It happens to all of us. We know what to do so well that sometimes we don't do the basics. But if it's happened to you recently, or you can feel it coming on, you might need a good reminder of why you should ALWAYS do a proper patient assessment, even during what might seem like a "routine" transfer. So read Amy Asiaban's JEMS.com article, "Embarassment by Assessment."
Wow. That sucks. Its good that Amy got out of it unscathed. Thats a great learning tool. Im very guilty.. We've recently had patients pass away during an easy transfer call. So I do agree with her whole heartedly
No...there is NO reason for a medical transfer to be treated any different than a 911 call. I treat as I would any other patient--to do any less is not appropriate:let alone unethical in my professional opinion..T
I thought it was a great article because it may remind someone to stay on top of their patient care. I made a GSW a year ago that was headed to a trauma center downtown. They had done all the early interventions. They gave me report and the story that they knew. He had a couple wounds to his legs that were severe and there was quite a bit of blood loss. They had given him a bunch of fluid, and I noticed on their monitor that his pressure was still in the toilet.
I asked if there was any other wounds, and was told he had a simple through and through on his R hip area. I decided to take a look myself. The nurse seemed a little put out but helped me get a look because it was hidden due to his position. This "simple" wound was gushing blood on to the back board underneath. It was hardly a through and through. The bullet obviously hit something important in there...plenty of choices in the pelvis as we all know...
I dressed it as best we could, and headed in. I was able to direct the trauma team to that wound on arrival. That was his big threat. He needed surgery and blood. I couldn't fix that, but I was able to give accurate info to the trauma team, and attempt to slow the bleed en route.
Had I got lazy it could have been worse for him and me.
Guilty as charged...OK wait, in my defense we're not talking about the trasfers that some of you have mentioned. We take completely stable pt's from one facility to another. (9 miles) This is an incredible money grab for our company. The ignorance of the public and the stupidity of our system alows for this to happen. We basically our double dipping their insurance companies. These are pt's that need a cath procedures. We get there, the staff takes a set of vitals and then disconnects the monitor. We connect ours and transfer pt to our stretcher. Takes us 5 minutes to the rig, another 15 minutes drive time and 6 minutes to cath lab. Usually by the time I can get through their paperwork, we're already there. I've never had an unstable pt and most of them never had confirmed MI.
We also have these "Immediate Care" facilities that advertise on all local media outlets. They are our best customers by far. We take about 15-20 calls a day for the BLS pt that needs to be admitted or just transport to higher level of care for C scan or MRI. Then there are the MD's office that have pt that came in for CP 3 weeks ago. No acute pain or distress, 12 lead negative and labs show no elevated Trops...so why do they need an ambulance ??? NO problem, this is what we get paid for, "hop in Ma'am. LOL
Believe me, I've had several of pt's crash and burn in front of me. There's two questions you have to ask yourself before accepting a pt from a facility..."Is this pt stable or unstable"? Secondly, "What is your gut feeling"? If the answer to both of these can let you lower your guard, then so be it. IF NOT, you'd better be on top of your game so your not diverting to closest facility and that just leads to more paperwork.
This goes to show you why you need to do an assessment on every patient that you have. I tell new medics to assess every patient that you encounter. There is no excuse for not knowing everything about your patient.
I feel a little ashamed to admit this, but early on in my career I can remember a couple of patients I slighted in this way. (Not doing a complete P.A., Hx, etc.) However, it wasn't very long until I was 'enlightened' when another unit was transferring a patient from a Dialysis Ctr to their N.H. and suddenly had the proverbial 'code from hell.' Awake / oriented / talking to full blown pulseless and apneic.
It took another crew being burned, not to mention the pt and family, but I learned a valuable lesson. Like I've heard it put many times... there is NO SUCH THING as a routine transfer.
1.Dont believe 99% of what you hear and only half of what you see.
2. When instructors offer lessons learned points commit them to memory
3. If I can do full body assessments under fire from AK47s and RPGs you can too while getting your report from the nurse.
4. All US courts have a "No Excuse" policy for medical providers.
i read you story jennifer wouldnt some of the responsibility fall on the hospital? after all they had the patient first? i know we shouldnt take the word of anyone and i guess this is a great example of no one taking the work of even the hosp. this must have been a horrible experience for you. i have been in court many of times as ems capt. thanks for sharing and reminding us that we should never take the word of someone and always do the pt assessment to cover our but.