Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Drew: There is a ton of literature on this subject. Have you done a pubmed search for bypass/destination determination? Literature, in general, supports the idea of transport directly to facility capable of definitive care in a handful of patient types, including hearts, pedi & trauma. There are some caveats....unable to manage ABC's for the trip, for example, warrants stopping somwhere closer. Search around on here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Good luck, , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee of the Governor's Emergency and Trauma Advisory Council (GETAC) Associate Faculty: Texas A & M Health Science Center (Medical School) Temple College EMS Program TEEX EMS Leadership Academy EMS Consultant and Instructor Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Drew: There is a ton of literature on this subject. Have you done a pubmed search for bypass/destination determination? Literature, in general, supports the idea of transport directly to facility capable of definitive care in a handful of patient types, including hearts, pedi & trauma. There are some caveats....unable to manage ABC's for the trip, for example, warrants stopping somwhere closer. Search around on here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Good luck, , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee of the Governor's Emergency and Trauma Advisory Council (GETAC) Associate Faculty: Texas A & M Health Science Center (Medical School) Temple College EMS Program TEEX EMS Leadership Academy EMS Consultant and Instructor Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 <<Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager>> Unfortunately, usually just for trauma. It leaves the other 80% of EMS calls unanswered in most RAC's. , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee, Govenor's EMS & Trauma Council Adjunct Faculty, TAMU Health Science Center (Medical School) Adjunct Faculty, Temple College EMS Program Re: Closest vs. Most Appropriate Facility Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 <<Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager>> Unfortunately, usually just for trauma. It leaves the other 80% of EMS calls unanswered in most RAC's. , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee, Govenor's EMS & Trauma Council Adjunct Faculty, TAMU Health Science Center (Medical School) Adjunct Faculty, Temple College EMS Program Re: Closest vs. Most Appropriate Facility Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 <<Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager>> Unfortunately, usually just for trauma. It leaves the other 80% of EMS calls unanswered in most RAC's. , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee, Govenor's EMS & Trauma Council Adjunct Faculty, TAMU Health Science Center (Medical School) Adjunct Faculty, Temple College EMS Program Re: Closest vs. Most Appropriate Facility Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 This is a subject addressed by your protocols. You always want to have medical direction in to make a decission not in your protocols. DPEMS500@... wrote: <<Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager>> Unfortunately, usually just for trauma. It leaves the other 80% of EMS calls unanswered in most RAC's. , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee, Govenor's EMS & Trauma Council Adjunct Faculty, TAMU Health Science Center (Medical School) Adjunct Faculty, Temple College EMS Program Re: Closest vs. Most Appropriate Facility Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 This is a subject addressed by your protocols. You always want to have medical direction in to make a decission not in your protocols. DPEMS500@... wrote: <<Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager>> Unfortunately, usually just for trauma. It leaves the other 80% of EMS calls unanswered in most RAC's. , BS, LP Director, & White Pre-Hospital Services www.swphs.org Member, Air Medical Committee, Govenor's EMS & Trauma Council Adjunct Faculty, TAMU Health Science Center (Medical School) Adjunct Faculty, Temple College EMS Program Re: Closest vs. Most Appropriate Facility Have your checked your regional RAC trauma plan? TSA-A addresses this issue in the plan. Kay , RAC A Program Manager Closest vs. Most Appropriate Facility > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 We have three patient categories that are transported to special facilities (frequently bypassing smaller/closer facilities): 1. Critical Trauma patients go to Level I trauma center 2. STEMI patients go to designated cardiac center (cath lab with interventional cardiologist) 3. CVA patients go to designated cardiac center Other patients can go to the closest or patient requested hospital. _____ From: dbohn Sent: Wednesday, April 27, 2005 12:19 AM To: Subject: Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 We have three patient categories that are transported to special facilities (frequently bypassing smaller/closer facilities): 1. Critical Trauma patients go to Level I trauma center 2. STEMI patients go to designated cardiac center (cath lab with interventional cardiologist) 3. CVA patients go to designated cardiac center Other patients can go to the closest or patient requested hospital. _____ From: dbohn Sent: Wednesday, April 27, 2005 12:19 AM To: Subject: Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Why would a CVA patient go to a cardiac center? Might as well take them to a day care center. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Why would a CVA patient go to a cardiac center? Might as well take them to a day care center. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Why would a CVA patient go to a cardiac center? Might as well take them to a day care center. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Only because that's what we call them; these hospitals are capable of providing fibrinolytic therapy for strokes, others are not. john _____ From: Bledsoe Sent: Friday, April 29, 2005 3:07 PM To: Subject: RE: Closest vs. Most Appropriate Facility Why would a CVA patient go to a cardiac center? Might as well take them to a day care center. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) <http://www.EMStock.com)> Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Only because that's what we call them; these hospitals are capable of providing fibrinolytic therapy for strokes, others are not. john _____ From: Bledsoe Sent: Friday, April 29, 2005 3:07 PM To: Subject: RE: Closest vs. Most Appropriate Facility Why would a CVA patient go to a cardiac center? Might as well take them to a day care center. E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) <http://www.EMStock.com)> Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 What does the law say about this? I got into an argument with my LP partner about this subject.He said he would take an adult code to children's medical center if it was the closest facility. (in the scenario, I said that children's and parkland weren't next door, that children's was the closest facility but a regular adult ER was another 5mins down the road). He also said that if we had a burn pt, I said if they had second degree burns to 36% (both legs) if he would go to medical center at Lancaster (our closest facility), or Parkland. I said that the weather was bad or something, no bird available so we would trans. by ground, and he said that he would go to MCAL. We run an MICU, I am a basic and my partner is an LP. I think he is in the wrong, but what does the LAW say? Red Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 Where should stable cardiac patients be taken? It is amazing how often this question comes up for debate. The answer is simple  What is in the best interest of the patient? There is no law. Only the moral law of doing what is right. To answer that question we only need to be the patient. Four years ago I was being transported to San with chest pain by Bulverde/ Spring Branch EMS. They asked me if I wanted to go to North Central ER because it was closer. I emphatically said, ³NO². I wanted to go to a hospital with cardiac cath and open-heart capabilities. So would you and so would any knowledgeable patient. The additional time for me to ³divert² to a cardiac capable hospital was only 9 minutes. That decision probably saved my life. We emergency physicians have all lived through the nightmare of transferring cardiac patients from a hospital with no cath lab to one of the cardiac hospitals. It delays definitive care by at least an hour or more, which places these patients in grave jeopardy (time is muscle) and unduly stresses them with another ambulance ride. Because of the delay these patients often die in our facility or arrest in route. One slightly longer ambulance ride is always better than two separate transports. Even if the patient goes into V-tach in route, paramedics can shock the patient just as well as we can. That is why I have mandated paramedics under my medical control to take all suspect cardiac patients to the closest hospital that has cardiac cath lab facilities. They should only stop at the closest (non-cardiac) hospital if the patient is crashing (malignant arrhythmia, hypotension, airway problems etc). This policy should be obvious to anyone analyzing the situation. Many recent trials have driven this point home. This is the standard of care. This is in the best interest of the patient. This is in the best interest of the ED physicians. And this is certainly in the best interest of EMS to provide patients with their best chance of survival. The only feeble complaint I have ever heard is from one of the non-cardiac hospitals, because they were loosing revenue. That argument should never enter into our decision to do what is right. Larry MD > What does the law say about this? I got into an argument with my LP partner > about this subject.He said he would take an adult code to children's medical > center if it was the closest facility. (in the scenario, I said that > children's and parkland weren't next door, that children's was the closest > facility but a regular adult ER was another 5mins down the road). > > He also said that if we had a burn pt, I said if they had second degree burns > to 36% (both legs) if he would go to medical center at Lancaster (our closest > facility), or Parkland. I said that the weather was bad or something, no bird > available so we would trans. by ground, and he said that he would go to MCAL. > > We run an MICU, I am a basic and my partner is an LP. > > I think he is in the wrong, but what does the LAW say? > > Red > Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 Where should stable cardiac patients be taken? It is amazing how often this question comes up for debate. The answer is simple  What is in the best interest of the patient? There is no law. Only the moral law of doing what is right. To answer that question we only need to be the patient. Four years ago I was being transported to San with chest pain by Bulverde/ Spring Branch EMS. They asked me if I wanted to go to North Central ER because it was closer. I emphatically said, ³NO². I wanted to go to a hospital with cardiac cath and open-heart capabilities. So would you and so would any knowledgeable patient. The additional time for me to ³divert² to a cardiac capable hospital was only 9 minutes. That decision probably saved my life. We emergency physicians have all lived through the nightmare of transferring cardiac patients from a hospital with no cath lab to one of the cardiac hospitals. It delays definitive care by at least an hour or more, which places these patients in grave jeopardy (time is muscle) and unduly stresses them with another ambulance ride. Because of the delay these patients often die in our facility or arrest in route. One slightly longer ambulance ride is always better than two separate transports. Even if the patient goes into V-tach in route, paramedics can shock the patient just as well as we can. That is why I have mandated paramedics under my medical control to take all suspect cardiac patients to the closest hospital that has cardiac cath lab facilities. They should only stop at the closest (non-cardiac) hospital if the patient is crashing (malignant arrhythmia, hypotension, airway problems etc). This policy should be obvious to anyone analyzing the situation. Many recent trials have driven this point home. This is the standard of care. This is in the best interest of the patient. This is in the best interest of the ED physicians. And this is certainly in the best interest of EMS to provide patients with their best chance of survival. The only feeble complaint I have ever heard is from one of the non-cardiac hospitals, because they were loosing revenue. That argument should never enter into our decision to do what is right. Larry MD > What does the law say about this? I got into an argument with my LP partner > about this subject.He said he would take an adult code to children's medical > center if it was the closest facility. (in the scenario, I said that > children's and parkland weren't next door, that children's was the closest > facility but a regular adult ER was another 5mins down the road). > > He also said that if we had a burn pt, I said if they had second degree burns > to 36% (both legs) if he would go to medical center at Lancaster (our closest > facility), or Parkland. I said that the weather was bad or something, no bird > available so we would trans. by ground, and he said that he would go to MCAL. > > We run an MICU, I am a basic and my partner is an LP. > > I think he is in the wrong, but what does the LAW say? > > Red > Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 What about the burn pt. situation? My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 What about the burn pt. situation? My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. Closest vs. Most Appropriate Facility > > > Does any one have any research on Closest vs. Most appropriate facility? > Should patients be transported to the facility more capable of > addressing their illness \ injury even though there is a much closer > facility that will only begin treatment, many times available on the > ambulance, then transfer out to the other facility hours later? If so > what criteria should they meet to justify the bypass? I have my own > opinion but have not seen any studies, thanks in advance. > > Drew Bohn NREMT-P > Operations Training Officer > Orange County Ambulance Service inc. > Orange, Texas > drewbohn@... > dbohn@... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 I guess it will all come down to opinion. I would rather take my child to Texas Childrens in Houston for surgery rather than beaumont. I say that because it really happened to my child. The local hospital didn't know what was wrong with her. Texas Childrens did within an hour. To me experince and proper care is the all the difference. Lee > What about the burn pt. situation? > > My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. > > > Closest vs. Most Appropriate Facility > > > > > > Does any one have any research on Closest vs. Most appropriate facility? > > Should patients be transported to the facility more capable of > > addressing their illness \ injury even though there is a much closer > > facility that will only begin treatment, many times available on the > > ambulance, then transfer out to the other facility hours later? If so > > what criteria should they meet to justify the bypass? I have my own > > opinion but have not seen any studies, thanks in advance. > > > > Drew Bohn NREMT-P > > Operations Training Officer > > Orange County Ambulance Service inc. > > Orange, Texas > > <mailto:drewbohn@o...> drewbohn@o... > > <mailto:dbohn@g...> dbohn@g... > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 I guess it will all come down to opinion. I would rather take my child to Texas Childrens in Houston for surgery rather than beaumont. I say that because it really happened to my child. The local hospital didn't know what was wrong with her. Texas Childrens did within an hour. To me experince and proper care is the all the difference. Lee > What about the burn pt. situation? > > My partner stands his ground about if he was in a court of law, that a lawyer would hang him out to dry for " passing by one ER to go to another ER that I think is better. I'm not a DR and I cant make that decision! " I hate to say it, as it makes all medics who have many years experience look bad, but he's old school....big time. I can go on & on about other things, but this subject and the 12-lead are the ones that most concern me. > > > Closest vs. Most Appropriate Facility > > > > > > Does any one have any research on Closest vs. Most appropriate facility? > > Should patients be transported to the facility more capable of > > addressing their illness \ injury even though there is a much closer > > facility that will only begin treatment, many times available on the > > ambulance, then transfer out to the other facility hours later? If so > > what criteria should they meet to justify the bypass? I have my own > > opinion but have not seen any studies, thanks in advance. > > > > Drew Bohn NREMT-P > > Operations Training Officer > > Orange County Ambulance Service inc. > > Orange, Texas > > <mailto:drewbohn@o...> drewbohn@o... > > <mailto:dbohn@g...> dbohn@g... > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2005 Report Share Posted April 30, 2005 Why would you fly a burn patient? Will it make their burn better? E. Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2005 (http://www.EMStock.com) Re: Closest vs. Most Appropriate Facility What does the law say about this? I got into an argument with my LP partner about this subject.He said he would take an adult code to children's medical center if it was the closest facility. (in the scenario, I said that children's and parkland weren't next door, that children's was the closest facility but a regular adult ER was another 5mins down the road). He also said that if we had a burn pt, I said if they had second degree burns to 36% (both legs) if he would go to medical center at Lancaster (our closest facility), or Parkland. I said that the weather was bad or something, no bird available so we would trans. by ground, and he said that he would go to MCAL. We run an MICU, I am a basic and my partner is an LP. I think he is in the wrong, but what does the LAW say? Red Closest vs. Most Appropriate Facility Does any one have any research on Closest vs. Most appropriate facility? Should patients be transported to the facility more capable of addressing their illness \ injury even though there is a much closer facility that will only begin treatment, many times available on the ambulance, then transfer out to the other facility hours later? If so what criteria should they meet to justify the bypass? I have my own opinion but have not seen any studies, thanks in advance. Drew Bohn NREMT-P Operations Training Officer Orange County Ambulance Service inc. Orange, Texas drewbohn@... dbohn@... Quote Link to comment Share on other sites More sharing options...
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