Questions for PA Paramedics

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Specializes in LTC, Urgent Care.

1). A medic that I know made a bad choice in transferring a patient and in doing so, caused serious harm to the patient (with the patient ultimately dying). It's been rumored that the family may sue. So my question is this: is there for medics, like we as nurses can get?

2). We were to receive a resident back from the hospital today who had an IV with potassium running. After much ado, the hospital d/c'd the potassium and the resident was transported BLS. The medic who was supposed to transport refused to do so, stating that he was not allowed to transport potassium without a pump (it would have been without a pump). It caused a lot of problems for us at the LTCF - ie: scrambling to get the meds that he may have been able to come with. Just wondering if anyone can enlighten me as to the regs concerning this matter. I'm in the EHSF region, if that makes a difference.

Thanks for your help!

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They always stop the IVF for the ride and we just start back up. couldn't this have been done?

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Specializes in Emergency & Trauma/Adult ICU.

Would you infuse KCl without a pump in any setting? I wouldn't.

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Specializes in LTC, Urgent Care.

No I wouldn't.. The CEO of the company stated it could be done, while the medic refused to do it. Just wanted to know for myself what is true....

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Specializes in CTICU.

It's a JCAHO recommendation (? requirement) with regard to medication errors that potassium is NEVER infused without a pump. I've personally been involved in a case where a patient got a bolus of potassium and died, the case ending in coroner's court - you don't want to be there, trust me!

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Specializes in Emergency & Trauma/Adult ICU.
No I wouldn't.. The CEO of the company stated it could be done, while the medic refused to do it. Just wanted to know for myself what is true....

The medic refused, thankfully, because he/she knew it is poor practice.

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Why didn't the hosp just place the K+ on a pump for transfer. I would me more concerned with having the pt on a monitor depending on the amount of K+ infusing although more than 10MEQ (our protocol) and I'd absolutly want a pump

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Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.

It appears, with the info available, that the medic did the right thing.

I also appears that he has removed him/herself from the liability loop by refusing to transfer the patient under improper conditions. Federal Law places the responsibility of the transfer on the REFERRING facility, and if they discontinued the infusion and sent the patient via BLS without an RN, it was THEIR fault if it resulted in an unfavorable outcome. I hardly see how this medic is going to be liable for the decisions made by the referring hospital. As a former medic and PHRN (in the EHSF region, no less), I would stand with this medic's decision given the available info.

There were alternatives, however. The hospital could've contacted an ambulance provider that has RN's (i.e. Hershey Medical or one of the area flight programs), to either complete the transfer (by ground, they will do it) or assist by providing an RN. The hospital also could've provided an RN.

It would be nice if the ambulance service could've provided a pump, but most EMS agencies operate on a limited revenue flow. The hospital could've provided a pump, but then there is the liability issue of whether or not the paramedic has completed an appropriate inservice on the infusion pump. I know the hospital wouldn't allow their staff to use pumps that they haven't been trained on, so it's unfair and disingenuous for them to expect the EMS agencies to be familiar with the large variety of pumps that might be available. And as far as the CEO...if I wrote a post for every time I saw a CEO make a claim that was in favor of generating a revenue transport, but in violation of the law, I'd get my own section of this forum...

I just see more and more of this unraveling; why is it that the patient died because of a temporary pause in their supplemental potassium? It seems to me that such a patient was pretty labile anyway, and probably shouldn't have been discharged in the first place.

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Specializes in LTC, Urgent Care.

This particular hospital seems to dump patients, even those who probably shouldn't be d/c'd, when they're at full capacity and need the beds for incoming pts.

Anywho, thanks for all of the replies. I'm obviously not familiar with EMS protocols and was just concerned about what could happen to this particular medic.

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Specializes in ER.
Why didn't the hosp just place the K+ on a pump for transfer. I would me more concerned with having the pt on a monitor depending on the amount of K+ infusing although more than 10MEQ (our protocol) and I'd absolutly want a pump

The hospital can't place the K on a pump for transfer because the ambulance was a BLS unit. That means it is basic life support and the person who refused was probably an EMT. EMT's are not allowed to monitor any type of IV infusion. I don't think they are allowed to do a push either. I may be wrong about the push. To have an infusion running the unit must be ALS certified meaning advanced life support. These are paramedics who can start IV's, push certain meds, and monitor certain infusions. I'm not sure what medications are specifically allowed, but I know they can do the emergency drugs like epi.

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Specializes in Flight Nurse, Pedi CICU, IR, Adult CTICU.

The hospital can't place the K on a pump for transfer for an ALS service either, unless they agree to send an RN. At last check, paramedics were not permitted to administer IV potassium in Pennsylvania.

This paramedic did the right thing, and is way outside the liability loop on this one. If anyone is successfully sued, it will be the referring hospital, and the physician who discharged the patient.

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The hospital can't place the K on a pump for transfer because the ambulance was a BLS unit. That means it is basic life support and the person who refused was probably an EMT. EMT's are not allowed to monitor any type of IV infusion. I don't think they are allowed to do a push either. I may be wrong about the push. To have an infusion running the unit must be ALS certified meaning advanced life support. These are paramedics who can start IV's, push certain meds, and monitor certain infusions. I'm not sure what medications are specifically allowed, but I know they can do the emergency drugs like epi.

The original crew was als the hospital only sent the pt bls after the K+ was d/c per the original post

Karl

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