Getting Dispatched to a hospital

[LCFD968 10]

Question for all the EMS providers, Members, Paid and Volunteer:

Is it me or is there a problem when an ambulance gets dispatched to a hospital for a "severe alergic reaction" and the patient is located in a doctors office above the Emergency Room?

I also just heard instructions from Medic three to the ambulance that the best way to access the office is to go through the emergency room.

[firefighter36 52]

This happens in my district quite often. There is a medical office building attatched to the local hospital, whose ER is accessible with a quick walk of the stretcher through the hallway. Per DOH and the powers that be, we usually have to load the patient and sometimes an ALS provider into our ambulance and transport them to the ER via the parking lot. Seems rediculous, but I guess that it is just the way it goes.

What angers and confuses me more is when we are dispatched for people who are in their cars or on the ground right outside the doors (literally) of the emergency room. (No Joke!) I have arrived on scene to find little to no patient care being administered by Hospital Staff, because apparently it violates their SOPs, in that they cannot "transport" a patient from outside the hospital into the hospital. I kid you not, that was the reaction that I got when I inquired. However, It was ok for them to wait at the door with a hospital bed so we could carry the patient from where she fell (3 ft. away) to the bed on a long board so we didn't "have to worry about using our stretcher." At least that was the instruction from the MD waiting at the door with the nurses and the hospital bed....

While I wholehearedly believe in safety and following the rules, there are some absolutely rediculous perdiciments we can find ourselves in. Anyone else have a similar incident or some insight on the issue?

[IzzyEng4 427]

Two words - Insurance Liability

Once some one dials for emergency help, regardless if its at a hospital, EMS must respond. Sucks but its the truth.

[FFD941 20]

Mbendel36...I agree

Edited April 10, 2007 by FFD941

[PC415 1]

I actually dispatched it and couldn't believe I had to dispatch what I was dispatching. (Hey, how many times can you use dispatch in a sentence ) ESPECIALLY when I had to tell the ambulance to go through the ER to get to the patient. We do what we have to do I guess.........

[x152 179]

Two words - Insurance Liability

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Perhaps, but a "responsible" response is required. If a customer/business is calling 911 (or the "routine" line) for assistance, then we should respond to the request for service. Not due to litigation concerns, but because that is what we do when someone requests assistance.

However, the dispatch protocal and responders should take into consideration where they are responding and act accordingly (i.e. = non-emergency response if warranted).

My jurisdiction has several facilties where this same scenario plays out on a daily basis. We have adopted procedures for these facilities and reduce the response priority of EMS and omitted the response of fire as a first-responder.

There was a time when an Engine Company would respond to an emergency room for a medical call because we had a one-size fits all policy.

With a little common sense and some decent information gathering from call-takers, this scenario is no longer occuring.

[FDNY 10-75 640]

Albany Fire/EMS took one last week for a woman in labor in the ER parking lot. She was less than 100' from the doors that lead to the ER. They were waiting for a bus to transport her to the ER until one of the REMO docs came on and advised them to move her into the ER... Ridiculous.

[Guest]

i was told at WMC, there protocol is that any incident outside of there doors, the hospital must call 911. that is SOMEWHAT logical because of insurance reasons...but when we do a call to the 7th Floor to bring them down to the ER!!...i have no i dea why the hell we get called. and of course, once you get to the 7th Floor, no one knows what the hell you are doing there, no one knows who the pt is...regardless...they're in a friggin hospital!!

[Guest]

It makes sense from a liability standpoint. As EMS providers we are trained and should be proficient in the lifting, moving, and transportation of patients. I'm not sure if thats part of med/nursing school - but from what i gather its not, thus if something were to happen if hospital employees were moving the patient...your looking at a nice fat lawsuit. It's unfortunate that they are taking a 911 unit out of the system, but i suppose its part of the job.

Edited April 10, 2007 by 66Alpha1

[Guest]

It makes sense from a liability standpoint. As EMS providers we are trained and should be proficient in the lifting, moving, and transportation of patients. I'm not sure if thats part of med/nursing school - but from what i gather its not, thus if something were to happen if hospital employees were moving the patient...your looking at a nice fat lawsuit. It's unfortunate that they are taking a 911 unit out of the system, but i suppose its part of the job.

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very true. WMC used to use a courier for tx'ing emergencies, but they were not reliable nor trust worthy...i even think a pt died b/c the courier neglected the pt. also from what i was told becasuse of this...WMC contracted transcare for 87Alpha/Bravo1, Bravo 7a-7p (running w/ 37-M2) and 7p-7a Alpha

[mikerabbit 2]

Wouldnt it be faster for a trained / certified nurse to transport the pt downstairs?

[JetPhoto 626]

I agree total stupidity!

Then anyone who bills turns around and bills them for a mile! LoL!

[Guest]

Federal law, The Emergency Medical Treatment And Labor Act (EMTALA) actually requires that any facility that accepts Medicare & Medicaid money, handle any and all medical emergencies within the boundries of their property and a radius of 250 yards around their facility. The law was put into effect to stop hospitals from refusing to treat those who couldn't afford to pay for treatment.

It is the same law that requires a hospital to take your patient once you are on their property. Another part of the law prohibits "Patient Parking". This is when the ED lets the patient sit on your stretcher forever. Technically, once they enter the facility, EMTALA requires the hospital to perform an examination on the person & provide any emergency treatment needed.

Perhaps next time you are in one of these situations, you utter those 6 little letters. If the ED staff doesn't know what it means, have them look it up (http://www.medlaw.com/healthlaw/EMTALA/statute/emergency-medical-treatme.shtml). If enough people mention it and the facility realizes it can lose its federal funding for violating EMTALA, maybe a lot of these problems will be resolved!

[Guest partyrock]

Federal law, The Emergency Medical Treatment And Labor Act (EMTALA) actually requires that any facility that accepts Medicare & Medicaid money, handle any and all medical emergencies within the boundries of their property and a radius of 250 yards around their facility.  The law was put into effect to stop hospitals from refusing to treat those who couldn't afford to pay for treatment.

It is the same law that requires a hospital to take your patient once you are on their property.  Another part of the law prohibits "Patient Parking".  This is when the ED lets the patient sit on your stretcher forever.  Technically, once they enter the facility, EMTALA requires the hospital to perform an examination on the person & provide any emergency treatment needed.

Perhaps next time you are in one of these situations, you utter those 6 little letters.  If the ED staff doesn't know what it means, have them look it up (http://www.medlaw.com/healthlaw/EMTALA/statute/emergency-medical-treatme.shtml).  If enough people mention it and the facility realizes it can lose its federal funding for violating EMTALA, maybe a lot of these problems will be resolved!

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You know, I had this whole thing written out, looked up the actual wording and was in the middle of writting it when I had to walk the damn dog. Thanks for stealing my thunder.

The only thing I'll add is that the hospital is required to preform avaluation and initiate treatment in a timely manner. Don't start going off about EMTALA when the ER is in the middle of two shootings and a stroke and you're stuck with an intox frequent flier.

I can't believe you guys had to transport down from the 7th floor. How do you guys handle OB trips to the ER here in Westchester. A little further south we get 'em into the ER and either go up with an escort or leave them to be taken up by transport. I know a hospital needs a bus to go from building to building out in the open, but this sounds like a big misunderstanding.

[Guest]

Could this be a stipulation made by the hospital's insurance carrier?

[helicopper 1,050]

Could this be a stipulation made by the hospital's insurance carrier?

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Within the hospital it is simply absurd! You should send them a big fat BILL for service to discourage the practice. Why would the insurance company make them call EMS for intra-facility transfers? Don't they wheel people to the OR, ICU, units, X-ray, etc. every day? If a person is going from the ER to the ICU on the 4th floor, they generally take an elevator not an ambulance!

If you have to enter the hospital to access a patient, my simple mind tells me that they're already within the confines of the hospital and don't need an EMS response. EMTALA is a great thing to know about but I would also hope that common sense would prevail.

I thought this thread was going to talk about associated nursing homes and/or doctors offices/clinics in "nearby" buildings - I never imagined that you'd be going to the hospital to pick up our patient and drop off our patient - talk about a short trip.

However, the dispatch protocal and responders should take into consideration where they are responding and act accordingly (i.e. = non-emergency response if warranted).

My jurisdiction has several facilties where this same scenario plays out on a daily basis. We have adopted procedures for these facilities and reduce the response priority of EMS and omitted the response of fire as a first-responder.

There was a time when an Engine Company would respond to an emergency room for a medical call because we had a one-size fits all policy.

With a little common sense and some decent information gathering from call-takers, this scenario is no longer occuring.

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You hit the nail on the head here - common sense must apply. I would also suggest that if the hospital (or other healthcare facility) is a system abuser, the EMS agency should meet with the hospital to discuss alternatives - perhaps a contract for an interfacility transport provider is in order? I don't think it is appropriate for healthcare facilities to be a drain on limited 911 EMS resources.

[JetPhoto 626]

I would love to see you tell the ER dept. head that just to see the expression on your face when they tell you "SO, call whoever you want I'm busy, now go wait till I find a bed"

I love it when I bring a patient in and they tell me "Ya know, you could have brought them to xxx hospital in Poughkeepsie!"

[Guest]

I was just throwing an idea out

[LCFD968 10]

I just don't get it, how in the world this can happen. If someone went down and stopped breathing the floor above the ER would they still call the amulance? This person , yesterday, was having a "SEVERE REACTION" to medication and the employees, Doctors and nurses WAITED for the ambulance.....What ever happened to common sense,... If that person died right there because they waited for the ambulance who's going to be held accountable? The same insurance company that tells them they have to call 911!!! Just INSANE!!!

[ckroll 101]

Not only should there be some common sense added to the pot, EMS is drilled to provide right care at the right time.. 'treat the patient, not the machine.' It appears someone needs to add 'treat the patient, not the protocol.'

[Guest paramedico987]

It is my understanding that BY LAW any medical emergency on the grounds of a hospital MUST be attended to by a doctor from that facility.

Example:

If you back over somone in the ER bay, you can't just bring them to the nearest trauma center. The doctor from the ED MUST evaluate the patient and then request a transport to a trauma center if necessary.

I wouldn't have had anything to do with this patient's care, just like I wouldn't treat ER patients I'm not going to treat admitted patients either.

[Guest]

I work in Rochester, NY, and we go with some regularity to the various emergency rooms because people have called 911 FROM THE WAITING ROOM of the ED because they feel that they have been waiting for too long and now want to go to another hospital, or because they have maxed out the narcotics that they will receive and want to go somewhere else to start over. Once I got dispatched to a hospital because some one had called 911 and said "help" from one of the inpatient beds. They didn't even know what floor the call came from, so we, along with hospital security, had to walk through the whole hospital looking for someone who may have called!

[Remember585 815]

I can't believe that ALSFirefighter hasn't chimed in on this one.

Remember that one time....at band camp, I mean HVHC (snicker snicker)...at like 3AM?!