911 call from outpatient surgery center

[Off Label]

Kind of an open ended question with a lot of possible answers, but how do folks handle calls to these facilities (general surgery, Ortho surgery, gun etc.) when there is an anesthesiologist and or surgeon that needs you to take their patient to an ER?

Obviously, these would be bona fide life threatening emergencies. You and your partner take the patient alone? Get orders from the docs? Bring a doc?

[Just Plain Ruff]

Treat em like you normally do from a doctors office.  They are physicians and they can give orders but if they want to continue to be in charge of the patient while the patient is in the ambulance then they have to go in the ambulance with the patient, otherwise, my protocols drive the patient care.  Bear in mind, most physicians will not go with you because of a myriad of reasons.  

They can provide written orders that can go with the patient and I'll follow those orders to their limit but if things go outside those orders, my protocols and treatment guidelines take over.  

I have only had a physician ride with me a couple of times and of those times the one I can really remember was the physician was clamping off the femoral artery from a massive crush injury.  Had he had let go the patient would have surely bled to death.  So he came with us.  

[paramedicmike]

Sometimes it'll depend on what the procedure entailed.  Sometimes it'll depend on patient presentation.  I've seen it go both ways.

Just don't assault any of the staff as I witnessed in one particular incident.

[1EMT-P]

It usually depends on the patient's condition & the procedure. I have taken staff from the surgical center to the ER with me to assist with the patient.

[ERDoc]

I wouldn't necessarily say that they are bona fide emergencies, at least not all of them.  Do you have a specific question or concern?  Otherwise, treat them like any other pt, but listen to what the docs have to say since they may have some important piece of information.

 

Mike, I think we would all like to hear that story.

[paramedicmike]

I think I posted here about it after it happened.  I'll have to look.

[scubanurse]

I used to treat them as any other call.  We occasionally have OB's ride down from the mountains with patients in labor and once they hit out doors they are just a friend to the patient.  Most of the docs up in the mountains have a good relationship with the EMS crews so they are welcome on the ride, but the EMS crew's can't take their orders since they are not the medical director.  We've had a few docs call in to our ER though to get orders for more pain meds, etc.  I'm not allowed as an ER nurse to take an order from an inpatient doc, only our ER doc's.  Makes codes really fun when we go up to the floor and they start telling me what to start the norepi or dopamine at...

[Spock]

I think the key to this question is good emergency planning.  These ambulatory surgery centers (ASC) are required to have a plan for unexpected hospital admissions and this plan includes the receiving hospital and the local EMS agency.  I agree with ERDoc that not all are true emergencies and are often related to an unexpected result or complication that may not be life threatening but do require hospital admission for further evaluation and treatment.  I have worked in the ASC setting and never had to transfer a patient  but that is only because of dumb luck.  If I would have had to transfer a patient, I probably would have gone in the ambulance but since most of the crews in this area know me, it would not have been an issue.  

Working together is paramount for good patient care and the treating physicians should provide solid information on the events that caused emergent transfer to a higher level of care.  When in doubt or faced with a conflict, consult medical command and let the doctors figure it out.  

May the tube be with you.

Spock

[ERDoc]

I agree with ERDoc that not all are true emergencies and are often related to an unexpected result or complication that may not be life threatening

Cough cough cough, the pt is taking a little longer to wake up than planned and it's getting close to closing time, cough cough cough.

Edited March 26, 2016 by ERDoc