EMS asks injured passenger which hospital she would like to go.?

Question

Car (after being hit by another car) was totalled after hitting head on with a tree, EMS arrived and treated passengers, describing one as pale and sweating. As they were preparing for the trip to the hospital, the EMS personel asks the injured which hospital to go. Injured responded, "the closest one is better, right?" And they went to the emergency room of closest one. Once there, after 4.5 hours, the pale, sweating passenger needed to be transported to a trauma center which was 30 minutes away. At the trauma center, passenger dies from multiple blunt trauma.

Now, at the scene of the accident where the car was totalled, shouldn't the EMS know to transport the "pale, sweating" passenger to a trauma center that is equiped to handle these types of injuries, instread of wasting away in the hallway on a stretcher of an emergency room waiting to be treated?

Answer 1

Both the EMS and the receiving hospital blew this one. The ER has a responsibility to triage and access the injuries of all arriving patients. They shouldn't have let this patient was 4+ hours and then transport to trauma. They should have recognized right away they were over their heads. Hire a good lawyer.

Answer 2

Hmmm....this is a good question. I've been a paramedic for a little over a year now, and I've had that question come up before.

Ultimately, the patient decides where to go...if the patient wants to be transported to podunk ER, and as long as he's alert/oriented and legally able to make the decision, then podunk ER is where he goes. When I've got a patient who wants to go to podunk ER and I think he needs to go to the trauma center, then I will try to talk him into it, but it's the patient's decision.

While "pale and sweating" is indeed a symptom of shock, it can also be a symptom of the patient being scared...and in a wreck, most patients are somewhat pale and sweaty at first.
Cars total fairly easily, and a "totaled" car isn't necessarily a reason to transport to a trauma center. You also have to take into account the patient's injuries, and exactly how the car was damaged. Was it a rollover, was there passenger compartment intrusion? Was the patient wearing her seatbelt? What were her vital signs? It's completely possible that at the time, she didn't have any other symptoms, and the medics thought that the regular ER would be just fine.

Despite the fact that the trauma center is the best place for a seriously injured patient to go, there's no reason why podunk ER had to put the patient on a stretcher for 4 and 1/2 hours while awaiting treatment. A regular ER is fully equipped to deal with trauma, stabilize the patient, and transport the patient via helicopter to a trauma center if need be. Just because the podunk ER isn't designated a "trauma center" doesn't make them any less able to stabilize an MVA that rolls in the door. The reason a trauma center is called that is because of the fact that they have surgeons standing by 24 hours a day...a regular ER is still equipped to diagnose and stabilize most major trauma.

Where I'm from, we have the ultimate podunk ER, but the trauma center was too far away to take a major trauma patient. The patient would be transported to the ER, stabilized, and flown the 30 minutes to the big-city ER.

As long as the medic gave a decent report to the ER, then it's up to them to treat the patient appropriately. It's not the medic's fault that the patient was triaged to wait in the hallway for nearly 5 hours; that fault lies with the ER staff. They obviously didn't recognize the seriousness of the patient's injuries, and react appropriately. If the ER staff thought the patient was in need of a trauma center, they could have the patient there via helicopter within 30 minutes, easily, and that's what they should have done.

You also have to take into account that EMT's vary in their training and scope of practice...there's a world of difference between a volunteer EMT-Basic (who can't start IV's or give most medications) and a paid, professional EMT-Paramedic who can do all of that. I can understand if an EMT-Basic is uncomfortable transporting a trauma patient 30 minutes to the trauma center...the patient in that case, does need to go to the nearest ER, where she can be stabilized and then transported to the trauma center. I can even understand the paramedic not wanting to take the critical patient to the trauma center 30 minutes away, when there's a local ER just a few minutes away. While paramedics can stabilize most injuries, they aren't doctors, and the patient needs a doctor, even if it's at a smaller ER.

Hope this helps...

Answer 3

EMS dont always know if a hospital emergency is backed up. In America they sometimes ask people which hospital they would prefer to go to because different different insurance funds cover different hospitals & the patient may not want to pay the gap or fee.
If a person was left in a hospital waiting room or corridor & died that is the fault of the hospital (& the system in general). Patients should be assessed by a triage nurse immediately upon arrival & then be treated in order of how badly injured or ill they are.
A pale & sweaty patient from an MVA is probably suffering from shock which could be caused by an internal haemorrhage so they would need an X-ray & ultrasound ASAP to assess if they had a bleed & how bad it was.
The EMS were right to transport the patient to the nearest hospital regardless of whether it was a trauma centre or not because all emergency medical units whether they are ERs or trauma units or military field medical units are all equipped to deal with most kinds of trauma casualties.
So I would say the hospitals were at fault because thy didnt treat the casualty fast enough. If the casualty had been treated at the 1st hospital they very possibly would have survived because they survived for more than 4.5 hours without treatment anyway. Sounds like the hospital screwed up to me.
Often it can be very difficult to diagnose internal injuries. Sometimes even extremely severe internal injuries do not present with symptoms that show how severe the injuries really are.

Answer 4

I've been an EMT for the past six years in Eastern KY, so I'm no stranger to car wrecks and trauma centers. Something that wasn't taken into account is that the ambulance crew asked which hospital the patient would like to be transported to, not specifying the trauma center. The situation could be that there isn't a hospital in their county, but they're surrounded by two or three local ER's. Transport would be required to one of these hospitals first for stabilization of the patient, which all ER's are equipped to handle. The patient in this situation sounds like she was alert and oriented at the scene, since she was able to choose which hospital she wanted to go to. Had the wreck been very serious, the correct choice would've been to fly the patient from the scene to the trauma center. If the patient was fine when the ambulance arrived at the hospital, then the medical staff there would be at fault because EMS did what was required of them to do.

Answer 5

Being pale and sweaty are not the only signs that the EMS assessed upon arrival at the accident scene. Airway (breathing), circulation (pulse) were also assessed - perhaps these were within normal limits. While EMS is trained to respond to emergencies, they are not diagnosticians - their job is to stabilize a patient, save lives emergently through certain measures. Depending on the location of the accident (for instance, if it was rural), and what the EMS found during vital signs, the question about hospital preference was a good one. Unless there were signs that would have indicated internal injuries and imminent danger of death, or bleeding wounds, he would not ordinarily assume transport to a trauma center. It sounds to me that the accident was at a rural location without much access to large hospitals - the closest hospital did not have a trauma center - once at the hospital, with the benefit of physicians and diagnostic testing, it was determined that a trauma center was necessary. This is pretty much the course of most treatment for emergencies - If anyone is on the hook, it would be the first hospital, not the EMS. (Incidentally, most states have a "good samaritan" law that precludes first responders and people who offer emergency treatment from being sued for damages while trying to help the emergently injured. Good luck -

Answer 6

EMS had no way of knowing the workload or abilities of the closest hospital and they are duty bound to go by what the victim directs them to; most insurance companies will not even pay for treatment from a more distant ER unless actually referred by the community hosptial.

Another thing to keep in mind in many smaller communities, EMS may be comprised fully of volunteer members/volunteer firefighters trained in minimal EMS training that have completed a minimal course to qualify.

Answer 7

...irresponsibilities manifest by non-recognition of priorities.

...passenger of mva is not to be asked which hospital to go to. that this is a practice is ridiculous and simply shows the complications within a system which do not recognize priority of life. whether or not he/she is qualified to full diagnostics place greater priority to not ask the question of a patient which can not be presumed to have cognitive abilities. what is non-apparent of injuries excludes possibilities of exact correct responsible choice and it should not also be presumed that mva patient would know which is best equipped. so non-recognition of who is best equipped to treat is premeditated by non-recognition of who is best to choose treatment and where.

this would be the inevitable consequence within a system which manifests priorities of economic exchange in relationship to life giving or life saving services.

they are responsible for irresponsibility and it is no more clearly recognized than in the notion that an attending ems would ask a patient of no diagnosis where is best to go.

and that sums it up.

furthermore...

that these types of events can occur indicate the worrisome realities that there has been purpose in reduction of all standards which would contradict a significant portion of more recent contemporary public relations news releases.

and yet.....people hurry to give money to health and other charitable organizations which never ceases to end.

and all to be recognized as good citizens and socially acceptable. moreover...the following news release postures about the good deeds of local constabularies to off-set the reality that children are at risk from the very organizations which have no public standard whatsoever.

i despise you medias and most who manipulate them.

come out now please.....let us talk about standards and responsibilities....the legalise.

bring the lawyers to the front and the politicians with their personal and/or public collected views.

until then.....yours truly is beside those with no voice.

which includes me if i believed some would help me know the pasts....and the futures.

be well me......avoid all government (including media) grandstanders.

p.s. please don't ask for my organs again at any time. you are not getting them.

Answer 8

there is not any excuse for this, there is adequate violence contained in the international with out a racist attack on yet another. What i'd favor to draw close, is what's the ideology of the perp and is he considered regularly occurring or is he an intensive? you purely suggested that he become white, no longer his ideology. no individual on the mainstream ideal is of the same opinion with this kind of habit, so why infer that they do? as far as Palin is going, i'm no longer particular basically what she believes, yet do suspect that this act would obtain a condemnation from her also. i recognize of no case were she has stated as for the homicide or attack on everyone else, she isn't an SEIU liberal.

Answer 9

It depends...the EMS is not a doctor so there are many nuiances they are not trained to handle and recognize that a doctor is...you would have to show that they should have known through medical expert testimony...if you can show this was in their training then yes...if not then no they acted reasonably even though te result was unfortunate.