Multiple patient, single ambulance transport scenario..

[Eydawn]

I want to know more about the IFT ALS patient we're transporting. Obviously not necessarily stable, as they're being managed on drips, but perhaps manageable for a little longer period of time as you assess the other patient? I need to really know the status of my first patient before I make that call. And I don't know much about Nipride, tbh, which leaves me at a definite handicap here.

I wouldn't leave a basic to watch the IFT patient for sure. However, if this patient is stable enough for us to delay transport for a few minutes, with me still managing care (aka we have enough resources to manage an increased transport time and the patient is maintaining well enough to do so), then we can pull over, drop the EMT-B to assess the car situation, and go from there.

What I really need to know is can I safely manage the care of these two patients- is this cardiac patient stable enough for me to have divided attention on an unknown, possibly cluster-f*cked trauma patient? Since it's just me, I need to be honest about my capabilities, and I can't do that unless I know the status of my IFT patient.

In the scenario where I can't manage both simultaneously, we stop JUST LONG ENOUGH to assess and treat immediate life threats and get that guy in the car more stable if we can (if the delay in transport of my original patient won't immediately kill him/her). Extrication if possible, airway if possible, cover with a blankets topped with a Mylar for hi-visibility, leave him in the best possible position we can given our time constraints. Then high-flow diesel to an area with comms, radio it in, and get another unit headed that way, using whatever resources are available (civvy, military, air, ground, etc). At the very least we can get a cop of some sort flying that way hopefully to provide some more basic level care until the cavalry arrives.

Now, I can see some people saying well, isn't that patient abandonment? The same holds true for the catch-22 in Dwayne's original scenario- if I leave one kid with the goobery redneck first responders, and that kid dies, didn't I abandon that patient? At least in this situation, I didn't ignore a distressed human being entirely, and did the best I could with shitty parameters.

I can't let my first patient die- that's neglect, and if I take on another patient and that causes me to be unable to keep my first patient alive, that's also neglect. However-- I can't, as a human being, pass by someone who I may be able to help (or at least provide some palliative comfort to, even temporarily) so I feel that I must at least try, if doing so will not immediately kill my first patient.

I will not, however, take on the second patient as a transport unless I feel like I can safely manage the care of both (or at least not inadvertently kill one or the other because both require too much focused intervention on my part). If I feel like I can manage care until I get to a rendezvous with another unit, I may take that risk, because I can then decrease the time to definitive care for the auto patient (that's assuming I can get them out at all...)

More info, plz! And thank you...

Wendy

CO EMT-B

[Kaisu]

Have had this happen a couple of times when on CCT transport. I cannot leave the patient with a lower level of care, thus my nurse stays with the transport patient, my EMT partner and I go to the mobile home rollover and help the two old people. We extricate with the help of bystanders and package for the transport unit, which in this case arrived 20 minutes after us. Note that this is a remote area with 1st response quite a distance away. Our transport patient was stable, requiring CCT for the administration of pain medication not within the scope of paramedic (in our state). If the CCT patient had deteriorated during the wait, my EMT could have continued with the nurse, leaving the medic (me) on scene without an issue of abandonment of any patients.

Running ALS transports, I as the medic would stay with my transport patient while my EMT partner assisted the accident scene as a first responder. All of these scenarios are impacted by the stability of the transport patient, the seriousness of the accident patents, the distance from help, the presence or absence of others on the scene, etc. etc.

We are trained to think and respond appropriately and adjust our actions to the demands of the situation.

[DwayneEMTP]

Of course I get the 'duty to act' on not retarding care...And I don't disagree with anyone's answers to this scenario, as I can see it both ways. But , I am curious....

Does anyone see a case where a long response time for a discovered accident would constitute a triage situation? Or does Duty to Act mean that the needs of one will always overried the needs of the many?

Dwayne

[RaceMedic]

hmmmmm

gonna have to ponder this for a bit ...

Race

[BushyFromOz]

Does anyone see a case where a long response time for a discovered accident would constitute a triage situation? Or does Duty to Act mean that the needs of one will always overried the needs of the many?

Dwayne

Whoa! What a question.

Much ponderage needed indeed!

[chbare]

Of course I get the 'duty to act' on not retarding care...And I don't disagree with anyone's answers to this scenario, as I can see it both ways. But , I am curious....

Does anyone see a case where a long response time for a discovered accident would constitute a triage situation? Or does Duty to Act mean that the needs of one will always overried the needs of the many?

Dwayne

In the case AK presented, no. I have already accepted care and have already initiated transport of this patient. The patient is on multiple, vasoactive medications. My primary task is to safely and expeditiously transport this patient to a facility where definitive care (presumably) will occur. I stop and my partner initiates patient contact, and now we are stuck and in both a legal and logistical mess. My bias is to avoid it and continue with the task at hand. Sorry for you if you are in that car, but that's my decision in this case. However, I appreciate other views, but I am not willing to complicate or compromise the primary task at hand. Especially, since there is a definitive legal and moral (IMHO) obligation to continue transporting my current patient.

[ERDoc]

I would have to go with not stopping. You have a pt on drips that require monitoring, in the middle of nowhere, with no radio contact or cell service and no idea when the next car will be coming. Best course of action would be to hurry to where you have some sort of contact with civilization and call it in at that point. It sucks for the person/people in the car but sometimes you get dealt a sucky hand.

[DwayneEMTP]

No change if we turn the scenario from a car to, say, garbage truck v loaded school bus?

I'm truly not baiting, but trying to explore if there is no gray area either in the duty to act, or as a moral/ethical provider.

Dwayne

[ERDoc]

I think an MCI is an even bigger NO. You are going to be the only provider on scene. What are you going to do? Get to where you can get in touch with 911/your dispatcher and call in the cavalry.

[chbare]

Agreed, no grey area for me in this scenario