Already treated in Mexico - What Would You Do?

[spenac]

Your taxi's here welcome to the USA.

[scope2776]

First off hind-sight is 20/20, so with that said:

The child is in no need of urgent medical attention, this I can surmise from the exscrupulous details of the scenario. The child may even be receiving better, or at least the standard, medical attention in Mexico.

Am I right in guessing the MOTHER AND CHILD ARE ON THE UNITED STATES SOIL, but not within the "border-zone" that is strictly enforced?

The mother is illegally present in the United States. The child is a citizen.

So obviously there is some sort of legal responsibility of care to provide to the child who is a citizen on US soil. Also there is the responsibility to not transport a known illegal alien.

The solution is better cooperation with the local LEOs and border patrol. Maybe meet up and write out protocols for this situation or establish a number to call in the event of a sticky situation like this, etc.

Also, if you would put the surrounding 500 miles without EMS cover by going out of service by transporting these patients, maybe your agency should look at assembling protocols for Paramedic Initiated Refusals. Because I would refuse these guys.

I voted no transport because the daughter is not in need of medical attention and the mother is breaking the law. Plain and simple she is breaking the law and by transporting her you may also be breaking the law. Maybe have LEO dispatched to take care of mom and transport the child if you think she is really in need of medical care. I mean it kinda makes me sound like a jerk, but if you are making the decision to transport illegals into this country, for whatever reason, you are making the decision that they do not pose a threat to the citizens of this country. And guess what - that's not your job, that's border patrols job. It's out of your scope to decide who enters this country. I mean, it's far out there but, what if you transported terrorists into this country??

[Just Plain Ruff]

Scope - If I remember right at least one or more of the 9/11 terrorists came through our border. Not sure if it was the canadian border or the mexican border. I could also be wrong but that's what I think I heard.

So the concept of transporting a terrorist is not out of the realm of possibility.

[PRPGfirerescuetech]

This is not an actual call, but is something that happens here often.

You are a medic in a border town 100 miles to nearest hospital with no other ambulances closer than 60 miles away. You have no communications with medical control, you work strictly written protocol. Law enforcement and fire do not respond with you. It is just you and another medic.

You are dispatched "child with broken arm".

On arrival you find a 10 year old girl already in a cast.

Mother explains that the child had fallen and broken it earlier in the day in the USA. She had family members take child take the child to hospital in Mexico. She hands you a x-ray film that shows fracture at or about center of the radius. Everything is lined up and there are no fragments. Patients cast immobilizes arm above elbow and below wrist. All vitals in normal. Cap refill less than 2. Good motor function of fingers without pain on movement. Pain is dull pain at most a 1 out of 10 per child. Patient has pain pills prescribed in Mexico but hasn't taken one because it "does not really hurt" since was casted. You examine child for any signs of possible abuse none seen on back, legs, abd, etc.

You ask mother since child is already casted why she called ambulance, she says that Doctor in Mexico told the family (keep in mind mother did not go with child) that the girl might need surgery and since the child has medicaid they decided to bring her back to USA to see Doctor. You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA.

So what do you do?

Transport. No other acceptable answer. You received a call for service. You provide that service, REGARDLESS of how much you agree with the need for the service.

[AZCEP]

Transport. No other acceptable answer. You received a call for service. You provide that service, REGARDLESS of how much you agree with the need for the service.

This patient does not need transported by ambulance. If other resources are available to do so, they should be considered.

Because the guardian of this patient is requesting ambulance transport, then you should provide it. The matter of taking a unit out of service to do so is not the immediate concern. Because your allowed to refuse transport for those that don't need it you should have a good grasp of the liability that this presents, and it sounds like you do.

This situation is a bit of a medico-legal mess. Transporting without the mother should be done only in a life threatening situation or obvious abuse, which this doesn't sound like. Transporting with this parent constitutes aiding an illegal immigrant, and could result in jail time.

This argument could go on for years, and there is no clearly right answer. It is a discussion that needs to happen though.

[spenac]

Thanks for all the responses. This is a tangled web for which there is no completely right answer other than follow local protocol. The local protocol allows us to deny a request for transport in some situations and no medical complaint is one of those so this patient and her mother will not go up by our ambulance. So we explain the reason to the mother do tons of paperwork and go get the next one. The legal status is something that was done to complicate this case and is something we face regularly here but we do not ever allow a persons legal status if known to change our way we treat them. We treat everyone Professionally and with compassion, but that does not mean we have to transport them if they do not need it.

Will we ever be properly staffed? No not going to happen but we are fighting for improvements. But even if better staffed I can never see a way to justify this caller being taken to the hospital, but if your the lead medic here when we get one like this it's your call, I'll back you on the transport. Now if your lead and your wanting to deny a transport to someone I feel needs to go, I just took over as lead medic and we're transporting, thats part of the process. Denying requires both medics of any level agreeing or the patient goes.

Hope this has some of you thinking that there may be more than one right way to be Professional. What works here may not work there, but it does not make it wrong. I definitely do not agree with some of the posts I've read since joining but I am not working where you work so I can not say you are wrong.

[spenac]

Transport. No other acceptable answer. You received a call for service. You provide that service, REGARDLESS of how much you agree with the need for the service.

OOPS I violated protocol and transported against the medical directors instructions I've therefore exceeded my scope of practice. At a later comment I gave the statement that our protocol allows denial if no current medical complaint and this clearly shows mother is not requesting us because of the child therefore no transport.

Thanks for your input and your local protocols do proably require you to transport all callers even if they just want a ride to eat at the hospital. Our protocols allow us to weed out some things but not many we still transport most that request it.

[PRPGfirerescuetech]

OOPS I violated protocol and transported against the medical directors instructions I've therefore exceeded my scope of practice. At a later comment I gave the statement that our protocol allows denial if no current medical complaint and this clearly shows mother is not requesting us because of the child therefore no transport.

Thanks for your input and your local protocols do proably require you to transport all callers even if they just want a ride to eat at the hospital. Our protocols allow us to weed out some things but not many we still transport most that request it.

My statements had NOTHING to do with protocols actually, but im not a strong believer in protocols really.

This is a simple answer.

Where is your biggest liability when dealing with a request for service?

Transporting every patient who requests your service? Or allowing your crews to determine who needs to be transported?

Considering the level of competency of EMS providers in America, im happy when we can tie our shoes before coming to work. Actually allowing EMS providers at their current level to determine who is capable of transport in potentially disasterous at best in our liability based field.

Now, in regards to your scenario, your wrong.

1. Child has 1/10 dull pain.

2. A medical doctor has determined a potential need for surgery.

3. You cant read X ray films.

4. The child has not been evaluated to determine need for surgery at medical facility of her primary caqre physicians request.

5. Soooo, her entire medical care has not been completed, and she has a "complaint".

Considering these facts, you have a 1/10 arm pain child who has been determined to be a potential surgical canadate by a physician with much more education than you. This child has been treated partially, and you see fit to not transport?

You have treated this child inappropriately.

Now, i bode to you two questions.

1. Explain your statement above regarding that mother "obviously not calling for the child". Why do you say that? She didnt get over the border. She even went through the effort of driving her child to a border point to initiate american EMS for transport, and get her child to an american hospital, at the request of her physician. Exactly what do you feel is occuring inappropriately here?

2. Since I have explained why this patient should have been transported, now tell me why she should not have been. Simple question.

Im open to discussion here.

[spenac]

My statements had NOTHING to do with protocols actually, but im not a strong believer in protocols really.

This is a simple answer.

Where is your biggest liability when dealing with a request for service?

Transporting every patient who requests your service? Or allowing your crews to determine who needs to be transported?

Considering the level of competency of EMS providers in America, im happy when we can tie our shoes before coming to work. Actually allowing EMS providers at their current level to determine who is capable of transport in potentially disasterous at best in our liability based field.

Now, in regards to your scenario, your wrong.

1. Child has 1/10 dull pain.

2. A medical doctor has determined a potential need for surgery.

3. You cant read X ray films.

4. The child has not been evaluated to determine need for surgery at medical facility of her primary caqre physicians request.

5. Soooo, her entire medical care has not been completed, and she has a "complaint".

Considering these facts, you have a 1/10 arm pain child who has been determined to be a potential surgical canadate by a physician with much more education than you. This child has been treated partially, and you see fit to not transport?

You have treated this child inappropriately.

Now, i bode to you two questions.

1. Explain your statement above regarding that mother "obviously not calling for the child". Why do you say that? She didnt get over the border. She even went through the effort of driving her child to a border point to initiate american EMS for transport, and get her child to an american hospital, at the request of her physician. Exactly what do you feel is occuring inappropriately here?

2. Since I have explained why this patient should have been transported, now tell me why she should not have been. Simple question.

Im open to discussion here.

I will not waste my time on all the points you have missed but number one the mother in scenario said there was no medical concern the only reason for the call was she the mother cannot legally get past the check point. "You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA."

Also read all the post mother is illegally in the USA. She is on the USA side of the border. She is wanting to get past the checkpoint 50 miles north. She is not at the border patrol asking for help. She had family take the child to Mexico for care and they brought her back to the USA. Now the mother calls from where she is illegally staying. Mothers legal status only is in play because that is only reason she gives for wanting the ambulance is to further break the law. read all the posts. "You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA."

The only reason the mother has requested the ambulance in her own words is she can't pass the check point!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I am sorry you work with incompetent medics, thankfully I work with professionals. Thankfully I work with a medical director that lets us operate as professionals. If you and your fellow medics can't tie your shoes as you say may I suggest side zip boots.

Glad you do not work with me since as you say you don't believe in protocols, I do not want a law suit for ignoring a higher educated persons instructions. What I do is within the scope of practice of my protocol.

Please read the posts and you find many points you wrongly state already dealt with. People with your attitude that you transport everything without using your brain were the cause of my taxi um ambulance driver rant yesterday.

[Laura Anne]

Oh dear......

Spenac,

I do feel your pain due to the fact that I, too had lived temporarily on a border town over in Southern California. I do not think we had established a protocol stating the denial of care due to no need for EMS intervention....at least not while I was there(5yrs prior). Perhaps things have changed and if so, I apologize. I am only going to comment on what we did as EMS providers when I was out west. Also, where I was, we had a hospital approx <10miles from the border town checkpoint.

***El Centro Regional Medical Center, Cali.***Gold Cross Ambulance, Imperial Co., Cali.***

There were certain situations where EMS was called to the Customs check point on the border for transfer of care from the Mexican EMS ambulance. In this case, there was no issue that I was aware of in reference to the status of the patients' nationality or their parents' if the patient was a minor. If the BPA found them and they claimed an injury/illness(which happened often as a scapegoat from detention), then we took them without question due to the verbal complaint noted and/or obvious injury/illness presented.

Now, if a patient was already in town/US soil and wanted medical care, then I see no reason for denying transport. Unfortunately, in this scenario, the parent has to make the medical decision for her child. Perhaps she's using her child to help her own personal situation, but I would not want to be the EMS provider who attempted to state this in a court room. Err on the side of what is best for the patient......that's what I would do.

Are we aiding the illegal immigrant into the states? Technically, she is already here approx 50miles, correct? And the child is an American citizen, therefore giving the mother the right as the legal guardian to accompany her. It's kinda like the pregnant illegal mothers who walk to the check points fully in labor, water broke and all, just to give birth over in the states, making their child an American and also giving them the legal right to stay. :roll: This is where the legalities come in and quite frankly, I just don't know how it is done since I left...again...apology. :wink:

Basically I'd transport the patient and mother. If BPA has an issue with the passing of the mother thru their check point, let them make the legal decision. Let her state to them what she stated to you. OBVIOUSLY, this won't go over well with her and she'll either lie or admit her wrong actions. As a medical provider though, I am not sure if can deny. This statement about being unable to refuse transport is due to what the standing protocols I go by up here in Pa. I think it's great that you all have the capability to , under your medical command, inform a person(s) that your services are not being rendered in the best interest of everyone involved and that, quite possibly, abuse if the emergency unit is taking place. If there is an alternative you can give the mother, such as a taxi voucher, a phone call to another relative/friend/etc.....let her do this so you can stay in the local for your community and any other 911 calls.

One side note: I personally do not have any problems tieing my boots prior to going on a call, nor am I incompetent in my job. Please do not let your judgement of providers where I work be tarnished because there are a few who may spoil the bunch. My understanding is that no one service, state, etc is perfect......but I do NOT like being portrayed as 'lacking' in my profession.