While in the ER

[jmnttylfsv]

Hello all,

Two days ago my partner and I transported a patient to a hospital I'm not to fond of. Years ago I took my brother to the Peds ER for a laceration to the hand and waited almost two hours.

Anyway, our patient was stable, she was there for positive C-Dif. We had been waiting for almost 30 minutes when another ambulance company walked in with their patient. They were standing almost 6 feet behind us. They were a BLS unit and neither of the EMTs spoke Spanish. Their patient only spoke Spanish, but the patient's daughter did speak English. All of the sudden the patient's daughter starts screaming, "HELP! HELP! She can't hear me! I think she's going." I could see the fear in her eyes and the patient didn't look good at all. She was pale. I looked around and no one in the ER stopped to see what was going on. It WAS a busy night, but even though the lady was screaming no nurse or physician or ER tech acknowledged her. Everyone kept going about their business.

One of the EMTs wasn't there and the other one just stood waiting for someone to do something. He couldn't really communicate with the patient, but he didn't even try. So i approached the patient, felt for a pulse, it was there and it was regular. I asked the daughter for medical hx, she said only TIA a few months ago. The patient looked like she was in her late 80s - early 90s. I called for my partner to bring our life-pak since our patient wasn't on it. We took blood pressure, sat, and did a four lead. B/P was a bit low but not too bad, her sat was 79, but she appeared to be on O2 because she had a NC on. EKG looked fine. My partner did a stroke assessment, fine also. The only thing was her O2 sat. I went to see how many liters she was on and when i looked behind the stretcher there was no O2 tank. I asked the EMT if they had one in the truck to bring it if not i would give them ours, we had 3 spares. So he brought his last O2 tank. Apparently he didn't want to waste his last tank. As soon as we put her on 3 liters her sat went up to 96 and a minute later she started responding better. The EMTs said she was there for a high fever. They thought the O2 wasn't necessary.

I had two problems with this: 1) How come not one person in the ER stopped to see what was going on? 2) Is the fact that you are in a BLS unit an excuse to not give proper care to the patient or take signs and symptoms slightly? The patient was not that serious, but had she had O2, her daughter wouldn't have had to go through that moment. She was terrified, she kept grabbing my arm and asking me to do something. Also the patient was lethargic and maybe she would have been feeling better the whole transport if she was on O2. When I work BLS units, i treat all my patients as if they were in an ALS unit, and i mean the assessments and constant monitoring of the patient. I wasn't sure if I was allowed to provide care to another company's patient, but I did what I thought was right, of course my partner and I kept our eye on our patient.

[nypamedic43]

Before I answer this I have 2 questions.

1. where are you located? and

2. what is your cert level?

[JPINFV]

her sat was 79, but she appeared to be on O2 because she had a NC on.

You know what's worse than a patient with an SpO2 of 79? A patient with an SpO2 of 79 who's already on supplemental oxygen.

They thought the O2 wasn't necessary.

Since the patient already had a nasal cannula on, I wonder if the patient was normally on supplemental oxygen. If so, then their conduct was tantamount to malpractice.

The patient was not that serious, but had she had O2,

Assuming the SpO2 was accurate, how is a patient being profoundly, severely, and symptomatically hypoxic "not that serious"?

[Yarbo]

Two days ago my partner and I transported a patient to a hospital I'm not to fond of. Years ago I took my brother to the Peds ER for a laceration to the hand and waited almost two hours.

Lucky you didn't wait longer. No clinics in your area do suturing?

Edited November 13, 2011 by Yarbo

[basejump]

You know what's worse than a patient with an SpO2 of 79? A patient with an SpO2 of 79 who's already on supplemental oxygen. Since the patient already had a nasal cannula on, I wonder if the patient was normally on supplemental oxygen. If so, then their conduct was tantamount to malpractice. Assuming the SpO2 was accurate, how is a patient being profoundly, severely, and symptomatically hypoxic "not that serious"?

I agree with you. I probably would have stepped up to triage alot sooner and stating the patients current status.

Lucky you didn't wait longer. No clinics in your area do suturing?

2h is a great time.

[jmnttylfsv]

I am located in Miami, Fl. I am an EMT and my partner a CCT Medic.

When I said the patient wasn't that serious, I meant after we provided O2 and her sat went up. Before and even after if she would have still been in a bad state to me it would be serious, since we treat the patient not the vitals. The 79 sat was definitely serious of course.

Back then when I took my brother to that ER, I wasn't in the medical field, I had no idea.

What boggles my mind is the fact that the daughter was screaming and asking for help and no one did anything. I notice that at other hospitals the staff is more aware of their sorroundings. Should this be a problem that this hospital should try to fix? Of course, but how can that be fixed? I think someone should have at least approched the patient.

Also, this wasn't my patient. I did not want to overstep on another crews call, and even more being from another private ambulance. I was unsure on what I was allowed to do. My partner and I didn't really talk about it. It all happened too fast so we didn't have time to figure out whether it was appropriate or not.

[DFIB]

What boggles my mind is the fact that the daughter was screaming and asking for help and no one did anything. I notice that at other hospitals the staff is more aware of their sorroundings. Should this be a problem that this hospital should try to fix? Of course, but how can that be fixed? I think someone should have at least approched the patient.

Muy buena pregunta pero creo que hay varias cosas que considerar. Just kidding.

I am going out on a limb here so please jump in and let me know if this is a pile of crap.

As far as the hospital is concerned I would consider that their primary responsibility is to their patients. This brings us to transfer of care.

The patient is not an ER patient until transfer of care has been established at least verbally and in a more formal sense signatures collected.

Patient transfer is a legal medical procedure between two health care providers, in this case one is represented by EMTs and the other by whoever receives at the hospital.

The patient transfer is initiated by the delivering EMT with a verbal report. Patient transfer is not initiated by the patient or the patient’s family members.

So my conclusion is that the ER is only responsible for their patients. It seems harsh that they would “ignore” the Hispanic patients daughter but considering that the patient is already under the BLS units care, one would assume that the Ambulance providers are aware of their patient more so than the “hysterical” daughter. If the EMT had been yelling “Help, Help” in might have been an entirely different reaction. I know that if I have a patient I believe to be critical I make sure to immediately communicate it. The hospital listens and reacts accordingly.

It sounds like the BLS unit was not paying attention at all and the patient was better off with you. They sound negligent to me. What I don’t know is if you had the right to interfere with their patient. The daughter was asking for help but was she asking you? Was her plea a legal transfer of care? What legal liability did you assume by stepping in? Or by taking the other services patient? Or by ridiculing the other private service and their reputation in front of their patient and the entire ER staff? Could the EMTs sue for usurpation of duties or emotional distress as result of ridicule suffered?

I hope some of the guys that work ER will chime in and give us some perspective

Edited November 13, 2011 by DFIB

[DwayneEMTP]

...What boggles my mind is the fact that the daughter was screaming and asking for help and no one did anything. I notice that at other hospitals the staff is more aware of their sorroundings. Should this be a problem that this hospital should try to fix?...

Yeah, I absolutely hear what you're saying, but your perspective is different than theirs...

If you've done any time at hospital clinicals you'll notice that rarely does anyone jump when an alarm goes off on one of the machines. That used to freak me the hell out! Certainly if a gazillion dollar monitor is claiming that there is an emergency someone should be beatin' feet!

But my perspective was different then also. They knew what the alarm meant, I didn't. Plus they had a pretty good handle on the patient, so were able to put the alarm into context. As negligent as they seemed, I don't remember anyone running any arrests immediately following the apparently (as I doubt it went unheard) ignored alarm.

Depending on where the hospital is located and how busy it is they likely hear someone screaming that their loved on is 'dying' many times per hour. The only significant difference is the volume. And I'll tell you what, from my limited experience the vast majority of these screams are going to come from people hoping to bump their place up in the line, not from actual concern.

From the reported age of the patient I'm guessing that she came from a nursing home, so the ER probably had a report from the ALF, the crew bringing her, and, sad as it is to say, someone may have mentioned her DNR, so they may have been hoping that she'd die on the cot before they had to deal with her.

People screaming about their loved ones in the ER is a lot like the drunks and drug addicts standing outside the house with all the dogs and rusted cars waving their arms and screaming, "You need to Hurry! Bob is having a heart attack!!" at which point you can get he's pissed at someone and faking, having an anxiety attack, or unresponsive from an overdose. As much as we would like to believe that all people are equal, you must consider the source when evaluating any situation...and I'm guessing, though of course can't be sure, that the ER staff did this.

Good on you for being upset about it. Not so good on you for you AND your partner leaving your patient to go and attend to another. But now it's time to close your eyes, try and remove yourself from the situation, take a new look, and see if you can view it from the ER staffs perspective. And if you can, see if that sheds any new light on your opinion and question.

'Cause see your description is of 'them and us' and that's a mistake. You're team didn't bump into the ER team. It's all one team. I'm guessing that a busy ER staff, seeing a CC Medic, that they assumed he would simply step over there, see what was going on, fix it, and/or then give the appropriate person in the ER a heads up if further action was needed. I know that's what would likely have happened in most ERs I've been in...if they were busy at least.

Don't allow yourself to fall into the We v Them mindset. They are smarter, their teams are really big compared to our little twosome, they have the power to make you stand by your cot for friggin' ever, and it's utter bullshit anyway.

Oh...and of course there is the fact that some ERs are mismanaged and full of apathetic lazy assholes...Just sayin'

Dwayne

[ERDoc]

since we treat the patient not the vitals.

No no no no no no . This cannot be further from the truth and I cannot stand how rampant it is in EMS.

As for the pt, someone screaming in the ER is a normal occurance. If I don't hear someone screaming about something, I start to worry. That being said, someone from the staff should have at least eyeballed the pt, however, like Dwayne said, if the EMS crew was not concerned it may have be reassuring to the hospital staff.

As for turn over of care, according to EMTALA, once the pt is on hospital property (and is some cases within a certain distance of the property) the pt becomes the responsibility of the hospital.

[DFIB]

As for turn over of care, according to EMTALA, once the pt is on hospital property (and is some cases within a certain distance of the property) the pt becomes the responsibility of the hospital.

Thanks Doc. This is a valuable jewel of information.