In our system, like many, the private ambulance companies in the area handle most transfers, but when they are out of rigs, they can reclassify a dialysis patient as a critical care cardiac patient to get out of their contractual requirement. Or there could be an actual legitimate medical emer...Oh who am I fooling.
THE EMERGENCY
A local private ambulance company (I'll call them F&B) has called in a request for a transfer, stating the patient meets code 3 priority status, which requires 911 activation.
THE ACTION
I can get you to the ER. I can get you to Pediatrics. I can get you to L&D in a hurry using the big elevator, should you need the extra room. I know where that hidden door button is to get into the cath lab. I can find most places in most hospitals, but when our instructions were to the Critical Care unit, I got curious.
We made our way up to the unit and got the usual hospital staff response. We were ignored. Often when ignored in the ER, we park the gurney so nurses have to find a new way out of the nurses station. So far no one has jumped the counter, but I've seen a few consider it.
Ignored and feeling lonely, I ask if anyone called for an ambulance. Nothing.
A physician approaches us doing a strange walk looking from us, then back over her shoulder down the hall, then back to us.
"Are you here for Mr Johnson?"
"We're here for a medical emergency. Did anyone request a private ambulance recently?" I offer to the entire room.
"I called for a transport for Mr Jones, but he just left for CT. He won't be back for 30 minutes." says a Doc barely looking up from a computer monitor.
"Did you request the ambulance code 3, lights and sirens?" Asking as I approach him.
"Yes, critical abdominal injury, we're going to operate tomorrow morning at Saint Farthest." Checks his watch, "I need to get a move on. The nurses can fill you in when he gets back, thanks."
And away he went. Not believing we had the correct patient I called the ambulance company mentioned on our data screen and, sure enough, the guy we were sent lights and sirens for is in the CT scanner.
Not to waste time, we notified dispatch of our situation, then filled out all the paperwork we could from the gentleman's face sheet.
35 minutes later, and ambulance still parked blocking the main entrance to the hospital, the nurse returned with Mr Jones who looked at us and frowned.
"You guys aren't from F&B, where's my crew from F&B?" he asks.
"They're a bit busy today, decided to upgrade you to 911 status."
"You aren't scheduled to pick him up for another hour, he still has to give labs," the nurse tells us.
"Maybe someone missed something here. We're here to get him right now, we've already waited too long. If he's not urgent or even ready to go, I'm going to have to leave and put him back in line."
"Fine, sorry to bother you." She snipped from behind the hastily drawn curtain.
I wish I had my own to slam shut as we push the gurney back out.
We left and never had to come back. Found out later an MVA happened near our station and a unit had to come from across town.
Comments
We have however, managed to solve this on most occasions. Previously if we were doing an ITU or critical care transfer it was a case of arriving on the ward and then having to wait anywhere from 15mins to an hour whilst they get the patient ready for transfer, get notes together, change syringe drivers etc. Now, the hospitals and our Ambulance service have purchased 'critical care stretchers' for each of our main hospitals. These stay at the units and have ventilators, syringe pumps, O2, suction etc already attached to them. They lock into 90% of our ambulances and so the new protocol is that the units dont even request and emergency transfer until the patient is packaged on the stretcher and is ready to go. We then arrive, leave our stretcher in the dept and pick up the patient on the critical care stretcher. Seems to be working really well so far and is cutting down on the wait in the hospital.
One bad point though....Less down time in the hospital, so less chance of a quick trip to the staff restaurant!!!