We had two auto accident victims last night where one had a broken leg, and the other had no obvious injuries except for dimished LOC and abdominal pain. The Life Line out of Indianapolis (about 30 miles away) was delayed for 45 minutes due to an accident further out. In addition, the Paramedics from a local town were delayed for forty five minutes due to the same accident. Our Dept. has 17 EMT’s (Basic level, Indiana does not recognize Intermediates only Paramedics after “B”) with the rest being First Responders, and the latest Fire/Rescue equipment (we just spent nearly $200,000. on our latest rescue vehicle). However, we do not transport under ANY circumstances. According to our Fire chief to transport we would have to be “certified” at a higher level which would entail having Medics on staff among other things.
Okay, I understand why the Paramedic services from the nearby town are preferred in most situations (although their response time is delayed by five to seven minutes beyond ours in most situations). However, why can’t we transport when it’s going to take them almost an hour to be on scene? What if that guy had been bleeding internally or experiencing a buildup in intracranial pressure?
Here’s what really rubs me. If I was driving alone along the road and came across an accident victim I very will might take him to the hospital (if he/she could be safely moved). However, in my capacity as an EMT/ volunteer fire fighter I have to just sit there and watch them suffer and possibly die (offering only those limited interventions we are authorized to give).
What are the operative laws that dictate this situation (we are in Indiana). Do these laws not recognize exceptions such as the situation we had last night (where medic transport is substancially delayed). If they don’t why the heck don’t they?
It is the inherent insanity of the legal profession to draft laws that must be followed to the letter without allowing for any extenuating circumstances.
Youd don’t think that all the laws passed by congress are written by the senators or representatives, do you?
Congressmen ‘know’ littld about the laws they vote for or against with the exception of their pet portion.
your best bet is to try to find someone locally to answer the question, as laws vary widely from state to state…
In New Mexico the volunteer fire department I worked for would only transport patients if no other transport was available, and it was critical for the patient to go to the hospital right now. This was a standing protocol from when I began as a basic and left as a paramedic. This decision was made by our medical director.
The state EMS Bureau also had a set of requirements for an agency to be a “Transport agency” but it was recognized that in some situations services who cannot meet the requirements may still have to transport someone.
<hijack> I find even more curious that there was no posibility of flight EMS responding?
Being ignorant of the laws in your state, I’ll venture that it may have to do with how your volunteer organization is chartered. Good samaritan protection typically only applies if you are taking action appropriate to the level of your training.
From a practical standpoint, how are you going to safely package the patient for transport? You have no litter, so the best you can do is long board and maybe a CID if you carry that, but then what? If, in the process of hypothetical transport, the patient’s injuries are somehow worsened, your ass meets Mr. Sling.
In reality, it has been done. Many years ago I responded to a car vs. motorcycle accident. The one footpeg had been driven through one of the patient’s ankles. Removal of the ankle from the peg was not an option, and I was concerned about volume loss while the bike was disassembled to permit EMS transport. So, we bandaged the ankle, tied the patient’s leg to the framework of the cycle to immobilize it, and then loaded the cycle and rider into the back of the rescue truck for a 2 mile run to the ER. IV’s were started in the parking lot outside the ER doors, and the ER doc and an Ortho doc decided how to best remove the fellow’s ankle from the bike.
The rescue vehical has been used in our area to trasport patients out of the remote areas, to the ambulance. Not being licensed to transport is the reason a rescue vehical can’t transport.
maybe a better mutual aid program needs to be establizhed.
When the shit hits the fan(disaster), paitents are transported by any means avalible. What criteria need to be met for a disaster?
Well the situation last night was unusual in that the Lifeline devoted to this area was in route to another situation (where the medics already were). That situation was more critical. However, our patient had stable V/S, but the diminished LOC with abdominal pain was still troubling. I think there should be something like a “15 minute rule”. If a patient meets criteria for even a “possible” critical situation and transport is more than fifteen minutes (or maybe the right number is 10, five, or twenty minutes) then we should be able to transport. If the situation is obviously critical (MI in progress) then we should be able to transport with an even shorter gap in arrival on the scene. Then again no one asked me.
Well, most EMS systems are at least open to the though of change. If what you say is true, it’s time to approach those people who make decisions and get something done.
Also, protocols are a guide on how to get stuff done, not the end all be all of medicine. On occasion you have to step outside your protocols (maybe a different medicine, or a different use for a medicine we do have) to do what is best for the patient. Here we are supposed to call the MD at the hospital we are going to when we do it to obtain permission to do so. Also, the Good Samaritan law does not cover us while on duty, but we are still covered by other laws and statutes as long as we are not dumb.
Just remember, as long as you do what you think is best for the patient, and what another EMT-Basic would reasonably do in your situation, legally you cannot be touched.