broken Posted June 30, 2007 Share Posted June 30, 2007 A patient has had a 4 wheeler accident and shattered his femur.He is transported 30 mins out of the woods in the back of a truck via fire and rescue.The patient is stable and in alot of pain but is very lucid and insistit he doesnt want to go to hospital b.EMS arrives on the scene and takes over the care of the patient.Youre informed by the fire and rescue that patient is in alot of pain but has no other injuries besides broken leg and that he insists that he doesnt want to go to hospital b thats 30 miles away and is a "trauma hospital"There is hospital "a" thats 19 miles but its not a "trauma hospital",then theres hospital c that is a "trauma hospital" and it is 32 miles.Patient is good besides pain,all vitals are 100% fine,no crying,no screaming,very lucid,and insisting dont take me to hospital b. What do you do? Link to comment Share on other sites More sharing options...
brentoli Posted June 30, 2007 Share Posted June 30, 2007 Let me make sure I understand this right. Subject has a closed femur fracture. Took 30 min for the subject to make it from the woods to the ambulance in the back of a truck accompanied by fire rescue. He is complaining of pain but does not want to go to the hospital via ambulance? At this point he doesn't have a choice. Looking at several factors. You obviously didn't get to inspect the scene to see what type of injuries would have been sustained. Also head injuries can obviously alter the mental status and the fracture would distract from an adequate neuro exam. I would be enroute to the trauma center, and meet up with ALS. Who can now chime in. Link to comment Share on other sites More sharing options...
broken Posted June 30, 2007 Author Share Posted June 30, 2007 Patient wants to go to hospital,just not hospital b.Hospitals a,c,d,e,f,g,h,i,j,k hes fine with,not b. Patient is LUCID AS CAN BE,NO HEAD INJURIES,NO OTHER INJURIES ASSESSED BY SEVERAL EMT,FIRE AND RESCUE,ETC.Patient is also medically trained and familiar with ABC's,1st aid, etc. Also,patients emergency contact person says "dont take him to hospital b,go to a or c" Link to comment Share on other sites More sharing options...
brentoli Posted June 30, 2007 Share Posted June 30, 2007 What do my protocols say about hospital choice? Link to comment Share on other sites More sharing options...
Code 8 Paramedic Posted June 30, 2007 Share Posted June 30, 2007 Based on my feeling and our protocols the pt should go to a trauma room, now if hospital a is not a trauma room its out... if hospital c is a trauma room and he is ok with c, go there if not call medical control at hospital a and see if they are ok with accepting him.. if they say no then you can tell the patient "they wont accept you" we have to go to b. convince him that he can have them stabilize his leg and then transfer him to another hospital for ortho follow up if he wants. Link to comment Share on other sites More sharing options...
spenac Posted June 30, 2007 Share Posted June 30, 2007 He's alert and oriented and doesn't want to go by ambulance. Explain the risks. Have him sign refusal. Then spend more time documenting his responses and all the other crap. Darn would have been easier to transport this one. I hate when people interrupt my Deny all patient way of thinking. Besides they have agreat meal special today that I could have gotten. Link to comment Share on other sites More sharing options...
spenac Posted June 30, 2007 Share Posted June 30, 2007 OOPS my bad he just wants to go to another hospital. Depends on protocols. In my area he's going to the one and only hospital thats 90 miles away, where he will be transported probably by air to another hospital with a trauma center 175 miles away. If he doesn't want to go to our only hospital then see previous post. Link to comment Share on other sites More sharing options...
flight-lp Posted June 30, 2007 Share Posted June 30, 2007 hospital "c" by ground EMS.................... There, that wasn't hard............. "a" is out of the question as it isn't a trauma facility and possibly will not have orthopedic services. He doesn't want to go to "b" that fine, its his choice. But instead of having him refuse everything, including transport, why not just honor his request and go to another trauma center only two miles further away? No harm, no foul.................. Oh yeah, if your BLS, meet up with ALS and give this man some drugs, he'll need it for the transport! Link to comment Share on other sites More sharing options...
broken Posted June 30, 2007 Author Share Posted June 30, 2007 Lets just say that hospital b is known around the state for messing patients up more than they fix them. You mean to tell me you guys are going to take a LUCID patient somewhere against there will/wish's??Why not go the extra 2 miles out of the way and go to a trauma hospital that the patient is comfortable with? And lets throw somthin else in....You took patient to hospital b,against his wishes and the docs there totally messed him up.He was a healthy young man and now,10 weeks after his accidnet,he has 100* range of motion and walks with a terrible limp that docs say will not go away without surgery.SHOULD YOU BE HELD FINANCIALLY RESPONSIBLE?REMEBER,HE WAS BEGGING YOU NOT TO GO TO HOSPITAL B.You didnt do the actual surgery but you did take him somewhere he was insistent that he didnt want to go to because he knew they were not good doctors.Seems that hospital b said he wasnt going anywhere until after surgery. Nevermind what protocal is,were talking ethically and morally,should you respect this persons wish's?Thyere in alot of pain and I dont think theyd be making a stink about going to hospital b if it wasnt important to them. Link to comment Share on other sites More sharing options...
scratrat Posted June 30, 2007 Share Posted June 30, 2007 Here's my shot in the dark. A single long bone fracture isn't necessarily a trauma. Any hospital with a orthopedic surgeon can fix it. The only other problem is, how can you be absolutely sure he doesn't have any other injuries? He could have c-spine issues. And if that hospital can't handle those injuries, then we have a problem. But if he is transported to the local hospital of his choice, it's better then nothing. Maybe they can fix his leg, then convince him of the need to be shipped elsewhere. That said, Id explain the risks of going to XYZ hospital vs. ABC hospital. Then if he still wants to go to XYZ hospital, then that's his wish. Just because he has an injury doesn't mean you can force him to go to the hospital that your 'protocols' says. For example, it is state law that we transport to the only certified stroke center in the area, if pt presents with possible CVA. However, that pt, or their PA, can request the other hospital. They are informed of the ramifications, and must sign a form signifying that they understand that the other hospital cannot properly manage them, and they may die. Then we transport them. Until they are unconscious or confused, then you have no say in where they be transported. Link to comment Share on other sites More sharing options...
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