urgent care triage... in parking lot

[l'infirmiere]

So I am an RN at an urgent care clinic and I am wondering what anyone's thoughts or experiences are with triaging a patient in the parking lot. We have a kind of no lift policy so if potential patient, for example, is unable to transfer into wheel chair (d/t orthostatic hypotension in this instance) we cannot see them; and there are other conditions we cannot treat, and whereas if we did we would only end up sending them off to the ED anyway... but I am wondering what the legal ramifications are for telling them to go to the ED vs. triaging by a nurse (in the parking lot in this scenario), and if the latter, then what is or should be the involvement of a provider. There could be other instances as well where a patient does not come into the clinic and the nurses or MA's go outside of clinic to triage. Just wondering what others' experiences are with this. I mean I am more than eager to run out to help someone in need but... logistically it's awkward (I am caring for patient's IN the clinic, we don't have any set protocol, we don't even have portable BP cuffs handy, etc) and legally seems iffy (like I send a patient to the ED and they would prefer to go via private vehicle but complications arise enroute and it is later found transport via ambulance would've minimized such complications). I suppose if provider were to also assess the patient, it would put me slightly more at ease, and maybe I'm making a big deal out of nothing, but nonetheless I'd love to hear others' thoughts on this, particularly from a legal standpoint. Thanks!

[Rob72, ASN, RN]

Weeeelll... if it isn't a traumatic bleed, or an Mi in the making, I'm not seeing much you can or should do. I would hope there is a policy of some sort, but:

If they can't make it in because of size, they probably are more chronic than critical, and sitting in place is probably more beneficial for cardiac workload than everyone getting in an uproar to move them.

Control bleeding.

If you have an AED, bring a CP in, or (talk to your manager & med director) do curbside & wait with them for EMS.

Imminent delivery. I'm not OB, its not my child/wife. I'll call 911. I don't want to pay 40 years of child support because some crack ho' says my actions caused X, Y, & Z.

Stroke/TIA, chew some ASA (again, what's your MD say?).

Get the legal requirements from your MD. Professionally, I'd do some ride-alongs with your local fire/EMS to beef up your primary survey/critical assessment skills.