Woman dies in ER lobby as 911 refuses to help

[1EMT-P]

The hospital in this case clearly had a duty to act and they failed to do so. When the 911 system was called they also had a duty to act and they failed to do so. The lawyer representing the family is probably going to demand an investigation and also file a civil action against the department of health, the hospital, the hospital employees, the local 911 system, the 911 employees and the local city/county government.

[Dustdevil]

The hospital in this case clearly had a duty to act and they failed to do so. When the 911 system was called they also had a duty to act and they failed to do so. The lawyer representing the family is probably going to demand an investigation and also file a civil action against the department of health, the hospital, the hospital employees, the local 911 system, the 911 employees and the local city/county government.

I believe you have a good point. But don't forget the cops. They are likely to eat it bigger than the other entities mentioned here.

I would not disagree with the good doctor's assessment that this unfortunate lady was probably terminal before the 911 call was ever made, and that timely transport would have made no difference in the ultimate outcome. However, that fact notwithstanding, this case still illustrates a serious flaw in our current thinking that must be addressed before it again causes us such embarrassment, or worse yet, somebody's death.

Yes, the current conventional wisdom seems to say that calls for service from within a hospital are to be ignored. But I am inclined to say the conventional wisdom is just straight-up wrong. There really is no valid justification for this policy. We have no way of assessing this patient's needs or situation without making contact with them. Call takers on the other end of a telephone across town simply cannot make an automatic ASSumption that this caller does not require service. This type of call screening has resulted in countless HUGE lawsuits in the past against public safety agencies. And the same principle and precedents will be applied to this case. Attorneys for the plaintiff will easily make the case that the ASSumptions being made by the call-takers were without legal basis, and will also raise equal protection and civil rights issues that will turn the whole case into a very sensitive issue that the government simply cannot fight. And they are right. A citizen is entitled to the very same consideration and service from their tax-supported agencies, no matter where they happen to be laying at the time.

It is not the hospital that saves your life. It is the care that is given there that is the destination. This patient was not yet at that destination, and therefore was as entitled as any other citizen to be transported appropriately. This so-called "policy" has to change. And, thanks to this case, it will.

[AnthonyM83]

It is the care that is given there that is the destination. This patient was not yet at that destination, and therefore was as entitled as any other citizen to be transported appropriately.

Transported to where?

[Dustdevil]

Transported to where?

How about putting her on your cot and "transporting" her straight past the retarded triage nurse and into a trauma room, where somebody with some medical competence might immediately recognise the critical nature of her symptoms? Doesn't seem that complicated to me.

The problem is, if you never make the scene to assess the patient, you have no idea what she needs. At the very least, she needs an assessment. And when somebody calls from a hospital waiting room, do you really know if they have received that assessment yet? No. So go.

[chc57802]

Even though the dispatcher was rude, they were following protocol. She was at the hospital, under their care, not any paramedics. The dispatcher should have contacted the hospital though.

A few years back, I was dispatched to the 5th floor of our local hospital, our supervisor was furious and tried to stop the call, but we were across the street and were walking down the hall when the call from him got to us. The woman that called 911 was a non-ambulatory patient and was being ignored by the floor staff, all she wanted was some water. After we consulted with her primary doc, we gave her some water. The floor staff was disciplined, our supervisor was disciplined, the dispatchers were commended.

I’m sure it would vary state-to-state, but it does not matter who calls 911, you send a response. The dispatchers in this case ASS-U-ME D that the woman was receiving care. Too bad.

[JPINFV]

How about putting her on your cot and "transporting" her straight past the retarded triage nurse and into a trauma room, where somebody with some medical competence might immediately recognise the critical nature of her symptoms? Doesn't seem that complicated to me.

The problem is, if you never make the scene to assess the patient, you have no idea what she needs. At the very least, she needs an assessment. And when somebody calls from a hospital waiting room, do you really know if they have received that assessment yet? No. So go.

Wouldn't that be an invitation for every patient that doesn't want to wait in the waiting room regardless of the severity of the complaint to call 911 for a 'go to the front of the line' card?

P.S. I wonder how full the ER was with nursing home patients with DNRs and a minor complaint that had a history that dictated a monitored bed.

[Dustdevil]

Wouldn't that be an invitation for every patient that doesn't want to wait in the waiting room regardless of the severity of the complaint to call 911 for a 'go to the front of the line' card?

Nope. You get there and she's vomiting blood and in septic shock, then yes... she goes to the front of the line. If she's not, she gets what this poor woman got, which was a visit by the cops.

Again, this isn't at all as complicated as some of y'all want to make it. You DO NOT KNOW what a run is until you get on scene. Period. Make the scene, just like every other caller is entitled to, then go from there. But this BS about call takers making ASSumptions on the telephone is absolutely unacceptable, and has already cost many an agency many millions of dollars. It's time we stop trying to be the farking phone police and start providing the service we are expected to provide. Otherwise, we get this kind of publicity and take another big step back from any small progress we have managed to make with the public. It's pointless and dangerous.

[katbemeEMT-B]

I agree with Dust, a call taker CAN NOT assume anything. They are relying on people with no medical background of any kind to relay information to them. How can they possibly know what is best for the patient or if the patient is in need of emergency help. Patients need a proper assessment before one can make that assumption.

A call I was on today is the perfect example (not an ED call). We were dispatched to an MVA with minor injuries. We arrived on scene to find a mini-van on it's roof. You could tell that the vehicle had lost control on the gravel road, hit the shoulder, and then flipped three times before it came to rest on it's roof. No patients were on scene. We were then told the four juveniles were at the farmhouse down the road so off we went. Once we made contact with the victims we agreed that three of the four definitely had minor injuries. The fourth victim who had been the driver had a large laceration to the top of his head and was complaining of pain in his chest. We assumed the pain was from the impact of the steering wheel (through our assessment) as there was no airbag deployment. At the ED he received 10 stitches in his head and they still were waiting on CAT scan results for the chest injury. Now was this an accident with minor injuries? Three yes, one no. It was a sheriff deputy who was on scene and we counted on for updates. Unfortunately, the victims status along with proper directions got lost in the communication from the deputy to the caller to the dispatcher and then us. The caller was where the information was lost.

So I will say again, if you get a call to the ED, go. Nothing is more important than that assessment. As my instructor used to say, "assessment, assessment, assessment. You can never do too many assessments on a patient".

[flight-lp]

Dust, you offer a very valid perspective on this particular tragedy. There was definitely a deficiency on the part of the triage nurse, but I still affirm that EMS should not get involved in most of these cases. My agency receives numerous calls from the ER waiting room, mostly impatient people who have a belief that their reason for visit supersedes all others. We call the ER and speak directly to the charge nurse who in turn goes to triage with the NP or PA and "evaluates" the situation. Based on that evaluation, I can say that we have NEVER had to respond to the ER. Now we have this case which is clearly gross negligence on the part of the ER staff. But I still fail to see why the shortcomings of the hospital need to be dumped into the lap of EMS. It sounds to me that even if EMS did arrive and proceed to the treatment area, the patient probably still would have received piss poor care. Just my .02 worth but I still say check with the hospital, if they deem everything o.k. then its their posterior, not mine..............................

[flight-lp]

I agree with Dust, a call taker CAN NOT assume anything. They are relying on people with no medical background of any kind to relay information to them. How can they possibly know what is best for the patient or if the patient is in need of emergency help. Patients need a proper assessment before one can make that assumption.

A call I was on today is the perfect example (not an ED call). We were dispatched to an MVA with minor injuries. We arrived on scene to find a mini-van on it's roof. You could tell that the vehicle had lost control on the gravel road, hit the shoulder, and then flipped three times before it came to rest on it's roof. No patients were on scene. We were then told the four juveniles were at the farmhouse down the road so off we went. Once we made contact with the victims we agreed that three of the four definitely had minor injuries. The fourth victim who had been the driver had a large laceration to the top of his head and was complaining of pain in his chest. We assumed the pain was from the impact of the steering wheel (through our assessment) as there was no airbag deployment. At the ED he received 10 stitches in his head and they still were waiting on CAT scan results for the chest injury. Now was this an accident with minor injuries? Three yes, one no. It was a sheriff deputy who was on scene and we counted on for updates. Unfortunately, the victims status along with proper directions got lost in the communication from the deputy to the caller to the dispatcher and then us. The caller was where the information was lost.

So I will say again, if you get a call to the ED, go. Nothing is more important than that assessment. As my instructor used to say, "assessment, assessment, assessment. You can never do too many assessments on a patient".

Yup definite breakdown in communication, the way I see it you had an MVA with no patients as they were no longer on scene.

In service, no patient............