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?

[loriangel14, RN]

You should be covered.I accompany patients to other facilities for tests and appointments and I am covered. You could ask the administration at the hospital.They should know.

[Dixielee, BSN, RN]

You are on the clock on a work mission, so you should be covered. I am certainly not a lawyer but have had to travel between sister hospitals while taking PACU call and have also had to accompany critical patients with EMS.

You shouldn't have to discreetly ask about it. It is a reasonable question.

[Jolie, BSN]

More importantly, you should be adequately trained before attempting a transport by yourself.

ACLS certification and ICU experience within a facility are a good start, but there are plenty of factors involved in safely completing a transport that never occur on "land" so to speak.

Until you have had training and a few practice runs with a preceptor, I would flatly refuse to do a transport regardless of whether it is down the street or across the state.

Good luck to you!

[akulahawkRN, ADN, RN, EMT-P]

While I'm not a nurse yet... I will have to agree with some of the above responses. While you likely will be covered during transport, you should refuse to do those until you and the other "transport" nurses have had a chance to get some guided experience doing those transports. As stated above, there are other considerations involved in transporting patients that do not occur elsewhere.

The nursing care itself doesn't change, but there will be logistical issues, mechanical issues, and care issues that will have to be worked through. You will have to make sure that someone on the other end is ready for the patient. You will have to make sure that you know the skill level of the crew that comes to transport. You will need to know their capabilities, even the ACLS crews. They may be limited in what fluids that they can transport with. They may be limited in what meds they can give. They may be limited in what procedures that they can perform. You will need to ensure that lines and pumps are compatible with the other facility and with the crew's equipment, unless you're bringing all your equipment with you.

You will also need to ensure that your ACLS nurses are actually capable of running a code on their own, including intubating and being able to manage a failed airway. Sure, the time and distance is short, but you don't want to send an ACLS nurse to babysit only to have the patient crump during transport...

The folks that do transport all the time do a lot of little things that make the transports go pretty smoothly and they don't think about them much because they just do those little things.

Take some time and shadow an ACLS crew doing those transfers. Just observe... then go forth and get a good preceptor to teach you what you need to know above and beyond just "ACLS" basics.

At least you know that there are levels of crew capability. You'd be amazed how many people do not know there is a difference.

[nurseprnRN, BSN, RN]

make sure you are as familiar with the contents and equipment of the rig as you are with the stuff in your home unit. if somebody decides to ruin your day with an in-transit emergency that is not the time to be figuring out how the suction works.

if several of you are doing this routinely, set up an orientation c the ambulance service for this. also, have a good method of documentation for every minute you're en route, from bedside to bedside, meds given, vs (and they're hard to get in a noisy rig sometimes), to whom report was given and where. i hate reviewing ems records that don't say anything of use, because it's sometimes an issue what they were told when they arrived, even if their care is not an issue, and who they told what on arrival.

yes, your employment is your employment, and they cover you, insofar as that's meaningful. and of course you should always carry your own malpractice insurance. anyone who tells you "the hospital will cover you" and "they won't sue you if you don't have insurance, they only go after the deep pockets" is dead wrong.

[rn/writer, RN]

yes your employment is your employment, and they cover you, insofar as that's meaningful. and of course [b']you should always carry your own malpractice insurance[/b]. anyone who tells you "the hospital will cover you" and "they won't sue you if you don't have insurance, they only go after the deep pockets" is dead wrong.[/size]

please, make certain you have your own professional liability policy. the hospital will cover you as long as it's in their best interest. but if they have to choose between themselves and an employee, what do you think will happen?

because you will be dealing with a separate entity--the ems crew and rig--you really need to make certain your backside is well-protected.

sounds like an interesting job.

[Kooky Korky, BSN, RN]

Why be discreet? Just ask. And get something in writing. Are you covered for vehicle accidents? Practice problems? Etc.

[shisquy]

Thanks everybody. I need to speak with some of my peers about this as well. I wanted to find out more information, discreetly, because this has been a very sensitive subject at my facility. In my current position, I walk a fine line between the bed side nurse and administration. This merger has created a great deal of tension and I don't want my asking to turn into "Nurse X is telling everyone that they are not covered by hospital insurance and that is why nobody will ride along!" Not that that could ever happen but... you know. I am determined to find out more. Thanks again.

[merlee]

Asking a question of your administration about liability is not the same as disseminating erroneous information. Asking us here about it may be helpful but it is not definitive.

I think that you have received excellent info about what to ask, especially about orientation to the rig and such.

And everyone should carry their own insurance.

Best wishes!

[nurse2033, MSN, RN]

My biggest concern would be the equipment you carry. Are you able to run a code with a single EMT to help you in the back? Paramedics do it all the time but their equipment is set up for it. A BLS rig wouldn't have ALS gear. Do you carry all the pressors you would need? I would think you would also need a set of protocols to cover you since an MD is not present if you need to start an amio drip for example. This is certainly possible, in fact, will happen sooner or later if you are doing cath lab transfers. IMHO you should have at least 2 ALS providers plus 1 BLS provider for what sounds like a critical care transport.

Yes, you should be covered under their insurance even off the property since you are performing work.

It sounds like you are operating without a clear job description/clear responsibilities. You should get yourself a job title and list of responsibilities (for your own liability protection).

There should be a clear and written policy covering the role of nurses transporting in the back of an ambulance.

Good luck.

[RescueNinja]

Your facility should have a policy on this. Mine does. As long as we follow our facility's P&Ps for our department/specialty we are covered.