Would you like to play a game?

[Guest guest]

Okay, let's play a what if game. For starters, this is *not* a real scenario,

*not* based on or around any EMS service or hospital, it's just a

" hypothetical. " Let's see how many violations we can find for COBRA, HIPPA,

EMTALA, etc. and see what makes sense.

Mike

Scenario:

You pick up a patient complaining of acute onset chest pain and tightness with

mild dyspnea (seems to be pain related, no rales, rhonchi or wheezing). All

vitals within acceptable limits for the patient, past medical history includes a

prior MI 6 years ago w/o stent or bypass. You begin transport to the closest

non-divert facility capable of assessing and treating chest pain. You perform

any applicable treatments for your level of care while enroute, obtain a

history, etc.

You call the hospital and give a report for your patient. The hospital asks why

you are coming there, " Don't you know we're full in the ER? " The hospital is

explicitly *not* on divert status of any kind, and the RN on the other end of

the phone is not telling you to go somewhere else, just telling you they are

full, but accepting the patient report.

You arrive at the hospital and unload the patient from the ambulance. Upon your

arrival at the ED, you are advised that there will be at least a 45 minute wait

*just to get a bed* to get the patient off your stretcher. The patient is still

on all of your therapies and you are mointoring those therapies, providing care

in the ED lobby.

1) Your patient begins deteriorating. There are still no beds available and the

ED staff is busy. You monitor and treat the deteriorating condition (could be

anything from turning up the amount of O2 to turning up the rate on an IV to

giving Lidocaine for frequent PVC activity - base it on your level of

capability). Thoughts?

2) Your patient begins deteriorating. There are still no beds available and the

ED staff is busy. You do not treat the condition because the patient is already

in the ED, whether or not they are on your stretcher, and you cannot get the

attention you need from ED staff to help out. What do you do?

3) Your patient does not want to wait. He wishes you to take him to another

hospital. Another hospital is 10 minutes away and has no patients in the ER

(you just know this by ESP). What do you do?

4) Your patient does not want to wait. He wishes to refuse AMA and get off your

stretcher and out of this ED. He wants you to discontinue all your therapies.

What do you do?

5) Your patient does not want to wait, AMA's from your stretcher, proceeds to

the lobby and dials 911 for a new ambulance. What should happen here?

6) Your dispatcher dispatches you to the call in the lobby. You can either be

on the dock at the hospital or already on the street. You choose. What do you

do now?

7) Your patient does not want to wait, AMA's from your stretcher, you clean up

and leave, then get a call for the same patient at a convenience store 1 block

from the hospital. What do you do and where do you go?

8) After the patient AMA's, you give a full report to the ED staff including all

the patient's personal information and history. Is this a HIPPA violation?