In a message dated 01-Oct-02 18:06:17 Eastern Daylight Time, tom@tomwaters.net writes:
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.
Was this physician your medical director? If not, I think this would have been the time to get the medical director involved. It is pretty clear to me that this physician probably did not have a good handle on the system issues involved. Money being a secondary (but important) issue, the ground transport took two systems (yours and the ground ambulance's) to a lower level or completely out of service for two hours. That is a significant disservice to the region. There may also have been issues about whether the RN had any legal standing as a healthcare provider in a ground ambulance. (Depends on your state EMS and Nursing laws) The referring physician and hospital also had an expectation which was not fulfilled. This may color future interactions unless you provide a significant amount of education to explain the decision making process (my doc said "no" is just not good enough). Finally, did you consider asking the referring physician to intubate the patient? Then it would have been a fait accompli and you could have kept the patient sedated and flown back.
Be sure this trip is reviewed by the medical direction and the management so that the craziness can be averted in the future.
Dave Thomson
David P. Thomson, MS, MD, FACEP
Associate Professor
Director, Transport Medicine
Medical Director, Telemedicine
Department of Emergency Medicine
Upstate Medical University
Syracuse, NY 13210
315.464.6219 (voice)
315.464.6220 (fax)
