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So i got a notice today from my department saying that all EMS runs Weather ALS or BLS MUST make a notification. apparently Nassau remsco passed this down because Winthrop was severely backed up for a few days.
any word on this? Because i really don't see the point in making in mandatory they cant force us to divert only suggest.
they tried forcing me today, i told him my pt refused to go to any where else pts drs at winthrop, he came back at me saying they will not accept him blah blah blah i said ok well im gunna try have a good day....
Last edited by kye994 : 01-11-2008 at 12:33 PM.
Reason: unnecasary language
First off regarding the Memo that went out today, READ IT. Its a temp measure to assist in getting YOUR PATIENT proper care. There is an influx of patients and many of the ED's are beyond their capacity. And why do you think we are diverting you.. Medical Control advises you to divert you when a hospital has advised us that they are unable to handle a patient. Explain how even if the patient wants to go their, is it in their best interest??? When that patient codes on your stretcher waiting in Winthrop and you were advised that Mercy is empty, Who does it hurt???
Mr Enginework.. Have you been in Medcom in the past 24 hours? Are you aware of whats going on?? You get on here and call us dicks? Winthrop has been complaining that they are beyond capacity. If they have beds well then they are lying through their teeth to us. The few Ambulances that have brought traumas in have reported that Winthrop is beyond packed. For you to call us Dicks is not only unprofessional but way out of line. If you have an issue feel free to call and speak with one of us. It serves us no purpose to divert you and advise you that they are not accepting patients and steer you another way.
And you should know that the "dicks" that work in medcom are also the AMT's you work with in the street.. So maybe find a different way to deal with things than sitting behind your computer and calling the AMT's names especially when you have no idea what is going on in the county
Under these circumstances it would make sense and would be the right thing to do for your patient - make them aware of the situation.
Like in my town, we have two hospitals that in various parts of our district, or equally the same distance away from one another. One place has a time honored rapport with us that has been built over the years, and for that matter we are treated like gold. The other hospital acts like they are a MASH unit, while tumble weeds blow across the pavilion. The reason for mentioning these two facilities is because the route to one of them is along a major thoroughfare and bridge, that is currently undergoing MAJOR renovation work. Lane directions change at various times of the day, the lanes are as narrow as possible, it may even be easier to take side streets below the bridge in order to avoid the construction, etc. In other words, this anticipated delay is something to consider when making a transport decision, especially if the patient wants to go to the hospital that requires travel via this bridge. Knwoing that they will be at the other hospital a lot quicker ... that is their right, so tell them.
Needless to say, in a case like this (Med Comm/Winthrop) you should exhaust all resources in order to make sure your patient is aware of the situation. However keep in mind that in New York State, if a patient is stable ... they have the RIGHT to pick their hospital.
Obviously medcom can not know the status of a hospital while they are sitting in a box @ NUMC. I think that Nassau Co. should have supervisors like NYC does to go check on hospitals that request diversion. They will be able to determine if the diversion request is proper. And calling Medcom names is not helpful, they are just relaying the info that the hosp has told them. If the ER is lying why blame medcom. Thats like saying if my dog sh*&s on my floor shoot the cat ... WTF.????????
Medical Control does have a good idea whats going on in the ED's. There are EAB supervisors that are routinely in the hospitals, and the 20 or so Police Ambulances routinely report the hospital conditions to Medcom.
This is an obvious problem throughout the County, not just at Winthrop, we have expereinced this at South Nassu and have different problems with Long Beach (staffing), it is far from Med Com's fault and calling them names is TOTALLY un-called for!
Also--please read the memo--it was ADVICE!! -- again this is information you should want to know in order to help make the determination what is right for your patient. I can just imagine the ranting that would be going on here if this information WASN'T disseminated---"we had to wait 45 min for a bed--this is BS, why weren't we told--we were OOS too long--we could have gone to another hospital and been back in service"
The County needs a mandatory diversion policy. As of now, Medcom cannot require anyone to divert, but may only suggest it.
I doubt that Mercy's change in status is responsible for the mess at Winthrop. Most of the patients who come to an ER do so by private vehicle. I wouldn't expect the average person to know that Mercy has lowered their trauma-receiving status.
A mandatory diversion policy would have to have some very strict requirements, otherwise some nurses would have their ER going on diversion every night. It would need to be policed with stiff penalties for it to work properly!
Like the County, City and Village cops out here in Nassau who started off walking a beat in Bed-Stuy ... you have a lot more respect for them, because there is no doubt that they have seen their share of the shit. Same goes for the nurses at the local hospitals - the ones who put their time in at Kings County, Mary Immaulate, Jamaica, etc. These are the nurses who would know when to request a diversion.
Zero beds, dual cardiac arrests, respiratory team is stretched thin between multiple patients, trauma's being made to wait and kept in the hallway ... some nurses call that "Wednesday."
Not having a smoking break in over 45 minutes and the kid doing his ER rotations from VEEB isn't back yet with the Dunkin' Donuts ... others might start to panic.
The original memo was faxed out to all depts after winthrop requested assistance. Medcom and Firecom were notified and were advising ambulances since January 4th when this started. Since its january, the weather warmed up and people became ill, also insurance benefits resume Jan 1st, not only winthrop but most ED's were overcrowded. Winthrop actually asked for help as the hospital couldnt move the patients out fast enough and EMS crews didnt cooperate (as the first posts establish) and continued in.
The notification mandate was done to allow crews to get an update from medcom as to the ED status. This is a no brainer.. why would you want to wait hours to turn ur patient over? Also, Although patients can request transportation to a hospital other than the closest, the EMS crew can REFUSE that request if the patient is not stable or the diversion will negatively impact the EMS system. That is state protocol. If going to winthrop for a pt request will cause you to be out of service for an extended length of time, say no... But explain to the pt the reasoning.
Nassau does not have a diversion policy becasue the docs at remac have been relunctant to approve it. It has come up multiple times. As some of the postings state, hosp staffing or admin problems are not EMS problems, although they do affect us. There is a policy if there is a power failure, flood or some other physical reason than you can be diverted.
The diversion requests from medcom have been requests, but its common sense.... If for some reason, you are "ordered" by medcom to divert (i.e, you are transporting a pt to a hospital for a specialty reason and its the wrong hospital) and the crew refuses, its a violation of protocol and state law....
BTW, a second memo is being faxed out today, advising pt counts are resuming normal levels....
The County needs a mandatory diversion policy. As of now, Medcom cannot require anyone to divert, but may only suggest it.
I doubt that Mercy's change in status is responsible for the mess at Winthrop. Most of the patients who come to an ER do so by private vehicle. I wouldn't expect the average person to know that Mercy has lowered their trauma-receiving status.
Even NYC's Diversion policy is "voluntary" by state law, no ER can refuse a patient. its just a reccomendation.
I also agree with 231X if you have diversion policy some nurses would get like 2 patients in the ER and go on diversion.
Another thing to consider is the NYC effect on these hospitals. In the last 2 years NYC REMSCO has been approving more and more txp's to winthrop,mercy,and st francis hospitals. Plus the NYC overload that Franklin gets. Also with the addition of the "STEMI" protocol in NYC you can pretty much get permission to go to any hospital with a cath lab ie South Nassau. Just another look at things.....
It is not an 'overflow' from the City, nor is a trip into Jamaica from the 5 Towns an 'overflow' from Nassau. NYS protocol allows a stable patient to be taken to the hospital of their choice. NYC is strict about this, Nassau is not as strict. Either way, it is the State - City and County lines aren't the issue we make it out to be. Borough lines in the City only effect the transport of EDP's. Trauma and cardiac criteria, etc. But a stable patient has their right to decide what hospital they want to be taken to. Be it someone from St. Albans wanting to go to Franklin, or someone from New Hyde Park wanting to go to Flushing. If they are stable, it is their right.
When you transport to most hospitals in Nassau, you wait for your patient to be triaged and transfered onto a bed, that they normally bring you. In NYC, you stay with your patient and your partner goes looking for a bed. If you find one, you grab it, make it and move your patient over. It's not a diversion situation, it's the norm and it's accepted. People really need to see "busy" to know why and when a diversion is needed.
In NYC, Telemetry is used for transport and RMA decisions. Notifications are made via the dispatcher or typed into the MDT.
New Medcom rules?
