Just wanted to get some opinions/thoughts from any ECRNs out there. I've heard some grumblings of late from some medics regarding some suspicious sounding diversions. Apparently an ECRN (or ECRNs?) has diverted several crews with signed refusals to go to the closest by pt's who were A/Ox3 but who had unstable vitals( one had a HR in the 150's and I think the other had a BP 220/110 ) . Obviously these were sick pt's and their desire to go to hospitals other than the closest was questionable. The issue however is if a person can be forced to go to the closest hospital ( which they may or may not have very valid reasons for not wanting to go to) after they have signed an informed consent and are A/Ox3. I know protocols vary from region to region but this still just seems odd to me . Any thoughts?
Apr 24, '09
Well, I am justapatient, but I was taken by ambulance yesterday (thursday) morning. I requested to not be taken to the closest hospital, becuase I am a patient at a hospital about 5 minutes further away. Have been for 19 years. I was having spasms in my extremities, so the paramedic said ok taker her there. He had not done any other assesment at that time. He gets the EKG leads on me and then thinks o no because my pulse was at 220. However they keep going to my hospital of choice. Was it the best move, well I am still alive, and will continue to be, which would have been questionable 1. at the local hospital and 2. when my docs got a hold of me if I had gone to the local hospital instead. The only reason really taht I requested it....I have been told any time I need to go to a hospital, if AT ALL possible go to mine.
Apr 24, '09
I know that a lot of regional advisory councils have started to get heavily involved in transport and diversion issues. You might see if your RAC has a website with some information.
Apr 25, '09
Just wanted to get some opinions/thoughts from any ECRNs out there.
While you are waiting for others to discuss this issue, even with a signed consent and AAOX3 a patient has a right to refuse treatment while in a hospital. I don't see this issue much different. If they get to a hospital not of their choice, they can just refuse treatment. Possibly there is a work-around for ECRN's I am not aware of. I would say about all you could do was explain to the person the necessity of moving them to the nearest facillity (health-wise) and they may be charged extra for taking them to a further facillity, also have them sign a form that you aren't responsible.. yada yada.
Apr 30, '09
A couple of years ago, my city's EMS system discontinued diversion. So now, now matter how busy we are or how many admitted patients we're holding (up to 40-some at times), we continue to receive ambulances.
I remember how confusing and time consuming diversion was prior to this. Medics were smart, AMA the patient to destination, and continuing taking them to the hospital of the patient's choice, even if they were on diversion. Regardless of the base hospital's request to divert, the patient can refuse and request transport to the diverting hospital, as long as they sign the AMA and are a GCS 15. This was kept hush hush but as patients figured it out, diversion ceased to properly function.
Diversion is such a mess. You receive patients who have never been to your ER and then it's a mess trying to get old records from the other hospital etc...it's so time consuming.
Of course, there are extreme instances when hospitals must divert like in the event of a disaster or equipment malfunction. But having a full hospital (which is most of the time) is no reason to divert anymore. In my honest opinion, EMS works better when diversion isn't an issue.
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