Deny Transport?

[JPINFV]

seems to me that you would take an unstable pt out of the hospital to a place of lesser care and you clam that you would do what is best for the pt? some nursing staff at hospital would rather have a pt transferred then take care of them and they need to be stood up to some times and I thought that we could have a light hearted discussion about things, I meant no disrespect but if you want to go at it we certainly can go!

Err, nursing staff do not order discharges. I guess "unstable" depends on what your definition of "unstable" is. Hospice discharge of unstable patients is common. Some conditions can be cared for in lesser settings. It is not the job of the EMT to decide if a patient is "stable" enough for transport. Sure, make sure that there is no on-going treatments that is out of your scope of practice, but other than that, it is not your job to determin if the patient is "stable."

[JPINFV]

Just curious, is why I asked. Perhaps you could throw these two drowning men a liferaft or some friendly advice. They are losing badly and don't even realize it.. :roll: It barely seems sporting really?!?!?

8)

Pinymayu

Hehe, advice?

1. Check your emotions at the door. While, yes, pinymayu's pictures are funny if you aren't on the wrong side of his posts, it does not help if you're all rallied up about them [i've been on that side before. cough CVA thread cough]. You WILL NOT be able to defend any argument you make if you're more emotional than Rosie O'Donald after being kicked out of a candy shop.

2. Understand that not all sick patients need a hospital. This is when entering into a professional conversation with other members of the patient care team [which, by providing transport, emergent or scheduled, you are a member of] is important. So your dialysis patient is bloated with crappy lung sounds [for example]. Well, maybe what the patient NEEDS is dialysis. By transporting the patient to a place other than the dialysis center, you are actually delaying the care that the patient actually needs.

Another example could be a patient being discharged that is in obvious respiratory distress. Talk to the staff, the staff recommends a breathing treatment and calls RT. RT administers a breathing treatment [which can also be done in a nursing facility]. Patient is not breathing much easier. You transport without incident. Again, as my earlier post stated, it is not the responsibility of the transporting crew to determine if the patient is stable. That responsibility lies on the man or women with 8+ years of post secondary education and several years of on-the-job training [residency], not the person with 120 hours of advanced first aid training. [for the record, I'm an EMT-B].

3. There are only 2 times that you should "refuse" transport. 1. Unsafe situation. Violent psych patient is not "unsafe," it's an accepted risk. Have staff sedate if need be, put patient in 4 point restraints, transport. I honestly believe that most EMS assaults, especially interfacility psych transports, happen because either the transport crew were assholes or stupid. If the patient might be anything approaching dangerous, talk to the staff. Furthermore, DO NOT TEASE THE PSYCH PATIENT. I like happy psych patients. They tend to be fun to transport. I do not like angry psych patients. I do not want, and will not, act in a manner that makes a happy psych patient into an angry psych patient [use of restraints, if deemed appropriate, is an exception. They can be as mad as they want in leathers]. EMTs that do that deserve what they get.

2. Patient requires an ongoing treatment that you can not provide. Other arrangements might need to be made, either with a member of the hospital staff riding with you [example from my company would be a CCT of a patient that requires a balloon pump. The hospital has to provide a tech to run the pump], or with a company that has a CCT program.

[pinymayu]

"tskstorm, "

Content Removed - Admin

Out Here,

pinymayu

[Just Plain Ruff]

I've kept out of this for the better part of three pages but this is ridiculous.

this thread has deteriorated down to the lowest level. Each person resorting to personal attacks. I am as guilty of this at times as the other but this has gotten down to becoming really really nasty.

I urge all three participants of this name calling insulting and negative thread to stop. You've made your points and I am sure that all but the three participants are just reading these replies for the joy of seeing this dissolve into a "I'm better than you" are post.

Does anyone really care at this point who's right and who's wrong.

[nursenae]

As a matter of fact I do care who is right or wrong if these folks may be transporting me or my family one day.I am married to a retired paramedic one of the best in our state.As a professional I would find it very hard to deny health care to someone/any one.What we see as a dumb call or a bs call as some have said[not my words] and you don't transport and that person may actually have an unseen medical problem that could have been found and treatment started sooner if they had gone by EMS.

I have been a nurse for 25 years and if EMS came to transport my pt.I would not let them transport if unstable.That person is my patient until they are on the stretcher.If I had seen a change while EMS was enroute I would have had someone call the dispatch and slow them down.

That one poster up there must be a college educated EMT-P using all them there fancy purty words.I did not say assume because I know better.

I do not have a comment about dialysis pt. because i have never had to care for them.

The DNR is supposed to be the patient at all times,there should be enough copies for the HHN and the pt's family each to have one.Hospice knows their pt.,but ER nurses and Docs deal with death and dying pt. almost daily and they can comfort the family.Make sure YOU have a copy before you put the pt. on the stretcher if you do not intend to do CPR enroute.You better believe I would sue you if you did not help my family member,cause you choose to write living upon arrival to facility or however you put it.

To me any time you walk away from a pt. and deny them help you are abanding them.I know I am a nurse and did not have to face what you all have.I realize I have misspelled words, but I get excited when I read all this.

I do want to say to all of the EMT-B,EMT-P and all others......THANK YOU for all you face on a daily basis.God bless each and every one of you and please stay safe and watch out for each other :wink:

[Just Plain Ruff]

this thread is no longer about who's right or who's wrong it's about 3 people (Maybe two now) that are name calling and seeing who can one up the other. It's a verifiable pissing match.

I for one do care what your level of care is and how you treat patients. In my opinion, if you make patient transport and you refuse to take them to the hospital when they have asked to go, NO MATTER what the complaint they have, then you are not doing your job. We'd all like to not transport these abusers and patients who we deem to be stable enough to not have to go by ambulance and have them go some other way but we can't. It's our job to provide care and transport.

Yes there are bullsh(*(T calls that we find non emergent but it's not our emergency.

[nursenae]

Very well said.And if you don't like to do transports.....well maybe you should seek another place of employment.

[Just Plain Ruff]

good reply nurse. I used to hate transfers but I realized that transfers are really what make our bread and butter.

[MeekoBB]

I refused a transportation once.....I was working a private transport service and was called to a nursing home. They wanted us to take a 400+lbs patient to a hospital where there are 3 closer just so she can have IV meds. I didn't refuse because of the distance...Hell I would have taken the patient to VA if requested, I refused because there was NO WAY our service was capable of her transport and I told the supervisor, ours and the nursing home's. Even if we left the stretcher at the nursing home and shoved her on the floor, she would not fit and the lift of the coach van was not wide enough for her extra wide big boy wheelchair, not that it could handle the weight. Besides, we were still baffled that they got her into the room in the first place.

We advised they would need to call 911 and request the assistance of Rescue.

[EMS49393]

("tskstorm

This makes no sense to me ? What you said to me sounds like @ dont take your mva pt to an ER if the dialysis ctr is closer cuz he has [u)

n stage renal failure.

Every now and again, I feel the urge to purchase English textbooks and hand them out. :roll: I hope you don't write "pt being transported to dialysis for n stage renal failure" on your run tickets.