THE HAND-OFF
You deliver your patient to the hospital late one night… and you wait. Then you hear the tones drop again for another emergency in your area, but you know there is not a second crew available. What do you do?
Your patient is still on your gurney, no one has come to register your charge, and no one seems to be available to provide continued care. While Federal law has clauses which would allow you to leave, some states, such as NYS, require you to remain until actual care of the patient has been transferred to qualified nurses or ER doctors.
Unfortunately, the past few years (pandemic, Medicare/Medicaid cuts, and nursing contracts) have contributed to a serious nursing shortage throughout the state… and nation. While the nurse(s) in the Emergency Room is (probably) not ignoring your presence, it does not help you to remain “hostage” waiting to successfully transfer your patient’s care. If you leave, there is a real possibility that you (and crew) will be charged with patient abandonment. You wait, hoping that another nearby service will respond to take the new call quickly and you become more frustrated when second, or third, tones drop.
Meanwhile, in addition to the frustration of your crew, the community that relies on your PROMPT service becomes agitated. Critical patients may suffer due to delayed responses and transfers. If your agency relies heavily on community donations, that can take a nosedive when folks start seeing neighboring ambulance squads responding instead of their local crews. Blame gets tossed around, fingers are pointed at the EMS crews, the short-staffed nurses, the hospitals. And if a patient dies, and there is any chance they could tie delays into the reason, lawyers can have a field day. Nobody wins.
Your agency chief and your crew need to know the exact rulings about patient handoff and when it would be called abandonment. Whether your crew is volunteer or paid, there is an expense to your EMS agency for time at the hospital. And there is loss of income every time a call must be handed over to another agency. Delays waiting to turn patients over to the hospital staff are not only frustrating, but it could also be dangerous to a critical patient.
Your agency chief, along with staff and riding members, should contact your local regional EMS office to learn the EXACT process expected during the hand-off of a patient. It would also be beneficial to get your Medical Director on board asking him/her to negotiate with the local hospitals to help expedite the transfer of ambulance patients to the care of the medical staff at the hospital.
Finally, it might be advantageous to recommend to the hospital board that a “desk clerk” be hired to accept the transfer of patients; ideally this desk clerk should have some medical knowledge, not necessarily that of an ED nurse, such as a nursing student or off-duty EMT/Paramedic (Pay would not be comparable to that of an ED nurse).
In the long run, it is the care of the patients that should be the primary importance.
I'm a former NYS EMT and still part of an EMS & FD family. I like to think I can write ;)
