Yet More Problems on the EM Horizon

[docB]

This is a seperate problem so it gets a seperate thread.

We have a bad overcrowding problem in Vegas. This winter, like most winters, the hospitals fill up and admitted patients must be held in the ED. This means that we run out of space and the waiting room and the ambuances stack up. When it's bad we can have ambulances the have to wait several hours to place their patient. Obviously it's bad to have these ambulances off the street. The ambulance companies really hate it because it means that ambi is not producing revenue. The ambi companies hate this so much that they convinced the legislature to pass a new law that says that after 30 minutes any ambi crew can dump any patient in the ER and leave. That's any patient regardless of thier condition. Consequently over the last week or two since this law went into effect we have had ambis dump SOBs and CPs into chairs in the hallways without O2 or monitors. Vag bleeds, syncope, broken bones, all go into chairs if they're lucky.

The problems that come when legislators try to fix health care is that they always fix the wrong issue. The main problem wasn't that ambis were having to wait. It was that the hospitals and ERs were overcrowded. But they aolved the problem for the ambi companies and made the overall situation worse.

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[a_ditchdoc]

Having been on the other side of this, as a Paramedic, I can see some logic in this. Having to wait inside a hospital, where legally, in most states, paramedics are not alowed to treat, seems to be of little utility. Likewise, when I have had to stand by with my constipation, vomiting, dirrhea, fever, or superficial lac patients because there are no beds while calls are going out for shootings, vehicle accidents, and unresponsive patients, I have gotten more than a bit frustrated. My theory has always been that at least in the hospital people can get SOME care if their situation deteriorates, while the public that calls for an ambulance can get none. The public pays taxes in most places for EMS services, and our job generally ends when we arrive at the emergency department. I know that this is crappy for the hospital staff, but EMS gets backed up just like they do. Passing the waiting on to EMS, and the people that need an ambulance, just causes more problems rather than solves them.

I do agree that the overcrowding needs to be addressed.

 

[docB]

Having been on the other side of this, as a Paramedic, I can see some logic in this. Having to wait inside a hospital, where legally, in most states, paramedics are not alowed to treat, seems to be of little utility. Likewise, when I have had to stand by with my constipation, vomiting, dirrhea, fever, or superficial lac patients because there are no beds while calls are going out for shootings, vehicle accidents, and unresponsive patients, I have gotten more than a bit frustrated. My theory has always been that at least in the hospital people can get SOME care if their situation deteriorates, while the public that calls for an ambulance can get none. The public pays taxes in most places for EMS services, and our job generally ends when we arrive at the emergency department. I know that this is crappy for the hospital staff, but EMS gets backed up just like they do. Passing the waiting on to EMS, and the people that need an ambulance, just causes more problems rather than solves them.

I do agree that the overcrowding needs to be addressed.

But if the house is full the house is full. We're not making the ambis wait out of spite or laziness. There are no beds and no nurses to care for these people. EMSs problem is solved but no we have crumpy patients left in hallways. They aren't getting any care once EMS dumps them because there is no one to deliver that care. And I'm not talking about the minor stuff because that comes off the gurney and goes to triage and then the waiting room. I'm talking about the sick stuff.

 

[a_ditchdoc]

But if the house is full the house is full. We're not making the ambis wait out of spite or laziness. There are no beds and no nurses to care for these people. EMSs problem is solved but no we have crumpy patients left in hallways. They aren't getting any care once EMS dumps them because there is no one to deliver that care. And I'm not talking about the minor stuff because that comes off the gurney and goes to triage and then the waiting room. I'm talking about the sick stuff.

I understand this. And I would hope that anyone with a good conscience would not dump a crappy patient in order to finish his meal. Also, most paramedics I know would prefer to stay with a sick patient than to respond to a toothache or fever across town. Staying with a patient is often less work for us than responding to new calls. The problem arises when EMS is backed up and ambulances are need to respond to true emergencies. I didn't mean to sound flippant in my previous post, but I have seen times when serious accidents, arrests, or shootings have been paged out and the nursing staff saw no urgency in helping us clear our unit.

As an aside, I often stayed to assist the ED staff when they were packed, and have even been called specifically to assist them (community ED). I didn't mind when calls were not pending. ED overcrowding is a huge problem with few solutions on the horizon...

 

[tonem]

I'm with DocB on this one...your responsibility is to the patient in front of you, not the potential shooting victim...besides if the ED is backed up so badly where are you gonna leave the GSW when you get them to the hospital...in the chair next to the GI bleed you dumped 30 minutes earlier? Youre responsibility doesnt end when you get to the ED it ends when you transfer care...dumping someone in a hall is not transferring care

 

[basementbeastie]

we have had ambis dump SOBs and CPs into chairs in the hallways without O2 or monitors.

...that sounds like now-legalized abandonment....

having been on both sides....i have been frustrated to no end waiting to transfer a pt to the ED....

 

[docB]

I want to point out again that this is not a problem with the medics. They are being forced to do this by their companies. If they call in as at the hospital at 1400 their dispatch will call them at 1430 and ask why they're still there. These are not little local companies. These are national ambi companies.

 

[basementbeastie]

I want to point out again that this is not a problem with the medics. They are being forced to do this by their companies. If they call in as at the hospital at 1400 their dispatch will call them at 1430 and ask why they're still there. These are not little local companies. These are national ambi companies.

....let me rephrase that to: legalized, institutional abandonment....

 

[Jeff698]

Well, isn't this just typical. We are arguing amongst ourselves over scraps thrown from the table.

This law did a great job of getting two normal allies to fight each other when they should be working together to realize both the troubles of ambulances backed up outside and the EDs backed up inside are not the problem. Rather, they're both symptoms of the same problem further upstream.

Our health care system has systematically decided to decrease the in-hospital resources needed to treat the number of patients that need to be treated. We've cut staff and funding for critical care beds as well as floor beds. Labs are so understaffed it takes one to three hours to run a friggin' UA. Ancillary staffs have been decimated across the country. The people closest and most involved with patients have been cut to allow for more (and much higher paid) people MUCH further from patient care.

Lucky us. The evil that we know (trial lawyer scumbags) have been joined that the evil that we didn't expect (value-sucking MBAs).

Take care,
Jeff

 

[Jambi]

These are national ambi companies.

Leave it to AMR...