There is a bit of an issue going on here with frequent ambulance “Code Reds” (no ambulance available) and I am curious about one aspect. Is it standard practice in other jurisdictions that paramedics regularly have to stay with their patients in Emergency for extended periods rather than promptly get back to their ambulances?What is the practice in your jurisdiction (take your pick of jurisdictions) for how paramedics hand over seriously ill patients to Emergency departments?
I could ask my sister in law for more details if you’re interested, but AFAIK in Spain they try to get someone to come with the patient; they’ll fill in as much paperwork as possible in the ambulance itself and hand everything (paperwork, patient and companion) to ER personnel. Ideally, the companion will be someone who knows the patient and the patient’s medical history. Hospitals are supposed to be able to access any patient’s medical history, but there are interface issues between different IT systems, plus some doctors have the extremely impolite custom of not entering their handwritten notes into the system, so it’s still best to have someone who can give a rundown of relevant history and current issues. The companion also contacts the rest of the family (if they didn’t tell someone else to do it before leaving with the ambulance), keeps the patient company, helps them stay calm…
Worst case scenario would be a patient who’s unable to respond or whose answers cannot be trusted (unconscious, agitated, deliriums), for whom no ID is available (thus their history can’t be located) and for whom no companion could be located (or, if one is available, it was just someone at the site who volunteered to come and stay with the patient, but who doesn’t really know them).
Ambulance personnel are supposed to complete the handover as fast as possible; if there are no other calls and they’re based at the hospital, they’ll go to the personnel room. If there’s a call or they’re assigned to be elsewhere, they’ll leave once the handover is finished. They will not be asked or expected to stay with the patient.
I used to rent a room in an old lady’s house when I lived in Miami, and we once had to call 911 for her. We got an ambulance from the FD; her daughter stayed behind to look for insurance papers and came in a taxi (she was still too nervous to drive), but the firemen allowed me to come in the ambulance and got me permission to stay with her despite not being family - as one of them put it when the nurse tried to keep me out “she’s the person in charge, she gets in!” She was incoherent, but I knew her medical history, what meds she was taking, etc., so my presence speeded up some things which would otherwise have been delayed until the daughter got there. I don’t see what good it would have done to have one of the firemen with her.
I assume you’re talking about “boarding” where ambulance crews stay with the patient and the patient stays on the ambulance stretcher until the ED is ready to see them. It’s not been a problem where I work, especially with critical patients. We notify the hospital we’re transporting to before we arrive, so they have a chance to direct us elsewhere if there’s no room at the inn. Also, we have a metro-wide system for tracking hospitals. If a particular hospital is overloaded in the ED they can go on divert and not accept most ambulances (there are situations where they can’t turn us away). Our dispatch keeps us notified of hospital diverts.
Once we arrive at the hospital, we’re not expected to stay with the patient indefinitely. We’d consider any more than a few minute wait for the ED staff to get to our patient eccessive.
There may be some legal differences that account for this. My understanding is that the patient is considered to have presented to the hospital as soon as they arrive on the grounds of the hospital. This makes that patient’s care the responsibility of the hospital at that time.
St. Urho
Paramedic
The hospital I worked at had a break room specifically for ambulance attendants, and also storage space for the local ambulance companies. If they used up any meds or other material during the run to the hospital, they could restock without having to return to their home base.
Doesn’t really answer the question directly, but it does indicate that the attendants did not normally just hand over patients to the ER staff and get right back into the road.
In many jurisdictions in the U.S. it is a firefighter that is trained as a paramedic who stays with the victim throughout the emergency. I believe part of the reason for this is to keep the ambulances in service as much as possible. Another reason, I believe, is that the fire department is usually the first responders and they want one person who is in charge of care from start to finish.
Typical turn around times were about 15 min or so, we would check them in, give a report to triage nurse, and help get the patient moved over to the hospitals gurney/bed. Finish out our paperwork, change sheets on our gurney, get everything strapped down and buttoned up for next call then report to dispatch that we are “back in service” and our location.
Most hospitals also have an “express lane” for ambulance crews to check in that is not part of the normal waiting area so the public does not see the 30 patients that came in via ambulance while they are waiting and wondering what is taking so long.
Some hospitals do this and they provide a billing card to the crew so that when a patient checks in they pull stickers off the product they take (say an IV tubing set) apply stickers to the card, and place the card with the patients chart. The hospital staff does the same thing with their materials on the same card. The materials then get billed to the patient by the hospital and the ambulance company is reimbursed in the form of replacing their used materials. We only had one here locally that did that. The boss liked it because we didnt get stiffed on materials if the patient turned out to be a non payer and the hospital has much better resources to handle collections issues than the ambulance company.
When I ran as a tech we stayed only as long as it took to flag down a nurse or someone qualified to sign the paperwork that they were ‘taking charge’ of the patient. Sometimes if it was really busy or if the patient was really bad off it could take a few minutes. We also ran with three ambulances so if one was dropping off the other two would (hopefully) be able to respond.
If anything, in my experience, the fire guys are the first ones to bolt. If you have a fire medic onboard to assist with a patient, you get to the hospital, the fire engine s/he is assigned to is waiting for them outside. Most of the time, ambulance crew takes over care and fire leaves unless you have a labor intensive patient (codes, carrying 400 pounds down 3 flights of stairs, etc)
The fire guys may be able to provide patient care, but the ambulance crews dont fight fires, you get the fire guys clear ASAP.
Company I worked for had 9, and we were the “little guy” the other place had like 30.
To directly answer the OP in our areas this was called “Level zero”. When things got busy, the EMS dispatchers would start adding comments to the effect of
“A138 , arrive hospital 14:26, level 2”
“Level 2” means two ambulances available for the whole city and is a not so subtle hint to not putter and flirt with the nurses and get the hell back on the street. They usually didnt bother saying anything unless it was down to like 3 available.
Thanks guys.
Cop not a paramedic but I certainly have been on a lot of medical calls. I work in a very suburban area with several hospitals at the nearby urban area. As others stated turn around time is just long enough to drop off and restock. Although there is coordination and mutual aid from surrounding towns sometimes they are informed they need to have a quick turn around because of a large volume of calls. We have a paid service during the day on weekdays, volunteers at night and weekends.
ETA that is the ambulance service BLS is volunteer. ALS paramedics are paid and regional.
“keep the ambulances in service as much as possible” Huh? Seems opposite.
To look at it cynically (and perhaps more clearly) FD, unlike other EMSs, have kick-ass unions.
“In charge of care” goes to ER prontissimo, I would think.
P.S. Notwithstanding above, mad props to FDNY EMT for rescuing me that one time.
They had a big problem, with this very thing, where I live. They had a duty nurse, specifically to handle incoming ambulance emerg, but if anyone called in sick, in the large hospital, they would take them. Mean time, emerg is backing up, ambulances are backing up. Big to do, as the Provincial government had provided special funding for the triage nurse, (to avoid such back ups!), who was being used as back up, for the regular nursing staff, instead.
Correct, fire goes back in service first. Although there are exeptions, the fire guys fight fires, pry apart cars, remove cats from trees 
and get laid way more than they deserve. They do medical stuff as a sideline. Ambulance crews are first and foremost patient care providers, its all they do.
12 Years as a Battalion Chief in a rural FD. EMTs get hands on patient and cant turn over till someone of equal or higher training takes responsibility. Causes huge issues with resourcing larger/longer incidents as you are having highly trained and motivated people sucked out of your available personal. I always pushed my EMT only to patients first when I had a chance to save fire/EMTs for everything else thats going on.
I clearly recall the night we were running multiple calls and had no medical or transport for the motorcycle vs deer because the high school party with the funnels and whiskey had EMT hands on first. Unfortunately its luck of the draw.
Better coverage = Greater Staffing = Higher Taxes. Its not a union issue its a cost benefit analysis on how often you will be ‘short’ generally done by a non-first responder…
Quite a sad condition when staff has to anonymously resort to the news media as it infers internal quality controls don’t work. The Minister certainly sounds sympathetic but the problems indicate otherwise.
I wouldn’t car to have to spend any more time in the ED than necessary to complete reports and prepare the rig for the next run, especially knowing there are pt. waiting for help!
As for being an outlying unit, we get called in for what we call mutual aid occasionally and are happy to be of help.
Sound like a case of daily life that for most of us would be a rare event. I can see where moral would be low.
Very sorry to hear of this. 
What does this mean?
If you have a guy who is only an EMT and a guy who’s a firefighter and EMT, you’re going to instruct the EMT to take responsibility for the (first) patient, and reserve your firefighter/EMT for fighting a fire or for caring for later victims when things really go pear shaped. You have to tie up one guy, so you choose the one with fewer skills.
Quibble, there are plenty of piddly EMT’s floating around with all manner of specialized skills and experience that make the average firefighter look like he got the job because he likes polishing chrome. Fire is a different skill set, not always a “superior” one. Here locally 80% of the firefighters are EMT-1’s where as at last check around 70% of the ambulance crews were EMT-P (Paramedic)
Its about suitability to the task, and applicability of skillset, the average ambulance crew is better equipped and has more experience with patient care than fire. Obviously exceptions exist where fire and ambulance services are one agency.