Ambulance Passing Accidents

[irishfire2491 24]

As everyone know there are a lot of different EMS agencys out there paid/Volly/Privite

My question is When you have a Pt in the back of your ambulance and you are transporting to the hospital and you come arcoss an accident. What can you do?? WHAT Should you do??? and a lot of ems agenicies have fly cars that follow the ambulance to the hospital should they stop and give treatment as the ambulance is still transporting Becuase your goal is to get the PT to the hospital!!!

If you are transporting across State lines with a pt and on your return back to NEW YORK and you come across accident what can you do as a NYS EMT in a Different State as for treatment wise???

Just a couple of things that i have always been thinking about at work??

Thanks

[Guest]

As far as operating with an out-of-state EMT in New Jersey, State Statute reads:

8:40A-7.3 Reciprocity

(a) A person validly certified as an EMT-Basic by the NREMT, the State of New York or any member state of the Atlantic EMS Council (currently Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia) shall have status as an EMT-Basic. No further testing shall be required, and the EMT-Basic certification card issued by the out-of-State certifying agency shall be valid for the purpose of proof of EMT-Basic certification. This section shall not be construed to permit a person to practice beyond his or her certifying state's scope of practice.

In my opinion, If you advertise a service, you have to offer that service. Even if you can 't transport, at least stop and ensure it has been called in. Every situation is different and it can be what if'd to death. All you can do is the best you can under the circumstances presented....

[nycemt728 49]

If the pt is stable, you are permitted to stop and stabilize the pt at the scene of the accident. With regards to coming back, I know that the tri-state area has agreements that allow EMTs from the bordering states to operate in their states w/o applying for receprocity for the purposes of interstate transports. I believe this extends to flagdowns. At the very least, stabilizing/prepping for tx should not mix too many standards of care. As far as I can tell, most states say an ambulance is an ambulace, and so long as it is staffed and equipped, they should assist as possible. With regards to tx to an ED, I would suggest leaving that to the locals so you can get back to your job and they can get to the closest facility. (I know that when I go interstate tx, I don't know the facilities or streets around my route or destination.)

[Goose 188]

This issue was addressed directly to me at one of my places of work. We have a number of outlying stations that are near or on state borders. Just to reiterate what many have said above, if your responding in m/a or transporting to facility out of state you have reciprocity waived while not actively practicing in that state. Just practice as you would if you were in NY. This probably covers flagging as well, as long as your not grossly negligent, i cant see you taking any heat for it. Just make sure your in constant communication with your dispatch center and that state's.

[firemoose827 324]

No one realy addressed the problem of coming across an emergency while transporting a pt. Once you establish pt contact you cannot break that contact unless someone of equal or higher training takes over pt care. If you dont its called abandonment. I know you would want to help the other person as well, but the pt in front of you is your current priority.

Make sure its called in, if you have extra EMT's or medics drop them off with some gear and continue on the the ER with your pt. Thats happened to me once or twice where I was transporting a pt to the ED and we stumbled across another emergency. One was a drunk who fell went boom, we happened to have a police officer near by who responded and waited for the second rig to arrive. The next was an MVA. We had an extra EMT on board whom we left at the scene to assess and render treatment untill the second rig arrived.

Just remember your laws, everyone learns them in basic (as dull and boring as it is). Abandonment is a serious issue, so if you have old miss Smith with the sniffles and you come across an MVA with entrapment, blood guts the whole nine yards, remember not to abandon miss Smith. Its hard but its our job.

I have never experienced the Inter-State transports, nor have I ever been a National Registry EMT, so I cant help you there.

Hope this helps brother, stay safe.

[nycemt728 49]

Obviously, the person doing the stabilization and assisting w/ the flag would be the driver, not the tech already involved w/ pt care. When doing this, you must obviously consider whether your driver is qualified (ie a EMT not just a CFR or driver) and if this can be done safely w/o jeopardizing pt number one. It's not abandonment if the EMT never leaves the pt.

[ckroll 101]

Stop to make sure there are no life threats,

Drop off manpower and equipment if appropriate and

Get rolling to the hospital with patient number one...

Stop, Drop and Roll,...it's got a nice ring to it.

[Oswegowind 17]

I think as long as your patient is stable that you should stop and assess the new condition and call for the appropriate resources. Of course your first move should be to notify the dispatch center that you are stopping your transport and the conditions about that. Then assess and update as necessary...remember be brief cause they are going to have to talk on the radio to send the help you need. If you are transporting a critical/unstable patient then you definitely should not stop, however once again contact the dispatch center to send a unit to the location to check. Otherwise, use common sense!

[helicopper 1,050]

Oh sure, in an ambulance everyone is going to stop. In a fire engine, they're just going to go blazing past! (like the pun?)

[Guest partyrock]

When acting anywhere you are not certified you are to act within your scope of training. That areas protocols don't matter. As long as your patient is stable you are required in NYS to stop, provide care until care is properly transfered. If you're outside NYS you're still operating under NYS guidelines. If your patient is unstable you are to continue on to your destination while making the apropriate notification. Here's where I'm not sure...I believe you are suppose to notify the incident you are passing that help is on the way and that you have to continue transporting.

[RWC130 594]

"Rampart, this is Squad 51 we have a problem"

Good topic, Here is MY two cents....

If you are transporting a PT, any PT and you are flagged down for a job

you should make notification via radio or phone reporting the emergency

and continue transporting your PT.

If you have an extra CFR, EMT, or Paramedic on board and you can drop

one at the scene with a Bag, O2, Collars great.

Make sure you write up an Incident Report to document the situation VERY WELL

indicating you were flagged down and had a PT already onboard enroute to the ER

in your DIRECT patient care. Upon being flagged down you made notification to XYZ Dispatch and PD, FD, EMS were dispatched. Contact a Supervisor. CYA!!!

As far as the flag down if you don't have DIRECT patient contact OR started

care and left it's not "Abandonment"

However... If you do jump out of the Ambulance to check on the second

incident leaving the PT that would be 100% Abandonment.

It does not matter if your PT has bad diarrhea and the flag down is a gunshot.

The PT in your DIRECT care in the back of the Ambulance is your priority.

[JBE 328]

I had dilemma like this a number of years back. We were heading from PHC to a diff breather way out at the other end of our district. We were coming up Stoneleigh Avenue and passed an MVA. Alamo Medic was on scene and looked like she had her hands full. We debated stopping to assist and then kept on going. I understand there was a higher medical authority than I on scene but felt we were right there and should have stopped.

I guess it was just me being a young EMT and wanting to do the right thing, and maybe a little bit of the desire to work on some trauma stuff. In hindsight, I suppose there may have been ramifications if we stopped and assisted.

In regards to the topic at hand, this is where it's a good idea to have at least two EMT's on board. You stop, drop off the one EMT with some gear to begin treatment until another bus gets there, or relieved by an equal or higher medical authority.

[20y2 43]

Abandonment is NOT temporarily leaving a stable or potentially unstable patient in ther back of the ambulance to tend to another patient, its permanently leaving them without continuing medical care. Some of you the definition a little too literally.

[ckroll 101]

One definition of an MCI is more patients than resources. A full ambulance passing an MVA would seem to me to be a reasonable extension of this. Different standards apply in that situation. Someone has to control the scene and triage. Absent a life threat in the back of the passing ambulance, I see an argument for stopping and staying until some one of authority is on location.

In an MCI we can be called on to make the life/quality of life decisions and not always for the same patient. Sometimes it is necessary to perform a rapid extrication on one person to get to someone else gravely injured.

If I were put in the situation of passing an MVA, I would explain and ask permission [of my stable patient or potentially unstable patient] to stop, then triage and make care decisions based on how I could render an appropriate level of care to the most individuals. If the loaded patient is stable [and as an ALS provider, I really should have seen to that already], then what the passing ambulance can bring to the MVA is radio communication with EMS dispatch and evaluation.

While any number of motorists may have called in the 'car in the woods', trained personnel reporting 3 victims, need for extrication, expedited response and maybe launch a helicopter, is a huge value add. If establishing an airway or controlling bleeding, or just keeping a panicked well intentioned bystander from yanking the kid with the neck injury out of the car to save him from a leaking radiator is absolutely priceless. And none of this is knowable if you do not stop and triage. It shouldn't take more than 10 minutes for back up to get there and then you are on your way.

Years ago I was in the position of transporting a nosebleed in an elderly gentleman when my corps failed to field a second ambulance for a child with an obstructed airway from a dislodged trach tube. Mutual aid was not assigned and help for this person was at least 20 minutes away, the hospital 8 minutes. We had to drive by the home of the second call. I asked permission of my patient's family, we stopped, we picked up the second patient. The fix took 3 minutes to suction, reinsert the tube and deliver blow by O2. The radio report to the hospital was complicated. While I fully expected to get reamed out by some authority somewhere, it never happened.

Right there in the front of the BLS protocols it says nothing in the protocols is intended to replace good judgment. A case can be made for stopping, and a case can be made for not stopping You can hide behind the protocols or you can make them work for you, it's your choice.

[Guest partyrock]

If your patient is stable you have excuse not to stop. To flag yourself for an assignment like you did ckroll is interesting. I'm not sure where that stands. But as for passing the accidnet, what if it was a ped struck and all you see is a shoe in the road and people swarming around a car. Are you going to drive by because you patient doesn't want to be bothered? Wether its a person with a bullet in their chest or a drunk with a booboo if we see a person and are able to provide aid without compromising our patient then we are to stop and provide aid until relieved by a appropriate medical personel.

[ckroll 101]

The act of asking permission from the existing patient is a courtesy extended to make the first patient aware of what is about to happen and to make him or her part of the process. Needing emergency medical treatment is hard enough on a person and creates a feeling of loss of control. As with all medical care, let the patient know what is going on and get approval before doing things. No stable patient is going to deny us the opportunity to provide care to another human being.

Explain that something bad has happened to someone else, that they, our first patient is and will remain our top priority, but we need them to understand that it is necessary to stop and help, if it is OK with them, and you will receive a resounding yes. By communicating and building consensus with the first patient .. if the situation goes to hell, and you do need to load and transport a second patient... and divert to a trauma center or a landing zone.... at this point, you need the cooperation and understanding of the first patient. The reason to stop to assist is that it may be something bad, and if it is, you and your first patient may get tied up. It's not likely, but it's not impossible either.

You have a legal commitment to the first patient and a moral/ethical commitment to any that follow. Allow the first patient to share in the sense of doing what is right and compassionate by involving them in the decision to help others. Everyone goes home happy.

EMS is much like whitewater rafting. Things can go badly, and it happens quickly but in very foreseeable ways. Read the rapids before you run them and plan for unexpected turns. A few corrective strokes early beats pulling against current later.

[Guest partyrock]

People suck. A buddy of mine who runs out of Sta 20 in the Bronx recently picked up an abdominal pain (the guy had too many doughnuts). As they were leaving for the hospital 3 blocks away they came upon a child struck by a car. While he went to treat the child his partner and the patient and his family went ballistic. They were fully apprised of the situation but they didn't care. They believed that since they were in an ambulance they were experiencing a "true emergency" and should not be delaying their transport.

Absolutely keep your patient informed and be understanding to their situation. Even though me know its not an emergency often times people believe they are experiencing an emergency. But be careful about involving them in the decision process when its not their decision to make.

[Future Fireman 4]

People suck.  A buddy of mine who runs out of Sta 20 in the Bronx recently picked up an abdominal pain (the guy had too many doughnuts).  As they were leaving for the hospital 3 blocks away they cama upon a child struck by a car.  While he went to treat the child his partner and the paitent and his family went balistic.  They were fully apprised of the situation but they didn't care.  They believed that since they were in an ambulance they were experiancing a "true emergency" and should not be delaying their transport.

←

Man, some people really are jacka$$es at times. Just because you're in the back of an ambulance for eating too many donuts and getting an upset stomach, doesn't mean you're the king and you deserve royal treatment. If EMS finds one guy enroute to the hospital that broke his leg or has been stabbed. EMS should call it in, care for the guy until unit assigned shows up, even if your first patient is talking BS about what you're doing. Screw that guy if the hospital is 3 blocks away or less, have your partner drive him down to the ER and get back to that scene ASAP.

My 2 cents.

Mike

[ckroll 101]

Wow. If you think people suck, you need to find a profession that involves less contact with people than EMS has. It is not ours to judge and we do not know what life experiences have brought people to the place they are. Difficult people are difficult for a reason. If you're only in EMS to help the nice, clean, grateful, people, you need to let go your disgust for humanity or perhaps sell cars for a living.

[Guest partyrock]

I am a firm believer that the average human has forgotten and forsaken most if not all of the qualities and characteristics that makes us different from the rest of the animals. In general unless it affects someone we know we don't want t be bothered. I think all of us have been cursed at for blocking traffic, have had cars speed up to use the lane opening for our lights and siren, get harrassed for waking the neighbors when we respond to actual emergencies. I've seen people litterally step over the sick and dying (not the homeless guy on the corner everyday, but woman who fell down the stairs). Then of course theres the killing and maiming of others for no reason. I can explain why a hard working man with 7 daughters was shot in the face during a robbery (he pulled a gun and animal coward defended himself. doesn't make it any less tragic and wrong, but its why it happened) I can't explain why a few idiots ran through a block cracking people in the head with a bat for nothing more than kicks. I don't get why someone walked through a club slashing random people across the face becasue his ex was in there with another guy. I can go on and on.

I treat every person who lands at my feet the same way. Wether they be criminal, cop, little old lady, or fellow firefighter they all recieve unbiased treatment because it is not for me to judge individuals. I don't know what brought them to their station in life nor do I care. I only want to know what has put them in my care and what I can do to help it.

Just because you don't like my philosphy don't judge my patient care. I've chosen to remain in EMS as much as possible inspite of a career as a firefighter and more lucrative offers in other jobs. Like you said "It is not ours to judge and we do not know what life experiences have brought people to the place they are."

[Remember585 815]

I hate people. Period. End of story.

But I still help them, because I know deep down inside that everyone appreciates us and wants to shower us with praise, gifts and tons of money.

It's one of those "deep, DEEP down" feelings that people seem to have a hard time finding. I'll hang in there to see it, should be worth the wait.

[/sarcasm]

I love being a member of my FD, even though many, MANY times when I go on either a fire or EMS call, people call us names, tell us we're pretend firefighters, etc., etc., etc. It's the nice people that say thanks periodically that make it worth it.

Edited June 17, 2007 by Remember585