Patient Advocate

[ERDoc]

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.

There are several issues here:

1. In that case, we just shouldn't have ambulances at all. As several have said, risk vs benefit. You don't seem to get that.

2. You work for a company that encourages putting it's employees/patients (customers?) safety and livelihood at risk? Your company sucks. Please stop defending them. I understand we all need to work and not all employers are idea, but if you work for a company that encourages unsafe behavior you might want to rethink towing the company line.

3. What are your state's seat belt laws? I can only speak of where I worked (NY). It was a state law that any pt in the ambulance had to have a seat belt on. I can provide a link if anyone cares that much. There is no way you are going to properly restrain a person on the floor. So, not only is your company encouraging you to put your employees and patients/customers at risk, they are also encouraging you to break the law.

[hatelilpeepees]

Our state is GA, and there are no laws regarding seat belt use in the back of an ambulance, there are laws regarding the front seat passengers.  Regardless, if you have even been in a wrecked ambulance, you know that the seatbelts in the box are usually useless, unless your company invests in having lap/shoulder belts, instead of just lap belts.  The entire stretcher, with patient, will dislodge from the floor and crush anyone who is in the "Captain's seat".  

It is obvious that I am not going to convince you that putting a patient on the floor, unrestrained, is no less dangerous than using a stretcher if involved in an MVC, as I guess you guys are refusing to believe video evidence.  So lets quit beating this dead horse and move to another one.

How many of you who are on the OP's side in this, have ever put a second back-boarded patient on the squad bench ?  Do you really believe that the patient will remain on that squad bench in an accident ?   Where are your "safety concerns" there ?  Are you going to suggest to me that every time you have done so, that there was not another ambulance (private or 911) that could have responded and transported the second patient "SAFELY" (by your definition) ?

Edited October 12, 2011 by hatelilpeepees

[medicgirl05]

Even if I say I completely belive you about the useless seatbelts in a wreck I still have to point out that there would still be a huge legal issue in taking a patient on the floor. Every report I write I put "Patient is resrained with #seatbelts". I think not having any at all would be a lawyers field day.

I have put a second backboard on the bench seat on multiple occasions. ALWAYS secured with three seatbelts. The difference is that the backboarded patients are out of MVCs. The 911 service I work for has NO other service within a 30 mile radius. So it is often deemed that the benefit outweighs the risk in such a scenario.

[Happiness]

I am sorry, but I would have terminated you.

Really now you couldnt have come up with a better response than that to MG. And since you say you are a manager you wouldn't even come up with a discussion on to the why's that is poor management skills at its best. A manager resolves issues, and termination for something Im sure could go to court is not the resolution

So lets put this in a way that even you can understand. Ya that statement is just rude

It is obvious that you have never handled this type of transport, so please withhold your opinion when you have no clue what you are talking about. Again rude you have no idea about the vast amounts of experience that travel through these forums

but I doubt that is the way it really happened. That is quite the assumption and you basically just called her a Liar, very bad form.

I would have assisted and techd the call, to alleviate any of the ridiculous fears that have been mentioned here. Well I guess YOU should have been there and because you were not how do you know those fears are rediculous. A patient ADVOCATE would have found a way to transport the patient, not abandon them in their time of need. So Im not to sure on how many Managers can be concidered pt ADVOCATE when they run by policy and not by common sense. Your position in the company is pulled by the all mighty buck there is no pt advocate in it.

Again, much like crotchity USA, you are refusing to answer my question: Well that could be said the same for you as I asked you to questions (hummm still waiting) and comparing long time members to the likes of Crotchity is just insulting

What other type of patients do you refuse to transport ? The poor, minorities, drunks ? Yep If I have a valid reason to not transport and if you must know 90 % of my call volume are the above.

No dwayne, i am not hiding, just have to work for a living every few days.

I admit I may be hypersensitive because I am obese and know what it feels like to get the look of shame from all the skinny people, but again, to me, being a patient advocate means we find a way to meet their needs versus refusing care. . This is were my question came in as I asked How do you want to be transported in you time of need Safely or not Safely, and again you bring up the advocate, again you are an advocate when you are there doing the deed and the OP did meet the needs by getting the proper ambulance to get the pt and it was above and beyond the call of duty. She made sure her pt was taken care of before she left and you seem to not see that.

Or to give another example. I think we can all agree that Dopamine would never be administered by a nurse in an ICU without it being on an IV pump, yet we do it all the time. Irrelevant to anything said we are not nurses in an ICU.

So does that mean if a 1000 lb patient presents to your ER, you will refuse care because your stretcher is only regulated for 750lbs ? So your telling us that I should put a 1000 lb pt on this stretcher so that it can collapse and create more injury?

I am the one being attacked here yep agreed and I have pointed out a few reasons why above, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly Well in this case you jumped the gun and probably just fired someone that had great skills as a medic without hearing the whole thing through, How is that fairl, and we have a policy that does not allow the medic to refuse a call Just because you have it dosnt mean it is right. 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 You know I thought about this for awhile and yep I do sort of agree with this statement but at the end of the thought process it came to me, You are not the one that is putting Your safety at risk, so therefore why should you give a dam again the all mighty buck rules. 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. You have missed the whole point of every thing that was said.

I have read each and every response to this thread and Im sorry HLPP you brought alot of this on yourself. Lets take a look at this whole thing. So first you have made good comments on other threads but like others have said this one has made you snap a bit. You have said your obese and a bit hypersensitive to this topic.

Ok lets look at your profile pic if that is you, Your a pretty blond girl that looks a bit chubby and you have big boobs which make women look even chubbier than they really are. So by being chubby is it fair to say that really if you had a choice to go to an appointment safely and compfortable you wouldn't take it. I dont think that is true and I think you would probably wait. The other thing is that I am sure the OP did go back and talk to this pt and explain everthing to them. Maybe MG can comment on that What did the pt feel about this whole thing because really that is the bottome line. You are a 23 year old Manager well that is not a real good time line of experience and you will learn in life that policy is not always right. There is a ole addage that says After Me you come first and that is so true in this profession. My safety comes before the pts and the pts safety comes befor the greenback. I agree with the others in saying there is something that has happened to you to make this type of response.

[DFIB]

IHLPP I am sorry that your service has such an inflexible policy regarding transport and safety. I understand the nuances and difficulties of keeping a job but I think I would try to be a medic advocate in this case. I wish you all the best.

[BushyFromOz]

putting a patient on the floor, unrestrained, is no less dangerous than using a stretcher if involved in an MVC

= Logic Fail

but as a manager I have to enforce all policies fairly

You company has a policy that allows your patients to be placed in danger? Your company sucks.

no patient is safe in the back of an ambulance during an MVC

Maybe your company should come up with a policy of buying safer vehicles, they do exist, just look outside your backyard....i know it may hurt your ego, but the truth is out there.

I absolutely believe your in management, trying to defend an indefensible position and yet being offended somehow that people would dare question your policies or ideas, how dare people do that, youre in management dammit!

I have a large sense of "deja moo" = the feeling ive seen this bull-shit before

Edited October 12, 2011 by BushyFromOz

[Happiness]

Okay I have decided to read up on this topic and am posting some of the sites for you all to comment on. I really do not like the responses that HLPP has made but have decided to look into what can be done about the problem of transporting obese pts, as in reality it is a growing problem in our health care system.

http://www.the-aaa.org/about/positionpapers/morbidlyobese.html

http://www.usfa.fema.gov/pdf/efop/efo39810.pdf

http://www.independentmail.com/news/2010/apr/30/heavy-lifting-medical-first-responders-pay-price-h/ I liked this one as it does mention a price of converting an ambulance, it mentions that the service is unable to refuse an obese pt. but most of all it states that if you invest in the converting you as a service will be able to save in insurance costs because your medics will have less injury

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Bariatric-Patient-Handling-Program-.aspx#USVA06 from nursing points of view

It is very apparent that the obesity is very much on the rise in our communities. So maybe the question should be posed to all ambulance services is Are you prepared for a bariatric patient, if no then maybe they should become that way. As I have been reading this and other information there are ways to deal with these patients without sliding them onto a floor in a non emergency setting. If as the OP says the other service does exactly what she refused the pt for then the transferring hospital should be the first line of pt advocacy and make sure that their pts are being transferred safely within an ambulance that is properly equip. Pretty much as far as I can see the OP should never have been put in the position of having to refuse the patient in the first place and her service should maybe refused the transfer saying that they were not properly equip.

I have to admit that I have been kind of forced to learn more about this topic and thanks MG for bringing it forward.

We have two options that I have seen used here for medivacing the obese here, one is to call in the Military Buffalo out of Nanaimo and the other is a special plane and crew from Alberta. In looking at all of the equipment that really is required to safely transport an obese pt I can now see why our Lear jet isn't used.

[ERDoc]

Our state is GA, and there are no laws regarding seat belt use in the back of an ambulance, there are laws regarding the front seat passengers.

I find it hard to believe that your dept of health or whatever your credentialling agency is doesn't require pts to be restrained.

I guess you guys are refusing to believe video evidence.

Anecdote is not evidence.

How many of you who are on the OP's side in this, have ever put a second back-boarded patient on the squad bench ?

In 10 years in 911 and private service, I can say NEVER. It was against company policy and illegal since there are no belts.

[Krysteen]

HLPP, I can see where you feel attacked but also constructive criticism is an excellent learning tool. I have been there:) I am curious though as to what the outcome of this employee would have been had there been an MVC involved? Is it kind of like a damned if you do damned if you don't situation? Would you have your employees back then? Not that it would matter because they may face their licensing board, the ultimate authority.

For me I would rather have my day in court saying " I felt that my patient was in need of urgent medical care and the benefits outweighed the risk then; my boss says I can't refuse a transfer and I just "figured" we would not be involved in an accident."

As far as the backboard on the bench seat, sure do. My ambulance has three safety restraints there for that reason.

[Paramagic]

It is obvious that I am not going to convince you that putting a patient on the floor, unrestrained, is no less dangerous than using a stretcher if involved in an MVC, as I guess you guys are refusing to believe video evidence.

No, you're not, because that is not the case. Our rigs have stretcher and harness systems designed in conjunction with a university based engineering department that specialises in crash testing and investigation. They have been shown in exhaustive testing to be effective in frontal, rear and roll over incidents, and this has been borne out in real life as well. If your organisation is too cheap and nasty to invest in the safety of their staff, then you may have a point.

How many of you who are on the OP's side in this, have ever put a second back-boarded patient on the squad bench ? Do you really believe that the patient will remain on that squad bench in an accident ? Where are your "safety concerns" there ? Are you going to suggest to me that every time you have done so, that there was not another ambulance (private or 911) that could have responded and transported the second patient "SAFELY" (by your definition) ?

Never. If a patient is backboarded, it is because I have a genuine suspicion that they have a spine or spinal cord injury, therefore they get a second rig, because I cannot safely care for two spinal cord injury patients by myself. In fact we don't even have a squad bench. Nonetheless, you keep carefully constructing straw-man arguments that have no bearing on the issue at hand, and that keep getting shot down.

Do you really not understand risk/benefit? Can you honestly not see where you would accept a higher level of risk in transporting, because the benefit of getting to definitive care is greater than the risk? It really doesn't matter what 'policy' is, the decision ultimately has to lie with the provider who is a the scene. Not even the military accepts their soldiers blindly following orders without weighing up the situation for themselves, yet you expect your staff to do exactly this.

It scares me that someone who identifies themselves as a paramedic appears so completely unable to see the world in anything other than black or white.