Fly or No Fly

[Guest guest]

Here is a situation that occured several weeks ago with a family member.

You have a 38 y/o female who is c/o chest pain to the center of the chest

with pressure in addition to the pain. They go to one of the local ER's

that does not handle anything over a stumped toe. They do the typical

cardiac work up, 12 lead, etc. Lab showed only a slight elevation in Trop

maybe .4, not change in 12 lead that should indicate any MI. I'm called by

another family member about this entire situation. I speak with the nurse

who says that she is going to Abilene since she is cardiac...WRONG. I

instruct the nurse that she is to be taken to either Baylor All Saints in

Ft. Worth, Providence or Hillcrest in Waco. I provide names of the

cardiologist that I have worked with at all three locations. The nurse

tells me that she will work on getting a place. After get off the phone,

the nurse then ask the pt what she wants, and is told by the nurse that she

is to do what I have told them.

As I'm returning back to the city from Dallas, I called the hospital back

and they have secured Baylor Ft. Worth. I had ask the nurse to let me know

before they left the ER. No call. When I arrive, I find out that the doc

in the box has decided to fly her out instead of going by ground. I

question the nurse, and ask if there was a change in the pts condition, and

I'm told no. Why are you flying her out then? Because the doc wanted it

done. Great no prior consent from me, as the family thought that I

knew...WRONG. I tell the ER nurse that this is a waste of air medical

services for someone with no major status change.

I'm in luck, the crew is still on the ground, so I make contact with them

and find out that there is no change, and they again that it could have been

sent by ground. As I told the crew, I could have got an ambulance from

either place where I work and it would not have cost them anything. I came

within a hair of pulling them off the bird and ground pounding it to Ft.

Worth.

To make long story short, a cath was done and no blockage was found of any

kind. Maybe a muscle spasm that cause Trop to become elevated to a 4.5, but

no heart damage.

So, is this unnecessary use of air medical transport or not? Should the doc

be billed for this? To me, the pt was stable enough to go by ground and

would have saved $7,000.

--

Wayne Dennis, EMTP

EMS & Clinical Supervisor

Life Care Plus EMS

Member, Injury Prevention - GETAC