"Too unstable for transport"..........WHAT?!?!?

[TazziRN, RN]

Okay, a little background. We have a very nice little RV park in town that is popular. At 0930 I got a pt by ambulance, an older man who was down for at least 3 hours......fell in his RV while on his way to the BR. Why his wife didn't wake up, I dunno. Why he didn't call out for her, I dunno. He lay there stark nekked for at least 3 hours before she woke up and found him. The doc and I questioned him, he was very with it and said there was no fall, no dizziness, no chest pain, nothing. He had a recent hx of GI bleed but his labs with us were fine. He had severe pain because he couldn't get to his routine pain meds this morning, so I gave him 2.5 of morphine IV. That literally snowed him for 3 hours but he finally woke up enough to talk to us, but he had mentation changes: if left alone he seemed almost obtunded. Somewhere in there I put in a foley and got crud out; he was uroseptic. Called the on call doc to admit him and she said "Just because of his age, let's get a troponin." We were not expecting an abnormal result so we were all shocked when it came back at 29!! Scratch the admit, start working on transferring him. I got the runaround from the hospital near where the pt lives; to save time I called the ambulance company to get a critical care transport started. The crew arrived an hour later, and right after that the pt started crumping on me.

Oh yeah......we are a rural facility, no specialists. Our ICU is like a larger hospital's tele unit.

The transport nurse actually told me, "I can't transport him, he's too unstable for transport."

Eh?????

If he's too unstable for transport, he's sure as (^%# too unstable to stay here!!!!!!!

[RN BSN 2009]

That's just crap.... he needs to move to a bigger facility and really fast!

[CritterLover, BSN, RN]

i guess that is along the lines of saying "sounds like that patient is too unstable to come to icu"????

as long as you followed the emtala guidelines as far as stabelizing the patient before transport, you've done all you can. you know-- make sure the appropriate drips are hung, meds given, tubes placed......

of course, what the transport nurse was telling you is that he/she didn't want the patient to die on him/her. can't say i blame them, but what would happen to the patient if left at your facility???

[chenoaspirit, ASN, RN]

Yep, we get that at our hospital too. Its frustrating isnt it. Its a shame

[sissiesmama, ASN, RN]

I'm SO glad you posted that!! I thought I was the only RN that had gotten the response. For a little over a year, I was the night RN in the ER of a small rural hospital, kind of like the one you described. I enjoyed it, never thought I'd see anything "good", and saw more traumas there than the larger city ER I worked for later.

When you get that reponse from the transport nurse or nsg supervisor in that type of situation, it makes you just want to say ""WHAT??!!!

Anne

[TazziRN, RN]

i guess that is along the lines of saying "sounds like that patient is too unstable to come to icu"????

as long as you followed the emtala guidelines as far as stabelizing the patient before transport, you've done all you can. you know-- make sure the appropriate drips are hung, meds given, tubes placed......

of course, what the transport nurse was telling you is that he/she didn't want the patient to die on him/her. can't say i blame them, but what would happen to the patient if left at your facility???

this same transport nurse, a year or two ago, came to pick up an acute cerebral bleed from us. the neuro asked us to give mannitol, so we got it started just as the transport team got there. the nurse refused to take him until the mannitol was completely infused and observed for a short time to make sure his pressure didn't take a dump.

um...........and this helps the pt..........how????

[tgb3rn]

Well this type of crap must happen all over. I like the night I had to call the lifeflight bunch for transport and they tell me the humidity was to high for them to fly. No fog, no rain, not a cloud in the STATE. I don't think the guy on the other end of the phone liked it much when my response was " so your telling me this guy is going to die because the air is to thick for you to fly through". Granted I'm not chopper pilot but this was just nuts to me.

Tom

[sanctuary, BSN, MSN, RN]

Well this type of crap must happen all over. I like the night I had to call the lifeflight bunch for transport and they tell me the humidity was to high for them to fly. No fog, no rain, not a cloud in the STATE. I don't think the guy on the other end of the phone liked it much when my response was " so your telling me this guy is going to die because the air is to thick for you to fly through". Granted I'm not chopper pilot but this was just nuts to me.

Tom

Hmmmmm....... Air too fat, me no fly. for sure.

[TazziRN, RN]

Hmmmmm....... Air too fat, me no fly. for sure.

Me sitting next to you waving at the idjit who tries to........"Bye.....see ya at the Pearly Gates!"

[chris_at_lucas_RN, RN]

So how did the story end? How is the patient?

[PANurseRN1]

Personally, I would never argue with a pilot over whether or not the weather conditions restricted flying. That's their area of expertise, not mine.

[BittyBabyGrower, MSN, RN]

Honestly, you have to give the Lifeflight people a bit of slack, they know what they can and can't do in that chopper and as one that has flown, let me tell you, if you can wait out something like the Mannitol incident, then all the better, better to be in a controlled environment if you can. As for flying conditions, that is the pilot's call, there are lots of variable as to when we can or can't fly. It can look crystal clear to you, but up in the chopper it isn't. The pilots aren't going to risk our lives if he feels that the conditions are right to fly. I understand why you guys are frustrated, but you can't blame the Lifeflight team for doing what they are doing.