Multiple patient, single ambulance transport scenario..

[Bernhard]

Not yet read all of this thread, but sure will if I have enough time (or need a distraction from work).

Great post, big problem...

So, I was surprised by the bariatric patient thread when there were several, (if memory serves), that said that they have never, nor would ever transport a patient on the bench seat.

We have no bench, we have two real seats including seatbelts (in driving direction) beside the stretcher and one at the patient's head (driving backwards). it's relatively common to transport one laying and one sitting patient if needed.

In older ambulances (when old german ambulance standard was valid before the EU wide came to effect) we had only one seat beside the stretcher but the possibility to fix a second stretcher (foldable emergency stretcher as used in disaster response). Therefore I had the opportunity to transport two laying patients more than often in days long ago. The 2- or even 4-stretcher ambulance concept now is a thing only known to disaster response services.

What I would have done? Used my local possibilities...:

• We have enough ambulances, within a time frame of 30 minutes I can have up to 30 regular EMS amulances and around 5 different EMS helicopters. Within 60 minutes this would make a lot more (100 ambulances, 30 helicopters or so if I really really want). Happens from time to time if our neighbouring MUC airport calls for mutual help (happens around once a year, mostly for preparation issues - what a sight!).
  
• If regular EMS helicopter won't fly, it would be time to call in help from the police or even the army. Our police helicopters are euqipped with emergency stretchers fixing points and can be used as transport units in case of need. Most police helicopter crews are additionally trained as EMTs, a ground medic or doctor and equipment will be taken on bord. The police crews are known to flight in far worse weather conditions than the civilian EMS helicopter crews (allthough most of them are ex-police or -army pilots). I had it only once that the police helicopter unit leader himself barely made it safe to the ground and didn't allow the second heli to land. The one patient he then transported through heavy snow storm survived due to his effort. The other patient had to go by ground ambulance but wasn't that critical.
  
• Some of our non-transport first responder vehicles are old ALS ambulances. Usually they're not allowed to transport any more, but if real needed it would be possible without problems. Did this several times.
  
• We have volunteer disaster response units, which are capable of transporting patients. one such standard transportation squad (2 ambulances) is designed for transportation of 2 laying and 2 sitting patients but some can take up to 8 laying (not much treatment possible then, though). Level of care with those units is "Advanced BLS", some are even real ALS. Those units will be deployed in events with >10 patients, can be called earlier if needed. Each county has at least one such squad. Expect response time around 15 minutes plus driving time to scene. Happens occasionally.
  
• Each german standard fire fighting vehicle has a foldable stretcher on board, unfolded usually fitting in the crew compartment (transverse). Thus, a very basic transport would be possible. Never had to try this, just heard from a neighbour county (where firefighters decided to do so, until EMS command-on-scene were able to stop it).
  
• If there is such a number of patients that all available transport capacity wouldn't help getting them away at once, I call in a medical treatment post. Standard volunteer disaster response units (each county has at least one) can manage around 25 patients on-scene, depending on severity (25 at least, if only minor injuries, they can handle far more). Deploying time should be a maximum of 30 minutes plus driving time to scene. Within 5-10 minutes after arriving they should have built an operational medical post (inflateable tents and such) and beeing able to get/hold patients stable for next transport. Does happen.
  
• There are concepts to handle more than 50/100/... patients on scene to buffer transport with multiple standard disaster response squads. A sufficient large treatment area for 150 patients or more is built up within 20-30 minutes. Deploy time depends, if called out of nowhere usually within 2 hrs. somewhere in Germany. I only know one instance that this was needed recently in Germany: the Loveparade 2010 fatality. But in Duisburg there were multiple large units on stand-by near the event, so they were available on-scene within ~30 minutes.
  
• To get around long transport at all I would suggest building up an operation room or a whole hospital in the field: European community disaster modules are able to perform basic surgery and next Red Cross ERU (Emergency Response Unit) "field hospital" is 2hrs flight time away. It will take 2-3 days to build it up, though.
  

All in all, I never had to leave a (living and willing) patient on scene. And I don't want to do so. Over here it's just a matter of knowing the possibilities (see above) and calling them in quick.

My personal record of patient transport with one ambulance is 4, plus 3 staff. All in an old, small VW bus... (yes, it was looooong ago).

Again, for all of course, but for those of you that claim that you have never, and would never transport a patient on the bench seat, how would you handle this call?

Oh, you didn't meant me. Too late, all written above.

I only saw one realistic way to deal with this issue...I'm curious of the thoughts of others...

Just be prepared. I was in such situations often enough to participate in developing a mutual aid and disaster system so that nowadays it works as written above. A lot of effort, time, money and sweat needed to be invested...

[Lone Star]

I was one that stated that was against transporting the bariatric patient on th floor, I've never said that we couldn't transport multiple patients in on vehicle; simply because I've been in a position to have to do it on more than one occasion.

In the above scenario, I would have snatched the highest provider on scene who seemed to have his head together so that which ever patient I wasn't currently involved with had at least EMT-B monitoring until I could get back to that patient.

I am by no means a 'Super Medic/Paragod', but I would damn sure do my best for each of the patients!

Ultimately, the difference of transporting one on the stretcher/ one on the squad seat and transporting one on the floor of the truck is that the two patients can be restrained with the proper devices, whereas the one on the floor has nothing (unless you're talking about the cot hardware in the floor) to restrain your patients movement in the result of a hard stop/crash.

[hatelilpeepees]

Good twist Dwayne, and I am glad you were able to transport both on the stretcher (I have done the same with peds, and I have transported many on the squad bench as well, SO I AM AS GUILTY AS EVERYONE ELSE), but what would you have done if they were both adults ?

To those who say this situation is different from an emergency bariatric call, you are wrong ! Dwayne lacked the resources he needed in a timely manner, and did what he had to do. When you have a patient who can not fit on the stretcher safely, the floor is the next best option, if bariatric resources are not available in a timely manner.

To those who say transporting a patient on the squad bench is perfectly safe, I can not agree, even if you say you use spider straps, and run the seat belts through the hand-holes on the backboard (which most do not do).

1. Strap your partner to the board today and the squad bench, get the truck up to about 30-40mph and slam on brakes hard, then imagine what would happen if you actually hit something.

2. Remember, most squad benches are made out of 1/2 - 3/4 inch plywood or some form of veneer. Your car seat belts are bolted through metal, the bolts holding squad bench belts are not (some trucks have the female end of belt secured to the aluminum frame in the wall, but the male end is still attached to the wood bench). Those belts will not hold anything in a serious crash (and I have seen crashes where the "two lids/seats of the bench came loose in a crash, because it is only held to the bench by a 1/2 inch x 6ft piece of piano hinge.

Take a look inside your bench today, how is it secured to the floor and the wall (and the pieces of the actual bench to itself, are the corners glued together, is there any metal flange and screws holding it together). How are the belts secured (through wood or metal)? How are the seats secured to the base?

P.S. If you think that flimsey net at the end of the bench will not break away in a serious crash, you are wrong there too.

[DwayneEMTP]

In my opinion, both patients were emergent, and both would likely have suffered detriment if treatment at a trauma facility was delayed longer than absolutely necessary.

Had it been two adults I would have put one on the cot, and one on the bench and transported in that manner as the risk/benefit would have, in my opinion, tilted the scales in the direction of my taking calculated risks to save lives.

Unfortunately girl your argument will remain as impotent in this thread as it was in the other..perhaps be even more so.

Dwayne

Edit. I'm not arguing with your belief that ambulances are flimsy pieces of shit, though the two ambulance crashes that I've run on, both roll overs, the box was in pretty decent shape and the cot was still in place. In one, the basic that had been sleeping on it when the crash occurred was strapped in and hanging upside down uninjured.

You keep throwing out these numbers/measurements, claiming, "every ambulance in the country is made exactly like this", and though you keep screaming for research you've not offered anything but a video to back your claims.

Just sayin'....

Edit 2. Who ever said that my situation was different from an Emergency bariatric call. Every person that I can think of in that thread claimed that they would do whatever they had to do in an emergency. You're the one that claimed that fat people don't have emergencies but only call the ambulance out of embarrassment.

I've been trying to stay onboard with you off and on, but you're making it near impossible. Stick with a story girl, and ONE scenario, unless you lay the groundwork for another.

[ERDoc]

HLPP, at the risk of taking this thread off topic, you still just don't get it. NO ONE argued at any point that in an emergency, you shouldn't do whatever it takes to transport a bariatric pt. We were all arguing just the opposite. Your reading comprehension skills are seriously lacking. The other thread was talking about a bariatric pt on a non-emergency, interfacility transport. Either learn to read or stop being a troll.

[Just Plain Ruff]

Dwayne, you just take both kids. No question. Put one on the bench seat and the other on the cot. Simple. I don't like having to take care of two critical kids but you know the old saying 'you do what ya have to"

I had a transport about 15 years ago.

Car into telephone pole, blizzard like conditions, we were actually on the way back froma long distance transfer and came up on this one. ONly one really hurt person but 7 total people in the car.

Called our dispatch and had them call the county that we were in to have an ambulance respond. They told our dispatch that the closest ambulance was 45 minutes away. We had a transport time of about 40 minutes to the nearest hospital.

We just packed all 7 of the patients in the ambulance and away we went.

Got reamed from the staff of the hospital on why we brought them all in in one ambulance. I told them why. They understood.

I had 4 sitting on the bench seat, one in the captains chair, one in the front seat of the ambulance (this one was not injured) and one on the cot. I was on my knees for the 40 minute drive.

Leaving the people there would have been negligent. And waiting for the other ambulance would have been silly.

Does anyone remember transporting a patient hanging from the cieling? IF you ahve been around for a while you might remember it.

[DFIB]

HLPP I have to admire you girl for your persistence. But after about a week it sounds to me that you are simply refusing to accept wise council. Not mine but there are folks that are.

John Adams once said “Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.”

The simplicity is that no self respecting provider will leave a potentially critical patient on the scene regardless of their size. The bench is not ideal but necessary. And is reasonably safe so long as restraints are in place. Obviously it is not as safe as a padded room full of hardbody cops but will get the job done and still meet minimum safety standards in most states. I would assume that the bench would not be a problem for you in GA since you demand patients be transported unrestrained on the floor and fire medics that refuse to do so.

Putting a potentially critical patient on the bench could save their life whereas putting a non critical on the floor could produce just the opposite.

David Antin the poet and critic once said “I was trying to find out what it was that everybody else understood without giving up my stubborn and hard-won lack of understanding.”

Seems appropriate here.

[nypamedic43]

HLPP.... Lacking resources in a NON EMERGENT situation is called WAIT until said resources can be arranged. Lacking resources in an EMERGENT situation is called an MCI, and you do what you have to, just like you would in an EMERGENT BARIATRIC situation. Putting 2 patients in the back of the ambulance was absolutely appropriate given the situation where a second ground unit is over an hour away and the helicopter can't get closer than 15 to 30 minutes. You can't just leave one to transport the other. Take them both and meet your incoming resources.

I have to agree with Dwayne. I'm not arguing with you anymore.

[Just Plain Ruff]

I've been involved in a ambulance crash with two patients. one of the bench and one on the cot. Both patients were strapped down the best we could and the bench patient had a net on the end of the bench. Both patients suffered no injuries. Me on the other hand, yep I did.

To blanket state that the bench is not safe is just that, a flimsy blanket.

No-one that I've seen on this thread seem to want to transport the patient on the bench seat but the mother of all necessity usually dictates that you do just that.

And why in the hell if you feel that the bench seat is unsafe, why are you using an unsafe piece of equipment to transport a patient.

Would you use an unsafe defibrillator on a code? Would you use expired drugs on a patient? Aren't you saying that the bench seat is unsafe so why are you transporting patients on the bench seat if it's so unsafe????????

[RaceMedic]

Ruff,

At my 911 we can still hang from the ceiling if the need is there. It is not common practice but it is another tool when needed!

Race