Reply
 
Thread Tools Display Modes
  #1  
Old 08-12-2018, 01:59 PM
rainy rainy is offline
Guest
 
Join Date: Dec 2002
Location: GA
Posts: 1,136
Paramedic choosing destination ER

A family member had an accident and I had to call 911 for ambulance transport recently. They were taken to the nearest ER, but then that hospital decided they needed to send her on to another hospital with a trauma center...she had two fractured bones. The same ambulance crew did the transfer. The paramedic said had he known about the second fracture he would have taken her to the trauma center to begin with.
I was wondering if paramedics actually have that sort of authority? The trauma center is an additional 45 minute drive beyond the nearest ER. If it matters this is in Georgia, and neither trip was a lights and siren affair.

-rainy
  #2  
Old 08-12-2018, 02:17 PM
Nava Nava is offline
Guest
 
Join Date: Nov 2004
Location: Hey! I'm located! WOOOOW!
Posts: 39,753
The answer of exactly what can and must the paramedics do will vary by location, of course (like any legal question), but in general they're expected to take the patient to the nearest center that can take their case, to the best of their knowledge.

If the nearest medical center doesn't have a NICU and the patient is a preemie delivery, taking her to a more-distant place with a NICU is what makes medical sense.

Last edited by Nava; 08-12-2018 at 02:20 PM.
  #3  
Old 08-12-2018, 02:44 PM
rat avatar's Avatar
rat avatar rat avatar is online now
Member
 
Join Date: Dec 2009
Location: Seattle, Wa
Posts: 4,816
When I was in a car fire, where I had burns across 33% of my body and 3rd degree burns across most of my hands and arms I had to actually reach into my pocket with 3rd degree burns to use pay phone to call my girlfriend and get her to pick me up and go to a better ER.

Often outside of a need to go to an actual trauma center they will go to the ER that they are contracted with or that will fit income levels or company policy.

Note that this was in Benicia, California at they wanted to take me to Vallejo, where I knew through my girlfriend, who was an E-room nurse in Oakland that my wait time would have been for hours.

She drove me to Walnut Creek and my follow care doctor agreed that I would have probably lost usability of my hand had I gone to Vallejo due to the long wait time. The Paramedics had hinted that if I could find someone to drive me that it would be better but had no choice. Apparently had my face been burned they could have changed but exposed finger bones with embedded plastic weren't enough for them to make that call. They were apologetic but were obviously fearful of their jobs in making a change in drop off or to let me use their phone to call my girlfriend.

This was 15 years ago and things may have changed, but in my experience the EMTs and paramedics are not given that power at least in California.

Last edited by rat avatar; 08-12-2018 at 02:45 PM.
  #4  
Old 08-12-2018, 03:08 PM
septimus's Avatar
septimus septimus is online now
Guest
 
Join Date: Dec 2009
Location: The Land of Smiles
Posts: 17,600
From this (documentary?) on para-medics in New York City:
Quote:
Frank: "Major Tom, I'm going to Mercy Misery; you take yours to Bellvue."
Tom: "Ok, Frank. You take yours to Heaven; I'll take mine to Hell."
  #5  
Old 08-12-2018, 03:11 PM
RivkahChaya's Avatar
RivkahChaya RivkahChaya is offline
Guest
 
Join Date: Feb 2012
Posts: 9,924
When my son had croup and was having difficulty breathing, and we called 911, they got his airway opened with steroids, and then put him on oxygen so his pulse-oxygen, which had been down to something like 79%, was up to 98%. That took about 15 minutes in the ambulance in front of our building, before we left to be transported anywhere (which goes to show why there's an advantage to calling an ambulance, and not driving there yourself).

When they were ready to leave, there was a choice between two pediatric hospitals, one was a big pediatric hospital downtown that treated children with all sorts of long-term problems, as well as acute illnesses. The other was a pediatric wing in a regular hospital, and not where you'd want to go for your leukemia, but just as adequate for treating something acute, or casting a broken bone, or something like that.

The driver asked us where we wanted to go. DH and I looked at each other. We didn't really have any idea, although one did seem closer than the other. The EMT asked us what kind of insurance we had, and it turned out that both hospitals took our insurance, so it didn't matter for that either. So we just chose the closer one-- didn't have to go through downtown, either. I was riding in the ambulance, and DH was following in the car. Turned out to be really good we had the car-- they kept the boychik overnight, and DH decided to stay wit him, so I went home to get him some stuff, and let the dog out; discovered we'd left dinner on the stove still on low. Didn't burn, even, but would have if I'd stayed until morning. Probably would have set the fire alarm off, and maintenance would have entered the apartment, and we could have gotten into some trouble.

Anyway, the ambulance here I think is a city utility. There was no charge for it on our bill, which had plenty of charges on it. We were told that you can get into trouble for calling "frivolously," but if you have a real emergency, you are good.

So, if the ambulance is maintained by the city, then they aren't bound to take you to any hospital, which is good. There are a lot of people's insurance that limits them to just one hospital system, and there are, IIRC, 5 in Indy. That's not 5 hospitals-- 5 systems. Each system has different buildings around the city. The trauma center for one system might be north, and for another might be west. The pediatric center for one is downtown, and for another is north-central. There's a psychiatric center downtown, and a pretty well-known maternity center downtown. Yet another hospital has a NICU (a famous one), but not a general pediatric center. And they're all spread out. I don't know how the ambulance drivers can keep them all straight.
  #6  
Old 08-12-2018, 04:37 PM
Chronos's Avatar
Chronos Chronos is offline
Charter Member
Moderator
 
Join Date: Jan 2000
Location: The Land of Cleves
Posts: 79,525
There was a case a year or two back with a cop being abusive to hospital staff for following the hospital's privacy policy. The cop was also on an ambulance crew, and threatened that he'd take only indigent patients to that hospital in the future, as retaliation.
  #7  
Old 08-12-2018, 05:48 PM
Tim@T-Bonham.net Tim@T-Bonham.net is offline
Charter Member
 
Join Date: Mar 2003
Location: Minneapolis, MN
Posts: 14,463
Quote:
Originally Posted by Chronos View Post
There was a case a year or two back with a cop being abusive to hospital staff for following the hospital's privacy policy. The cop was also on an ambulance crew, and threatened that he'd take only indigent patients to that hospital in the future, as retaliation.
Didn't matter, since that cop was soon fired over this. And he wasn't part of the ambulance crew, just a cop who came by later, and wanted a blood alcohol test on a patient (without a warrant).
  #8  
Old 08-12-2018, 06:17 PM
bob++ bob++ is offline
Guest
 
Join Date: Jan 2013
Location: Worcestershire UK
Posts: 6,195
In the UK the ambulance is operated by a regional Ambulance Authority. If you dial 999 their control will asses the level of the emergency (First question always seems to be "Is the patient breathing?" and allocate a suitable crew; not all crews are paramedics and some crews are specialist paramedics, sometimes with a doctor on board.

After stabilising the patient they will decide which hospital to go to: This will depend on several factors like the treatment required, the distance and how busy the A&E is at each potential location.

The downside of all this being 'free' is that they get a high level of frivolous calls and a lot of calls from people with chronic ailments that should have gone to their GPs.
  #9  
Old 08-12-2018, 06:20 PM
Jeff Lichtman's Avatar
Jeff Lichtman Jeff Lichtman is offline
Head Cheese
Charter Member
 
Join Date: Feb 2000
Location: El Cerrito, CA
Posts: 4,179
Paramedics take into consideration the proximity of the hospital, the patient load at different ERs, and the complaint of the patient. In my area there used to be an ER/hospital that specialized in strokes and heart attacks, so patients with these problems would be taken there even if another ER was closer. The best local trauma center is about a 40 minute drive from where I live, and sometimes they take patients there by helicopter.

Paramedics can call ahead to determine the best place to take a patient. The medical staff at an ER can tell the paramedics whether they have too many patients already, or they think the patient would get better treatment at a different ER.
__________________
'Tis a pity that I have no gravy to put upon Uncle Hymie.
  #10  
Old 08-12-2018, 06:45 PM
kanicbird kanicbird is offline
Guest
 
Join Date: May 1999
Posts: 18,943
In our fire department we are relatively close to a hospital (15 minutes), but depending on the extent of injury they may be sent to one about a hour away with a class 1 trauma center. Also to note that further one is about 20 minutes by air which is sometimes used.

the call is usually done by the EMT's though sometimes we make that call, we do the best we can given our level of training. And that level of training for firefighters is unfortunately limited so the safe call is to send them to the further location, by air.
$$$$$$$$$$$$$$$
  #11  
Old 08-12-2018, 07:54 PM
digs's Avatar
digs digs is offline
Guest
 
Join Date: Mar 2002
Location: West of Wauwatosa
Posts: 8,661
My kid got hit by a car, and the ambulance took him to the ER that his mom works in. She was doubly horrified to see his broken body being rolled in... since it's the only hospital in town our insurance wouldn't cover.

We had a six-month battle trying to get his care paid for (finally got it).
  #12  
Old 08-12-2018, 08:05 PM
running coach's Avatar
running coach running coach is offline
Arms of Steel, Leg of Jello
Charter Member
 
Join Date: Nov 2000
Location: Riding my handcycle
Posts: 35,471
Quote:
Originally Posted by digs View Post
My kid got hit by a car, and the ambulance took him to the ER that his mom works in. She was doubly horrified to see his broken body being rolled in... since it's the only hospital in town our insurance wouldn't cover.

We had a six-month battle trying to get his care paid for (finally got it).
Is ER care no longer universal in policies?
  #13  
Old 08-12-2018, 09:51 PM
Chronos's Avatar
Chronos Chronos is offline
Charter Member
Moderator
 
Join Date: Jan 2000
Location: The Land of Cleves
Posts: 79,525
...And the doctor said, "I can't operate on this patient, he's my son!".
  #14  
Old 08-12-2018, 09:53 PM
Projammer's Avatar
Projammer Projammer is offline
Member
 
Join Date: Apr 2006
Location: SW Arkansas
Posts: 6,489
Quote:
Originally Posted by Tim@T-Bonham.net View Post
Didn't matter, since that cop was soon fired over this. And he wasn't part of the ambulance crew, just a cop who came by later, and wanted a blood alcohol test on a patient (without a warrant).
The defective in question was also a part time paramedic and was fired from that position due to the comment about only transporting transients to that hospital.
__________________
Lurking in the corridors of my mind.
  #15  
Old 08-12-2018, 09:56 PM
D'Anconia D'Anconia is offline
Guest
 
Join Date: Oct 2014
Posts: 4,079
Quote:
Originally Posted by rat avatar View Post
When I was in a car fire, where I had burns across 33% of my body and 3rd degree burns across most of my hands and arms I had to actually reach into my pocket with 3rd degree burns to use pay phone to call my girlfriend and get her to pick me up and go to a better ER.

Often outside of a need to go to an actual trauma center they will go to the ER that they are contracted with or that will fit income levels or company policy.
Your local fire department has a contract with specific hospitals?
  #16  
Old 08-12-2018, 10:22 PM
rbroome rbroome is offline
Member
 
Join Date: Jun 2003
Location: Louisiana
Posts: 3,152
In my home town there are 2 local hospitals within 10 minutes of each other. The hospitals have set up agreements where different specialties are located at each hospital. One has the NICU, the other the Cardiac care. etc. Both hospitals still have cardiac docs and oncologists, etc. but each specialty works at whichever hospital has that service. Saves money. The ambulance drivers know which hospital to take which patient. It can get sufficiently complicated that the hospitals are asking that people don't drive to the nearest ER-call the ambulance instead. That way people will get to the right hospital without a transfer. Obviously the hospitals aren't worried about the cost-that is the patient's problem.
  #17  
Old 08-12-2018, 11:21 PM
kaylasdad99 kaylasdad99 is offline
Charter Member
 
Join Date: Sep 1999
Location: Anaheim, CA
Posts: 30,155
Beginning of June, I got a text at work from kayla. Her mother's blood sugar was low. It did not respond to feeding her apple juice (actually, it came up momentarily, then crashed again). After the third blood sugar reading within 30 minutes made it clear that she needed medical attention, I told kayla to call 911. Then I started making preparations to come home.

The fire department sent their paramedics (we pay a monthly fee to ensure that first-responder calls don't result in a charge from the city), but they deferred to the private ambulance service that arrived on scene to handle the transport. I asked kayla to request that kaylasmom be taken to her preferred ER (her PCP is in an office building on the same campus as the hospital, and she generally just prefers that hospital and ER, as do I). kayla indicated that they may comply with the request, but when I arrived at the preferred ER, I got a call saying that the ambulance crew would be taking her to the closer ER.

I still got there in time to meet the ambulance.

For-profit healthcare (and attendant services) is the shit.*



*"The shit" is meant to be interpreted as "a terrible way to run a system." if I meant "This is AWESOME," I would have written "the shizz."
  #18  
Old 08-13-2018, 12:45 AM
Nava Nava is offline
Guest
 
Join Date: Nov 2004
Location: Hey! I'm located! WOOOOW!
Posts: 39,753
Quote:
Originally Posted by bob++ View Post
In the UK the ambulance is operated by a regional Ambulance Authority.

(...)

The downside of all this being 'free' is that they get a high level of frivolous calls and a lot of calls from people with chronic ailments that should have gone to their GPs.
Spain's got those same regional services folded into the general emergency number (112); if it's medical and sounds like it may be a matter of moving the patient and not the medics they transfer it to Nurse By Phone. NBP can send an ambulance/doctor/nurse or tell the caller to go to the day center/hospital as appropriate.

I know that a region which had what they considered a lot of frivolous calls and visits started handing out "invoices" detailing approximate costs; people would say "whaat? but you know what can I do with this much money?" "exactly! that's the point! we can do a lot of things with that much money too!"
__________________
Evidence gathered through the use of science is easily dismissed through the use of idiocy. - Czarcasm.
  #19  
Old 08-13-2018, 11:47 AM
Tom Tildrum Tom Tildrum is offline
Charter Member
 
Join Date: Apr 2002
Location: Falls Church, Va.
Posts: 13,944
ObSimpsons:

Quote:
Marge is loaded aboard an ambulance. The sign on the front reads, "DOWNTOWN GENERAL"

Homer: {to ambulance driver} I want my wife to get the best treatment money can buy!
{driver changes sign to, "BETH ISRAEL"}
Whoa, whoa, whoa! Don't go nuts.
{driver changes sign to, "ST. MARY'S"}
Eh, better than that.
{driver changes sign to, "SPRINGFIELD PRESBYTERIAN"}
Perfect.
{the ambulance speeds off}
  #20  
Old 08-13-2018, 01:02 PM
rat avatar's Avatar
rat avatar rat avatar is online now
Member
 
Join Date: Dec 2009
Location: Seattle, Wa
Posts: 4,816
Quote:
Originally Posted by D'Anconia View Post
Your local fire department has a contract with specific hospitals?
I moved back up North, but it appears that they did rectify this issue in 2010 in that county.

https://www.solanocounty.com/civicax...x?BlobID=26280
  #21  
Old 08-14-2018, 01:11 PM
Spiderman's Avatar
Spiderman Spiderman is offline
Guest
 
Join Date: Oct 2000
Location: somewhere East of there
Posts: 9,741
Jeff Lichtman got it right. EMS should transport to the closest appropriate facility. Bypassing a local hospital for a trauma center or stroke center is acceptable. A local ER crying "uncle" & asking EMS to divert elsewhere for a period of time is acceptable. Going where the patient wants to go, if it's appreciably further is getting into a gray area. If anything happens to that patient enroute to the further ER, including a vehicle accident/incident, EMS personnel will need to be able to justify why they were going to the further location when things went south, otherwise they are in breach of their duty.


Quote:
Originally Posted by Chronos View Post
There was a case a year or two back with a cop being abusive to hospital staff for following the hospital's privacy policy. The cop was also on an ambulance crew, and threatened that he'd take only indigent patients to that hospital in the future, as retaliation.
Jeff Payne.

Quote:
Originally Posted by running coach View Post
Is ER care no longer universal in policies?
Probably a case of in-network vs. out-of-network & what percentage of the bill they'll pay, & what type of discount off of 'rack rate' that they've already negotiated.
  #22  
Old 08-14-2018, 03:30 PM
outlierrn outlierrn is online now
Guest
 
Join Date: Nov 2005
Location: republic of california
Posts: 5,519
In my county EMS protocols include diverting from the nearest receiving to the appropriate STEMI or trauma center.
__________________
Just another outlying data point on the bell curve of life
  #23  
Old 08-14-2018, 08:58 PM
ZipperJJ's Avatar
ZipperJJ ZipperJJ is offline
Just Lovely and Delicious
Charter Member
 
Join Date: Aug 2001
Location: Northeast Ohio
Posts: 24,800
I was at a local ER this weekend and the nurse attending to my family member was complaining that squads bring too many patients to their ER "They will pass up several ERs to get here." Her ER has a trauma center and is attached to a hospital with a cardiac unit, so they are well-equipped. They have 22 rooms in the ER! But she said there are a lot of patients that come in that don't need the extensive care of their hospital, and could have been taken somewhere else.

Why this happens (from an EMT's perspective), I don't know. Maybe they are hedging their bets and taking everyone directly to the top-of-the-line ER?

FWIW my family member is a heart patient so the EMTs told us they were taking him to this further ER as opposed to the one much closer. They said they always take cardiac patients to that one.
  #24  
Old 08-16-2018, 01:07 AM
gotpasswords gotpasswords is offline
Charter Member
 
Join Date: Mar 1999
Location: San Francisco area
Posts: 16,234
Quote:
Originally Posted by rat avatar
Note that this was in Benicia, California at they wanted to take me to Vallejo, where I knew through my girlfriend, who was an E-room nurse in Oakland that my wait time would have been for hours.

She drove me to Walnut Creek and my follow care doctor agreed that I would have probably lost usability of my hand had I gone to Vallejo due to the long wait time. The Paramedics had hinted that if I could find someone to drive me that it would be better but had no choice.
Guessing they were going to take you to Sutter? In your situation, Iíd much rather be at John Muir as itís a trauma center. Not that Sutter is a bad hospital, but John Muir is IMHO a better hospital.

Takeaway lesson for everyone - learn and file away in the back of your head which hospital(s) near you is a trauma center, which one is the best for whatever specialty - cardiac care, pediatrics, etc. thatís important to you.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 02:20 AM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2018, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright © 2018 STM Reader, LLC.

 
Copyright © 2017