Ambulance Personnel and wait times

[Kince]

Hello all,

I'm working part time with the local ambulance service and as a dedicated employee have had a wonderful opportunity to study the finer details of the ED waiting room paint job and interior decor. By this I mean, I generally spend 2-3 hours per green-->amber patient being triaged before being relieved. This is a duty I see as necessary, as certainly (in my region) leaving even a green patient in the waiting room without signing them off would legally be considered abandonment.

I'm just wondering how the ED's in your areas of the world handle stretcher bound patients. Do the paramedics and ambulance personnel wait hours being triaged? Do you have a special stretcher bay so the crews can hit the road again?

I was in the ED for 6.5 hours today with a green patient. It was so busy, infact, we ended up having our patient treated while in the stretcher, we transported the patient ourselves to CT scan, and then only then upon completion did we offload to an emergency treatment room.

I'm interested to know. Especially from the big centres where volume is high.

[Jennifer, RN]

Where I work, we try to take report from our medics as soon as possible. the only time they ever hang out is if a pt is crashing. Then they will stay to assist or observe. I work in a busy ER (level 2) that sees ~60,000 pts per year, but we always manage to get report in a timely manner.

If pts get sent to triage, the medics get the pt to sign in and the triage nurse gets face to face report from ems.

Do nurses really make ems wait up to 6 hrs to give report? How unbelievable!!!

[vampireslayer]

EMS would NEVER wait hours to give report! That's ridiculous. If we don't have a nurse available to take the pt. immediately, the medics may wait 10 or 15 minutes, and then, if there's still no one who can take the pt, the team leader will take report so EMS can go on their way, and then the team leader will give report to whatever nurse finally picks up the pt.

VS

[UMichSCN07]

About 5 or 6 years ago, I occasionally had to wait upwards of an hour at one of my two main hospitals for there to be an available bed to get the pt. off my cot. But within 2 years, both of the main hospitals expanded their ER's and I've never had to wait more than 30-60 sec. since.

Mike in Michigan

[nuangel1, BSN, RN]

the ambulance personnel come straight into the ER with the pt..no waiting room .patient is sent to a room if available hall if not,then nurse obtains report and ambulance personnel leave.if we are backed up we may ask them to wait 5 min and move pts around to make a room for the new pt.but thats occassionally.some pts are sent to waiting room and triage nurse receives report from ems.the pt registers and is then seen .

[buckeyedoc]

I am a paramedic who transports to about 10 hospitals. There are a couple of them that we walk into knowing we are going to have to wait to get a room. It doesn't matter whether the pt. is in full blown CHF or has a hang nail, the nursing staff acts as if there are more important things to do, i.e.-chatting with co-workers. It's not uncommon to have 2-3 squads waiting for a room when there are 8 sitting empty and they're at full staffing.

[MedictoRN]

After the second time of having to wait more than a few minutes, I would call the nursing supervisor from the back of the ambulance and inform them of my ETA and that I expect them to meet me at the ER so that I can hand over the patient to them. A paramedic's responsibility isn't to babysit patients in the ER hallway it is to provide service to the citizen's outside of the hospital. Waiting in the ER is a great way to open up some pretty big liability issues for the paramedic and his company. He has a duty to respond to the next call, just like the ER has a duty to accept the ambulance patient. Neither of them get to decide when that happens.

I am a paramedic who transports to about 10 hospitals. There are a couple of them that we walk into knowing we are going to have to wait to get a room. It doesn't matter whether the pt. is in full blown CHF or has a hang nail, the nursing staff acts as if there are more important things to do, i.e.-chatting with co-workers. It's not uncommon to have 2-3 squads waiting for a room when there are 8 sitting empty and they're at full staffing.

[buckeyedoc]

After the second time of having to wait more than a few minutes, I would call the nursing supervisor from the back of the ambulance and inform them of my ETA and that I expect them to meet me at the ER so that I can hand over the patient to them. A paramedic's responsibility isn't to babysit patients in the ER hallway it is to provide service to the citizen's outside of the hospital. Waiting in the ER is a great way to open up some pretty big liability issues for the paramedic and his company. He has a duty to respond to the next call, just like the ER has a duty to accept the ambulance patient. Neither of them get to decide when that happens.

I've gotten in the habit of grabbing the first nurse I see and start giving report in the hallway. I usually hear, "I'm not his/her nurse." My reply to that, "Well, you are now." I don't play games when I walk in the ER.

[RoxanRN]

I am a paramedic who transports to about 10 hospitals. There are a couple of them that we walk into knowing we are going to have to wait to get a room. It doesn't matter whether the pt. is in full blown CHF or has a hang nail, the nursing staff acts as if there are more important things to do, i.e.-chatting with co-workers. It's not uncommon to have 2-3 squads waiting for a room when there are 8 sitting empty and they're at full staffing.

Sounds like it's time to just pick a room and off-load your patient. The staff would get the idea.

[flightnurse21]

What needs to be remembered is that once a pt. is inside the hospital (actually within 250 ft. of a hospital's doors) that pt. is the responsibility of that facility. To act otherwise is an EMTALA violation, common courtesy and common sense should prevail--but when the wait time starts to get ridiculous, tell any nurse--or even a doctor, "here's your pt. and you are breaking the law if you ignore or refuse to listen to my report", then for dramatic effect, let them know you explained this to the pt. and his/her family and that there is a lawyer among them. Paramedics cannot tell their dispatchers "we're too busy to take another job right now" anymore than an ER can say "we're too busy and you have to wait". If someone threw a rabid skunk through my livingroom window, I think it would be my immediate responsibility to deal with it.

[debbyed]

i work with some excellent medics. it is not unusual for any number of hospitals in our area to be on yellow or red alert. about 40% of the patients arriving via medic can be sent to the waiting room after initial triage, our medics are great about starting iv lines on only the most seriousely ill or injured patients. another 10% go directly to rapid care.

the remaining 50% need an er bed. our er has 38 beds and no place for hallway beds. when i tell a medic that rm 19 is being discharged, by the time i finish triaging the next medic, medic 19 has cleaned the bed and put the patient in it,

on those really fluggly days we may have a 20 -30 min wait with several medic in the hall. because we have always treated each other with respect there is little contension. they know i'll find them a bed asap, they also understand that the 90 year old walkin with the o2 sat of 80% gets the next bed.

we have a medic room where they can get coffee, soda, fruit juice, milk, and the all time favorite choclate milk, along with snacks and cerials. we treat them with respect and they treat us the same. thats especially helped when that 40 week pregnant woman comes in the front door. we don't have ob/gyn. after a medical screening exam {yes she is in labor!!!)most times if there is a medic in the er they will volunteer to take the patient 10 minutes down the road to the hospital that does do babys.

our medics are angels, just don't tell them i said that.

[buckeyedoc]

What needs to be remembered is that once a pt. is inside the hospital (actually within 250 ft. of a hospital's doors) that pt. is the responsibility of that facility. To act otherwise is an EMTALA violation, common courtesy and common sense should prevail--but when the wait time starts to get ridiculous, tell any nurse--or even a doctor, "here's your pt. and you are breaking the law if you ignore or refuse to listen to my report", then for dramatic effect, let them know you explained this to the pt. and his/her family and that there is a lawyer among them. Paramedics cannot tell their dispatchers "we're too busy to take another job right now" anymore than an ER can say "we're too busy and you have to wait". If someone threw a rabid skunk through my livingroom window, I think it would be my immediate responsibility to deal with it.

The ER that I worked in had a 2 squads from the same agency pull in. They walked in together. The charge nurse (well, she's not now) decided to turn both of them away and send them to another hospital. Unfortunately, the squads did leave and go to another hospital. Fortunately, the patients were not critical. The charge nurse from the other receiving hospital called made the call. The nurse was relieved of her duties.

[bill4745, RN]

I'm in a small community hospital near Phildaelphia. After consulting with the charge nurese, the patient is sent to triage and the medics leave.