Patient Advocate

[Krysteen]

I am the one being attacked here, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly, and we have a policy that does not allow the medic to refuse a call. You can disagree with the company's stance, but that is our policy. And I disgree with most people's answer that a safety concern can be variable and open to interpretation. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways.

Is there a misinterpretation of this policy? There is a difference in refusing a transport because your shift ends in ten minutes. I suggest changing or modifying that policy. Be a little proactive here before you are in the eyes of the public when something terrible goes wrong.

[hatelilpeepees]

all i can say is WOW

[Paramagic]

all i can say is WOW

Wow what? Wow, you have realised that there is such a thing as risk versus benefit? Or just Wow, I refuse to alter my worldview, therefore I won't engage in any of the discussion taking place, except to reiterate my position, or to mount ad hominem attacks using strawman arguments?

[scollins1191]

Wow what? Wow, you have realised that there is such a thing as risk versus benefit?

I completely agree. This was NOT an emergency situation and if the medic transporting did not deem it to be safe then they should not have transported. How can someone be fired for doing what is best for the PT? I understand that people needed to get where they are going and quickly, and if the hospital knew that they needed to be somewhere else for something important they would have taken care of it. And from previous posts it sounds like the hospital already had a secondary plan in place. Patients safety trumps all else, I would have refused it as well. There is a saying in the fire service "risk a lot to gain a lot, risk little to gain little". There was little to gain so little was risked. Makes sense to me.

[systemet]

I am the one being attacked here, as far as my management skills go, feel free to attack,

I'm not sure if this is directed at me, but just for the record, I'm not attacking you personally. I'm just disagreeing with your opinions / position. There's a very real distinction between these two things that a lot of people seem to miss, especially when discussing situations on the internet.

but as a manager I have to enforce all policies fairly, and we have a policy that does not allow the medic to refuse a call.

Do you? I mean, I have no education in management, and no experience as a manager. So I'm pretty much completely unqualified to have an opinion here.

That being said though, it seems hard to think that any set of policies & procedures can adequately predict or attempt to address every particular situation we deal with in the field. I can think of numerous instances from my time in EMS when managers chose to ignore or outright violate various policies in specific situations. Often this was justified as being done, "because it was the right thing to do", or it was seen as being "in the spirit of the rules". These people managed to do this in the confines of a collective bargaining agreement, dealing with a fairly aggressive union.

If there's a conflict between a written policy, and the best judgement of the supervisor, or the employee, shouldn't one of the first questions we ask be "is this policy pertinent to the situation at hand?", or "in light of these events, should this policy be changed?". This may be a silly question, but aren't the policies and procedures of a given organisation a dynamic entity subject to change over time as new situations are encountered or best practice changes?

You can disagree with the company's stance, but that is our policy.

I don't understand what you're trying to say here? Of course I can disagree with the company's policy. I'm also able to disagree with statement's like "the sky is purple" (take that, Jimi Hendrix), or "1+1=2". I don't expect my disagreement with a company's policy is going to magically change the fact that they have a policy I disagree with. I mean, it would be nice. But it doesn't seem likely to happen.

And I disgree with most people's answer that a safety concern can be variable and open to interpretation. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways.

I don't understand the logic here. Surely safety (which is essentially risk), is a continuum? We can agree that me placing a portable radio on top of the dashboard while driving an ambulance is a "safety concern". Me sitting on the hood while my partner drives 120 km/ h is also a "safety concern". Just because both of these actions are unsafe, doesn't mean that they're equally unsafe.

I think this is another false equivalency. You raise a very good point that the patient compartment of an ambulance is not a good place to be in a collision. I just can't agree that the risk of injury in a collision is the same whether the patient is restrained in a harness on a cot, compared to lying on the ground.

If this is the case, then why use the restraint system on the cot at all? Would you have an issue with a crew that routinely transports patient's without seatbelts? Or a crew that refuses to use a child safety seat or restraint system (e.g. a Pediamate) because "the patient compartment is fundamentally unsafe... so why bother trying to provide an incremental increase in safety?".

[Edited for "there" verus "they're"]

Edited October 13, 2011 by systemet

[hatelilpeepees]

No syst that was not directed at you.  To the group, I do apologize for being rude, I was on the rag last week, and had some other stressors going on, I should not have been so rude with people who disagree.And yes I do understand the concept of risk versus reward and benefit analysis, but I just don't think the "risk" of performing a non-emergent transport a few miles is as great as many of you do, but everyone is welcome to disagree.About our policy, it was actually formed out of concern for our patients and our industry. We had a local busy 911 provider who created a policy where they would not transport any DNR patient for any reason; their logic was that using a 911 ambulance for a DNR patient was a waste of resources. This created a black eye for EMS for all bedridden patients who live at home and not in a nursing home. We had another 911 provider that refused to run nursing home calls, regardless of acuity of the call. And of course, as a private provider we frequently ran into the medic/nurse who would refuse to run a late call, long distance call, or a call because it was below their education (MICU Nurse doing a discharge to nursing home). We also terminate for any founded customer complaint (after investigation). All potential employees are made aware of all of our terminateable offenses before they are hired, so they know where the line is drawn. No one is forced to work for us. And for the record, I am probably a little too sensitive because I am obese, but it is also because we transport alot of these patients because they have been so mistreated by 911 services, that they refuese to call 911 anymore. We do have a wider bariatric stretcher to use, but we have encountered patients that are too large for it's weight rating. I am only aware of two services that have true bariatric ambulances, with wench and ramp. Most services use the tarp. We treat them like we would any other patient, and do not judge/abuse them, or make them feel bad for calling us. Yes, their predicament is of their own making, but most disease processes are of the person's making. Do you lecture people for smoking or having diabetes ?I googled "obese patient killed in ambulance wreck", in a variety of versions, and I did not see one news story regarding this risk. Which is not to say it has never happened, but it is obviously a rare occurence. I would argue that any call involving an MVC in a roadway or down a steep embankment is far more dangerous than this call.

Edited October 13, 2011 by hatelilpeepees

[hatelilpeepees]

Found this interesting:

http://www.setexasrecord.com/news/238677-patient-sues-after-ambulance-cot-detaches-during-rollover

[Kaisu]

Found this interesting:

http://www.setexasre...during-rollover

Now imagine the liability if there wasn't a deep pockets manufacturer to sue and you had transported this patient on the floor. This was a 911 situation versus a stable interfacility transport.

If I take a patient that I feel I am not qualified to take, either due to equipment deficiency, my personal limitations, patient instability etc. and the transport goes wrong it is my ass. I would take the loss of a job over the loss of my livelihood in a heartbeat.

[hatelilpeepees]

I saw it completely opposite, the patient was still injured even though he was restrained properly to the stretcher. If the ambulance wrecks, I promise a lawsuit is coming no matter what.

[medicgirl05]

I saw it completely opposite, the patient was still injured even though he was restrained properly to the stretcher. If the ambulance wrecks, I promise a lawsuit is coming no matter what.

In that case, wouldn't you prefer to be able to say that you restrained and did everything you could to keep the patient safe? Or would you be ok saying the patient was on the floor of your ambulance completely unrestrained?

Edited October 13, 2011 by medicgirl05