My ground EMS employer is implementing a policy that will not allow crews to leave a patient in the ER with any of the following pieces of equipment in place:
The policy is designed to prevent our reusable medical equipment from being lost/destroyed. There are only two exceptions covered in the policy, otherwise our crews are expected to retrieve the equipment before leaving the hospital. One exception would be if we are in overload and need to get back in service immediately. The only other exception is we can leave a traction splint on a patient going to surgery. Otherwise, we are required to retrieve our equipment from the Pt prior to leaving the ER.
Has anyone experienced such a policy?
How do most systems handle equipment that is left with a patient at the hospital?
Would your hospitals be open to removing equipment earlier in the course of care than what they currently do?
This was put out recently without going to our EMS advisory board and I am looking at bringing up at our next meeting. My opinion is that this policy is inappropriate and places undue risk on patients and EMS providers. I can foresee an issue arising between ER staff and our Paramedics when they tell them they have to remove our splint so we can leave? I have routinely transported multi trauma patients with vacuum splints in place that are not removed prior to them going to the OR and I don't want to be the first person to ask a trauma team to remove my splint so I can leave.
Here is the policy with all reference to my employer removed.
To establish guidelines to follow regarding EMS equipment left at a hospital.
A. The following equipment shall not be left at a hospital; if possible:
1. Pedi Immobilizer
2. XP1 (KED)
3. Vacuum Splints
4. Sager Traction Splint
B. In the event of ambulance overload contact the EMS Officer to advise of equipment at the hospital so that your unit can return to service as soon as possible.
Advise the hospital personnel that you need to get back in service and give them your unit contact information, along with EMS Officer's contract information.
THE SAGER TRACTION SPLINT IS THE ONLY ITEM THAT CAN BE LEFT AT THE HOSPITAL WHILE NOT IN AMBULANCE OVERLOAD. THE ONLY CONDITION THAT THIS CAN HAPPEN IS IF THE PATIENT IS GOING TO SURGERY WITH THE SPLINT.
C. Each time an EMS crew transports to a hospital they should check in the designated area at that ER for EMS equipment and return it to their station.
D. Anytime equipment is picked up from a hospital, the paramedic in charge needs to contact all EMS Officers, along with all personnel that are assigned to that station by email and advise what was picked up.
E. All equipment picked up should be cleaned prior to returning it to service.
F. If something has to be left at the hospital, send an e-mail to all paramedics and EMS Officers stating where the equipment was left, contact information with which the equipment was left with and an incident number.
G. The EMS Officer should make every opportunity to retrieve the equipment from the hospital within 24 hours.
Seems straight forward although emails to everyone seems a bit excessive especially if you go on holiday and come back to 900 traction splints left at the hospital emails.
This is a situation for the agency to discuss with the hospital and where possible many hospitals here set aside a storage cupboard for ems restocking and equipment and a supply of equipment. The cupboard is normally covered with a combination lock. Drop someone with a splint off, pick a new splint up out of the cupboard and go back in service. I guess its different for us as in the UK we're one health service it all balances out in the end.
I think that equipment recovery is a task for admin/non frontline staff such as supervisors ect. Technology as it is, equipment can be asset tagged including a GPS platform to track the location of the asset. if an agency wanted to it could locate all of its equipment fairly quickly.
Bottom line, patient care comes first, asset management later and by staff appointed to that role, not shoe horning it into the paramedic's responsibility.
I dont know, if it doesnt cause patient or agency harm to have you wait for the equipment I dont see the problem. I think emailing EVERYONE is a bet excessive but if EVERYONE in your agency means two people then thats different... The policy says if you're in "overload" then you can leave it so that avoids harming other patients. What dont you like about the policy?
We have no policy prohibiting leaving equipment at the hospital. When something is left, the crew writes a note to me (EMS captain) on a white board for that purpose, and either I or other crew members who will be in the area of that hospital track it down later. For us, the problems with waiting around for the equipment would be two: 1) we are volunteers, so people may have to leave for all sorts of unrelated issues involving other jobs, child care, meetings, fundraisers, lack of sleep,etc
2) As I write this, I am missing a KED (the only thing that ever seems to REALLY go missing for any length of time). How this happens is that we often transport to a rural critical access hospital, then they fly the patient to a trauma center if needed. Typical for patients requiring a KED, right? You think you are immobilizing them as a precaution, and by definition they are stable or they would be a rapid rollout. They do not necessarily meet criteria for being flown from the scene. The hospital is not going to take them off the KED to fly them. Now your KED is MUCH farther away from home, and it may be awhile before anyone goes there in the normal course of events who can pick it up. For reasons unclear to me, our trauma center Fedexes backboards home to the volleys, but KEDS languish for months (lifetimes?) in an overfilled equipment room.
So, not sure such a policy would work for us although it seems to be a good idea.
All in all I think your employer is overreacting to a minor problem, Im not sure how many KED's, sagers, and vac splints you use in your service, nor how many of those end up missing but asking you to deliver the patient to the ER and strip off the immobilization is inappropriate at the best, and potentially liability laden at the worst. IF you show up to the ER and take a KED off a patient, without the doctor clearing them, you and your service could be held liable for further injury. In a court of law the patient's lawyers would call an 'expert' paramedic to the stand and ask him or her if that is something that is routine standard of care and we would have to say no, they would also ask if removing equipment like that places the patient at risk for further injury and I would have to say "yes." You may want to ask an EMS lawyer/ firm what their take is on it, just say'n
Our only policy is add the equipment to the whiteboard list and make sure you are restocked from the extra supply closet. The three main hospitals we transport to all have equipment return areas and we seldom have problems getting things back
May I suggest a meeting with hospital staff if there are issues? Also it never hurts to label everything with marker or stickers- including a phone number especially if you work with helicopters.
The hospitals might have a difficult time with that. I hope that your bosses talked with them before issuing such a policy. I can see some difficulty with removing spinal immobilization equipment from somebody before they have been examined and "cleared," one way or the other, by physical exam or by radiograph.
I hate when the bosses put the medics in the middle of these things - like issuing such a policy and leaving the medics to feel the wrath of the hospital staff.