Would you stop?

[Richard B the EMT]

Something else for consideration, although not directly connected with this string:

Most systems I am aware of, have rules and regulations stating that the EMT or Paramedic not driving the ambulance, must exit the vehicle and assist, as a flagman (flagger, as a non-sexist title?) the person driving, in backing the ambulance, except in specific cases like CPR in progress.

Is this a kind of patient abandonment? It is not direct patient care, the personnel is not physically in the ambulance, but guiding the driver while moving the ambulance in reverse.

[vs-eh?]

Since we are discussing this to some depth, let me throw a couple other scenerios at you....

1. You are at the ER with your asthma patient. The ER is currently full and you are awaiting a bed along with several other ambulances. An MVC with a confirmed pinned victim is toned 2 blocks from the hospital. Your nearest ambulance is responding from the other side of the district and will take over 10 minutes to get there. While you are enjoying holding up the wall awaiting your room assignment, a young lady bursts in to the ER screaming that her 8 month's pregnant sister is trapped in the car, bleeding profusely, and is unconscious. What do you do?

2. You are now a flight medic and are flying an AMI pt. from the outlying, podunk ER, to the tertiary cardiac care center. While flying over a rural area, you witness a school bus get t-boned by a logging truck. The bus flips over, then catches fire. It is 3p.m. and you suspect that children may be on the bus. You are familiar with this rural area and know that it will take almost 30 minutes to get an ambulance on scene. You do not see movement coming from inside the bus. Do you land?

Interested in hearing your opinions..........................

I can't really comment on #2, as I am not really familiar with flight paramedicine and logistics and such...

In #1, I assume these are the same patients?

While uncommon (and minus the drama), these scenarios do happen here. If the crew is able to hand off their patient to another crew (with a quick story and minus a stretcher) they will respond if they are able. BLS crew dispatched to a cardiac arrest with no ALS. Dispatch will call an ALS crew babysitting a patient in a nearby hospital and ask if one or both paramedics can respond. It does happen, I have seen it. As long as you have someone to observe the patient, the original crew (if able) will go. Crews hand off patients to other crews in hospital ten's, if not hundreds of times DAILY in hospital here. We have a major "offload delay" issue here, and patients are constantly being handed off to other crews. They are not being "abandoned" just handed off...

You have to discuss these scenario's via the perspective of your system. That is how things would happen in mine.

[Lone Star]

I see that there are at least three sides of this argument.

side 1- don't stop you already have a patient on board. they are your responsibility

side 2 - stop and render care until the other ambulance gets there

side 3 - stop only to ascertain injuries and notify dispatch as to what injuries.

Which side is correct - some would say side1, others side 2 and even others side 3

Does anyone have access to the law search system not sure what the name of it is.

If you do maybe you could do a search as to are there any lawsuits that fall under one of the three sides of this argument. What is the legal precedent to not stopping or for stopping??

If you have a medic in the back of the ambulance taking care of the patient and the driver gets out to check on injuries is that a bad thing? The patient is not suffering for the delay unless it's a long delay. (this does not include critical patients because no one will argue that you stop with a critical patient.). The emt or medic driver checks on injuries and the patient still has the same level of care that they started out with.

I personally don't see the harm in stopping.

let's put this on the other foot, many are saying that if they were the parents of the 9 month old and you stopped that you would sue.

how bout there is a patient in the car and you stopped long enough to get the address and call it to dispatch and you told the bystanders that you have another ambulance coming. Would you not be pissed off that the ambulance stopped but then kept on going??

Just curious how you'd feel or if you would sue the ambulance service for not rendering care???

What if you are the patient in that car and you saw the ambulance drive on by and not stop? You know it was one of the ambulances that service your town. What would you do? Would you sue them for not stopping.

The problem I see here Ruff, is that as soon as you make pt contact, (ie ask the pt if they're hurt or need assisstance) you can't leave that pt, until another unit shows up (staffed by equal or higher licensure crew members). Meanwhile, your currrent pt on board gets medical care delayed.

You cannot absolutely guarantee that the sz pt in the back of your rig is stable and the pts condition will not deteriorate.

I realize that my protocols are different that alot of others out here, but in each post I've identified the protocols that I'm using. Since these are the only protocols I know, I can't see any way that anyone can convince me that stopping is a good idea.

[stcommodore]

I think the crew did a great job in making sure that no bystanders were injured during the shooting. I think the crew did what they thought was necessary at the time they were at the MVC. The patient from the two lines we know about them sounded rather stable and at no time was ever left alone. I doubt half of you know what it is like to opperate in urban EMS service where this type of thing happens so simply on that have no right to comment. We all make choices on the information we have at that moment and they did, lives were saved by the actions of this crew and no they should not be fired.

[medic001918]

I think the crew did a great job in making sure that no bystanders were injured during the shooting. I think the crew did what they thought was necessary at the time they were at the MVC. The patient from the two lines we know about them sounded rather stable and at no time was ever left alone. I doubt half of you know what it is like to opperate in urban EMS service where this type of thing happens so simply on that have no right to comment. We all make choices on the information we have at that moment and they did, lives were saved by the actions of this crew and no they should not be fired.

You don't think many of us know what it's like to operate in an urban EMS service? I think you're greatly mistaken there. While we don't openly post our resume's for review, there are many urban and suburban providers on this forum. There are professional's that do this for a career, and there are volunteer's.

But, just for the record I do work for a rather busy city service (city=urban) and I have experience working for another large city (city again=urban). FDNY is not the ultimate in EMS care. There will always be a better service somewhere, no matter how good your service is.

Who's life was saved? The shooter died, and from the article noone else involved was transported. What did happen, is that the nine month old and their family that was being transported as well got delayed care and placed into an immediately dangerous situation. So dangerous that they were required to retreat to a deli for safety. A pediatric patient that has had a seizure is not a "stable" patient and is deserving of medical care without delay. There's no way that care was not delayed when they had to run for cover. While noone could have known the driver of the vehicle was going to pull a gun, any call we respond to is an unknown and no patient should be placed into that unknown while they are experiencing a medical emergency.

Be careful making false accusations regarding the experience of members of this forum. There's a vast wealth of knowledge here. If you sit back and read, you just might get an idea of the experience of many reguarly contributing members.

Just out of curosity since you've weighed in an opinion, what is your level of training and experience? Maybe you don't have the experience to comment either.

Shane

NREMT-P

[Just Plain Ruff]

commodore, way to go on the assumptions.

there are far more providers here that work urban EMS than you give us credit for

You must think we all are a bunch of hicks.

Please keep your assumptions to yourself because on this one point you were wrong.

remember what assumptions do to you?

[ncmedic309]

I doubt half of you know what it is like to opperate in urban EMS service where this type of thing happens so simply on that have no right to comment. We all make choices on the information we have at that moment and they did, lives were saved by the actions of this crew and no they should not be fired.

I don't know the stats on the urban vs. rural poplulation on here - but I do agree that these type things do happen very often in the urban setting. It's not often that weapons are involved or that it ends in a shootout - but us folks that do urban EMS are much more likely to encounter these type situations where we come across another incident while in transport or enroute to another call - it happens quite often here.

Either way, for you folks that seem to think it's quite easy to just wave and smile as you drive by another incident that needs your assistance - I just can't understand how you do it? If I'm enroute to another call (regardless of priority) and I come across bystanders waving me down from the sidewalk as they huddle around a male patient that appears unresponsive - I'm supposed to just keep on driving when I'm already there? Or the same scenario where your transporting a minor illness such as a 9 month old who likely had a febrile seizure - that warrants you just passing an incident that looks much more critical just because you have a patient on board? Your there - yet you just keep on going? That's just pure stupid...

[stcommodore]

Thats really what I'm going for...I haven't been in this type of situation but doubt I would have done much different. How many of us would be able to act with enough sense to secure a scene with an active shooter? How many of us would be able to be smart enough to exit the bus and find better coverage? I hope most of us...How many of us as paramedic students have been in active shooter calls? Hopefully not many, but dare I say this guy got a hell of a shift that day.

[flight-lp]

I don't know the stats on the urban vs. rural poplulation on here - but I do agree that these type things do happen very often in the urban setting. It's not often that weapons are involved or that it ends in a shootout - but us folks that do urban EMS are much more likely to encounter these type situations where we come across another incident while in transport or enroute to another call - it happens quite often here.

Either way, for you folks that seem to think it's quite easy to just wave and smile as you drive by another incident that needs your assistance - I just can't understand how you do it? If I'm enroute to another call (regardless of priority) and I come across bystanders waving me down from the sidewalk as they huddle around a male patient that appears unresponsive - I'm supposed to just keep on driving when I'm already there? Or the same scenario where your transporting a minor illness such as a 9 month old who likely had a febrile seizure - that warrants you just passing an incident that looks much more critical just because you have a patient on board? Your there - yet you just keep on going? That's just pure stupid...

Yea, like getting your ass shot isn't stupid.............Hence one reason why I have absolutely no hesitation to keep on going. I'll call for a unit, but there is no reason why individual "a" has any more right to my ambulance than individual "b". In my area, they will all get a unit. They will get one in under 10 minutes over 95% of the time.

Since there are still some that really don't get it, let me offer yer another tidbit.............

You stop at the horrific MVC that you come up on instead of continuing to your "BS" old man sick call. Your MVC victims turn out to be uninjured and they do not require EMS, so you continue to your original call. Upon arrival, your elderly male tell you his nuts hurt and that he has been "sick" for a couple of days now. His ball pain continues to worsen and enroute to the ER, his BP drops throught the floor and he becomes unconscious. Why?? And how are you going to explain the delay of emergent care this pt. required?? Because you saw a MVC? Because you elected to triage one call before even knowing what is occuring on the other? Hope you enjoyed your EMS career........................

Oh well, to each their own, I'm done arguing........................

[ncmedic309]

I'm done arguing........................

Well, this I can agree on - we're not getting anywhere with this - I've shared my opinions - the rest of you can battle it out. I'll catch the rest from the sidelines...