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]

This is NOT abandonment. The EMS crew gave a report to someoe of equal or higher (obvoulsy higher in this case) level of care, and then left. It is the responsibilyt of the staff member who receives the report to communicate with other staff members about this new patient. This is especially true since the charge nurse was well aware that the crew brought the patient in and I am asuming she also knew the C/C. It is not the job of the EMS crew to tell a nurse to go into the room, that would be the job of the charge nurse who again was aware that a new patient has arrived!

swtooth

[AnnieOaklyRN, BSN, RN, EMT-P]

Just a note Jennifer. Not picking on you, but an EMT or paramedic CANNOT give a report to a tech and leave, that IS abandonment as the person receiving the report must be of equal or greater training.

Swtooth

[rn/writer, RN]

I was an EMT for 17 years and have been a nurse for almost 13. I concur with those who say the EMTs in this scenario did their job as far as giving report.

The most responsible person in the picture is the MD to whom they gave their report. If that doc wasn't prepared to jump in and assume care, he/she should have directed the EMT's to another staff person.

Where I have a question is the idea of leaving a possibly unstable cardiac patient unmonitored and unattended in an ER room. That may not technically qualify as breaking the rules of transfer, but it surely seems to violate some important principles of patient care.

Perhaps the EMTs believed the doc or another staff person would be heading into the room right away. Even so, I can't imagine leaving this patient alone. If for no other reason than providing emotional support for someone who is hurting, stressed and scared, someone from the crew should have remained with the patient until the staff people made a connection.

That said, I can't ever recall bringing in an acute cardiac case where the room wasn't instantly a hotbed of activity. Usually within minutes of arrival, the patient had been given an O2, EKG, meds, and had lab draws and various other measures instituted.

From the information we were given by the OP, I'd have to say that the report portion of the transfer was properly given to a staff person of equal or greater licensure who ACCEPTED the responsibility. Again, if the doc was not prepared to take on the patient's care, said report should have been redirected toward an appropriate staff member.

The actual patient care portion of the transfer seems inadequate. To leave an unstable (or unknown status) cardiac patient alone is questionable. Even if this was a busy crew that needed to call back into service quickly, I just don't see this as being good practice. I don't believe this legally meets the standard of abandonment, but if I had been the patient, I don't think I would have liked being left alone.

If the crew had to get back on the road, they certainly could have stood at the doorway of the room and called for the doc or a nurse to come in so they could go. If there wasn't a pressing need for them to leave, someone should have stayed with the patient, not because of the legal aspects, but just out of common sense and kindness.

[dream'n, BSN, RN]

EMS gave report to the MD. It was the MD that dropped the ball.

[DizzyLizard]

The doc dropped the ball. I worked as an EMT for many years and our protocol stated report was to be given to the nurse assigned to the room and the RNs signature co-signed our run report to verify transfer of care was given. If the ED was busy and a RN wasn't available, report would be given to the doc that would be tending to the pt. Report was always given in the same room as the patient so he/she was part of their own care. It does concern me that the EMS crew left an unstable cardiac pt unattended. To me that constitutes neglect. They should have verified someone from the ED was at the pts bedside before leaving.....no matter how busy they (EMS) were.

[danh3190]

My question is did the EMS not see the ST elevation on their monitor and tell the charge or MD?

Even if the ambulance did have a paramedic on board many heart monitors routinely run in "monitor mode". As I understand it this mode is good for getting a good tracing for dysrhythmias in a bouncing ambulance but it can not be used to diagnose ST elevation or depression.

Some monitors will run only in "monitor mode". Our newer monitor can run diagnostic 12 leads but it runs in "monitor mode" for the routine rhythm tracing unless specifically set to "diagnostic mode". We usually run a 12 lead initially and sometimes on arrival at the hospital but during transport it's in "monitor mode".

[APNgonnabe]

I do currently run as an EMT. Danh, you are correct in the fact that the monitors used in the ambulance are not the best for seeing 'minor' or small changes in the base line. Now to the abandonment issue...I think that we need to know what their SMOs call for. Tech they did report off to a higher level of care however ours state that we must give report to the RN in the room. Also we can transfer care to PCT if it is a BLS run. So to play the blame game...we dont know everything.

[EricJRN, MSN, RN]

Also we can transfer care to PCT if it is a BLS run.

At the risk of derailing the thread a little bit... I agree with most of your post, but I wonder if this part is actually written anywhere officially. Seems like it could cause problems because most ER's want RN's to make the initial contact/assessment/triage. Are all of the PCT's paramedics? Even on a BLS run, I wouldn't think they'd want a paramedic transferring care to an ER tech who might be an EMT-B, EMT-I, or non-certified.

[APNgonnabe]

Yes Eric it is in writing...

"Care of a BLS patient may be turned over to Emergency Room Technician personnel."

That is straight out of our SMO's

[RunnerRN, BSN, RN]

On the issue of transferring care to an ER PCT.....I don't think it matters if the pt was brought for a hangnail, a cough, or CP. Giving report to a tech is just plain irresponsibile - both for the EMT-P giving report and the PCT accepting it. Regardless of the EMS crews SMOs, my ED's protocols state that report must be given to an RN or MD. Any PCT accepting report will be at risk of losing his/her job.

In my dept, many of the techs are EMT-Bs, but just as many are nursing students and lay people. And this is in a large Level I ED. It just seems like a bad idea. Let someone know you're here, and 95% of the time an RN will be in the room within 5 minutes.

[BVFD 333]

My question, why was the pt with c/o CP not better triaged. Time = heart?

[APNgonnabe]

Runner,

I agree that there could be problems, and your ER policy may have been written w/ your EMS system SMOs in mind. In the 5 yrs i've been w/ our service I do not remember a time that we did report off to the ED tech. I agree with BVFD that there probably should have been a increased response from the ED staff. Most of the ED tech in the facility that we transport to are emt-p.