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"Your former program receives a call from a hospital asking if you could transport a patient by air. You get dispatched to that hospital, go to the bedside, and then discuss the safety issues of going by air with the patient/family. Afterwards, the family or patient tells you they don't want to fly. Do you pack up your equipment and fly home? This would be a time consuming and cost prohibited procedure, and find it highly unlikely that any program operates this way. Not that patients don't occasionally refuse to fly, they do. " Well, this happened to me the other night....I arrived at the bedside with my RN partner. The patient was a 19 y/o/m with an isolated closed R femur fx. His BAC was 127, and he was not splinted. Additionally, he was in A-Fib c RVR, R axis, MF PVC's, PAC's, abberrant conduction delays, etc. Yes, Nineteen years old. (we later discoverd a familial hx of murmor, and we enroute found significant LVH on his cxr) Issues- A} He did not want to fly. Period. B} The referring facility did not know how to apply the Sager splint (nor it's ems squad) properly (I prefer the HARE, but that's another post...) C] They did try to put it on but he became combative. D] His dysrhythmia was "new" to all involved, and they did not know how to manage it, He is now a Medical/Trauma transfer. My partner and I together agreed that if the pt were to fly, he would need to be intubated and venitlated for flight, strictly for crew safety concerns. We (together) assessed his mental status, and although he had etoh on board (the 2mg of ms had long-since worn off) got his "consent" to intubate him for txpt. He was fully aocx3, and understood everything. Pain sobers people. The referring doc was wholly in favor of all of this. In fact, he was refreshingly concerned about our safety over all else. But... Our receiving ER doc would not let us do it, and said put the pt in their ambulance then and send him by ground. The referring town did not have ALS capabilities, and with the dysrhythmia, and a >2hour drive, he warranted it. So... As the medic, I said I would ride in their ambulance all the way back to our facility. My nurse said "We are a team, and I am going with you." We stripped the helicopter of all ALS equipment, vent, drugs, etc, and sent it home empty. When it arrived back home, it was out of service, due to lack of equipment and crew. We then snowed the patient, and proceeded by ground. We had to re-snow x2 more enroute, and made it home by dawn. The bls ambulance got to bill the call and mileage, we got to bill the 100 bucks for supplies. Nobody got to bill the nearly 2 hours of Jet A , 2 engine starts and stops. Rural EMS / Flight Services pose very different challenges. We had to do this, since we were there. We would have been faced with terrible PR issues, Abandonment, etc. if we packed up and went home, and as I posted in a different thread, you call, we fly, regardless of what it is (wx and safety permitting) Tom
Waters
NREMTP / CCEMTP /
Flight Paramedic
Wyoming Medical
Center / Life Flight
Casper, WY
1-800-442-2222
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