Already treated in Mexico - What Would You Do?

[spenac]

This is not an actual call, but is something that happens here often.

You are a medic in a border town 100 miles to nearest hospital with no other ambulances closer than 60 miles away. You have no communications with medical control, you work strictly written protocol. Law enforcement and fire do not respond with you. It is just you and another medic.

You are dispatched "child with broken arm".

On arrival you find a 10 year old girl already in a cast.

Mother explains that the child had fallen and broken it earlier in the day in the USA. She had family members take child take the child to hospital in Mexico. She hands you a x-ray film that shows fracture at or about center of the radius. Everything is lined up and there are no fragments. Patients cast immobilizes arm above elbow and below wrist. All vitals in normal. Cap refill less than 2. Good motor function of fingers without pain on movement. Pain is dull pain at most a 1 out of 10 per child. Patient has pain pills prescribed in Mexico but hasn't taken one because it "does not really hurt" since was casted. You examine child for any signs of possible abuse none seen on back, legs, abd, etc.

You ask mother since child is already casted why she called ambulance, she says that Doctor in Mexico told the family (keep in mind mother did not go with child) that the girl might need surgery and since the child has medicaid they decided to bring her back to USA to see Doctor. You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA.

So what do you do?

[spenac]

I will only reply to your questions or comments? I will not bias this by telling what we do as we get things like this several times a week. Keep in mind the big old hipo that all actually helps keep us from being able to be in the publics eye the way firefighters are but thats another gripe.

[tskstorm]

txp ... why wouldnt you txp ?

sure you're being a taxi cab in a sense, but if they called 9-1-1 txp. just my opinion

[dahlio]

Pretend like that woman did not tell you she is an illegal citizen in the US, and transport. If the border control says something, claim you didn't know. Not the most ethical thing in the world, but morally, I think it would be alright.

[spenac]

Pretend like that woman did not tell you she is an illegal citizen in the US, and transport. If the border control says something, claim you didn't know. Not the most ethical thing in the world, but morally, I think it would be alright.

Since all info came while involved in medical, could you even report her if you wanted to? Point to ponder in this discussion. Also what is your reason for transport, helping her or helping the child since child has no new medical complaint? Another point to ponder.

[spenac]

txp ... why wouldnt you txp ?

sure you're being a taxi cab in a sense, but if they called 9-1-1 txp. just my opinion

You would take a person with no medical complaint leaving your community uncovered? Nearest mutual aid is at least 60 miles out. What if your mother collapses while your out on this call and could have been saved had ambulance been there? Points to ponder. Remember patients mother states there is no medical concern.

[chaser]

...You are a medic in a border town 100 miles to nearest hospital with no other ambulances closer than 60 miles away. You have no communications with medical control, you work strictly written protocol... It is just you and another medic.

So, due to the parent's worries about being illegal, you would tie up the only EMS providers in the area to serve as a taxi service for a patient in no apparent distress or with no medical emergency ? Is this rational, or for the good of the community?

In this scenario, the child was brought to medical care by another party earlier. Have her do that again.

I am curious to hear your protocols on this type of situation.

[BEorP]

I voted yes. If someone wants to go to the hospital, take them. It doesn't matter who they are or what their complaint is. If there are not arrangements to cover your area when you go on a call then that is something that your service should be looking into and fixing.

[spenac]

So, due to the parent's worries about being illegal, you would tie up the only EMS providers in the area to serve as a taxi service for a patient in no apparent distress or with no medical emergency ? Is this rational, or for the good of the community?

In this scenario, the child was brought to medical care by another party earlier. Have her do that again.

I am curious to hear your protocols on this type of situation.

I'll get more into our Medical Directors protocols after see more thoughts and ideas. Like the way you're thinking.

[spenac]

I voted yes. If someone wants to go to the hospital, take them. It doesn't matter who they are or what their complaint is. If there are not arrangements to cover your area when you go on a call then that is something that your service should be looking into and fixing.

Again mother said "no concern" that required ambulance other than her illegal status. Do you need medical complaint to transport or are you just transporting illegals?

As far as need more ambulances and staff I agree but thats another gripe for another day. But even if we had one ambulance for every house in our 2000 square mile plus primary coverage area is there any way to justify this transport.

And please note I have not brought money into picture, we assume we will not be paid. But as another point to ponder do you feel medicaid would pay for this? But again we are not concerned with payment at this time, just more to ponder.