DFIB Posted October 10, 2011 Share Posted October 10, 2011 So, medicgirl05, are you still employed? How did things work out? Link to comment Share on other sites More sharing options...
ERDoc Posted October 10, 2011 Share Posted October 10, 2011 I'm a little late to the rodeo, but agree with the OP. You are taking a stable, relatively healthy pt in a bad situation that may result in more harm. No, we cannot guarantee that there will be an MVA, but if there is, you have needlessly put that pt in harm's way. It sucks for the hospital, but the pt is safe and the SW should understand the issues and if not, should not be working. What do you think will happen if the ambulance rolls and this pt is inured or killed? Does anyone think this company will back the MG? Hells no. They will sell her up the river to save their own skin. "If she didn't think it was safe, she shouldn't have transported. She's the medic, so it is up to her. We are just the owners and don't know a damn thing about medicine so we have no say or responsibility." Being the medic is a lot like being the pilot of a commercial aircraft. The company is going to lean on you as much as they can to make their money, but you are ultimately responisble for the safety of your vehicle and passengers. You have to answer to your surpervisors/company, but you also have a higher authority you have to answer to. Pilots have the FAA/NTSB and you have the jury you will face as well as you licensing board. Saying, "The company made me do it." will not save you. You will find lots of precidence in the aviation literature, and pilots have awesome unions to back them up, not so in EMS. You have the last say on what is go/no-go. I would not be comfortable transporting this pt either. Again, let's look at the rollover situation. You now have an unrestrained, several hundred pound projectile flying around the confined space in the back of the ambulance. You will get hurt, if not killed. It is not being prejudiced against the overweight, it is just reality. Some people have eaten themselves into the situation while other have just been dealt a sucky hand in life. Either way, it doesn't make the transport less risky. 1 Link to comment Share on other sites More sharing options...
DwayneEMTP Posted October 11, 2011 Share Posted October 11, 2011 What's up HLPPs? You had such a strong, maybe even arrogant opinion...Did it somehow just evaporate at the first sign of significant debate? Dwayne Link to comment Share on other sites More sharing options...
nypamedic43 Posted October 11, 2011 Share Posted October 11, 2011 The silence speaks volumes. Link to comment Share on other sites More sharing options...
Happiness Posted October 11, 2011 Share Posted October 11, 2011 MG you did the right thing as far as I can tell. In my community there are more obese people than non. We have 5 ambulances on our little island and the one in the middle has the bariatric stretcher. When medivacs are for the obese they take the call. Your safety is first and then you pts is second. Now like I said we live in small communities here and in 15 years I have seen one call where they used the Manta mat for a 400 lb pt in medical distress. They did yes put him on the floor and they had a fire truck in front and back for the transport of 3 minutes to the hospital. The risk was worth the benifit in that case the pt one need to go to the hospital and that pt lived. This senerio seems to be a non emergency that was able to wait the extra 12 hrs for transport and if the other company did it that way it dosn't make it right On the topic of refusing pts I have the ability to say there is no way I am taking that pt if I feel unsafe . I personally have never refused and I rarely take the RCMP with me as they just aggravate them. I want my pts to trust me and I have had the biggest nut bar in the back. Phyc calls are the ones here I do well (yes there may be a reason for that and if I had to do my assessment in the back of the cop car, follow them to the ER then that is what I would do. As we fly out phyc's here we are the conection from the hospital to the plane. If I feel a pt hasn't been sedated enough then I go to the dr and explain why and we deal with it together as I am not going to waste anyone's time to have my pt refused by the air crew they are busy enough. Thank god I dont have people above threatning to fire me because I did my job. HLPP first of all MG was really the mature one in this forum and just basically said thank you for your input. She has come here for help in a dessision that she had to make and then you say she should be fired without really reading the post. You then try to make the senerio change to try and prove your point what fairness is in that? Ok and on a bit of a little topic but come on do you honestly think with the screen name you have picked any one respects what you have to say, as they cant stop laughing, myself included. When I look at your profile your what 23 oooohhhhhh the experience you must have in those years and you put that you are a paramedic but since your in the states exactly what level re you. So before you carry on with your little tantrum that others have pointed out, you as a person that is heavy HOW the hell do you want to be transported safely or unsafely. Link to comment Share on other sites More sharing options...
hatelilpeepees Posted October 11, 2011 Share Posted October 11, 2011 No dwayne, i am not hiding, just have to work for a living every few days. I still stand by my point, obviously opinions are like assholes, everyone has one. We do things all the time that are not by the rules or totally black and white. This is a special needs patient that most services are not equipped to handle, and you have to do what you have to do. In a perfect world every service would have a bariatric unit, but we do not live in that world. When we do, I will agree that the patient should be transported by that unit. If you remember the crash videos that were posted on here a few months ago, you saw that the stretcher did not stay in the harness, in just a 35mph crash. So to argue that the patient is safer because they are on a stretcher is absolutely not true (just watch the videos again, I am sure you can find them). This is all about 911 attitude in my opinion, in that the non-emergent patients are not as important, therefore the medic can choose to provide service or not. This was a patient in need of transport, and this provider is in the IFT business. If you are a CNA in a nursing home, guess what, sometimes you have to wipe butts, like it or not. In the IFT business sometimes we have to transport patients that we would rather not. No HOSPITAL can refuse to atleast provide minimal care to any patient that walks in the door, and there is a reason that law is in place (because hospitals used to refuse care). Once we start down that slippery slope, it is a means to our end. I admit I may be hypersensitive because I am obese and know what it feels like to get the look of shame from all the skinny people, but again, to me, being a patient advocate means we find a way to meet their needs versus refusing care. There is no place in an ambulance that is safe in a crash (maybe than other the drivers seat with air-bag), and crashes happen very rarely, so to hide behind the rare occurrence of a crash is stupid. If you are that concerned about patient safety, then you would never put a patient in an air-ambulance helicopter, as the rate of death in that vehicle far outweighs deaths in ambulance crashes. Link to comment Share on other sites More sharing options...
hatelilpeepees Posted October 11, 2011 Share Posted October 11, 2011 Or to give another example. I think we can all agree that Dopamine would never be administered by a nurse in an ICU without it being on an IV pump, yet we do it all the time. It is not safe, the equipment is not that expensive, so you could argue that we should "pay to play" or never administer this drug, if you are all really advocating patient advocacy on all fronts, at all costs. I think we could also agree that an IFT company that does cardiac cath transports should have 12-Lead EKG capability, but we know that is not the case nation-wide. We could also argue that we should only buy ambulances that can withstand a rollover crash without any significant damage to the box (or roof if it is a van), but that is not our reality. We could also argue that all IFT ambulances should be stocked/equiped the same as 911 ambulances since many do 911 back-up, but that has not happened yet. Link to comment Share on other sites More sharing options...
RaceMedic Posted October 12, 2011 Share Posted October 12, 2011 Ok so you refused a call based on PT advocacy. Great give yourself a pat on the back. I also work as a Medic/RN for a small IFT fixed wing and Ambulance service. I have refused calls based on PT condition and size as well. That is our job as medics to know our limitations and the limitations of our services we work for. We do not have a bariatric unit nor does the 911 service i work part time for. but i have transported an 1100lbs PT in the back of my ambulance in the manner your speak of before. However i did not ask for permission to remove the mounts i just did it. No that being said there is no local bariatric unit with in 300 miles so we had no choice. It was either transport him or deny him access to health care. Or worse yet he be transported by the neighbor in the back of a pickup. So it does happen. And to address your comment about a hospital refusing treatment, the short answer is yes private hospitals can refuse treatment and regularly do. They can not refuse to stabilize if they have an ER. Then the PT is generally immaculately transferred to a county or charity hospital. Just the facts, i do that very thing on a regular basis. One more thing, about the mounts for the cot in the back. I have worked an ambulance roll over (my own service, on my shift. My partners) and guess what ? The mounts held through the roll over at an estimated 85mph ( highway patrol estimate) the PT was being held securely by the straps on the cot while hanging sideways. If the mounts are regularly checked and tightened as needed they should hold through a 35mph MVC. They are tested. If the video in question shows them failing then i would ask about the inspection process in place for that service and how old were those mounts. Every time i get in to my ambulance i check my mounts for wear and tightness of the mounting hardware. My service replaces the locking arm in the back at least every 6 months just due to wear. the horns at the front are replaced yearly. I know we are not the norm, and not all services are like this but if you do not trust your companies equipment based on a video on the net then maybe you need to read the manufacturers literature and find out the limitations and expected life of the equipment. Also look up your major Ambulance builders and see the testing that the ambulance actually goes through to when being designed, They so have standards to follow. And if you still do not trust your companies equipment after that then maybe it is time to find another company. Just my two cents from my experiences, Regards Roman Link to comment Share on other sites More sharing options...
ERDoc Posted October 12, 2011 Share Posted October 12, 2011 (edited) HLPP, I have to completely disagree. It is just the opposite of the 911 mentality. The 911 mentality is, do whatever it takes, even if it needs duct tape and staples. This is a transfer of a stable pt. There is no reason they cannot wait for the appropriate equipment to safely transport them. To take them without proper safety equipment (which is what a stretcher is) is completely irresponsible on the part of the field provider. I think it would also be much more demeaning to a heavy person to be stuffed onto the floor of an ambulance versus sitting in a comfortable hospital bed for one more day. EDIT: Not to mention in most states it is probably illegal to transport someone who is not properly restrained. Edited October 12, 2011 by ERDoc Link to comment Share on other sites More sharing options...
hatelilpeepees Posted October 12, 2011 Share Posted October 12, 2011 So does that mean if a 1000 lb patient presents to your ER, you will refuse care because your stretcher is only regulated for 750lbs ? Link to comment Share on other sites More sharing options...
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