Response to external code blue

mommatrauma, RN · Apr 4, 2005

Anyone have a written policy for "external Code Blue" ? My ED responds to codes in the outpatient departments in our hospital, the internal code team doesn't or isn't supposed to...I need help, can't find a written policy anywhere for ED response to outpatient codes.

I no longer have acess to the policy, but the policy at my former place of employment was that they had to call 911. Our outpt center was across the street from the hospital but attached by an enclosed bridge you could walk across. Actually, if there was a code in any non-patient care areas as well, 911 had to be called. ie cafeteria, medical records...As the for the outpatient center, their staff were no longer allowed to bring pts from the MDs office either...if they wanted them sent to the ER, either the family had to drive them across or they had to call for an ambulance

firedup52 · Apr 5, 2005

I no longer have acess to the policy, but the policy at my former place of employment was that they had to call 911. Our outpt center was across the street from the hospital but attached by an enclosed bridge you could walk across. Actually, if there was a code in any non-patient care areas as well, 911 had to be called. ie cafeteria, medical records...As the for the outpatient center, their staff were no longer allowed to bring pts from the MDs office either...if they wanted them sent to the ER, either the family had to drive them across or they had to call for an ambulance

Thanks for your reply...I drafted a policy to present to a Critical Care Committee...I personally believe if the ED has to respond we should just start BCLS, scoop, and run to the ED. Our in-house code team, including out medical ICU doc responds and they start ACLS treatment in the hallway, i.e. Dopamine drips, etc...to the ED staff this is a no-no...get the victim to the ED ASAP, then do whatever you want! :angryfire

mommatrauma, RN · Apr 5, 2005

Thanks for your reply...I drafted a policy to present to a Critical Care Committee...I personally believe if the ED has to respond we should just start BCLS, scoop, and run to the ED. Our in-house code team, including out medical ICU doc responds and they start ACLS treatment in the hallway, i.e. Dopamine drips, etc...to the ED staff this is a no-no...get the victim to the ED ASAP, then do whatever you want! :angryfire

Yep, big no-no, thats why we don't get involved...let ems handle it...less liability should something go wrong...especially because i've seen the med residents run codes...they don't do it as often as ER, and it can be ugly sometimes...and that's when they know all the problems the patient has...the more hands off you are in that situation the better...

Peg804 · Apr 7, 2005

If there is a code called in out clinic or medical arts building, or cancer treatment center (all connected to the hosp by walkways) the ED responds with prepared code bag-monitor/defib. litter, RN, tech and Doc respond from ED, resp tech, perhaps Hospitalist (hospital md). Basically scoop pt back to ED, BCLS, monitor, maybe intubate-but BVM works, first round of meds. Goal is to get pt to ED, too hard to work code in elevator. Although I have done it prehospital.

rjflyn, ASN, RN · Apr 7, 2005

The hospital I just came from had Paramedics that worked as techs in the ED. The old policy was that 911 was called for emergencies that were of non patient in nature. The hospital relooked at that and last year established a response team made of a designated tech and security. If its for example a code then the code team responds as well.

As for a couple of posters that mentioned that their ED's dont get involved need to take a look at the EMTLA rules again. As example we had a issue raised a few years ago re a MVC on the corner outside the hospital. This corner falls within EMTLA's distance rule which states someone has come to the hospital when the are within this radius of the hospital and has to have the imfamus medical screening exam.

RJ:rolleyes:

sjt9721, BSN, RN · Apr 7, 2005

RJ...

I was thinking the same thing yesterday when I saw this thread. EMTALA does come into play when it is on the hospital campus. There are specific distance rules & such, but I can't (and won't try to) quote them. :rolleyes:

Anyone remember the situation that happened in Chicago (?) several years ago? Gunshot victim dropped off on the sidewalk a distance from the ED doors. No one went out to get him...he died...hospital got in trouble.

(I apologize for my lack of details! I hate trying to make a point when I can't remember the facts!!) :)

rjflyn, ASN, RN · Apr 7, 2005

I just found a reference. Its the 250yard rule. This also mentions the said Chicago incident. http://www.emtala.com/250yard.htm

RJ

RJ...
I was thinking the same thing yesterday when I saw this thread. EMTALA does come into play when it is on the hospital campus. There are specific distance rules & such, but I can't (and won't try to) quote them.
Anyone remember the situation that happened in Chicago (?) several years ago? Gunshot victim dropped off on the sidewalk a distance from the ED doors. No one went out to get him...he died...hospital got in trouble.
(I apologize for my lack of details! I hate trying to make a point when I can't remember the facts!!) :)

mommatrauma, RN · Apr 7, 2005

I just found a reference. Its the 250yard rule. This also mentions the said Chicago incident. http://www.emtala.com/250yard.htm
RJ

SJ, that Chicago event, although unfortuante was won because of politics, not because of laws broken...When that occurred, there were no "distance rules" set up via emtala. The hospital did not violate any emtala laws, but unfortunately still lost the case...Where I agree they were negligent, is that at the very least they should have notified 911...I'm not familiar with the whole case, so it may be that they did notify and it was too late anyway. I did read over the 250 yard law and although it does put a distance on the EMTALA laws, it still states that doctor's offices and restaurants are not included...also no where in the EMTALA laws does it say that a "code team" of sorts is responsible for retrieving the patient, or that the ED staff must go get them and bring them to the ED...it just states that they have to be brought to the ED for evaluation. Doesn't say how they have to get there...The hospital may be responsible...if 911 is called, they are still acting responsibly in trying to get the patient effective and prompt care. If someone drives up into our campus and dumps them on our sidewalk or can't get them out of the car, yes we do go out with a stretcher or a wheel chair for that, but otherwise we still didn't get involved, except to notify 911...

firedup52 · May 1, 2005

If there is a code called in out clinic or medical arts building, or cancer treatment center (all connected to the hosp by walkways) the ED responds with prepared code bag-monitor/defib. litter, RN, tech and Doc respond from ED, resp tech, perhaps Hospitalist (hospital md). Basically scoop pt back to ED, BCLS, monitor, maybe intubate-but BVM works, first round of meds. Goal is to get pt to ED, too hard to work code in elevator. Although I have done it prehospital.

That's why i drafted the new policy. It basically says: start bcls, scoop, and run. I have attendings, residents, etc. starting central lines, hanging dopamine, etc on the floor in the hallways. It's not safe practice.