Patient Advocate

[medicgirl05]

I found myself stuck in an interesting scenario and am curious how others would have handled a similar situation.

I was working for a private transfer service and my supervisor called and told me to take the stretcher out of the truck before heading to a local hospital for a transfer. She said the patient wighed more than our stretcher allowed so we would be transporting her on the hospital provided mattress. She advised that the hospital would provide the man power needed to get the patient in the ambulance and the receiving facility would help get the patient out. From the beginning I was not comfortable with this but I decided to go with it. When we got to the floor I went to see the patient before accepting care of the patient. The patient was very wide on the bottom half. I asked my supervisor if we could remove the stretcher brackets, but she said no. I asked the patient if she could tolerate laying on her side, she said no. I went and measured the ambulance and the patient and the patient was about 6 inches too wide. We talked about using pillows to prevent the stretcher mount from injuirng her and she was very willing to do that. Then we discussed getting her in the ambulance with the mount in the way. She said it wasn't an issue for the other private service to transfer her as they just slid her in. Hospital staff advised that service was unable to tranport her today but would have a unit in the morning. I refused the transfer for multiple reasons. I did not want the liability of the transfer. I was genuinely afraid of injuring the patient. The patient was being transferred to a rehab center so there was no issue of her not getting the level of care needed. I decided that waiting for an ambulance service better able to serve was the best thing for the patient. My supervisor was not happy, obviously. I am curious as to what others think? Suggestions for the future?

[nypamedic43]

Injuring the patient is a very real possibility in this situation. Not only from the stretcher mounts but what if the rig was in an accident? THe patient has no seatbelts to keep them from rolling around and landing on you. The liability is huge for that kind of scenario. Granted that is a worst case scenario but, still, it could happen.

We have an ambulance equipped with bariatric equipment, but even that has its limitations. Who's bright idea was it to try to transport a very large patient, in an ambulance, on a mattress on the floor, with no safety equipment? Thats just crazy and its time, that maybe, management needs to stop thinking about the almighty dollar and think about the possible ramifications of thier actions.

I dont think you did anything wrong. Bravo for thinking of the patient and not the owners pocketbook

[DFIB]

As a private business owner (non EMS) I am always dismayed when an employee turns down revenue but am open to hear their reasons for doing so. When the company is the only person liable they can make you do what they want or else. When you share liability as a prvider you should have the freedom to make difficult descisions like this one.

I think you did the right thing. Professionalism is king. The patient doesn't deserve a jerry-rigged transfer where they would be uncomfortable of possibly injured. The transfer from the bet to the truck would seem complicated and potentially dangerous for the patient and the people lifting. Exceeding the capabilities of our equipment is always a bad idea. It was not an emergency. If she was injured the company could face legal action. The hospital should remember you as the guy who considered all of the before mentioned aspects and made an unpopular decision that was best for all involved.

So you protected the patient, the equipment, the company and you and your crews safety.

Good call.

Edited for spelling

Edited October 7, 2011 by DFIB

[hatelilpeepees]

I am sorry, but I would have terminated you. First of all, the stretcher bar and antlers are easily removed from the floor. We do this type of transport frequently, we typically roll them to the truck on the hospital bed (fully raised), remove the head board and then just slide the mattress and patient into the back of the truck, then reverse the process at the receiving facility.

You probably pissed off every social worker and nurse in that facility, and showed them exactly how valuable your competitor is. There are very few services that have a bariatric wench and lift for an ambulance, so the other ambulance may not have been any better equiped than you. It is not your job to determine who you will and will not transport. Hopefully you will still have a job when you go back to work, but do not be surprised if you do not.

P.S. You have no idea what the next stage of treatment was, so you may well have delayed definitive care. She may have been scheduled for a procedure of some sort that day or the next day.

Edited October 8, 2011 by hatelilpeepees

[usalsfyre]

I am sorry, but I would have terminated you.

Sounds like the kinda place it's a privlege to be terminated from.

First of all, the stretcher bar and antlers are easily removed from the floor.

If you had read, she asked, and was refused.

We do this type of transport frequently, we typically roll them to the truck on the hospital bed (fully raised), remove the head board and then just slide the mattress and patient into the back of the truck, then reverse the process at the receiving facility.

Yep, since that's safe to place the patient in a position of being unsecured in the event of an accident.

You probably pissed off every social worker and nurse in that facility,

By speaking up and saying this isn't safe or right?

and showed them exactly how valuable your competitor is. There are very few services that have a bariatric wench and lift for an ambulance, so the other ambulance may not have been any better equiped than you.

Fine, let them absorb the liability if something bad happens.

It is not your job to determine who you will and will not transport.

The.Hell.It's. Not. Full Stop, end of message. It is absoloutely my decision, and mine alone, what ends up in the back of my truck. Because I guarantee if I had done this and it had gone bad the owner and supervisor would hang me out in the wind. If it means I get fired over refusing to do something...well, I was looking for a job when I got mine. Risking my job is one thing, risking my certification, career and ability to feed my family over the owner's pocketbook is another entirely.

Hopefully you will still have a job when you go back to work, but do not be surprised if you do not.

Sometimes this is what it takes to realize it's time to get out of a bad situation. You know, the kind of situation where managers ask their employees to perform blatantly unsafe actions.

P.S. You have no idea what the next stage of treatment was, so you may well have delayed definitive care. She may have been scheduled for a procedure of some sort that day or the next day.

I'm fairly certain definitive care doesn't include head injuries from being unrestrained in an MVC.

[hatelilpeepees]

usa, i guess you will never transport another patient then, as their is always the chance of an MVC involving the ambulance. I guess you will never start another IV due to the possibility of infiltration. I guess you will never administer another drug because you may overdose the patient. I guess you will never use a stairchair, as it is too dangerous to transport patients up and down steps. I guess you will never work a wreck in the roadway as there is the chance you could be hit by a car.

So lets put this in a way that even you can understand. Lets change this patients location to her home, and she has just called 911 for chest pain. Are you going to leave her there until the bariatric ambulance can come the next day ? If it is unsafe to transport her non-emergency to a bariatric facility, how is it safe today to transport her to a hospital facility, just because she called 911. Same ambulance, same crew, what you gonna do for her ?

Patients who weigh in excess of 700lbs pretty much have to be transported on the floor of the ambulance, in most parts of this country, unless you are going to advocate loading them onto an open-bed wrecker somehow. It is obvious that you have never handled this type of transport, so please withhold your opinion when you have no clue what you are talking about.

And yes I read that the OP said the supervisor refused to let them remove the stretcher gear, but I doubt that is the way it really happened. And how do you think the patient felt, when she was refused transport because she is too fat.

[medicgirl05]

usa, i guess you will never transport another patient then, as their is always the chance of an MVC involving the ambulance. I guess you will never start another IV due to the possibility of infiltration. I guess you will never administer another drug because you may overdose the patient. I guess you will never use a stairchair, as it is too dangerous to transport patients up and down steps. I guess you will never work a wreck in the roadway as there is the chance you could be hit by a car.

So lets put this in a way that even you can understand. Lets change this patients location to her home, and she has just called 911 for chest pain. Are you going to leave her there until the bariatric ambulance can come the next day ? If it is unsafe to transport her non-emergency to a bariatric facility, how is it safe today to transport her to a hospital facility, just because she called 911. Same ambulance, same crew, what you gonna do for her ?

I think an emergency situation would be much different. I do know that she was not going to recieve any treatment in the receiving facility that could not have been done in the hospital.

Patients who weigh in excess of 700lbs pretty much have to be transported on the floor of the ambulance, in most parts of this country, unless you are going to advocate loading them onto an open-bed wrecker somehow. It is obvious that you have never handled this type of transport, so please withhold your opinion when you have no clue what you are talking about.

And yes I read that the OP said the supervisor refused to let them remove the stretcher gear, but I doubt that is the way it really happened. And how do you think the patient felt, when she was refused transport because she is too fat.

Actually that is the complete truth. I have removed the floor brackets at my job working 911 and I know it is not difficult. My boss at the private service did not want them removed because that ambulance was the only one that was not at the mechanic and she was concerned that we would not be able to get the brackets placed correctly right away.

Just for clarification, the patient was large due to a medical illness. It had nothing to do with her being "too fat."

Edited October 8, 2011 by medicgirl05

[usalsfyre]

usa, i guess you will never transport another patient then, as their is always the chance of an MVC involving the ambulance. I guess you will never start another IV due to the possibility of infiltration. I guess you will never administer another drug because you may overdose the patient. I guess you will never use a stairchair, as it is too dangerous to transport patients up and down steps. I guess you will never work a wreck in the roadway as there is the chance you could be hit by a car.

Your really going to compare these situations? There's prudent, managable risk, and then there's stupid, unneeded risk. This falls in the later category.

So lets put this in a way that even you can understand.

Since apparently I'm stupid now.

Lets change this patients location to her home, and she has just called 911 for chest pain. Are you going to leave her there until the bariatric ambulance can come the next day ? If it is unsafe to transport her non-emergency to a bariatric facility, how is it safe today to transport her to a hospital facility, just because she called 911. Same ambulance, same crew, what you gonna do for her ?

Different setting, different needs. It's not safe to go to either facility. But again, it's about prudent risk. The risk of an undetected MI outweighs the risk of injury from an MVC. So sir, explain to me just what the risk of the patient hanging out at the sending is, and how it outweighs the risk of an MVC. Good luck.

Patients who weigh in excess of 700lbs pretty much have to be transported on the floor of the ambulance, in most parts of this country, unless you are going to advocate loading them onto an open-bed wrecker somehow. It is obvious that you have never handled this type of transport, so please withhold your opinion when you have no clue what you are talking about.

1080. Yes it was on the floor and no I didn't like it, but I was too new to know to speak up. I've done 6-800 multiple times. If your not willing to buy the equipment you shouldnt be playing.

And yes I read that the OP said the supervisor refused to let them remove the stretcher gear, but I doubt that is the way it really happened. And how do you think the patient felt, when she was refused transport because she is too fat.

As opposed to laying on the floor because she was too big?

One of your jobs as a supervisor is to respond to these kinds of concerns and explain and/or fix the issues raised. If you can't, then perhaps it's time to look at why. The appropriate response is not throwing a tantrum and firing people when they raise a valid point. Doing so means you have no business being a manager.

[JPINFV]

So, all the people who are refusing transport, what's the alternative, oh professionals of transport medicine?

Dear Hospital,

Stop taking large patients, regardless of why they're large. You'll never be able to get rid of them. Sucks to be you.

Sincerely,

Your local ambulance service.

Dear Patient:

Don't be large, what ever the reason. Maybe the local ranch with a flatbed used to haul livestock can swing around and transport you.

Sincerely,

Your local ambulance service.

[hatelilpeepees]

Well you are entitled to your opinion USA.  The point is that a patient is a patient and deserves to be treated as all other patients would be, emergent or non-emergent has nothing to do with it.  And once you start letting medics choose who they will and will not transport I can assure you that your service will be sued out of existance, or go bankrupt.  

Had I been the manager on this call, I would have assisted and techd the call, to alleviate any of the ridiculous fears that have been mentioned here.  EMS is not black and white, and sometimes we have to operate in ways that are not perfect.  Do you transport infants who are in arrest in a car-seat ?  NO.  Using your logic, we should, as we do not want to break the law, nor risk an accident.  But to knock a hole in your arguement, let's change her chest pain to a twisted ankle, are you going to leave her at home.  Unless you have no idea of how to operate an ambulance, there is no greater risk of this patient being in an MVC than any other patient you transport on a daily basis.   To deny care to a patient because of an irrational fear is negligent in my book.  

The cost to outfit all of your ambulances to handle 1000lb patients is not worth the cost, especially when you consider how often you would use it.  But I am sure your company would be willing to accept your cash donations to make it happen.P.S. A patient ADVOCATE would have found a way to transport the patient, not abandon them in their time of need.

Edited October 8, 2011 by hatelilpeepees