it poses a risk to you.

If the "risky behavior" can result in death, why would you ever choose to do it, and what other deadly situations do you allow to occur ? There was a whole thread where you guys argued against putting your life at risk for most calls, why would you not treat your patients the same way ?

And finally, I have to call BS on this whole possible risk/benefit arguement. I have seen most of you blast people who come in here with a statement that is not backed up with statistical proof or research studies. Show me any SCIENTIFIC PROOF that you have that proves this is a dangerous activity, and again please explain how something that is too dangerous for an IFT service is totally blessed for the Paragods of a 911 service ? I will argue that there is less risk for this patient, because the driver will be more careful than normal, knowing the patient is not strapped in.

And lets take this to a different industry. I would like to see how an ER Nurse could convince JCAHO that it is OK for her not to follow the hospitals safety policies because she is in the ER ---" those rules are only for the floor nurses who are in a less acute environment". Oh wait, I think that is why JCAHO was created, to protect patients from healthcare providers, who did not follow policies and create safety solutions for their patients.

P.S. Dwayne, I posted before I read your comments. I am just trying to point out the hypocrisy of stating a medic has the right to refuse to treat a patient in the name of safety because this patient is nonemergent, then turning around and saying the exact same action is suddenly safe because someone called 911. You know as well as i that less than 5% of our calls are truly life-threatening at the time of the 911 call.

My service is in north atlanta, the other services that have them are 20-30 miles away, and is either not manned (crew goes back to get truck at station) or it is only manned as an IFT transport vehicle M-F during hospital discharge time. Remember that most of my patients have been at their residence and had refused to call 911. We have tried to use those bariatric services before, but typically we find that they are already on a call, not available, have an ETA that is too long, or will not respond due to lack of the patient having good insurance. We have people who have pushed for us to purchase one, but in this economy, we do not have extra money laying around to purchase something we will use a few times per year. If we had $150k laying around to purchase the vehicle and stretcher, I would opt to use it for something we would use daily like new cardiac monitors.

Edited October 17, 2011 by hatelilpeepees

[ERDoc]

As for your JCAHO comparison, central lines fit your requirements. JCAHO says that they must be done under full barrier precautions into a subclavian. Exceptions are made for emergency situations where the need to get IV access is critical and not always possible in the subclavian.

[hatelilpeepees]

Oh Dwayne, about the cursing, I am not offended by that as much as I am when getting farted on at the station, but I left my laptop up, and my son was wanting to know why you were saying mommy was full of s**t. It is my fault for leaving this page up on my screen, but I dont think cursing elevates anyone's arguement, and I know several others on here have small children.

Thinking more basic DOC. Lets say JCAHO is in your facility right now. You have an altered elderly patient on a bed, with one of the side rails down. Do you think JCAHO is going to give you a "pass" because you are the ER and patients move in and out of your beds more frequently in the ER ? And if you have been involved with a survey, you know that they want to see your policies and training to address things that are infrequent, dangerous, and/or problem prone (thoughout the institution, across all departments). A department can not say, we do not have to know the infant abduction plan just because they do not work in the nursery every day.

And I am not insenuating that you do not know how JCAHO works, but often times the ER Docs are not really held to the same standard or asked to participate depending on which shift you work, or your standing in your groups practice.

Edited October 17, 2011 by hatelilpeepees

[ERDoc]

Yeah, JCAHO might be a little pissed if a patient wasn't properly restrained.

[hatelilpeepees]

Actually, JCAHO is very negative about using restraints, so they are on my side lol, I must admit you get an "A" for your avatars, they are always entertaining.

Edited October 17, 2011 by hatelilpeepees

[ERDoc]

Actually, they are against them being used improperly. When used for pt safety they are actually pretty supportive.

[Asysin2leads]

Wow... not knowing the difference between 'restraint' as in "a device to prevent injury during a motor vehicle collision" and 'restraint' as in "a device used to prevent the movement of an unruly patient." Really? That's what you're saying? I also find your logic dubious. "They don't always put the rails up in the ER, so its perfectly okay to go routinely transporting patients unrestrained." As for 911 'paragods' (really? you went there? I'd expect that from a 19 year old EMT-B but a manager for an organization?) the issue is that there is an urgent, life threatening situation occurring and that is the ONLY time where it is ethical or proper to make adjustments to written protocol. When someone's life depends on it. Not when its convenient. Not when its getting close to the end of your shift or when it'll save your company a buck. This is fairly obvious logic.

At this point you're just at the bottom of the hole and keep asking for shovels.

[DwayneEMTP]

Hlpps, I'm sorry if your son was offended, but this is intended to be a professional adult forum. I'm confident that you have been aware of the tone that these conversations take for a long time now. What did he think when he read that mom hates little peepees and gets bitchy 'when she's on the rag?" It's unfortunate that you failed to protect him from an environment that you felt is mentally/emotionally damaging for him.

I've left my computer open to porn in the past and had Dylan discover it...though it truly never occured to me to blame the website for the 'splainin' I had to do.

And I'm thinking that by playing the paragod card that you've now identified yourself as the manager of a volly paid per call organization/or a small transfer service. Why don't you just openly state your position? You've known the context of my argument from my professional description from the start. When people keep guessing at yours, why not just state it.

So, from your argument, I gather that you don't require your medics to properly restrain patients during transport? After all, there is no proof that it keeps them safe, right? Do you carry spinal boards? C-Collars? Epi, Lidocain? Yeah, I know you do, and I know your crews use them all the time, assuming that you actually have ALS crews...though I'm beginning to have serous doubts as to your honesty in these matters.

Do me this favor, as you claim that must ALWAYS follow company protocol. Post here your companies protocols for properly restraining patients during transport.

And now here, post the protocol that claims that you may disregard the above protocol when it's inconvenient during a non emergent situation.

And no, I don't have to post mine, first of all because I have a bag full of cool shit that I don't have oversight for, thus no protocols other than acceptable practice, and secondly it's morally and ethically my responsibility to break the rules, in the safest manner that I can conceive of, to get my patient to definitive care.

Now, don't wuss out on this. These are your arguments. That you MUST follow protocols, that your company is so progressive that it doesn't follow archaic seat belt nonsense, so this should be simple for you. I'm looking for the protocol provided by your company that supercededs the one requiring you to properly restrain your patients.

I have expressed my respect for your cast iron ovaries in this argument, and meant it. But now every post seems to smack of you understanding that you're wrong, but hoping that if you keep piling bullshit on top of bullshit that at least someone will drown under it...You know better than that...most of us can swim in bullshit for days without breaking a sweat...We've been doing EMS for a while.

Dwayne

[scubanurse]

Thank you for making a quiet night in the ER more enjoyable for us... as far as the scenario goes... I'm with everyone else except IHLPP... (very appropriate name btw for a "manager" with 22 years of "experience")...

In my opinion, and having been in all sorts of situations... the OP did absolutely the right thing. No question.

----

As far as the comment about restraints... we just had a JCAHO inspection...restrained a patient, who was combative and threatening the safety of all in the ER, in front of them and they applauded our compassion and concern for their safety and the safety of the staff.

The amount of experience on this board is amazing. I personally have experience with morbidly obese patients, as we have a special floor for them in the hospital. Recently, one passed away (), and the funeral home had to remove the body. We do this in a very respectful manner, after visiting hours if possible, clear hallways and have a special exit. Now here's the glitch... patient weighed 600+lbs. The ramp we normally use in this situation has a steep grade upwards. We were not going to risk our safety to move the patient out of the hospital per normal protocol. We improvised and brought them out the loading dock.... Not ideal, but it was the safest solution for all involved. We very well could have followed POLICY and used up excessive amounts of resources, risk the backs and safety of all involved, risked the deceased on the gurney falling and disrespecting the body in that manner. We changed policy to fit the situation. No one had an issue with this.

I really have no idea what your true position is, nor do I give a rats ass... Your behaviour from your screen name to your comments paint a much better picture of who you are as a person than a title ever will.

Also, please refrain from insulting the intelligence on this board. It does nothing to improve our outlook on your membership.

[hatelilpeepees]

Wow you have some dirty minds, my name does not mean what you think it means.  Dwayne, I am not allowed to post any departmental policies or documents on the internet, but I can give you the short list of some of the offenses that are an automatic termination:  Reporting to duty impaired, threatening someone or actual violent acts, committing criminal offenses while onduty, disclosing confidential patient information inappropriately, giving false information, theft of company equipment, etc..... probably no different from yours.

Yes employees are required to use 5 point restraints, or pedi mates, but when the patient will not fit on the stretcher, they are allowed to transport on the floor.  Much like Docs example of you cant put a 1000lb patient in a helicopter or on a CT scanner table.I am not trying to be argumentative, it is just that no one has answered my questions, whereas I have tried my best to answer all of yours. Again:What statistics or research do you have to prove that this is an unsafe act that has resulted in injuries or death ? If it is wrong and horribly dangerous to do this in a non-emergent setting, why is it suddenly OK to put patient's lives at risk when they call 911 ?And lets take it a step further, we have all seen those obese patients that end up growing into the fabric of their couch, and have seen fire departments cut a hole in the house, extricate patient with couch, and load them on a wrecker for transport. How is that safe ?

Edited October 17, 2011 by hatelilpeepees