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EMS abandonment?

Posted

Specializes in emergency. Has 8 years experience.

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

I would think the EMS crew. You cannot hand off the pt to a ghost, which is what they did. Giving report to the MD is not the same as handing off the pt.

Shamira Aizza

Specializes in Rotor EMS, Ped's ICU, CT-ICU,.

The facility and the department would've been held responsible; he was in your facility and someone on your staff was aware of his arrival, location, and condition.

Giving a report to someone is the benchmark of transferring patient care, and giving a report to a physician makes that benchmark more solid. They fulfilled this responsibility. If the physician who received the report did not lead the EMS crew to believe that he was not an appropriate provider to be receiving report, there is no way the EMS crew can read minds to find out who this person should be. And it is not the responsibility of the EMS crew to ensure that the physician notifies the ED staff.

I feel bad for EMS crews who are often simply disregarded and ignored when they are searching for someone who will actually admit that they are going to be receiving their patient so they can return to service and respond to their next call.

This is one of the consequences of overloaded ED's, and why I am an advocate of pursuing reasonable methods of diverting non-emergency patients to other types of providers (FP's, clinics, etc).

Larry77, RN

Specializes in Trauma/ED. Has 10 years experience.

Sounds like both the EMS crew and the charge nurse dropped the ball to me. I can't see this scenario occurring in my facility because either our awesome medics would have hunted one of us down or our charge nurses would have initiated the acute MI protocol until one of us had a chance to take over.

Also if the MD was aware of the symptomatic acute MI you would think they would either go right in the room or have the charge nurse page someone to the room immediately.

vamedic4, EMT-P

Specializes in Peds Cardiology, Peds Neuro, PICU, IV Jedi. Has 23 years experience.

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

Makes you wonder what was so important that the charge nurse couldn't go in?? Just a valid question. Your charge nurse, if the nurse assigned to pt. was busy, is the one to whom report should have been given..and since I'm sure she knew, she should have been ready to accept report.

EMS people don't "have" to wait for a nurse, nor do they have to give report to a nurse. If they gave report to the physician in person, then the handoff is complete.

The doc was the one taking the chance. Luckily this had a good outcome.

craigrn4er

Specializes in Emergency Room. Has 2 years experience.

I am not sure who would have been responsible. Probably depends on the lawyer and who had the deepest pockets. I would probably lean towards the ER facility. My question is did the EMS not see the ST elevation on their monitor and tell the charge or MD?

DoubleblessedRN

Specializes in cardiology. Has 5 years experience.

I would have to say the receiving facility. Run reports require a receiving facility signature, from either an RN or MD. If that is signed, that means s/he took a report and assumed responsibility for that patient. However, when I transport pts to the hospital (and I don't care if it's only for a hangnail or stubbed toe) I stay with the pt until a nurse comes to us. While I'm waiting I finish my run report and bill.

There has been some interesting discussion on this topic from a regulatory standpoint. The interpretation I've seen most is that, once the patient is on the grounds of the hospital, the hospital is responsible for the patient (EMTALA). The root of these concerns seems to stem from urban ED's forcing EMS crews to wait with patients to the point of excess (wait times routinely greater than an hour - crazy but true).

Also, the EMS crew is not tied to reporting to an RN. A physician meets the EMS standard of transferring care to a higher level. It's the ED's responsibility at that point to continue the care.

I think you'll see a dicotomy of opinions on this. EMS crews on onside, ED staff on the other. Hopefully, we can fix the greater problems (staffing, the need for better primary care, etc) and this little one will take care of itself.

Merry Christmas,

Pete Fitzpatrick

RN, CFRN, EMT-P

I use to work as an emt and know how hetic it can be in the ED. I feel EMS did their job by delivering the patient and giving report. I think it was the Doc's reponsibility to follow-up care at that point. Kudos to you for being aware of the situation and checking on the patient.

PANurseRN1

Specializes in Day Surgery/Infusion/ED.

If the ED was really busy, the charge may have had her own pts. It's not always feasible to have someone at the ready for when EMS arrives. Theier definition of "5 minutes" can vary. And I have experienced situations where they just showed up with pts and didn't call, and at least two occasions where they left without giving report to anyone, so it can happen.

One thing we can agree on: Our EDs are overtaxed, and it's not getting better.

Aliakey

Specializes in Emergency.

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

Since the EMS crew in this instance was county-based, it might have been ALS or a BLS crew, not MICU. Very common in my rural area; paramedics are in short supply. Only Paramedics (at least in Texas) may use a cardiac monitor. EMT and EMT-Intermediates can use an appropriate cardiac "device" for defibrillation only, per scope of practice (typically).

I know... too many designations in EMS, lol!

We are clearly obligated to transfer the patient/give report to a higher level of care in ER settings... RN, MD, etc. I do give report to physicians often, but they are also standing in the same room with the patient or meeting me at the stretcher. Personally, I would not give report without having the recipient (RN, MD, etc.) in the same room with the patient (or just outside the door for certain psych patients). Just helps assure me that patient care was transferred completely, and I usually also document that the RN or MD was present in the patient's room while verbal report was given. Good ol' CYA, if you know what I mean. ;)

Jennifer, RN

Specializes in ER, telemetry. Has 11 years experience.

In the ER I work at, the medics give report to the nurse or the tech assigned to that room, or the charge nurse. They then give a quick report to an attending and have to have their run sheet signed by an attending. The nurse is the one who is responsible for that pt once the pt arrives. She or he triages the pt, assigns acuity and orders labs, xrays, etc... before the MD ever sees the pt. In fact labs, xrays will be back before our docs come to see pts, unless, of course, the pt is in some sort of distress. So, in my facility, I could see it being an abandonment issue if the medics roll up out of there without giving the nurse report. That never happens though, thank goodness!!! We are all looking out for our pt's best interest.

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

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

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

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

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

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

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

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

Specializes in Med-Surg, Cardiac. Has 4 years experience.

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".

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