man hurt in parking lot of hospital needs to call an ambulance

[draco664]

I like the ambulance cover you can get here in Australia. Any ambulance trip (road, helicopter, aeroplane, anything) is free with the cover. A family policy covers parents and children under 18 (or under 25 if studying full time. It will be a while before my kids are that old though...)

It only costs about 10 bucks a month for a family.

[FArchivist]

I thought that most states have laws/rules on the book shielding "Good Samaritians" or shielding emergancy responders in a chrisis stiuation.

I guess those went by the wayside in our sue happy culture.

No, they're still there. It's just that they vary wildly from jurisdiction to jurisdiction and who they apply to depends on the law. In some places, you must have consent and state your training before you try to be a good Samaritan. In others, if you don't have certified training, you are not covered by good Samaritan protection and can be sued.

They don't apply to emergency responders and medical personnel, who are usually considered to have more a 'duty to rescue'. Those individuals are frequently covered under different laws and regulations relating to their work conduct.

Calling an ambulance in the parking lot of an ER is just ridiculous. It can't be about liability..or are they saying that all the other doctors, except for the ambulance ones, are incompetent?

No, but if anything happens in a medical situation that is outside procedure, it can open up liability. Say that there's a doctor on staff in the ER and he goes outside to the parking lot, does what he can, and then has the patient moved inside on a stretcher or what not. Should the stretcher get dropped or anything, he can be sued. For leaving his post in the ER, the people waiting for service can sue. And so on and so forth.

The baseline for determining liability is known as 'proximate cause', as in, being able to point to this event as being the cause of the injury you are suing for. This is generally determined by the 'but-for' test: but for the action, the result would not have happened. Had the doctor not left his post and usurped the procedure, the client would not have suffered the injury.

While there are variables to define this (forseeability, the risk rule, duty of care, etc), that's how you determine if someone is or is not liable.

[Gravekeeper]

No, but if anything happens in a medical situation that is outside procedure, it can open up liability.

Sadly, liability is one of the big problems here. If we weren't all so damn sue happy, it wouldn't be a problem. If a doctor or nurse leaves the ER to go help someone in the parking lot, they legally speaking assume liability on behalf of the hospital. In some places this will actually get you automatically fired.

That aside, in this particular case the key problem is that he drove himself to the hospital. Because an MVA is involved, the hospital by policy has to call in EMS because they have the proper extraction equipment and training for dealing with an MVA. So at some point hospital staff somewhere probably did respond to a similar situation like this, and the hospital got its ass sued off as thanks. So now they can't anymore.

If he had called an ambulance instead of driving himself this, ironically, would not have happened. But therein is another problem, we're not dealing with socialized medicine in the US so that ambulance probably costs a month's paycheque to call. So there's a very real incentive to never use an ambulance. Especially if the town/city uses a privatized ambulance service.

Speaking with a coworker who has a lot of health problems and has more than once had to be taken by ambulance from work, she has told me exactly how much it costs to ride in an ambulance.

Comparatively speaking, up here for example the ambulance fee is a flat $80 regardless of distance travelled or instruments used, etc. And only if you can afford it ( it gets waived for low income households ), and only if you were unemployed with no additional medical plan that would cover it through your workplace ( Mine for example covers...er....everything. )

[FArchivist]

Sadly, liability is one of the big problems here. If we weren't all so damn sue happy, it wouldn't be a problem.

I admit, I really, really, really hate the term 'sue happy'. We're not sue happy. Or rather, people don't understand why Americans sue like we do. The whole reason is based in history; the Founding Fathers HATED courts of equity, deeming to be no better than Star Chambers, and so our legal systems have been set up so that any grievance someone has against someone else can only be resolved:
a) in court or arbitration
b) MUST have a dollar amount assigned to the grievance for damages, or there is no grievance to adjudicate.

Whereas in places like the UK and France you have courts wherein the courts will perform equity (ie, make the situation fair), the ONLY option available for Americans is to get damages.

If a doctor or nurse leaves the ER to go help someone in the parking lot, they legally speaking assume liability on behalf of the hospital. In some places this will actually get you automatically fired.

Correct, due to a lack of equity systems in our legal system.

[Mikkel]

Speaking with a coworker who has a lot of health problems and has more than once had to be taken by ambulance from work, she has told me exactly how much it costs to ride in an ambulance. They even charge you to put you on the stretcher, they charge you for putting you IN the ambulance, they charge you for the ride itself (that is $100 out of pocket right there!) and they charge you seperately for every single instrument or procedure they have to do to you on your way to the hospital, and they also charge you to take you OUT of the ambulance and to wheel you IN to the hospital.

You know, when I hear something like that, I don't mind paying the Danish taxes. If I'm hurt, anyone can call an ambulance, I don't have to pay. The hospital is the same, whatever I earn, I will get help without having to pay anything. I have paid just by being a Danish citizen.

We're not sue happy. Or rather, people don't understand why Americans sue like we do. The whole reason is based in history

A good explanation. Would you say that the Founding Fathers were right in this? Though that may be better to discuss in a new thread .

[Gravekeeper]

I admit, I really, really, really hate the term 'sue happy'. We're not sue happy. Or rather, people don't understand why Americans sue like we do.

Regardless, you have to admit people have sued for some amazingly frivilous reasons down there and continue to do so. Some people will look for any reason to do so. It's a common SC threat when they don't get their way for example.

[Panacea]

http://www.kgw.com/news/local/Advent...115729339.html

A man who crashed in a hospital parking lot, 100 yards away from the er, was not able to receive help until the officer who was a witness and assisting him called an ambulance, so they could follow proper protocol.

He ended up giving the guy cpr so he wouldn't die while they waited for protocol and the blasted ambulance to arrive and transport him 100 yards away.

Rules and regs are getting to be ridiculous...when it becomes a matter of life or death break the damn rules!

I am a bit surprised someone from the ER didn't come out to assist. When I was an ER nurse, I would respond to these kinds of emergencies that happened elsewhere on hospital property. If they're on hospital property, the liability IS on the hospital to respond.

However, in this case, a response from EMS is appropriate. You don't move someone from that kind of accident without immobilizing them, and ER nurses actually have very limited training in doing that. I could do it . . . but then again, I've also been an EMT and taken a special trauma nursing course that not all ER nurses take (it costs about $500 for the course).

I do recall one instance when a patient fell and hit her head in the waiting room, and I was so concerned about a head injury, I had her immobilized. The other nurses didn't know how to secure the patient on the back board, and wanted to just lift her up. Fortunately, I did know and insisted on doing things the right way.

What's the first thing you're told? Don't try to move them until they're examined by someone who knows what they're doing. That would be the paramedics, who happen to be in the ambulance. And any doctors in the ER would probably be occupied with people who have already been admitted.

True enough, as I explain above. However, there are other things the nursing staff could have done to stabilize the patient without moving him, and being busy in the main ER is no excuse not to send ONE nurse to respond and begin interventions.

I still don't see how calling 911 and causing an ambulance to roll for someone already on the premises is responsible behavior. At that point, it should be up to the hospital to determine whether they have staff on had or to call for EMTs, as they already have access to that network.

The cynical part of me thinks that this is a ploy to force anyone experiencing an emergency to rely solely on ambulances for transport to the ER as a boost to the revenue generated therefrom.

^-.-^

It is responsible to call EMS for assistance in that kind of situation. That doesn't mean the nurses shouldn't respond, but since nurses are not trained on working a field scene, they should get help from the people who are.

Ambulances are often not part of the hospital system itself. They are either part of a local city or county organization, or a private ambulance company that works for profit. Ambulance companies are a low margin profit business (they are very expensive to run), and ERs are money losers for hospitals. Hospitals that own ambulances usually use them for highly specialized transportation purposes, and are not part of the 911 response system.

Regardless, you have to admit people have sued for some amazingly frivilous reasons down there and continue to do so. Some people will look for any reason to do so. It's a common SC threat when they don't get their way for example.

QFT. I got so many ridiculous threats when I was an ER nurse. My usual response was usually something along the lines of, "Knock yourself out." or "Good luck with that."

It really pissed them off

[drunkenwildmage]

I'm going to toss another point on this that hasn't been brought up, and that is the Union aspect of it.

What if the EMS, and/or the Nurses are unionized..depending on what is in their union contracts, if an EMS unit wasn't called in on the scene, then someone could haved possibility filed a grievance against ,most likely, the hospital.

[Plaidman]

Two words. Insurence Companies.


It wasn't like the doctors or the ambulances companies were laughing and rubbing their hands grinning and thinking yay money while that guy needed help.

There's a reason why when you have something wrong, and even if the doctor knows 100 percent how to fix ya, he still needs to go in certain order, (IE Bloodwork, xray, before going into specialized tests). If they skip a step, then the insurences companies go "Well, wait, you skipped this. Why did you skip this? You can't skip this. We're not paying for this". THen then hospitals have to eat the entire bill for that one patient, who he himself still only pays what his insurence companies says he owes.

For example.

It costs the Patient 10 bucks to get an xray.
It costs the hospital who still paying off their vast bills 100 bucks to use that xray, but with their insurence if they go in their prescribed order, may only cost 5 bucks. But if they skipped a step that was needed prior (Such as a doctors order or bloodwork), well now they need to pay 100 bucks.


Insurence companies wouldn't care themselves if was just outside the door. All they hear and read is "Doctors took in patient outside, didn't call ambulence"

[Panacea]

I'm going to toss another point on this that hasn't been brought up, and that is the Union aspect of it.

What if the EMS, and/or the Nurses are unionized..depending on what is in their union contracts, if an EMS unit wasn't called in on the scene, then someone could haved possibility filed a grievance against ,most likely, the hospital.

Sorry. NO, no, no no! Unions have NOTHING to do with how the job is actually done. Nursing unions and medic unions, where they exist, collectively bargain on wages and working conditions. They do NOT dictate actual practice.

The California Nurses Association (of which I was at one time a member) lobbys for legislation to improve patient care, such as the mandated nurse to patient ratios. But they do not dictate to hospital administrators what nursing policies should be . . . and they can't. That is a matter for the hospital and the Board of Registered Nursing.

Remember nurses, physicians, and paramedics are licensed. Their actions are supervised by state or national boards that can revoke that license if the provider is not performing to the accepted standard of care. Period.

Reading the original article, hospital administration stated quite clearly that there is NO policy to not treat patients who don't actually walk in the door. So if some staff member did this, they misunderstood hospital policy.

Two words. Insurence Companies.


It wasn't like the doctors or the ambulances companies were laughing and rubbing their hands grinning and thinking yay money while that guy needed help.

There's a reason why when you have something wrong, and even if the doctor knows 100 percent how to fix ya, he still needs to go in certain order, (IE Bloodwork, xray, before going into specialized tests). If they skip a step, then the insurences companies go "Well, wait, you skipped this. Why did you skip this? You can't skip this. We're not paying for this". THen then hospitals have to eat the entire bill for that one patient, who he himself still only pays what his insurence companies says he owes.

For example.

It costs the Patient 10 bucks to get an xray.
It costs the hospital who still paying off their vast bills 100 bucks to use that xray, but with their insurence if they go in their prescribed order, may only cost 5 bucks. But if they skipped a step that was needed prior (Such as a doctors order or bloodwork), well now they need to pay 100 bucks.


Insurence companies wouldn't care themselves if was just outside the door. All they hear and read is "Doctors took in patient outside, didn't call ambulence"

Not quite. Many ER physicians do practice "defensive medicine." They do this to protect themselves from legal liability in case of a lawsuit. And insurance companies do try to find what ever reasons they can to avoid paying a bill. But skipping a test is not one. Rather, the hospital needs to show that a particular test or diagnostic tool was necessary.

After the backlash against insurance companies in the 90's (in which HMO's acted as gatekeepers and wouldn't pay out on ANYTHING without prior authorization, which they tried hard not the grant), the insurance companies started paying on everything (using Medicare guidelines as a base), and in fact pay on things they shouldn't. They pass along the increased costs to the consumer in the form of higher premiums.

Hospitals DO eat the costs of uncompensated care: the self employed, the unemployed, illegal immigrants (who actually pay more often than not, usually in cash), etc. Those costs get passed along to everyone else in the form of higher charges: your example of xrays is on point there.