medicgirl05 Posted October 8, 2011 Author Posted October 8, 2011 The solution was for the service that has transported the patient before to do it again approximately 12 hours after I refused. That was planned before we left. There were a few other factors which I didn't seem relevant to the initial post. One of which was that the receiving facility was holding people over causing them to have OT and wanted things to be done in a hurry. I told my boss I would do the transfer if I could remove the stretcher brackets and she refused. I called her 3 times about it BEFORE I refused transport. I appreciate the input.
JPINFV Posted October 8, 2011 Posted October 8, 2011 Do you transport infants who are in arrest in a car-seat ? NO. Considering that the first company I worked for had a contract for a local children's hospital, all the time (unless it was an incubator transfer). Granted, we'd go back to the base to retrieve a car seat before being sent on a transfer, but we'd still put the car seat onto the stretcher (and I'd always reposition the straps to mimic a traditional 3 point restraint system). Additionally, a car seat option is becoming a standard feature of the captain's chair on new ambulances. I told my boss I would do the transfer if I could remove the stretcher brackets and she refused. I called her 3 times about it BEFORE I refused transport. I appreciate the input. See, I wouldn't have even asked if that was the make or break point. Horns come out, horns go back in, supervisor doesn't need to know if the supervisor isn't even there.
hatelilpeepees Posted October 8, 2011 Posted October 8, 2011 JPIN, I said pediatric patients in "ARREST", as in cardiac arrest.
JPINFV Posted October 8, 2011 Posted October 8, 2011 Ah, missed that. However patients in cardiac arrest shouldn't be transported anyways. 2
usalsfyre Posted October 8, 2011 Posted October 8, 2011 (edited) So your saying you don't trust paramedics to make decisions about what's safe or not? Or do you just not trust medics not to be lazy? This is not determining who "doesn't need" an ambulance, this is determining safe vs unsafe. Emergent vs not emergent is key, not only here, but in all of medicine. Would an ED doc intubate a non-NPO patient if they weren't in respiratory failure? Would a cardiologist perform a cath on a patient with a labile pressure if they weren't having a STEMI? No, the risk benefit factor shifts when the patient presents emergently. You don't have to have every truck equipped for bari transport. But if your doing non-emergent transport of these patients you should have some equipped for it. This is the dignified, SAFE thing to do. Otherwise you should be rolling the call to someone who can. What are you basing your minimal chance of an accident on? You anecdotal experience? What happens when the drunk hits you? Part of patient advocacy is ensuring safety. Loading a bari patient on the floor of the ambulance to make a few extra bucks rather than explaining to them respectfully we don't have the equipment to safely transport them is not advocacy in view. As for the pedi arrest patient...they make devices to do this safely. Again, you pay to play, or you don't play. Edited October 8, 2011 by usalsfyre 1
hatelilpeepees Posted October 8, 2011 Posted October 8, 2011 (edited) Again, much like crotchity USA, you are refusing to answer my question: 1. If it is unsafe to transport this patient in a non-emergent setting, why does it suddenly become safe in an emergent situation, isnt the risk of accident greater in an emergent situation. 2. You keep saying "pay to play", and have admitted that you have run several of these calls, so how many bariatric ambulances has your company paid for ? And I seriously doubt that you put pediatric arrest patients in a pedimate before you head to the hospital.You cant have it both ways, either it is unsafe to transport this patient all the time, or is it just when you deem that it is unsafe to get you out of doing a transport. What other type of patients do you refuse to transport ? The poor, minorities, drunks ?Here is something you might want to read:http://www.uwhealth.org/emergency-room/obesity-bias-weighs-heavily-for-ems/20377 Edited October 8, 2011 by hatelilpeepees
usalsfyre Posted October 8, 2011 Posted October 8, 2011 (edited) Again, much like crotchity USA, you are refusing to answer my question: 1. If it is unsafe to transport this patient in a non-emergent setting, why does it suddenly become safe in an emergent situation, isnt the risk of accident greater in an emergent situation. If you'll recall back earlier, I answered you directly by saying it's not safe to transport in an emergent situation. It's simply that the risk benefit shifts. There's ZERO immediate risk waiting for the appropriate resources in this case, not so in the emergent case. 2. You keep saying "pay to play", and have admitted that you have run several of these calls, so how many bariatric ambulances has your company paid for ? The company I'm at now has four trucks set up for bariatric patients. And I seriously doubt that you put pediatric arrest patients in a pedimate before you head to the hospital. Seriously doubt all you want. Not all of us panic and run to the ED without doing things properly when faced with a difficult situation. You cant have it both ways, either it is unsafe to transport this patient all the time, or is it just when you deem that it is unsafe to get you out of doing a transport. What part of RISK vs BENEFIT analysis do you not understand? If you can't grasp that concept, please refrain from making other medical decisions. This has NOTHING to do with dodging a transport. It's about safe, prudent action. What other type of patients do you refuse to transport ? The poor, minorities, drunks ?Here is something you might want to read:http://www.uwhealth.org/emergency-room/obesity-bias-weighs-heavily-for-ems/20377 Did I ever say I flat out wouldn't transport them because I find it distasteful? Or did I simply argue it's not safe for the patient given the equipment, and that it's better to wait for an appropriate set-up? Pulling out discrimination when you can't prove a point is poor form in an argument. Quite honestly, I'm insulted you would sink to this level when nothing I have posted should lead you to belive this other than your own biases. What you want to do is patently unsafe and frankly stupid when a better option exist. Cut the bull-crap of a "can do" attitude, it gets providers and patients hurt in addition to ensuring EMS will stay at the bottom of the food-chain in medicine. Edited October 8, 2011 by usalsfyre 2
JPINFV Posted October 8, 2011 Posted October 8, 2011 If you'll recall back earlier, I answered you directly by saying it's not safe to transport in an emergent situation. It's simply that the risk benefit shifts. There's ZERO immediate risk waiting for the appropriate resources in this case, not so in the emergent case. That's assuming that another company is present that has the appropriate resources. According to the OP, the normal transfer company does the mattress on the floor routine. So what to do if the only difference between the regular service and your service is the name on the side of the ambulance, and not the tools inside it?
Paramagic Posted October 8, 2011 Posted October 8, 2011 You cant have it both ways, either it is unsafe to transport this patient all the time, or is it just when you deem that it is unsafe to get you out of doing a transport. Do you find it stressful to see the world in black and white whilst trying to negotiate the grey of everyday medicine? Usalsfyre has said it over and over: what part of risk/benefit do you not understand? How on earth do you cope as an alleged paramedic and alleged manager if you cannot weigh up risk versus benefit on a case by case nature? What other type of patients do you refuse to transport ? The poor, minorities, drunks ?Here is something you might want to read:http://www.uwhealth.org/emergency-room/obesity-bias-weighs-heavily-for-ems/20377 Goodness me! Strawman much? 1
usalsfyre Posted October 8, 2011 Posted October 8, 2011 That's assuming that another company is present that has the appropriate resources. According to the OP, the normal transfer company does the mattress on the floor routine. So what to do if the only difference between the regular service and your service is the name on the side of the ambulance, and not the tools inside it? To sound weasly? I'd rather let the other company absorb the liability of this type of transport, both from a provider and a management standpoint. Especially considering this type of transport only pays a little over a hundred bucks. I don't know why owners continue to do this, other than "I haven't been burned yet".
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