Multiple patient, single ambulance transport scenario..

[Just Plain Ruff]

I know the option is available but I don't like that option.

Scares the hell out of me not to mention my patients when I did hang them as a 3rd patient.

[hatelilpeepees]

I am not argueing with Dwayne, or suggesting he leave anybody at scene, I would have done as he did, if it were two adults I would use squad bench. It is just that Dwayne got me thinking about how unsafe the bench is --- I admitted I do it all the time.

As far as the bariatric deal, its a dead horse, I will not discuss it anymore after this final comment : The only reason everyone said you should not transport the patient on the floor is that it would be unsafe in an MVC. Putting a patient on the flimsey squad bench is just as unsafe IN AN MVC. Thats all I am saying --- horse is beaten, shot, and buried.

[BushyFromOz]

As far as the bariatric deal, its a dead horse, I will not discuss it anymore after this final comment : The only reason everyone said you should not transport the patient on the floor is that it would be unsafe in an MVC. Putting a patient on the flimsey squad bench is just as unsafe IN AN MVC. Thats all I am saying --- horse is beaten, shot, and buried.

Your still ignorant of what risk / benefit is arn't you....

[Krysteen]

I mentioned that I also transport multiple patients on the patient advocate thread. As a matter of fact, when some others said absolutely never I paused, but then again I am in Rural EMS, what else am I to do? I have two ambulances, that is if anyone responds for the backup. Two Paramedics staff the primary rig 24/7. We ask that our EMTs answer for backup if they are able. So at most we could transport 4. I did work in an ambulance where the possibility to "hang" a patient was there but never used it, seemed a little unstable. We cover 240sq miles, but have zones where we have non-transport units that are dispatched because our on scene time could be up to 25 minutes. Nearest trauma center is around 40-60 miles depending on incident location. We have access to two air medicals. Last two potential scene flights I had, I really really wanted them to come but both were unable. We have the option to transport by ground to the most definitive care, Paramedic discretion. Otherwise, there are 5 other small hospitals they could be diverted to. There are other ambulance services, response times probably 25-40 minutes, who may come for mutual but generally if we man both our ambulances we will not request aid unless we have more then 4 patients.

I will also add that the "other" ambulance services are three very small volunteer services who have limited resources, and one paid full-time service which staffs only one ambulance each shift.

Edited October 20, 2011 by Krysteen

[Linuss]

Yes, it's perfectly fine to take multiple patients, and don't know why anyone would state otherwise.

Yes, at my last service, which was rural, I did it plenty of times. Usually trucks would transport 2, but sometimes there would be more.

My most was 3. This was due to an MCI machete attack (Yes, you read that right... machete).

[DFIB]

Yes, it's perfectly fine to take multiple patients, and don't know why anyone would state otherwise.

Yes, at my last service, which was rural, I did it plenty of times. Usually trucks would transport 2, but sometimes there would be more.

My most was 3. This was due to an MCI machete attack (Yes, you read that right... machete).

Where do you work? Mexico?

[medicgirl05]

I also work for a rural 911 service. We have at least a 30 minute wait for mutual aid. We had a MVA with 3 adult patients, one of which I deemed critical. We took out the stretcher mounts, tossed 2 BBs on the floor, one on the bench. EMERGENCY situations require different methods than nonemergency IFT. I had my partner drive as we were down a long,curvy, gravel road. I had a first responder assist me in the back. Extra pair of eyes/hands is always good, especially if you trust the brain behind them. Only time I've ever done that but I saw no alternative at the time. My medical director backed my desicion.

When you work rural you have to sometimes do things out of the box. You have to weigh risk Vs. benefit.

[akflightmedic]

I agree and so many people are just never exposed to the other side of the coin. This thread has caused me to reflect over the many things I have done in years past which were "out of the box" or completely "unfathomable" to most urbanites. I have had the benefit of working so many systems: city, rural, austere/remote, flight, 3rd service EMS, Fire Rescue....it has all been a huge eye opener and was only made possible by my desire to never become stagnant.

I wanted to share a call from an IFT job many moons ago. I was transporting a cardiac patient from a small hospital to the big city hospital which had the services this patient required. He was on multiple drips, pain free and being monitored. I was with an EMT partner who was driving. In the middle of this transport out in "the sticks" on a not so well traveled 2 lane highway, we came upon an overturned vehicle.

I have a cardiac patient on board and we see a single vehicle roll over. This area is about 35-40 minutes from the closest unit provided it is not already on a call. I do not see another vehicle in sight and radio comms are NOT working. This was also when cell phones were relatively new and too expensive for me to own one. (Probably would not have been good coverage anyways--hard for some of the younger providers to remember/imagine these days)

What would you do?

[RockDoc]

Never say never---During Katrina I was Scene Commander at Ellington Air Force Base receiving C-130's flying patients out of New Orleans. For over a week, day and night, every 2-4 hours these C-130's would land at Ellington with between 20-30 really serious patients aboard, mostly dialysis patients who hadn't received dialysis in over a week or more, some really sick folks. I had as many as 30 ambulances working at Ellington transferring these patients to the closest hospital that could help them, sometimes as far as 125 miles away. Houston Fire Department EMS was completely occupied trying to take care of several thousand patients housed in the Astrodome. I had to find hospitals/dialysis units (sometimes at 4 AM) that would take these patients in and treat them.

We saved our Level 1 hospitals for the absolute critical, "I'm fixing to die" patients and farmed the other patients out wherever we could. Sometimes as many as 3-5 patients were loaded in one ambulance (not critical ones) and transported . If there was room to strap a patient in sitting up or laying down, it was used. The object was to clear the last plane load of patients before the next plane load came in. During that week we handled over 1,000 patients and as miracles can happen, not one of them died. We used the morgue setup to catch catnaps between planes. Sometimes you just gotta do what you gotta do, the rules be damned.

[RaceMedic]

AK,

I am guessing that your IFT patient was fairly stable to begin with or you would have flown them out instead of driving ?

At any rate, as you describe if your current patient condition i would have stopped and investigated to be sure that this is a current MVA and not something that had been worked and is awaiting the tow truck.

On finding a patient, what is his condition? is he impaired? I have a duty to the person i am currently transporting so i want to know if this "new" patient is under the influence of anything (alcohol or stronger) before i decide if i am going to introduce him in to the back of my currently occupied ambulance. Just as s safety issue. Also as a side note, it would just be common courtesy to your IFT patient to ask their permission to bring the roll over patient in for transport (whether you decide to follow it or not). It also depends on the condition of the roll over victim.

I have transported in a similar situation before. however the patient i picked up was (by my assessment) able to ride in the front seat of the ambulance. He was not charged for the ride and was taken to the hospital. I have also delayed my transport and waited at an accident scene providing treatment while waiting for a 911 unit from the area while my partner monitored the patient in the back ( we were medic medic crews then ) so it was easier.

Race