While in the ER

[romneyfor2012]

Unfortunately DFIB, that is a US rule only, wont help you in your part of the world. But Doc is correct, once the patient is on their property (or within so many feet/yards from it), it is their responsibility to provide a screening exam, and then arrange transfer to another facility if it is something they can not treat. Did I miss it, or did we ever say what was really wrong with the patient ?. I would nicely and respectfully share your story with the ER Director, as allowing an outside person to treat patients in their ER should raise some concerns for him/her (not saying you did anything wrong, but if I were a patient or visitor and saw EMS have to treat a patient in the ER because the staff refused to jump in, I would be concerned).

[jmnttylfsv]

Thank you all so much. A lot of the things said added perspective to the situation. I'm glad this forum is here, it helps to understand things a lot better.

Thank youu

[Just Plain Ruff]

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.

Actually Doc that's not completely true. At several of the services I've worked for the helipads at the hospitals make great landing zone and I've been involved in two distinct EMTALA complaints where the ED physician has made a complaint of my using their helipad for just that a LZ for the helicopter.

Our EMTALA/COBRA investigator ruled for my ambulance service each time saying if the helipad, even on hospital property is used for a LZ only that its not a violation. Of course your localities investigator may have a dfferent interpretation of the rule. Mileage may vary of course.

[chbare]

Several facilities work that way where I live. EMS is able to "divert" around smaller facilities and use landing pads for flight intercepts. Protocols are in place as well as agreements to ensure the EMTALA police remain happy. Even if we don't land at a facility, we still contact facilities that we fly over or bypass just to let them know what we are doing and why. On occasion, these smaller facilities may even request we land instead of bypass. For example, we may be flying a suspected extremity fracture out of the wilderness and one of the smaller facilities happens to have ortho and takes the patient.

[ERDoc]

Agreed Ruff, but that is a very special circumstance. We do the same thing at the rural hospital I work at. The EMTALA issues go on the trauma center since they are the ones that have accepted the pt. However, if EMS brings the pt in the door, it now becomes the ER's pt. As for the issue of using the helipad, I don't know if there is any presidence for it.

[flamingemt2011]

There is an exemption for helipad use, as long as none of that facility's staff comes out to provide care during the transfer from ambulance to helicopter. Where it becomes gray is when a helicopter is forced to land at a hospital helipad due to weather or mechanical problem, and patient care is delayed while awaiting ground transport. That is not specifically addressed.

[Just Plain Ruff]

Agreed Ruff, but that is a very special circumstance. We do the same thing at the rural hospital I work at. The EMTALA issues go on the trauma center since they are the ones that have accepted the pt. However, if EMS brings the pt in the door, it now becomes the ER's pt. As for the issue of using the helipad, I don't know if there is any presidence for it.

True Doc, but where I come from the services I work for are completely rural. We don't contact the trauma centers we allow for the helicopters to determine which trauma center the patient goes to because we in the rural area don't have the informaition that the helicopters have in terms of who's open and who isn't.

So the majority of our flights are from a landing zone (helipad on a small rural hospital) to an available trauma center, stroke center or Heart center.

Now, what becomes the gray area and the emtala issue is the patient you are transporting form that small rural hospital and that patient crashes or gets sicker. EMTALA has been addressed based on the cobra forms and the transport is begun. When I call for a helicopter to land at the helipad of the hospital I never thought there would be an EMTALA issue especially when the patient is ending up at the same facility that they started out to go to.

What I have found is this on one particular call, you use the LZ (helipad) at the small hospital, my emt goes into the ER and notifies that hospital that we are using their helipad as a LZ only and the doctor in the ER gets his knickers in a bunch and cites COBRA and EMTALA. My emt then comes back out and says "the ER wants to evaluate the patient" I then say no. The doctor comes out and gets in the ambulance with me thus making my patient his. This was a critical trauma patient, the small ER doc whos hospital does not have Ortho, surgery or anything more than a 4 bed ICU. We now have a patient who is critical and is now being evaluated in the small town ED so this doctor can do whatever life saving magic he thinks he could do. In the end, the patient dies from his injuries in the small town ED and a major court case was started with the small ER/hospital losing big time, my butt being in court for several days, my being named initially to the lawsuit but dropped during the 2nd deposition.

The trauma center backed my decision to divert to the helipad, they did not support the doctors decision to bring their patient into the small ER and made it abundantly clear to the court that the patient died not because of actions on my part or their part (the trauma centers) or the helicopters fault, but the fault lay completely on the small town doctor who did indeed cause the patients death.

So my word of caution is use hospital landing pads with caution as some hospitals still firmly hold onto the belief that once on their property for no matter what reason, they are their patient. I can understand that belief but just beware.

I am a strong advocate of scouting out particular areas in a small town or rural area and work with land owners and business owners on the use of their land as a LZ.

We had a church with a huge parking lot that agreed to allow us to use their parking lot when no services as a landing zone. Biggest parking lot in the west end of the county and it suited us very well. there is still no substitute for a secure landing zone at a hospital but we have all made do in the past. Choose a nice field and land the bird. Land the helicopter onthe highway but that causes many headaches for drivers trying to get where they need to go.

Work with your helicopter service that you use most to scout out good areas, the pilots know what they need for landing.

Ruff

[DFIB]

There is an exemption for helipad use, as long as none of that facility's staff comes out to provide care during the transfer from ambulance to helicopter. Where it becomes gray is when a helicopter is forced to land at a hospital helipad due to weather or mechanical problem, and patient care is delayed while awaiting ground transport. That is not specifically addressed.

Hey amigo, I didn't think you were still around. Your leather skeleton is kind of ominous. I liked the rainbow clown more. It seemed kinda festive.

Good to see you.

Edited November 14, 2011 by DFIB