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Response Mode For Patient Pick Up


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#1 fpc218

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Posted 06 September 2007 - 08:20 PM

I'm in the process of writing a policy on the use of lights sirens while responding to a facility to pick up a patient. I'm looking mainly at ED and ICU pickups. I'm interested seeing some policies from other ground CCT services.

If possible, I would like an electronic copy of a policy. I have my opinions on the use of code 3 responses. I don't think they are not needed very often. I'm not looking for additional opinions, just facts on what other services are doing.

Thanks in advance for the information.


Steve Pack RN, BA, NREMT-P, CEN
Flight Nurse
Medflight of East KY
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#2 lems1169

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Posted 09 September 2007 - 03:01 PM

I'm in the process of writing a policy on the use of lights sirens while responding to a facility to pick up a patient. I'm looking mainly at ED and ICU pickups. I'm interested seeing some policies from other ground CCT services.

If possible, I would like an electronic copy of a policy. I have my opinions on the use of code 3 responses. I don't think they are not needed very often. I'm not looking for additional opinions, just facts on what other services are doing.

Thanks in advance for the information.
Steve Pack RN, BA, NREMT-P, CEN
Flight Nurse
Medflight of East KY



hi Steve

our policy is not available electronically but here it is

what ever the condition of the patient is it's always without lights-sirens. the return trip is up to the staff ''in the box'' to decide. The reason(at least one of 'em) for it is that the patient is in a better environment than the back of a truck.

Hope that helps.
Good luck
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Serge LeMay

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#3 BrianACNP

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Posted 09 September 2007 - 08:38 PM

hi Steve

our policy is not available electronically but here it is

what ever the condition of the patient is it's always without lights-sirens. the return trip is up to the staff ''in the box'' to decide. The reason(at least one of 'em) for it is that the patient is in a better environment than the back of a truck.

Hope that helps.
Good luck


Not always!! Depends on the environment you're picking them up from.



Brian
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#4 lems1169

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Posted 09 September 2007 - 11:05 PM

Not always!! Depends on the environment you're picking them up from.
Brian



I agree with you Brian as far as the states are concern, but my practice is in Canada (Quebec to be precise), and is a little different here. Our transfers originate from the ED and ICU's. The ones that come in from the local community centers don't get classified as transfers, there considered scene calls.

Hope that sheds some lights!?!
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Serge LeMay

''When dealing with citizens, if it felt good saying it, it was wrong.''

#5 BrianACNP

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Posted 10 September 2007 - 12:42 AM

I agree with you Brian as far as the states are concern, but my practice is in Canada (Quebec to be precise), and is a little different here. Our transfers originate from the ED and ICU's. The ones that come in from the local community centers don't get classified as transfers, there considered scene calls.

Hope that sheds some lights!?!


Sure....that makes sense for your locale. I guess, too, I see emergent transfers as ones where the transferring facility is unable to provide the required definitive management, and the problem is time dependent, for example: leaking thoracic aneurysm. Helicopters aren't always available to move those patients, especially when the weather is a factor (not that it is these days in the southeast).

Brian
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#6 JPatterson

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Posted 21 September 2007 - 07:41 PM

I also do not have an electronic policy for my service because we use staff discretion on these issues. The way that we minimize hot responses is by having every transport reviewed (as part of our QA/CQI program) to ensure that the documentation from the staff clearly shows a need. If you respond "hot" either way, you have to show that the patient was unstable at the time of request or was being transported directly to the Cath lab, OR, or Angio department for urgent intervention that can not be provided at the outside facility or en-route. If QA shows improper use of Code 3, the staff members involved are counseled by the Chief Transport RN. If frequent abuse is found then diciplinary action is taken. We also utilize the Road Safety driving system that records all transports and flags any code 3 runs for further QA. Since implementing this "policy," our code 3 responses have dropped dramatically and the documentation has improved especially on those runs that require a hot response.
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Jeff Patterson NREMT-P

#7 vamedic

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Posted 11 October 2007 - 06:43 AM

I am part of a PEDs / Neo transport team, and like everyone else, I do not have an electronic polcy available, but typically our pts come from refering ER and peds units. We generally only run code 3 TO a call if it was supposed to be a flight, but got dropped, or the pt sounds very unstable. out of 250 transports last month, we probably ran 5-10 hot
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#8 get in the choppa

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Posted 15 October 2007 - 06:30 AM

I work(ed) in a really rural area where we would drive hours from our station to pick up, then hours to the receiving facility which is usually a very small hospital. We go code 3 in on physician request, which happens about 1 every 8-10 calls. Transport priority is solely up to the crew. The code 3 call volume during the summer is low, and a big high during the winter seasons, due to the weather. The local flight companies are not IFR rated, and they don't fly in bad weather.
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#9 ParaMike

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Posted 14 November 2007 - 02:27 PM

The CCT service where I worked prior to moving into the ED our policy was non-emergency unless there were circumstances that REALLY warranted 10-33 traffic to the facility (Unstable pt with no air coverage, etc.) and even then it was left up to the crew and the supervisor on duty to agree. We also considered small outlying hospitals without CT or Cath services as scene calls as well therefore warranting 33 traffic if the patientís condition was unstable. On average, we would only respond emergency traffic on less than 5% of ER/ICU calls, and most of those were due to lack of air assets.
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#10 MSDeltaFlt

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Posted 07 December 2007 - 07:59 PM

I guess it would depend on the amount of information you receive prior to dispatch. If the pt's condition is time sensitive, then, yes, CODE 3 all the way. If not, then nice and easy. Remember, they're calling you for a reason.
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#11 CalRN

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Posted 19 February 2009 - 01:32 AM

Can anyone refer me to good research/policies regarding code three use after patient pickup? Where I currently work code three is ultimately up to the CCT RN (and in conjunction with the sending/receiving providers, on occasion). What I am looking for is empirical and research-driven responses surrounding the risks associated with going code three r/t the risks associated with not. I believe that Pitt did a study on EMS code three response/transport, but I would like to understand how that relates to ground CCT. Any feedback is appreciated!
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#12 medicerik

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Posted 19 February 2009 - 01:50 AM

I would also take a look at your state EMS laws to see what is prescribed. In Maryland, title 30 subseciton 9 actually puts some vague restrictions on when lights and sirens can be used by a commercial service. Maryland considers all non 911 ambulances to be commercial service.

Erik
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Erik Glassman, BS, CCEMT-P, FP-C, EMT-T

#13 JLP

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Posted 19 February 2009 - 03:52 AM

We are also Canadian, but it is different here than Quebec. We are under the same RLS rules as a 911 ambulance, and we go RLS if the patient is considered highly unstable. And yes, I agree - "safer where they are" depends on the specific sending hospital.
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#14 HeloRT

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Posted 20 February 2009 - 10:25 PM

We run a Helo/FW/Ground program. Going Code-3 is rare. Usually only if the patient is unstable and not responding to therapy. The last time I ran code was when I did a transport with my medical director and he had our driver do so (I wouldn't have). NTSB does not follow ambulance accidents, however some data does exsist in the Fatality Analysis Reporting System (FARS). In July-Sept 2001 issue of Pre Hosp Emerg Care, a paper of 1987 - 1997 data showed 339 ambulance accidents with 838 injuries and 405 fatalities. 60% of crashes and 55% fatalities were during "emergency operations". The link to the paper is: http://www.ncbi.nlm....0?dopt=Abstract
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#15 buffettrn

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Posted 13 February 2010 - 07:47 PM

I work primarily as on Peds/Neo Team. The ONLY time we respond lights and signs to a referring center is for a patient requiring Nitric Oxide therapy. If they are sick enough for lights and sirens consider flying, if it is to short to fly are you really saving that much time. (Statics say you only save what 10% of time) Coming home it is up to the crew and requires something that can not be done in the back of the truck.
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#16 skimedic5

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Posted 06 August 2010 - 06:06 PM

Our catchment area contains 12 other hospitals which are as close as 6 miles to us and as far as 60 miles. We only consider helicopter use for the furthest hospitals. Our lights/sirens process is that if the patient presents with a life or limb threatening condition that is time critical then lights/siren is appropriate. A very sick patient on a balloon pump coming to our cardiac care unit, without the intention of an emergent procedure is not time critical. A STEMI patient or severe trauma patient is.

We use similar guidelines for ground vs. air determination. We have a good ground system, transporting about 4,500 patients per year. There is little need for helicopter use for interhospital calls as we even base some ambulances in the vacinity of the hospitals which are furthest from us. Air generally does not save us any time even for the hospitals 50-60 miles away.
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#17 Macgyver

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Posted 06 August 2010 - 07:39 PM

I agree with you Brian as far as the states are concern, but my practice is in Canada (Quebec to be precise), and is a little different here. Our transfers originate from the ED and ICU's. The ones that come in from the local community centers don't get classified as transfers, there considered scene calls.

Hope that sheds some lights!?!



Gotta love those "scene calls with walls" - but they happen in the US as well. Probably 20% of the IFT's I do are in a less well taken care of situation where we are getting them from than with us...
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Ken BHSc, RN, REMT-P

#18 Macgyver

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Posted 06 August 2010 - 07:41 PM

We go code 3 in on physician request, which happens about 1 every 8-10 calls. Transport priority is solely up to the crew.


Key points
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Ken BHSc, RN, REMT-P

#19 lems1169

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Posted 16 August 2010 - 03:35 PM

Key points


The problem is when the MD asks for an urgent/emergent transport but actually it a BS/dumping call.

Lots of it from a particular health centre/MD (call her Dr. transfer :angry: )

lots of credibility loss. Return is also the crew's choice sometimes /w consult /w the RN.
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Serge LeMay

''When dealing with citizens, if it felt good saying it, it was wrong.''

#20 Human External Cargo

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Posted 17 August 2010 - 09:58 PM

The problem is when the MD asks for an urgent/emergent transport but actually it a BS/dumping call.

Lots of it from a particular health centre/MD (call her Dr. transfer :angry: )

lots of credibility loss. Return is also the crew's choice sometimes /w consult /w the RN.


I don't quite understand this "consult with the RN" regarding mode of transport thing........

If the patient's clinical presentation and expected tertiary care intervention warrant it, a safe Code 3 response is completely reasonable both to and from the sending facility (you don't need to be going fast and crazy here, just moving safely and efficiently through traffic). Why you would consult with an in-hospital professional (e.g. a Physician, RN, RT, or whomever) regarding a pre-hospital professional's work environment is beyond me. Your patient, your transport, your liability. Regardless of who has ordered the transport, I personally call ahead to the sending facility, receive a detailed report, suggest treatment plans prior to our arrival, and then deliver the most efficient and safe response that I can.

All input provided by the other allied health care professionals is weighed in my decision making process but at the end of the day, it is my CCP partner and I that make the call in the best interests of patient care and safety.
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