Already treated in Mexico - What Would You Do?

[tskstorm]

"<< city boy ... i dont have any protocol that says make a medical decision/refuse treatment/txp cuz the next available unit is too far away. "

Not refusing because mutual aid to far away.

"Why not run an intercept with that unit 60 miles away ? split the ride half way ?"

Mutual aid is only available for emergencys, this is not emergency. So now 2 ambulances and 2 areas uncovered for 1 none emergency and that assumes that the mutual aid is available. Also now you have to consider costs that we've been ignoring is it fair to ask them to lose money to. They are a different agency not part of ours. They only have one ambulance as well.

"Further, theres no new medical complaint except the broken arm ? ... here's a question how well does the parent/child speak english ? are you certain she said what you think she said ? "

Actually family is not requesting us for broken arm, they want us to go to the hospital because the patients mother cannot pass checkpoint. Child good english. Second medic is native of Mexico if that helps scenario so he can speak with patients mother. We will also in scenario allow you to speak fair spanish, so it is definite that the mother is just asking for a way past check point.

"I don;t know the "text book answer" but i would take the pt. cuz i have no idea, whats going on under that cast, dont know if it was done right, or what. again I'd probably go for an intercept but im a city boy what do i know lol

"

Good catch never trust Doctors care in Mexico, but for this scenario patient was seen by one of the few very good Doctors in this border town, one that you would trust with your childs care, cast done better than what they'll get at our small town hospital we take them to. X-ray shows proper bone set. Again intercepts only done if need second medic in back for real emergency or if when in route another call comes in then you sometimes give them first patient then go back for the next. I'll forgive you for not knowing frontier medicine if you'll forgive me for getting lost when try the city medicine. Can't imagine only 10 minutes to hospital. Primary service I am with patient at least 90 minutes. My part time service will spend about 45 minutes with them unless I go as mutual aid back to my primary area.

[spenac]

Well the big difference between you and myself is ... I was never taught to read X-rays .. so I couldnt use that as a diagnostic, (outta my scope,) and again would take them on the basis of not knowing if proper care was rendered(spelling?)

and as far as wether or not a pt is legal/illegal and getting stopped etc... the pt the young girl is us citizen isnt she(i think this was stated) Why would you know the mothers legal status ? the mother is not your patient and is irrelevant to the pt's care.

on a side note it was once explained to me that anyone over 65(legal i presume) gets medicare, and anyone who cant afford insurance or medical care(cant remember which, pretty sure its cant afford much of anything.) gets medicaid. If this is right how did the young girl get medicare ? (if im wrong can someone explain it better?)

I still don't know and am sticking with TXP the pt .. lol

[spenac]

No, I am not a lawyer, so my responses can be trusted

I only relate the information as it was explained to me by a sheriff's deputy. If you do not know the status of the patient, or can not obtain the information reasonably, you can be cited for transporting an illegal. Delaying transport to obtain the information would not be encouraged, and often it would be the agency at fault, not the individual provider.

Basically da.... if you do, da.... if you don't by what your saying. Glad your not lawyer definitly had me worried for a little. Just kidding all you lawyers on here.

[Ridryder 911]

So let's say you do transport the child.. and now what is the ER supposed to do? They cannot treat the patient until the mom gets there. She (mother) stated there is no medical reason for transport? .. Then why are you even there. She wants the child transported she has two options Transport the child herself or go with the child. The child is not enough distress that immediate care needs to be performed.

R/r 911

[spenac]

Since it's getting late heres more info for our area.

First our Medical Director allows us to deny transport under a few instances. On this particular case in the scenario if we showed up at the hospital with a patient that already had been treated and only reason we were requested was the mothers legal status we would be talked to and questioned if we could not follow protocol. There is no medical need for ambulance, the mothers legal status can play no part in whether to transport or not. Patient can safely be transported by POV which is also determining factor as to getting paid by medicaid.

As far as the law in this case we could be guilty of transporting illegals a felony and could face jail time. Had the little girl needed medical attention could have changed law interpetation according to BP and other local LE. Our instructions from all law enforcement agencys is to take care of our patients. In fact if they show up on scene with us none of the agencys check patients legal status. I am not a lawyer and have not studied all the laws rules regulations on this matter so what I say is not set in stone.

Off the record we have heard rumors that none of the agencies want to know the status because they would then have to take the patient into custody and would thus foot the cost of all additional care both in the ambulance and the hospital. Rumor even has it they sometimes take people into custody as they leave the hospital even when they knew in advance the person was illegal just to avoid the bill and the posible bad publicity.

Now normally while we may think people are illegal most do not tell us. Most also will act very sick or injured, thus we have to transport just to see a miricle occur just after the checkpoint 50 miles north and by the time we reach the hospital they're completly cured and leave hospital w/o seeing the doc. Many contract nurses and docs think we're darn good at treating patients until the reg staff explain to them just what happened. As a side note it is also interesing to watch the blood pressure drop shortly after we pass the checkpoint. Wish mine would lower just by passing it. May need a grant to study why it cures some people but not others.

Please keep in mind this is a scenario that combines things that do occur in our area w/o dealing with a specific patient.

Keep discussing I'm enjoying seeing how others think. We have always been instructed that we cannot report any information as to legal status as it could be breach of patients right to privacy and in the scenarios case the mother by default would be protected by it as well. What do ya'll think?

[spenac]

So let's say you do transport the child.. and now what is the ER supposed to do? They cannot treat the patient until the mom gets there. She (mother) stated there is no medical reason for transport? .. Then why are you even there. She wants the child transported she has two options Transport the child herself or go with the child. The child is not enough distress that immediate care needs to be performed.

R/r 911

If we tranport the child the mother goes. No need for the ambulance even based on what the mother has said. The ER would just tell her to follow up with her local doctor and then local doctor would help schedule a specialist if needed.

The reason we are there is the mother sees an easy way past the checkpoint. In our area people see it as a free and easy way past the border patrol, but most do not out and out tell us they are illegal. After about 60 miles north a person will probably never be checked for legal status unless they get stopped for traffic violation and they know this and use the ambulance to bypass all reg and suprise checkpoints.

[Dustdevil]

Apparently I am the only one, but I can't get past the premise of the scenario.

The mother is IN THE U.S. She wants you to take her and the child to a hospital IN THE U.S.

Is this a correct interpretation? If so, in regards to the Border Patrol, what exactly is the problemo?

And is she hott?

[spenac]

Apparently I am the only one, but I can't get past the premise of the scenario.

The mother is IN THE U.S. She wants you to take her and the child to a hospital IN THE U.S.

Is this a correct interpretation? If so, in regards to the Border Patrol, what exactly is the problemo?

And is she hott?

Ah senorita mas fina no not in this case and not part of deciding to transport or not. Her child is USA citizen, she is not and she is here illegally. She is basically trapped in the border zone and sees this as a way out to the interior of the USA. She has not given any medical reason to transport her child but has clearly stated she is illegal and cannot pass the checkpoint. Had they called when the break occured we would have transported without hesitation, but this patient has already had the injury fixed. Odds are based on what is seen and stated nothing further needed until time to remove the cast.

As mentioned per protocol this patient is not eligible for transport and would be denied transport. Now a twist if the mother is smart a couple of hours later they will call 911 again and this time she will focus on how severe the pain her child is getting. Pain will also be in neck and back radiating to the legs. Child will have been coached to say everything hurts 10 out of 10. Now what do you do, transport? Do you deny because you suspect the fake? I'll let ya'll chew on that a while as it happens often as well.

[Dustdevil]

She is basically trapped in the border zone and sees this as a way out to the interior of the USA.

I still don't understand. :?

She is already IN THE U.S.A., right? So then, what is this "border zone" and "check point" she is worried about?

[spenac]

I still don't understand. :?

She is already IN THE U.S.A., right? So then, what is this "border zone" and "check point" she is worried about?

The border patrol checkpoints are about 50 miles north of the border in our area. At the checkpoint they stop all vehichles going north and ask for proof of citizenship. The border zone runs from the border to the checkpoint. Many people can get day passes at the point of entry to enter up to 25 miles of the border into the USA to shop and visit family and some decide to stay illegally. Some illegally walk accross the border no fence and the rio grande is not that grande anymore. Many people live in this area illegally for years not able to re-enter Mexico (w/o having to sneak back into USA) and not able to go further north. Many raise their familys here. There is a large number of Border Patrol agents in the area but they are mainly here to try and stop illegal crossings of the border but it's a large border.

So her being in the USA does not give her full access to the USA. Once past the checkpoint she will be able to go any where in the USA she wants. This is the biggest abuse of the ambulance in our area, using us to get past the checkpoints. We have asked the Border Patrol checkpoint to start stopping and checking us but there orders are to let us pass without delay and the illegals know this and use it.