am I covered by my facility when transporting?

[shisquy]

Hi there. So, my hospital recently bought the hospital less than half a city block away. I am now overseeing many areas within both facilities. The roads between the hospitals are public roads and we have a contract with a local ambulance service to shuttle patients back and forth. This service does not always use an ACLS crew so some of the patients we will be sending to the cath lab at the other hospital will require an ACLS nurse to ride along. This ride along will be brief. Is the nurse traveling in the rig covered by hospital Liability Insurance once off hospital property? Perhaps there is an EMT out there that can help me with this one. Where could I discreetly find out more about this?

[FlyingScot, RN]

You definitely need a set of protocols that are updated at least every two years and are signed off by a physician. These will provide a standard of care and act like orders while on transport. In addition you need a clearly defined medical control physician and a way to contact him immediately when the proverbial you know what hits the fan. It would be beneficial that you carry a transport bag with necessary equipment and medications you might need while on the road. This will augment what is on the rig but will also be familiar to you. It should be checked at least once every 24 hours and the zippers locked with breakaway plastic locks so you'll know immediately if something has been removed. Your facility's nursing scope of practice needs to be re-written to allow for the things you might have to do in an emergency. Your need for intubation skills depends on how far away you are. If it's only blocks than BVM is becoming the preferred method because of the high rate of intubation misadventures in the field. There are other adjuncts that are less prone to placement error and may be more appropriate in your situation. LMA's for example. In addition to all of that someone needs to review your state's laws regarding who can transport. For instance, in Ohio one of the people in the back has to be at least an EMT. It's stupid but it's the law. So all of the nurses had to get their EMT's since we transported with RT's. It sounds like your organization should really develop an honest to God transport system if this is going to be a frequent occurrence. They are asking for trouble if they think all it's going to be is throwing a patient in the back of a rig and driving from point A to point B.

[BittyBabyGrower, MSN, RN]

You should have a policy and procedure on the books that outline this. Just like anything else. We only ground transport now and we have to be checked off on the ambulance every year, usually the drivers do it. You have to know emergency shut offs, where everything is, who to work everything in the back, where the emergency kits etc are, how to use the in rig phone. We always had to do this for the aircraft too, but that was regulated by the FCC.

You should also have your own flowsheets and documentation, and sets of standing orders if there is not a doc with you. And don't forget permits to transport if the patient is awake and alert. Anytime you take them off hospital grounds you should have a permit signed. We have to have parents sign them before we even leave the other hospital or even our own.

Carrying your own insurance is a good thing too.