EMS vs ER

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Permalink Reply by Bren *ResqRN2113* on October 21, 2007 at 8:14am

I know this is a sore subject with all medics, having worked in an ER for four years now, I can say this is a rhetorical question. There is no true answer to this one. Families or caregivers sent these pts to the ER for many reasons, but mostly I find is..."I don't know what to do anymore...help me". We even get them from nursing homes with DNRs that states no actions be taken, but the NH sends them anyway so they can say that their expired pt numbers are low. (that's because they send them to the ER to die). You are providing quality care, but just remember the ER person who is now taking care of a pt (along with four to eight others just as bad) who are just as sick or worse and here is another pt who should be in a long term facility with better care, but because of limited money and family, is being treated at home by someone who is not trained to properly care for them. That nurse is WRONG for reporting you, you can't make that decision infield and until nurses spend a little time outside of a building, they will never understand.

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Permalink Reply by Beth on October 21, 2007 at 10:23am

It seems that if it is not a full code or trauma the hospital staff gets huffy. We don't make the pts call 911 they do that all by themselves. The pts or their families feel that they need to be seen. The hospital doen't need to get mad at us for their actions. But they shouldn't have reported you for what the family wanted. The family wanted the pt seen because they are probably scared and don't know what to do. What if you gave the D50, left and it didn't work? Would you feel guilty if you got called back for a code? You did what the family wanted and you followed your protocalls.

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Permalink Reply by Joe Stoltz on October 21, 2007 at 12:01pm

Wow, they want to treat patients by remote control? I have seen cases where a pt. gets D50 (by ALS tech NOT basic) in the residence and refuses transport, signs refusal, etc. but never your situation. We are having problems with hospitals going on diversion, essentially discouraging incoming ambulances from showing up and encouraging them to go elsewhere. Maybe this is preventing scenarios like what you've described.

I would contact your agency medical director about it. If you are a EMT-B then you can't give D50, that's simple. Maybe the good ER doctor and or nurse needs to be brought up short, and chances are others are having the same problem.

Let us know what happens.

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Permalink Reply by Bren *ResqRN2113* on October 23, 2007 at 7:46am

It has happened to my family, but until I worked in the ED, I had the same attitude. In the original scenario, that nurse had no right to report the medic. She needs to go back and read the EMTALA laws that we can't refuse anyone for any reason. Even if it was a simple bandaid change, we are obligated to care for those who come in either by ambulance or POV. In todays world, the pts are sicker and with insurance cuts, most do not have insurance or their own doc. My hospital has been on divert (or pre divert) for so long, we don't remember what a normal day is like. If all that nurse had to do was push D50, then God Bless Her! I would love to have something simple like that instead of a pt with twenty different drugs and four different baseline illnesses that they are seeing three different doctors about and then decide to crap out in the ambulance bay during unload!

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Permalink Reply by Chiefy on October 30, 2007 at 3:52pm

Sounds familiar. I work for a private ambulance part time and we bring NH pts in all the time and get that "why'd you bring them here?" look. I'm sorry but if my pt get denied proper care, someone's gonna get called out on the carpet. I'm not afraid to make the call. Nobody works their whole life, paying taxes, raising a family, to end up having someone roll their eyes at them. Last time I checked, they get the same hourly rate to treat the poor as the do the wealthy. Treat them properly for the medical problem, and treat them with DIGNITY.

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Permalink Reply by Beth on October 30, 2007 at 5:50pm

Well said. I agree whole heartly. Whose said that NH pts don't have money? Maybe the only proper care they will receive is at the hospital.

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Permalink Reply by Tracy turner on November 2, 2007 at 10:35pm

I also work for a private ambulance (full time) we too bring NH pts in all the time that most likely don't need to be going to the ED but the NH isn't able to give the right care for different reasons so we catch hell from the ED for bring them in. I think this is going to be the way it is until healthcare gets tons more workers that actually care about what they are doing.

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Permalink Reply by D.MAN on November 2, 2007 at 8:18pm

it has happened to me before i just do my job.i just try & bite my tounge.

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Permalink Reply by Deb on November 4, 2007 at 11:37pm

We have the same type problem here as wel, it seems ER staff gets huffy when we bring pt's in 95% of the time. I work for a private company responding to 9-1-1 calls mainly, we do have a few NH we cover. Our major problem is the diversion issue. Nurses can not seem to recall that we have to take the pt where they want to go. We have had hospitals refuse to answer the phone when on diversion, or simply answer and say we are on diversion and hang up. Here we have what we call TCC, it does help us in the field. In cases like this we would call TCC everything on a recorded line. Although they are more helpful in trauma situations, that do have a way of helping us in time of need.

deb'

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Permalink Reply by Bren *ResqRN2113* on November 5, 2007 at 4:51pm

We have the same problem with diversion. We are a Level One Trauma center and a city/county authority, so we have to take any and all trauma, STEMIS, or Stroke Alerts. As a nurse, I am constantly frustrated that we are forever over ran with pts. Usually this is compounded by those who think the ER is a primary care physician. We were on divert so often, admin created a new one: pre-divert! (what the difference is, no one seems to know). We have seven ICUs and one Immediate Care Unit (not sick enough for ICU, but too sick for the floor) and this month we opened a new Med/Surg ICU. All this, and we are still holding ICU pts in the ER! I get more angry at having to function as an ICU nurse when I've never been trained as one. NH pts are caught in the middle (along with the medics who transport them). Yes they have the right to go to any hospital they want, but when will the medics be given the decision making power to determine in the field that the flu-like symptoms can call a cab to a DOCTOR'S OFFICE and not have to be transported to the ER! Come on, medics (for the most part) are trained to tell them difference! Are we that lawsuit-shy?

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Permalink Reply by Joey Everhart on November 19, 2007 at 9:28am

It's not so much being lawsuit shy as it is refusing pt. care. If the pt. wants to be transported then we HAVE to transport them by law. We cannot refuse care just because they have the sniffles.

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Permalink Reply by MIKE TOIKA on November 5, 2007 at 5:28pm

Seems to me that unless this patient improved to AAOx4, or had a "legal guardian" or family with "power of attoryney" for healthcare, that this patient would need to be transported anyway. ER's are not allowed, at least where I'm from, to refuse treatment, and we as medics can't refuse transport to a medical facility. Seems that its the typical ER attitude of don't bother us, and who do you think you are. Funny, thought that went out in the 70's. Oh well

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