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Question for anyone who's done Private Transport!!!!!!!!
Ok... I just have to ask... I had a situation with a patient and am curious as to whether my partner and I may have.... "Over reacted" maybe? We were asked to transport a 1yr old kid with a Femur Fx. It was a complete break positive rotation, edema, shortening... THE WORKS!!! They wanted us to take the kid from lying on the bed and sit him up into a car seat, AND maintain C-Spine. Are my partner and I TOTALLY wrong thinking that this was NOT A GOOD IDEA by any means???
Replies to This Discussion
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Permalink Reply by Liam on
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See this is a grey area looking at everyones responses. I have a few questions to be answered to give a solid answer as I work per diem on a childrens hosp. transport team and your story is rather vague. 1) Was the child coming from another facility and cleared C-Spine with accompanied CT's? 2) Did you have direct contact with the recieving medical director or better yet your on-line medical command before you moved the pt? 3) When you raised concerns did you document it in your PCR with the Dr.'s name and possibly medical license # that directed you in doing the movement in the car seat? 4) Was it a trauma transport or was it just moving child from an ER to a peds stepdown?
This looks like a typical story of inexperience working against you in a typical pt. transport company that is looking for the bottom dollar. I personally would have varified all the bases before moving the child. Is it wrong to move a FX in a child seat as the seat is most of the time the safest way to move an infant? Not really. I would have possibly thought to put a short board splint on the leg. Possibly used a pedi-mate or a Pedi-board instead of a car seat to keep the leg straight. There are a lot of answers that need to be asked before moving the child. When in doubt go back to the basics of BLS. Falls 3X the childs height or greater= Significant MOI and the pt. needs a full workup prehospital. Interfacility its a grey area due to docs being in contact with each other and continuity of care being a lot better. Do what you feel is right and realise there are plenty of other transport companies out there screaming for EMT's and Medics. Hope that helps.
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Permalink Reply by Amber on
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Ok... The child's c-spine WAS cleared by the transferring facility but they stated that we needed to maintain C-spine en route. We did NOT talk to the Dr. as my partner was the Medic on scene and did NOT want to argue anymore because she was already on thin ice for standing up for another pt. We did in fact document the Dr's name from both the transferring and receiving facilities. And it was a pickup from a free-standing to take the pt to a peds facility that offered peds ortho. I think I answered all ur questions... if you have any more feel free to ask!!! :D
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Unfortunately I did transport the kid in the car seat but I was more or less TOLD that I'd lose my job if I didn't. And I lost it anyway... SO.... APPARENTLY... It didn't matter and I really should have just REFUSED in the first place huh?
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Permalink Reply by Joe Stoltz on
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I'm not sure what type of agency you are with, but you must have some patient treatment protocols to follow. Here in NYS we certainly do, and a femur fracture definitely needs to be immobilized before moving the patient. I'm having difficulty imagining how to do this with the baby in the car seat.
Anyway, it sounds like there's some history that contributed to your being fired. But I would check your protocols and see if you followed them. It may be that the doctor did not. Good luck and just keep following your training, patient well being comes before doctors' ego well-being.
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Permalink Reply by Adam Schmitt on
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I too work for a private service, and sometimes the company is for itself more than what is right. I believe if what you had done was for the best interest of your pt than you have done the right thing. If you were fired for it, I wouldnt want to work for a service that wouldnt back me up, as long as you have done everything you can do for your pt. If that decision coincides with the accepting facility Dr's great! if not, have some documentation on the refering Dr's decision, on not doing anything that was requested. That put the issue back on the Dr's, believe me it helps and it keeps you on the straight and narrow. Stay safe and hold your head high on what you believe was the right thing to do
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Permalink Reply by Don 5271 on
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Very good point. Once you take charge of the patient, they are your responsibility. You do what you were trained to do, and do not listen to anyone else. I owned a private ambulance service for many years and ran into this type of issue many times. I always told my employees that they are responsible for the safe transport of their patients, and do what they feel is best. A little discrete diplomacy is always a good thing to preserve our accounts, but patient care always comes first. Also, if its a BLS transport, and you get there and you feel its an ALS transport, contact your dispatcher before you take charge of the patient for advise. They may switch it over, or have an ALS unit meet up with you.
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Permalink Reply by Brian Dumser on
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Why not a back board and c-collar, along with a traction splint for the femur? We use car seats as well, but not for something like that.
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Permalink Reply by Gareth on
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Over here (in the UK) the C-Spine should have been cleared before leaving the departing hospital. If not, then board them. It's not difficult... AcBC as it goes... And at a guess, the poor kid is gonna be more comfortable lay flat than trying to sit the poor little thing up in a chair???
The only time we make any sort of compromise with kids and c-spine injuries is if they are small children and they start getting more distressed when you try "pinning them down and strapping them in". In some cases they are likely to do more damage to themselves trying to resist you. Obviously we don't ignore the c-spine issues, but we'd look at other ways to maintain it. G
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Permalink Reply by FETC on
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Your are providing a inter-facility transfer under doctors orders right? Seems barbaric that they did not provide the child with any form of stabilization of a femur fx before tranfer not to mention ALS for pain management, etc.
Next time, (unfortunately you were fired) but next time I would call your supervisor before touching the patient to clarify the procedures with the powers to be.
You were not in a private home doing 911 work under our standard of care protocols, and facility to facility transfers are in reality doctor to doctor, hence the nickname you work on a bus.....
Sorry to hear you guys got the shaft...
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Permalink Reply by danny on
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where you a bls unit or a als unit for the private transport you were employed with and if so what did your standing orders or medical directions say. i would hope that you stablized the leg and yes i think you were correct in your thinking. but the question i have is who were the who that wanted you to do this. and did they have any medical training. danny d
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Permalink Reply by anne potter on
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I would have to say your right in thinking that it was a bad idea.. What was these people thinking.. In this case transport via car then ..Why bother asking for help.. I guess my friend sometimes we will never know what other people are thinking... Just know you have our support ...
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Permalink Reply by Floyd Aldridge Jr on
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Amber,
I would have to say that you and your partner were in the right. and I would talk to legal personell about this. I feel that you 2 should not have been fired. As long as you have written documentation then your employer should hire you back. Thats just my 2 cents!! But I would talk to a lawyer ASAP!!
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