Friday, May 15

You Make the Call...Level Zero

Ambulances are busy tonight, more so than usual, and for the last few hours you've been running back to back runs. Dispatch is on you as soon as you radio at hospital to turn around as fast as you can. Calls are pending.

As you're on the way to yet another call you hear calls going out over the air:
"Engine 99 and an ambulance when available respond to..."
"Truck 99 copy, we're out of ambulances we'll put you in line..."

And so on and so on.

You arrive at a call and pick up one of your regulars who has, once again, fallen out of bed and the home health care staff can't, or won't, pick him up, so here we are. We'll discuss the politics of this dispatch another time.

While transporting the stable patient you are very familiar with you hear an engine not far away calling frantically for an ambulance.
They report a traumatic injury, fall from a bicycle, unconscious and an unstable airway. You recall the medic on that engine is a good practitioner and know that if they're calling for help, they need it.

Your driver leans back and says, "They're between us and the trauma center. Wanna go for it?"
You're on the way to the same hospital already. Your patient looks at you and says, "Go for what?"

You make the call.


Shasta said...

Not knowing what the guidelines are, I have to guess here. I'm thinking that this is akin to a triage situation in an emergency room: say, if a nurse is taking a history on a stable patient, then there is a code called, the nurse runs for the code. So, you are in the same position. Your patient is stable, and you are getting a street version of a code call for a patient who will likely suffer serious consequences, or even die, without immediate assistance. I say, you go to the guy who really needs your help RIGHT NOW.

Chris said...

Can your patient go on a chair? If yes, transfer them to a chair, get one of the fire guys/gals to supervise the current patient, and go to assist the fire medic. If necessary, transport both patients, but I would advise stealing a firey to assist. It's a "what could happen" vs a "what is happening now" situation.

Would probably make the offer to dispatch, and let them decide.

Anonymous said...

Just reading that post makes me emotionally and start to panic. I know what your dispatchers are thinking, because I would think and say that same things.

STOP! I would want you to stop! Not just because I am a dispatcher, but because I don't want someone to die on my watch while I am in control of all the ambulance out there.

Have the Medic driving go to the trauma call, I wouldn't care who went out to help the fire medic, but someone go help - leaving the other medic to sit and watch the stable patient.

Then the fire medic and the ambulance medic can get the patient stabilized then you can hopefully wait for the next ambulance to clear and come do patient transport.

Of course, as a dispatcher, I would probably be on the phone to the closest hospital begging and pleading for them to release a medic unit so someone can come help you.

I would have done my best to call in mutual aid too.

I would have done anything to not leave the fire medic alone.

John said...

Sorry, and it sucks, but if the patient is in the bus, you can't hop another call. His or someone else's lawyer will sue you for delaying that patient's transportation to "definitive care" becuase you have a duty to the patient you have, but not the one you want to go to. this comes up often enough that we address it in initial paramedic training.

MotorCop said...

Emotionally, you go help the guy that needs you more.

Legally/Policy-y (?!), I'm guessing you're similar to us. If I have an in-custody and I'm transporting to the jail and another cop calls for cover, I'm stuck (depending on the severity of the cover call and what my in-custody did...they might find themselves walking on the freeway...but don't tell Admin I said that!)

The Bus Driver said...

Personally, I'd stop and help the patient in need. I agree with the comment about moving the stable patient to a chair and transporting 2 for 1 deal.

Additionally you might just save the critical patients life.

Legally, I'd worry about the HIPPA and the whole patient privacy thing, but honestly we're human and I would forego the whole "privacy" thing in the event that you will save the other patient.

Dances with Corgis said...

Agree with John. We just covered a very similar situation in my EMT school and that is the "correct" thing to do.

Michael Morse said...

Screw it, stack em up! Rescue 1 resembles a circus wagon some nights.

I once had a stable heroin addict enroute to the ER when a fire truck collided with a full minivan. Multiple trauma codes. I tried to stop, the addict went beserk and had to move on, only after help arrived. Horrible position to be in.

Firecap5 said...

Well. Now this is a toughy.

IF the firemedic can get the patient packaged for transport quickly, and you can move the non-critical patient to the bench seat, you could pick up patient #2 and the firemedic(He has to go with so that there is no question of abandonment for patient 1)and BF&B to the hospital.

This is one of those areas where the LEGAL answer may be to pass on by and drop off #1 and run back for #2.

For me morally, I would try to get both in one shot, with a medic for each patient so there is no accusation of abandonment. Gonna be pretty crowded back there though......

Anonymous said...

Trauma pt. is gonna be on a backboard so you can slide him onto the bench seat. A bit awkward to work on there I'll admit but probably easier than playing musical cots.
Grab an EMT from the Engine (to drive) and have your partner hop in the back to watch pt. # 1 and help you with # 2.

Anonymous said...

I suppose the 'right' answer varies by state, but I'm sure if you had your partner stay with patient 1, there would be no issue of abandonment. If they were very stable, diverting to pick up a critical patient that was in close proximity(and a rider or driver) shouldn't be able to be constued as delaying care. After all, they'll probably be sent straight to the waiting room by the Triage Nurse. I'm just waiting to see families of people who died from waiting for transport because a system abuser was tying up the nearest unit, sue the system abuser. If I was on the jury for that trial, I'd have the system abuser pay the deceased's family even a dollar a week for the rest of their lives just to think about what they did. Triple J FL