Pt calling an ambulance from a hospital ER?

[KE5EHI]

I'm trying to find an answer to this question:

If a person goes to a hosptial emergency room, and while waiting in the waiting room (either pre- or post-screening), and the person feels that they are having to "wait too long," can they call for an ambulance from the ER? If they do, can the EMS provider legally pick them up from the ER without the hospital filling out transfer paperwork? Or can the ER just try to do a refusal on the person and then let them go by ambulance? Or does the person have to leave hospital property?

I've been looking around trying to find an answer. EMTALA seems to imply that if a person is on hosptial property, and has a medical issue, the hospital must screen them to determine the severity of the issue. If that person wants to leave the care of the hospital, they must be informed of the risks and sign a refusal (or the hospital must attempt to get them to sign). At that point is the hospital free of responsibility if the person calls for an ambulance from the ER?

I guess what I'm wanting to know is can someone call for an ambulance from hospital property, and the EMS provider take the person without hospital interaction?

Note: The EMS service here is a private company and not hospital based.

[Ridryder 911]

We get a couple of these calls a week... and just think our average wait time is only about 45 minutes in ER... We personally do not accept the call as they are refusing medical care if they are not going to be seen there. If the physician authorizes transfer then it is another issue.

The supervisor will notify the charge nurse or triage nurse and inform them of such incident. This usually resolves the problem. If there is an agreement to go somewhere else after proper paperwork is done, then (dependent on situation) we might consider transport.

We actually have patients request for us to pick them up out of ER and re-transport them back into ER so they would be seen faster... one was for a tooth ache..

As far as EMTALA describes that patients should be evaluated even if they are on their property site, the patient should fill out a refusal if not wanting to be evaluated. Again, this should be an administration policy within hospitals and EMS, and handled internally first and then notify EMS if cleared.

R/r 911

[JPINFV]

My understanding is, locally, if you dial 911 from a hospital location then you only get a police response. Apparently they've had this from a patient on the floors a few times when she wasn't happy with the hospital's care or the doctor's orders (last I heard, the rule was that she either needed to put up and follow her treatment plan or sign AMA and free up the bed).

[wakkoemt807]

On more than one occasion here I've seen people tired of waiting in the waiting room leave the hospital, call 911, get transported back to the ER by ambulance thinking they're going to get in faster, get seen by the triage nurse who recognized them and more often than not already triaged them, and get bounced BACK to the waiting room. They don't get seen any faster and now have a bill for their one block ambulance ride. :roll:

[paraloco]

We've seen this before in our area. Poor patients, not letting them abuse the system. lol A few years ago, my partner & I were walking out of one of our local hospitals. As we approached the ER entrance, I heard a man screaming into the payphone a few feet away, asking someone to come get him and take him to the other ER. We left, heading back to the station and pulled into a Stop & Rob, then continued. About a block from our station, a car passed us and pulled into the parking lot. When we got out , the driver indicated his friend was ill, and that the ER he had been in had done nothing for him. It was the same guy. Circling the drain. No air movement, turning blue, getting combative. We had to RSI him. We took him to the other ER in town. It was not a pleasant conversation that took place on the phone between the charge nurses of the two ER's. Just goes to show ya. Anybody ever get dispatched to a sick call and told to respond non-emergency(on the basis of what the caller told the dispatcher), then get there and the patient is in bad shape? I got caught like that once, and a good thing we had what we refer to as our BS kit, for just such happenings. Had an IV setup, and we were able to give a bolus fairly quickly.

[Thunderchild145]

We had one where the pt complains of SoB but has a SpO2 of 98% but we put them on a nasal canula anyway, well, since their complaint doesn't warrent getting directly into the ER, they get put into triage where there is no O2 and the nurses wern't going to just give him a bottle of O2. He asks us to take him to a different hospital but of course we cant since we've already transferred care. Anyway he leaves, calls a friend to pick him up from the hospital.

Strangely enough: Picked up the same guy for an MVC 30 minutes later. I don't get it. He wasn't driving, his friend was.

Anyway, back on topic. I'm pretty sure that if you call for an ambulance from an ER here you just get a police response, too, but I can't swear to it.

[AnatomyChick]

Ok... so ... I'm working as a dispatcher a few years back. At the time our 9-1-1 was located at our Hospital. I get a call on the 9-1-1 line, look up to see the location as I'm picking up the phone and notice that the call is coming from within the Hospital (Hospital street address & phone #). I look at my partner with a questioning look, and say "9-1-1 where is your emergency?"... to which I hear... "They won't let me out of the trunk"... so I repeat "where is your emergency" and then I get "They won't feed me anything, and the nurses are being mean to me". About that time, I remember that one of our frequent Psych patients had been brought in earlier in the day... me being the quick :roll: dispatcher that I am, I put 2 and 2 together, and tell her that I'll make a couple of calls and see if I can help her out. I then call the ER nurses desk and tell them "Jane Doe is calling from the her Room", and the nurse sighs, and tells someone in the background "go get 'Jane's' phone and see what she needs"... that's the only call that I ever took from the ER. I don't think it's a common thing here, although I'll have to ask my current dispatcher friends.

Jo

[zippyRN]

On more than one occasion here I've seen people tired of waiting in the waiting room leave the hospital, call 911, get transported back to the ER by ambulance thinking they're going to get in faster, get seen by the triage nurse who recognized them and more often than not already triaged them, and get bounced BACK to the waiting room. They don't get seen any faster and now have a bill for their one block ambulance ride. :roll:

and lost their place in the queue being re list on the time of their return attendance

[AnthonyM83]

We get that a lot, too, though they usually call from the payphone at another area of the hospital. We'll transfer them back to the same ER, since it's the most accessible receiving hospital...or AMA. But I really feel for these people, as their wait times can be over 6 or even 12 hours.

What I would do in their places is taxi or bus it over to a richer neighborhood, then call 911 from there.

[Code 8 Paramedic]

I had this happen a few weeks ago... patient was waiting for 4 hours at the ER. He was a frequent flyer who comes in for the cold and flu symptoms... but there isnt ever anything wrong with him.. It got the full response to the front of the ER.. fire,police and us. The look on the triage nurses face was priceless! she had no idea we were comming. The patient walked up to us and asked to go to the hospital across town. So he jumped up into the truck and off to the other hospital we went. When we got there and told them the story.. he went straight to the waiting room... where he waited for another 4 hours...