EMS abandonment?

[UtErRnEmt]

last week an outlying county ems crew brought in an elderly male with the c/c of chest pain. the charge nurse sent them to a room but all the staff nurses were in other rooms and didn't go into the room with the pt. well ems put the pt on the er stretcher, hooked up his o2 (no monitor applied)and apparantly left. i was the first nurse to check on the pt (even though he was not in my assigned room) and when i put his monitor leads on st elevation was obvious. ran a 12 lead and he was having an inferior mi. pt and family couldn't tell me if ems gave asa or ntg.

turned out the ems crew gave report to one of the docs in the nursing station who didn't go into the room until after i did.

wondering, if something had happened to the pt during that time frame (such as lethal arrhthymia or severe drop in b/p) would i have been held responsible, or would the ems crew for not staying until a nurse came in, or the doc since he took report.

thanks in advance

[AnnieOaklyRN, BSN, RN, EMT-P]

It also does not matter what the HOSPTIAL POLICY is it is a legal standard for EMS personnel and has nothing to do with a hopsital policy. Legally EMS personell are responsible for transfering patient care and report to a person that is equal or higher level, so that should be an nurse or physician unless the techs are at the paramedic level.

swtooth

[RoxanRN]

It also does not matter what the HOSPTIAL POLICY is it is a legal standard for EMS personnel and has nothing to do with a hopsital policy. Legally EMS personell are responsible for transfering patient care and report to a person that is equal or higher level, so that should be an nurse or physician unless the techs are at the paramedic level.

swtooth

Unfortunately, it IS a matter of policy at my facility. Working in the ER as a paramedic, I was not allowed to take report.

[TrudyRN]

OP, why would it fall on you? It seems to me that the MD would be in trouble.

I wonder, too, if EMT's were aware of and communicated the ST elevation.

Where was Charge Nurse? Did the nurse whose room the pt was put in know she had a new pt? And that the pt had CP?

I think you need to check policy with your ER manager so there is absolutely no doubt about whose responsibility this sort of thing is.

[UtErRnEmt]

thanks for the feedback.

the assigned nurse was with an infant in resp distress being transferred to a peds hospital.

i was triaging another chest pain pt who had come in just prior to the one in question.

the charge nurse was doing whatever charge nurses do.

i don't know exactly what was said during the ems incode and a run sheet wasn't left so i don't know if there was an emt-p on the bus

[Jennifer, RN]

In the hospital I work at, all of our ER techs are EMTs. We have a few CNAs but they function strictly as CNAs. Our EMTs are authorized by our hospital admin to take report on ER pts, as well as perform all the basic triaage tasks, such as initial EKGs, IVs, blood draws, ISTAT lab draws. We have a 42 bed ER with 2 doctors on at a given time. We may have multiple critical pts in the dept at one time. The doctor signing the run sheet is not necessarily the doc seeing the given pt. The role of the nurse in my dept is to order necessary labs/xrays/ekgs per protocols and need. If the pt is unstable, the doctor then is informed and sees the pt stat. Our doctors do not do EKGs or place pts on cardiac monitors, so to leave a cardiac pt in a room without being monitored, without a primary nurse or EMT (someone who will start taking care of the pt) aware of pts condition and status is neglectful. When tranferring a stable, worked up pt to a tele floor, we can not leave the pt in the room until a nurse has arrived to take over care, i.e. continue to monitor the pt. In a perfect world, all the docs would pitch in and help with triaging pts, do Ekgs, place foleys, start IVs, but it hasn't happened in my ER yet.

[Shamira Aizza]

It also does not matter what the HOSPTIAL POLICY is it is a legal standard for EMS personnel and has nothing to do with a hopsital policy. Legally EMS personell are responsible for transfering patient care and report to a person that is equal or higher level, so that should be an nurse or physician unless the techs are at the paramedic level.

swtooth

Hospital policy is definitely the legal standard.

EMTALA has policies and suggestions on these issues, and sometimes the policies are as vaguely defined as "health care provider" without defining what level of licensure that provider must have, followed by a policy saying that the hospitals must follow their own policy if they have one (i.e. hospital policy may say a report has to be given to a physician, or specifically to the RN assigned to that room). AND, if the hospital violates their own policy, they can be considered in violation of EMTALA.

OTOH, it would be hard for a hospital to implement their own policy over a completely seperate institution such as a ambulance company.