Re: [texasems-L]Diversion Notification

January 7, 2006

The liability issue relates to abandonment. As for protecting your patch,

if you protect your patient, the patch takes care of itself.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

In a message dated 1/8/2006 3:37:28 AM Central Standard Time,

micahjackson911@... writes:

Don't forget the liability issue with releasing care to a person less

qualified than you also. That seems to me to be the real issue here with doing

that. Sure it releases you from having to wait. However, if you ever went to

court concerning a patient that was dropped off under those circumstances and

declined, what do you think would happen.

I think that you do what you got to do to protect your patch when it comes

down to it.

salvador capuchino wrote:

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

The liability issue relates to abandonment. As for protecting your patch,

if you protect your patient, the patch takes care of itself.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

In a message dated 1/8/2006 3:37:28 AM Central Standard Time,

micahjackson911@... writes:

Don't forget the liability issue with releasing care to a person less

qualified than you also. That seems to me to be the real issue here with doing

that. Sure it releases you from having to wait. However, if you ever went to

court concerning a patient that was dropped off under those circumstances and

declined, what do you think would happen.

I think that you do what you got to do to protect your patch when it comes

down to it.

salvador capuchino wrote:

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

Don't forget the liability issue with releasing care to a person less qualified

than you also. That seems to me to be the real issue here with doing that.

Sure it releases you from having to wait. However, if you ever went to court

concerning a patient that was dropped off under those circumstances and

declined, what do you think would happen.

I think that you do what you got to do to protect your patch when it comes

down to it.

salvador capuchino wrote:

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

Don't forget the liability issue with releasing care to a person less qualified

than you also. That seems to me to be the real issue here with doing that.

Sure it releases you from having to wait. However, if you ever went to court

concerning a patient that was dropped off under those circumstances and

declined, what do you think would happen.

I think that you do what you got to do to protect your patch when it comes

down to it.

salvador capuchino wrote:

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 7, 2006

Don't forget the liability issue with releasing care to a person less qualified

than you also. That seems to me to be the real issue here with doing that.

Sure it releases you from having to wait. However, if you ever went to court

concerning a patient that was dropped off under those circumstances and

declined, what do you think would happen.

I think that you do what you got to do to protect your patch when it comes

down to it.

salvador capuchino wrote:

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 8, 2006

salvador capuchino wrote: But these CNAs are hired by

the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

I was under the impression that the CNAs were hospital staff; thank you for

clarifying that. It seems, then, that the ambulance service is willing to aid

and abet patient abandonment, in fact facilitating that by hiring the CNAs! That

makes communication between a hospital RN and a non-hospital CNA; even poorer

than normal.

Unless the ambulance service is under the impression that the transfer of care

is to a person of equal training.... the phrase " warm body " comes to mind.

" The true soldier fights not because he hates what is in front of him, but

because he loves what is behind him. " - GK Chesterton

---------------------------------

Yahoo! Photos – Showcase holiday pictures in hardcover

Photo Books. You design it and we’ll bind it!

January 8, 2006

salvador capuchino wrote: But these CNAs are hired by

the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

I was under the impression that the CNAs were hospital staff; thank you for

clarifying that. It seems, then, that the ambulance service is willing to aid

and abet patient abandonment, in fact facilitating that by hiring the CNAs! That

makes communication between a hospital RN and a non-hospital CNA; even poorer

than normal.

Unless the ambulance service is under the impression that the transfer of care

is to a person of equal training.... the phrase " warm body " comes to mind.

" The true soldier fights not because he hates what is in front of him, but

because he loves what is behind him. " - GK Chesterton

---------------------------------

Yahoo! Photos – Showcase holiday pictures in hardcover

Photo Books. You design it and we’ll bind it!

January 8, 2006

This sure sounds like abandonment to me, plain and simple.

Tater

salvador capuchino wrote:

But these CNAs are hired by the ambulance company to

relieve medics at the hospital when they are going to

hold the medics for a long time.

Salvador Capuchino Jr

EMT-Paramedic

--- Larry wrote:

> salvador capuchino wrote:

> " ...In other words the medics gave report and a copy

> of the run report to the CNA and left with another

> stretcher and got back in service. Meanwhile the

> CNAs stayed with the patient on the EMS stretcher

> till the hospital had a bed available. The nurse

> then only had the run report and the CNA to get a

> report from.... "

> Oh can I see a big problem with that one. As the

> RN is in charge of the CNA, I would have chased down

> the RN and made them aware of the patient. That

> solves tem playing 20 questions with the CNA later

> (note: There are good, conscienous CNAs, but that is

> too much of a liabiity, in my mind, not only for the

> ambulance service, but the hospital as well.)

>

> " The true soldier fights not because he hates what

> is in front of him, but because he loves what is

> behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos

> Got holiday prints? See all the ways to get quality

> prints in your hands ASAP.

>

> [Non-text portions of this message have been

> removed]

>

January 8, 2006

In a message dated 08-Jan-06 10:57:57 Central Standard Time,

scapuchino@... writes:

I agree, but I believe the service is operating under

the assumption that the patient is the hospital's

responsibility once he/she is on their property.

While this may be true, it does not absolve the delivering service from

giving an appropriate report....and some how I doubt that the courts would

agree

that a second hand report from a CNA would qualify as 'appropriate'...

I know that if I was called as an expert witness on a case involving

something missed because of a change over like that, I'd have to see some

pretty

impressive documentation and deposition work by both the paramedic and the CNA

involved before I'd agree that it was an appropriate report. It's bad enough

that we don't even get a faint copy of a trip report any more...

ck

S. Krin, DO FAAFP

January 8, 2006

ARGH!

This is one of the most common frustrations I have. You do NOT have

to transfer care to someone of " equal training. " You have to transfer

care to someone able to take care of the patient. In this case if the

patients are stable and the CNA is capable of recognizing " oh, this

guy looks worse " and call the RN for the ER they're ALREADY IN, that

seems legit. Now, I'd be worried as the ER admin that I'm liable for

the care provided (or not provided) by these CNA's due to EMTALA and

the fact that the patient has presented to my ER. In many cases if

the ER is full and making you wait, dropping the patient with the

triage nurse works wonders. One or two ALS patients dropped in

triage, IV's, reports and all will change things...

Anyhow, if my MICU rolls up on a major accident and calls for mutual

aid, and a BLS truck arrives, I can transfer a patient that only needs

BLS interventions from the care of me or my partner, a paramedic, to

the BLS crew. That's not abandonment. In some cases, it's probably

not abandonment even if they DO need ALS care, if someone else needs

it MORE - in that case, you're just handing them off for transport.

Abandonment means leaving the patient without the ability to get care.

It does not mean ensuring the provider you leave them with can

perform every skill you can, else many RN's wouldn't be able to take

patients from medics who can administer paralytics and perform

intubations...

</rant>

Mike :/

> salvador capuchino wrote: But these CNAs are hired by

the ambulance company to

> relieve medics at the hospital when they are going to

> hold the medics for a long time.

> I was under the impression that the CNAs were hospital staff; thank you for

clarifying that. It seems, then, that the ambulance service is willing to aid

and abet patient abandonment, in fact facilitating that by hiring the CNAs! That

makes communication between a hospital RN and a non-hospital CNA; even poorer

than normal.

>

> Unless the ambulance service is under the impression that the transfer of

care is to a person of equal training.... the phrase " warm body " comes to mind.

>

> " The true soldier fights not because he hates what is in front of him, but

because he loves what is behind him. " - GK Chesterton

>

> ---------------------------------

> Yahoo! Photos – Showcase holiday pictures in hardcover

> Photo Books. You design it and we'll bind it!

>

January 8, 2006