Paramedic choosing destination ER

Factual Questions
1

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

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.

3

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.

4

From this (documentary?) on para-medics in New York City:

5

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

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

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

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

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.

10

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

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

Is ER care no longer universal in policies?

13

…And the doctor said, “I can’t operate on this patient, he’s my son!”.

14

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.

15

Your local fire department has a contract with specific hospitals? :confused:

16

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

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

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!”

19

ObSimpsons:

20

I moved back up North, but it appears that they did rectify this issue in 2010 in that county.

https://www.solanocounty.com/civicax/filebank/blobdload.aspx?BlobID=26280