101 Things the Fire Department wishes you knew



Wednesday, November 12

...for the code 3 transfer...


A smaller ER in a quieter part of town has hit the panic button when a patient walks in with injuries they are unable to handle. The law says a patient must be "stable" and meet certain other criteria before they can officially be "transferred" between facilities. Or, the doctor can just call 911 and run and end around the entire system.

THE EMERGENCY
A man was struck by a car on his bicycle and the driver has been kind enough to drive the rider to the nearest ER for evaluation. The rider walked in, registered and took a seat to be seen. When the physician, who is doing his mandatory ER time away from his pediatric practice, got worried this was out of his league, he calls us.

THE ACTION
We arrive with only the information regarding a transfer so we're getting our things together when a nurse comes running out and tells us to hurry. Hurry? Isn't there a doctor in there with all that high tech equipment, bright lights and staff? We hustle in to find the bike rider, lying flat and our physician friend pale and sweating.
"He's a trauma patient, he needs to be seen at the trauma center immediately."
"What happened?"
"I told you he needs to goto the trauma center!"
I took a breath, looked at the patient who was smiling in the hospital bed with nurses scrambling to start IVs and take further tests.
"Are you hurt?" I asked the rider noting here was no blood, no missing limbs, not even an abrasion on his elbows. "I'm fine, I just want to get checked out so the guy in the car feels better."
I motioned the doctor into the hallway and my partner starts a more thorough assessment. I inform the Doc that since he activated us under 911 protocols, we're in charge of patient care unless he accompanies us to the hospital. If this is a transfer, the patient seems stable enough to maybe not need the trauma center. I ask what of the certain criteria in our system qualify the rider for a trauma center visit and am told, "His heart rate is 48."
I poke my head in, "You bike a lot friend?"
"300 miles a week."
"That explains the heart rate, Doc."
"He still needs a trauma center!"
We agree to take the rider and the rider is happy to comply, just to get to another physician. If that seems embarrassing you should have seen me trying to explain the situation to the trauma team as we arrived with a patient telling bad jokes. The physician from the first hospital had called ahead and told a wild story that had no less than 15 professionals awaiting our arrival.

3 comments:

Dantarious said...

You saved that guys life. Sometimes the best thing you can do is remove the patient from a potentially harmful situation. A job well done on your part.

The Happy Medic said...

"saved" is a pretty heavy word there. This guy had nothing wrong with him and I couldn't convince the Pediatrician of that.

Dantarious said...

Yes, but what might the Pediatrician have done to rectify the life threatening bradycardia! The patient was obviously in shock. :-)