[FiestaRed]

I was wondering about this one. Has anyone received any formal training on how to do this properly? I imagine medics, fire, and law enforcement do, but have never seen this addressed in the ED. I would think there is some legal thing here -- they are outside the ED, and inside their own private vehicle which is their personal property. Technically they aren't on hospital property because they are in their privately owned cars. We have had several people hurt this way, and I just had a crappy incident today as the triage RN involving this. You got your fat can into the car, now you get it out.

-Mark

[MrsWampthang]

so I know how to get people out of vehicles safely, both for them and for me. If they are big and/or unable to help themselves at all, get help! Never attempt to lift someone that you know you can't lift by yourself. Our ambulance bay sits almost right next to our ER walk-in entrance, so there have been times that I have asked the ambulance crews to run over and help. If someone is really critical, I have had the vehicle back straight into the bay and we get the patient out on a gurney and straight to a trauma room. The most important thing is never to try and act like the macho, I don't need no help, kind of nurse. Get help getting people out of those vehicles, if there is an EMT class or medic class going on in your area, ask the instructor if you can sit in on the part where they practice patient extrication. There are tricks to it, that keep everyone, especially the patient from getting hurt further. Check with your ER manager and find out just what your liability is as far as digging people out of vehicles outside of the ER. We do it at our ER all the time. Mostly it is just the patient that has hurt their back and needs a little assistance to get into a wheelchair. Again, I get help from other nurses, techs or whoever is available if I know I can't move this patient by myself. I have a lot of years to be a nurse and can't afford to mess up my back this early in the game. Hope this helps.

Pam

[traumaRUs]

We too have our share of "grandma was fine when I put her in the car, but now she's not breathing" patients. Personally, I do pre-hospital care as a volunteer PHRN but we do it as a team always and we have had only a few problems. I live in Illinois where there was the big stink in Chicago a couple of years ago when an ER staff did not help someone on their driveway who had been shot, so we always go out and help. We also get some drive-by's where gunshot victims are dumped on the driveway.

I would also approach the ER manager and ask for an inservice on safe removal of patients from vehicles. It is invaluable.

[MrsWampthang]

First rule of approaching any scene is "is the scene safe?" whether it is out on your apparatus apron or outside your ER doors. I wouldn't want to go out to help a gun shot victim and become one myself. Fortunately we don't have that happen but once in a blue moon.

Pam

[qanik]

It doesn't matter if they are in there own vehicle, they are still on hospital property looking for help. A patient looking for help anywhere on hospital property has triggered EMTALA and you are required to help them by law. I also practice in Chicago as someone else mentioned. At the time I was an ED manager of a large trauma center in downtown Chicago. After the "incident" mentioned, EMTALA was modified. In a nut shell all hospitals are required to "draw" an imaginary border around their entire property line. Inside this line, the hospital must respond to a patient emergency. The only case where you do not is if you have to cross a "major roadway". This brought about many changes as we found code carts don't roll well in the mud, can you defib in a puddle, how do you pull a 500lb Gun shot patient out of a tiny car etc etc etc. We wrote numerous policies to address the situations. Most importantly depending on where you work, as someone mentioned, is scene safety as no one can respond without security. If the scene is still unsafe (gangbangers still fighting) then 911 is called and no one responds. Other things to address are how to get your equipment to the patient (jump bags etc), how to transport the patient (can you get a cot to them or do you need fire department help) and the list goes on and on. Getting back to your original question, if the car rolled up to the ED area, the triage nurse would go out with a security guard to the patient while Two ED techs (EMT's) would get a long board collar or cot depending on the situation and the four of them would get the patient out. They always have the option of overheading more help to the bay STAT. Sorry so long.

Qanik

[traumaRUs]

Qanik - just curious - where do you work? I did some agency shifts at Loyola and was amazed at the similarities between us! PM me. judi

[depedsnurse]

Being a volunteer EMT the only advice I can pass on is a backboard. Slide it up under the patients rear. Of course this is not a 1 person job. I hope this helps somewhat. I know what it is like to be looking at a situation and wondering how am I gonna get out of this 1

Sandy

[CEN35]

Well it depends on the situation, you never realy know whether it's legit or not?

The one thing that I can tell you is that EMTALA is in control of your answer. They pretty much are a federal organization that sticks their fingers into hospital stuff, just like OSHA, HICFA, and the infamous joint commision. EMTALA though, is more outpatient, ER related.
What EMTALA says regarding this issue:

#1 - The ER/ED is responsible for eveything within 400yds of the ER (i.e. parking lot, ER bay, and yes even the nearest street if you a re a rinky dink ER only a few feet from the street.

#2 - The ER is responsible for any outpatient settings operated by the hospital, that are not attached to the hospital. (i.e. the outpatient surgery center 3 miles away) Which creates a huge issue if they have a problem, and your on diversion. If you were to divert, legally the hospital/med control c/b screwed, if something bad happened.

So in partial answer to your question, the ER is responsible for those patients.

As far as formal training? I never asked, I was an EMT prior to being a nurse.

Quick story:

We always had people pulling up, honking their horns, yelling out their car, he's short of breath, he can't breath, I think my son broke his leg etc etc. Most of these require minimal transfer from the vehicle. You can take time to think about how to do it.

However now and then................true story

A vehicle pulled up to the ambulance bay honking their horn. I told sombody there was another apparent emergency in the bay (laughing).
So as I walked out, this lady was screaming that her husband stopped talking. I walked around the car, he had his last agonal breath. So obviously no time for worrying about how to transfer. Another guy and me dragged him up on to a cart (too heavy to lift). We wheeled him in room #2, 200 joules, and bam he was back and went to CCU.

So clearly it depends on the situation. But I don't think hospital administrators worry about your back and/or how to transfer a pt out of a vehicle.

The hospital where I work sits with it's back to a Harbor. We had a boat pull up during lunch time, the boaters were waving frantically. A group of Interns went out but couldn't move the pt over the rocks and mud, they had to send them down to a dock and call 911. One of the Interns went with, but couldn't do much. I'd heard the pt had fallen in the boat and lacerated her liver. I don't know how the legalities of that worked out, but we see crabbers/boaters tip over into the water a couple times a year, so I'm sure there's some kind of protocol in place. On the flip side, I've stood in a patients room and watched a couple of guys go through the parking lot trying to break into cars. There's as much excitement on the outside of the hospital as there is on the inside!

[sjt9721]

Whoever is responsible for providing your unit-based education should provide the staff with training to remove a patient from a vehicle. The training should include the use of cervical/full spinal immobilization for trauma victims and the use of backboards/slideboards for unconscious patients (and any other situations that could arise). You should also be instructed on how to accomplish these things while keeping yourselves safe as well.