Woman dies in ER lobby as 911 refuses to help

[paraloco]

Our dispatch would have notified the shift commander, who would have called the charge nurse about it, or gone inside himself to assess the situation. I agree that the hospital was negligent. But. It looks really bad for the dispatcher to do what they did, and public perception is the reality. I'll bet the dispatcher gets fired, so the city can offer up some fresh bleeding meat to the media and the family of the victim. Policies will change, and we'll be caught in the middle. I can see people approaching a crew who has dropped off a patient and are on the way out, past the waiting area. Or putting their truck back in order out in the sally port, and being asked to take somebody to another facility. Has disaster written all over it.

[AnthonyM83]

Everyone bringse up transporting to another facility...wouldn't the most accessible receiving facility be that same hospital?

Though to be fair, that would have at least gotten them out of the walk-in lobby and into the ER hallway with the other patients on gurney waiting to be seen. Though if she was in custody...PD usually doesn't wait in the walk-in lobby. They usually wait in the actual ER with the medics and their patients...so I guess literally it would not have done much good.

[medic001918]

... the ED staff felt it was best for the patient to seek medical attention else where.

I don't believe that hospital staff can feel it best for the patient to see medical attention elsewhere UNLESS it's for a higher level of care. If the hospital is so busy that they can't handle a case that might show up by private vehicle or by ambulance, then the facility is negligent for not going on diversion. Even in that case, they still have to handle patients that walk in as far as I know.

And as far as calling them and telling them that the call is being recorded and that this is an emergency, the dispatcher can't really provide that information as they have done no assessment of the patient. It falls on the facility to handle their incoming patients. It's not the role of dispatch to provide checks and balances for a receiving facility. This would be the closest appropriate facility for the patient.

Shane

NREMT-P

[MAGICFITZPATRICK]

Every one better get nice hair cuts and nice clothes because they are all going to court.The jury should take about 10 minutes to return a guilty verdict.They will be bankrupt by the end of the trial.

[katbemeEMT-B]

I don't believe that hospital staff can feel it best for the patient to see medical attention elsewhere UNLESS it's for a higher level of care. If the hospital is so busy that they can't handle a case that might show up by private vehicle or by ambulance, then the facility is negligent for not going on diversion. Even in that case, they still have to handle patients that walk in as far as I know.

And as far as calling them and telling them that the call is being recorded and that this is an emergency, the dispatcher can't really provide that information as they have done no assessment of the patient. It falls on the facility to handle their incoming patients. It's not the role of dispatch to provide checks and balances for a receiving facility. This would be the closest appropriate facility for the patient.

Shane

NREMT-P

I would assume you read this thread and understand that the point is a patient calling 911 from or near the ED. And yes if a patient tells dispatch that they are being ignored in the ED dispatch would call the ED and tell them the call is being recorded. The dispatcher is not going to ignore them too. There is no patient assessment needed to relay information from a caller to the ED. Dispatch is there to give information that is being given to them. They would treat the call the same as if it were a 911 call in a home when the caller stays on the phone until EMS arrives other than to remind the sometimes arrogant ED staff that they are being recorded.

As far as the ED staff being so busy they must divert, that works great for patients who may be coming in by ambulance. Any patient coming in by private vehicle isn't going to get diverted as they don't have contact with the hospital until they get there. Transporting to most hospitals outside of our area is a higher level of care. That said, it isn't just Joe Schmuck with the sore toe the hospital would have us take. It is the patient that is stable but really needs to be seen. Would it not be more negligent to leave this patient sit in the ED waiting room for hours while they deteriorate. They set it up just like they would a normal transfer. I know of only one such time since I have worked on the service this has happened and that was when there was a multi-vehicle pile up. We transferred a patient with a possible ruptured appendix to the Metro as the ED was overflowing and they didn't feel she could wait. She was brought in by private vehicle after the patients from the accident had arrived. The hospital was closed to ambulance transports but as I said, you can't divert private vehicles.

[medic001918]

A booked regular transfer, or even a "stat" transfer (as they're sometimes called here for emergent situations) has to be booked by the hospital. Not by a patient sitting in the ED and calling 911. So is what you're saying is that if a patient is sitting in the ED and decides to call 911 to go somewhere else it falls on the dispatcher to call the hospital and provide checks and balances to ensure the hospital is handling the situation? Sounds to me like a good way to get seen faster. If I don't want to sit in the waiting room, I'll call 911 and they'll call the hospital for me to get me some attention. The dispatcher must know what's going on better than the triage nurse (who in this case did a horrible job). Where does EMS dispatch come into play when a patient is already in the ED of a legal receiving facility? The real answer is that they don't. This dispatcher didn't handle the call as well as they could have with regard to comments made...but I don't think they had a duty to call the hospital or send an ambulance when the patient is at the hospital. If a patient is in the ED it's reasonable to assume that the patient has been seen by a nurse and appropriately triaged (althought it was a poor job in this case). I don't know about you, but I've seen plenty of patients tell me that their condition is worse than it is. If all the people who told me they were "dieing" and ended up in the waiting room were right, there'd be a much larger issue. It's the role and responsibility of the triage nurse to assess these patients and prioritize them. Again, it's not the role of the ED to provide some quality insurance by calling the hospital and advising them that this is a taped call and that they receieved a 911 call from their waiting room.

I'm sorry to hear that many other hospitals outside of your region would be a higher level of care. The two major hospitals we deal with are both trauma centers (one is a level I and one is a level II). This gives them a large capacity of handling patients. However, even when these hospitals are on diversion they still manage their walkin patients. Up to and including MI's, GSW's, etc. If a patient needs to be transferred somewhere, they do it.

I guess a better answer would have been if the hospital couldn't handle this patient due to patient overloading then they should have been the ones to book a transfer for the patient to another medical facility. They didn't feel this was warranted for whatever reason they had. In this case it's the hospitals fault to own. Not that of anyone else's. Not the police department, fire department, EMS crews and not even dispatch.

Shane

NREMT-P

[spenac]

Wanted to answer the poll but couldn't figure it out. Read it closely. "Do you think the dispatcher should have contacted paramecdics".

Whats a para mec dics? Is that something nasty? Must be one of ya'lls big city terms.

[katbemeEMT-B]

A booked regular transfer, or even a "stat" transfer (as they're sometimes called here for emergent situations) has to be booked by the hospital. Not by a patient sitting in the ED and calling 911. So is what you're saying is that if a patient is sitting in the ED and decides to call 911 to go somewhere else it falls on the dispatcher to call the hospital and provide checks and balances to ensure the hospital is handling the situation? Sounds to me like a good way to get seen faster. If I don't want to sit in the waiting room, I'll call 911 and they'll call the hospital for me to get me some attention. The dispatcher must know what's going on better than the triage nurse (who in this case did a horrible job). Where does EMS dispatch come into play when a patient is already in the ED of a legal receiving facility? The real answer is that they don't. This dispatcher didn't handle the call as well as they could have with regard to comments made...but I don't think they had a duty to call the hospital or send an ambulance when the patient is at the hospital. If a patient is in the ED it's reasonable to assume that the patient has been seen by a nurse and appropriately triaged (althought it was a poor job in this case). I don't know about you, but I've seen plenty of patients tell me that their condition is worse than it is. If all the people who told me they were "dieing" and ended up in the waiting room were right, there'd be a much larger issue. It's the role and responsibility of the triage nurse to assess these patients and prioritize them. Again, it's not the role of the ED to provide some quality insurance by calling the hospital and advising them that this is a taped call and that they receieved a 911 call from their waiting room.

I'm sorry to hear that many other hospitals outside of your region would be a higher level of care. The two major hospitals we deal with are both trauma centers (one is a level I and one is a level II). This gives them a large capacity of handling patients. However, even when these hospitals are on diversion they still manage their walkin patients. Up to and including MI's, GSW's, etc. If a patient needs to be transferred somewhere, they do it.

I guess a better answer would have been if the hospital couldn't handle this patient due to patient overloading then they should have been the ones to book a transfer for the patient to another medical facility. They didn't feel this was warranted for whatever reason they had. In this case it's the hospitals fault to own. Not that of anyone else's. Not the police department, fire department, EMS crews and not even dispatch.

Shane

NREMT-P

Well, first off your lucky to have that high of a level of care. I live in a rural area and we are happy to at least have a hospital. One doc, three nurses, and six beds in the ED. Trying to give you a visual. Now normally there isn't a problem with patient overload. As I stated, I only know of the one time which happened to be as a result of a large accident in which the ED filled up with patients brought in from that. The patient that called 911 walked in the ED waiting room, waited for a short period of time, and then requested an ambulance take her elsewhere. Now, dispatch does have a responsibility to respond to this call to 911. They acted appropriately by calling the ED and letting them know that this patient was requesting an ambulance. They strongly suggested the nurse check on this patient. As stated in my post, the ED staff gave the go ahead for the ambulance and treated it just like they would a normal hospital transfer. I guess you missed that part.

By calling the hospital, the dispatcher took the responsibility off of their shoulders and put it on the EDs. HMMMM...sounds smart to me. Did this patient HAVE to call 911? I don't know, I wasn't there. The fact of the matter is that she did. The other fact is that dispatch handled it with professionalism and in a timely manner. And yet another fact, the hospital DID take responsibility for this patient by acknowledging her (albeit after being called by dispatch), assessing the patient, and making the decision she needed to receive care elsewhere (hence the patient transfer). Just a tidbit, her transfer was delayed briefly to allow two helos to touch & go to transfer victims from the accident.

I hope this clears things up for you.

[ericenglund]

I don't put the blame on anyone but the hospital. BUT.....they could walk outside and call 911

And she'd more than likely be taken to the closest facility, right where she started.

[IowaEMT]

King/Harbor has the 2nd busiest trauma center in the country and their ER sees around 200 cases a day. Lets say that they decide to close the hospital. Then what? Where are all these people going to go for treatment? Find the next closest hopsital and turn it into the next King/Harbor?