Insurance / Scenario

[Ken Lawson-Williams <Macgyver@FlightMedicMail.com>]

Ted:

Please let me know offline what you find out. Practice in NWT and extremely often am out of my area. OPA insurance only covers Ontario MOH paramedics, NAEMT insurance unavailable in Canada, BAEMT insurance only covers in UK, so far unable to find individual insurance coverage.... agents all claim that employer MUST cover employees while at work and no additional coverage needed.

Real "Grey Zone". Medical Director assures us that as long as within protocol, company insurance covers us, but never the same as having additional own insurance to provide own lawyer if necessary to look out for your interests, not the companies.

Scenario: Transport a pre-booked patient to a facility in another province for CT with radioactive dye. Facility refuses to recieve report or assume care as patient is not from their hospital, ony an outpatient for tests. Requires that you remain with patient and continue care in waiting room (up to 3 hours past scheduled time common), CT suite, recovery area etc. Note that this is not a professional request of the flight team to see if we can assist recieving, but a demand that we stay at their side throughout (else abandonment as they have not accepted patient).
   (1) Have limited ammount of portable O2, battery life etc
   (2) Ferno #9 on EMS cot is not comfortable or very safe (no side rails or brakes and tall/tippy) 
   (3) Administrering any form of x-ray is out of scope
   (4) Administrering any form of radioactive dye is out of scope
   (5) Company has no protocol for either proceedure
   (6 Root cause is diagnostic suite has no RN on staff to recieve report, and hospital does not want to send one from ER or wherever to babysit the patient and receive report. IE: staffing issues at tertiary centre.

Questions:
   (a) If patient codes, and we start our protocols, and facility doc's arrive and want to use different protocols, do we have to release care (to the typical hospital "cluster code" with multi students/residents etc)? Is doing so under those conditions (rushed, critical info only transferred, ie: not full report) appropriate?
   (b) What are the list's feelings on advising staff on arrival that if no report given and no transfer of care performed, will advise sending MD and our Medical director/boss etc. that they had refused to accept care and since tests are not in our scope (to perform or accept charting responsibility for) we are returning to sending facility immediately?
   (c) Supervisor's opinion that once on hospital property, hospital patient (legally) no matter what unit clerks/unit nursing supervisors or hospital policy might say. IE: if patient had flown commercial / taken a taxi to the facility and they walked in under own power and processed through outpatients, hospital would have care of patient. Since pre-test patient is stable enough to be unatteded (no IV or O2 or ECG clinically required, just applied for transport and the return), method of delivery to outpatient door should be irrelevant to how admissions treats them?

Fly Safe. 
Ken L-W CCEMT-P/WMT

"If in the last few years you haven't discarded a major opinion or 
acquired a new one, check your pulse. You may be dead."
- Gelett Burgess

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