Offloads In Ed's

[Richard B the EMT]

Tskstorm:

We all know NYC is a completely separate animal

How true!

In the event the hospital is just busy and neither the hospital nor the crew are being jerks, and there are 3 ambulances or more, in triage, for 30 or more minutes, the hospital will go on redirection

FDNY EMS crews can ask for a supervisor to do something like that, usually, a temporary diversion. A formal diversion request is something that has to be initiated by the on duty hospital administrator. At ALL times, unless there is some in-house disaster at the hospital, diversions are a courtesy, not a right.

I don't know if the explanation of how things here work will help you any, my initial thoughts would be anytime you are waiting over 30 minutes notify your supervisor and have them notify appropriate hospital personnel.

Our policy is to try and clear from the hospital in what might be soon changed from 20 minutes. If we are delayed at an ER for more, we advise dispatch of the delay (triage, beds, signature), and again at 20 minute intervals. If we hit an hour, dispatch can (and will) ask the crew if they need a supervisor, but if I feel I need the supervisor at 40 minutes, no penalty to me and my partner if I go formal on the radio and ask for their response, or even sooner.

[Urbanmedic461]

We've now hit 4 hour off-load delays. I've even had an active chest pain on off-load for 1 hour. Another one with stroke symptoms onset >6 hours, off load delay 1.5 hours....

[fireflymedic]

Wow, that is totally unacceptable. People call 911 (the legit ones at least) because they need immediate attention not 10 hours from now ! Typically when we call in, we are given a room assignment prior to arrival and that keeps thing running pretty smooth in general. Yes we get backed up, but on average I've never had to wait more than 20 min and that was with a b.s. patient. Granted I have seen stretchers in every way shape form and direction in the halls even two in the nurses station ! Only if we don't call in, or if they have several major traumas hit them at once does it take very long. Typically walk in, hit the buzzer, go to your preassigned room (or hallway) and hand them over. Even private hospitals aren't that bad. Now if you are out in the waiting room, well, you might be waiting QUITE a while !

[JPINFV]

Wow, that is totally unacceptable. People call 911 (the legit ones at least) because they need immediate attention not 10 hours from now !

Too bad people don't think about that when it comes time to approve that new tax/fee to support the local emergency medical system.

[MontvilleFire39]

Hospital waits are a a reoccuring problem in Memphis. The FD is taking measures to reduce wait times with the hospitals in the form of monthly meetings with all recieving facilites and having EMS lieutenants intervene in extreme circumstances but these fail to address the real issue IMO.

In Memphis, we are unable to refuse transport if it is requested. Additionaly we "must" transport the destination of choice. This is compounded by a disturbing amount of "BS" calls. There is an extreme lack of primary care utilization thus the burden falls on the emergency rooms and in turn the EMS providers. It is routine to repond to a non acute complaintant and arrive to find multiple working vehicles with multiple family members present and then be followed to the ER. Add to this the ever long myth that patients will be seen quicker if arriving by ambulance. Hahahah.....not true if I can help it.

This problem is worsened by hospitals refusing stable, low acuity patients without major injury but an sort of MOI. There is only one trauma center in Memphis. It only has two 2 bed "resucitation" rooms and 10 lower acuity beds. In addition to serving the greater Memphis region, they serve a good portion of Arkansas (who does not have a level 1 trauma center) and a large portion of Missippi. Needless to say they are slammed. Most of the other ED's tend to "recomend" a higher level of care for anybody involved in type of traumatic event.

The solution is increased access to primary care which is difficult to implement with a high percentage of poverty level residents, increased education which is difficult to provide to a large percentage of low educated citizens, and paramedic initiated refusal which is a legal "no-no".

My record for a hospital wait is 7 hours and 45 minutes to two hours is not uncommon. In fact on multiple occasions I have seen 10+ of our 33 ambulances waiting at one hospital.

Edited March 13, 2009 by MontvilleFire39

[FL_Medic]

Nifty, who are you? Do you work with me? Too much of a coincidence to be a different system.