Walk / Don’t Walk

don't walkI had no idea that walking patients to the ambulance was such a risque thing to do.

Since the debut of Chronicles of EMS I have been seeing posts and getting emails about how folks are glad they saw me walking patients to the ambulance because it proves I’m willing to show the cameras what’s really happening.

Well, news flash – I walk patients to the ambulance all the time.

When their condition permits, of course.

But when Bubba Fishbiscuit calls because he is out of “brain pills” again, or sprains his wrist guess what folks, he walks if he wants to.

I have even been known to walk patients INTO the ER! AAAAAAAHHHHHHHHH!

My question to you is, why aren’t you?

If your patient doesn’t need the cot, or want it, why are you “required” to use it? And the stair chair too?

I dug through my County Guidelines, Department Protocols and even Department rules and regulations and found nothign about folks not being able to use their good legs when they want to.

Forcing people to make you carry them is insulting.

“No Ma’am, we have to for liability reasons” is the exact opposite of what you’re doing. By letting them walk they are responsible for their actions. When you carry and drop them, well, that was your call.

So why is it that so many Paramedics and EMTs were taken aback when I allowed people who were walking around when they called me and walking still when I arrived to walk into the ambulance?

can't billIs it billing?

Is it?

Is the ability to be reimbursed for the transport more important than the patient? If you are required to carry or cot everyone no matter what, then yes.

Ask your Medical Director about walking patients to the rig who have non life threatening injuries or who are stable per their history and protocols and request to walk on their own, watch what they say.

Now go ask your billing department how hard it is to get Medicare to reimburse when you start your narrative with “Pt ambulated without assistance to Medic99.” Watch their eyes catch fire.

Your protocols should outweigh your policies because your policies cover you and your protocols your patients and we’ve covered more than once in this forum that this thing isn’t about us, it’s about them.

If Bubba’s had a few too many, he gets carried. If he’s going to reach out on the stairwell and twist in the chair causing my knee to go out, who’s fault is that? Bubba’s for reaching out or mine for not helping him down the stairs in the first place.

Have a serious talk with your system administrators if you are not permitted to let your patients walk to the ambulance. Show them the Chronicles episode and show them that I do it all the time and, gasp, no one dies.

But, and I hate that I have to add this, follow your established policies and protocols until otherwise advised by those who have the power to change things.

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28 thoughts on “Walk / Don’t Walk”

  1. I think there are quite a few reasons why systems insist on having patients carried to the ambulance. The top reason would probably be the billing issue. If a patient can ambulate, do they need an ambulance? Medicare (and therefore Medicaid and every other insurer) says no. For agencies without strong tax support and dependent on those reimbursements to be able to make budget, that's a big deal.

    Another reason is liability. In some areas, once you make patient contact that patient is your responsibility. If you allow them to walk, and they fall or injure themselves, you will be held liable for not carrying them just as you would be held liable for carrying them and dropping them. Many jurisdictions allow a work around for this by having the patient sign a Refusal of Medical Aid with a specific option of “carry” on the form. This is something often over looked because it is not cohesive to billing and therefore rarely utilized.

    The final reason, and I think this is more of a regional issue as opposed to an industrial one, a patient who walks in can completely pass the ambulance triage nurse, not collect 2 free pillows, and have a seat in the waiting room… where they will wait… and wait… and wait. The ambulance crew? Well they can get stuck waiting with the patient until the walk-in triage nurse is ready to see them. This can become a sticky situation for turn around times, especially in areas where receiving agent signatures are required.

    Honestly, I was glad you walked that patient for an entirely different reason.

    It makes me feel less guilty when I walk mine.

  2. I think there are quite a few reasons why systems insist on having patients carried to the ambulance. The top reason would probably be the billing issue. If a patient can ambulate, do they need an ambulance? Medicare (and therefore Medicaid and every other insurer) says no. For agencies without strong tax support and dependent on those reimbursements to be able to make budget, that’s a big deal.

    Another reason is liability. In some areas, once you make patient contact that patient is your responsibility. If you allow them to walk, and they fall or injure themselves, you will be held liable for not carrying them just as you would be held liable for carrying them and dropping them. Many jurisdictions allow a work around for this by having the patient sign a Refusal of Medical Aid with a specific option of “carry” on the form. This is something often over looked because it is not cohesive to billing and therefore rarely utilized.

    The final reason, and I think this is more of a regional issue as opposed to an industrial one, a patient who walks in can completely pass the ambulance triage nurse, not collect 2 free pillows, and have a seat in the waiting room… where they will wait… and wait… and wait. The ambulance crew? Well they can get stuck waiting with the patient until the walk-in triage nurse is ready to see them. This can become a sticky situation for turn around times, especially in areas where receiving agent signatures are required.

    Honestly, I was glad you walked that patient for an entirely different reason.

    It makes me feel less guilty when I walk mine.

  3. I think there are quite a few reasons why systems insist on having patients carried to the ambulance. The top reason would probably be the billing issue. If a patient can ambulate, do they need an ambulance? Medicare (and therefore Medicaid and every other insurer) says no. For agencies without strong tax support and dependent on those reimbursements to be able to make budget, that's a big deal.

    Another reason is liability. In some areas, once you make patient contact that patient is your responsibility. If you allow them to walk, and they fall or injure themselves, you will be held liable for not carrying them just as you would be held liable for carrying them and dropping them. Many jurisdictions allow a work around for this by having the patient sign a Refusal of Medical Aid with a specific option of “carry” on the form. This is something often over looked because it is not cohesive to billing and therefore rarely utilized.

    The final reason, and I think this is more of a regional issue as opposed to an industrial one, a patient who walks in can completely pass the ambulance triage nurse, not collect 2 free pillows, and have a seat in the waiting room… where they will wait… and wait… and wait. The ambulance crew? Well they can get stuck waiting with the patient until the walk-in triage nurse is ready to see them. This can become a sticky situation for turn around times, especially in areas where receiving agent signatures are required.

    Honestly, I was glad you walked that patient for an entirely different reason.

    It makes me feel less guilty when I walk mine.

  4. Your post is excellent HM and hit’s every point I would have made. Carrying people who can walk does not decrease liability, it increases it.

    A 19 year old with a headache can walk just fine. A 90 year old with dyspnea can’t. The problem is that some EMTs (and medics) don’t have the judgmental tools to tell the difference, hence “one size fits all” rules.

    Carry everyone rules just encourage the myth that all calls are emergencies when anyone who works in an urban system can tell you that much of what we do is clearly not emergent in nature.

    We do have a rule that all patients are supposed to go on the wheeled cot, but that’s during transport, not into the hospital.

  5. Your post is excellent HM and hit's every point I would have made. Carrying people who can walk does not decrease liability, it increases it.

    A 19 year old with a headache can walk just fine. A 90 year old with dyspnea can't. The problem is that some EMTs (and medics) don't have the judgmental tools to tell the difference, hence “one size fits all” rules.

    Carry everyone rules just encourage the myth that all calls are emergencies when anyone who works in an urban system can tell you that much of what we do is clearly not emergent in nature.

    We do have a rule that all patients are supposed to go on the wheeled cot, but that's during transport, not into the hospital.

  6. Our service actively encourages us to walk a pt if they can/want to/suitable to walk. Why? They are more scared of us hurting our backs lifting the pt and being off on workcover than a pt falling over. Our pts also don’t tend to sue us.
    As for at the hospital, go grab a wheelchair & push them into dept. Keeps everyone happy. We have same triage nurse for walk ins as ambulance so you wait no matter what.

  7. Our service actively encourages us to walk a pt if they can/want to/suitable to walk. Why? They are more scared of us hurting our backs lifting the pt and being off on workcover than a pt falling over. Our pts also don't tend to sue us.
    As for at the hospital, go grab a wheelchair & push them into dept. Keeps everyone happy. We have same triage nurse for walk ins as ambulance so you wait no matter what.

  8. I agree with totwtytr, the rules and protocols if you think about it, are made with the lowest common denominator in mind. No one in the 4 county area arround Philadelphia have a “carry” rule as far as I know. But more than a few medics in both the suburbs and the city should, due to the fact that they do not apply the ABC’s ( for the non EMSers Ambulate Before Carry) of EMS appropriatly. The poor old guy with back pain I saw the other night is a prime example. He was made to climb out of the ambulance and then sit in the cold/blowing snow on the back step so that they could go and search for a not readily avalable wheel chair to put him in. If I did not already have a patient on my litter I would have put him on mine.

  9. I agree with totwtytr, the rules and protocols if you think about it, are made with the lowest common denominator in mind. No one in the 4 county area arround Philadelphia have a “carry” rule as far as I know. But more than a few medics in both the suburbs and the city should, due to the fact that they do not apply the ABC's ( for the non EMSers Ambulate Before Carry) of EMS appropriatly. The poor old guy with back pain I saw the other night is a prime example. He was made to climb out of the ambulance and then sit in the cold/blowing snow on the back step so that they could go and search for a not readily avalable wheel chair to put him in. If I did not already have a patient on my litter I would have put him on mine.

  10. I couldn’t agree with you more. Unfortunately, my state (MA) ties my hands. Take a look at this list of common (valid, according to OEMS) complaints against EMTs/Paramedics in Massachusetts.
    http://www.mass.gov/?pageID=eohhs2terminal&L=5&L0=Home&L1=Provider&L2=Certification%2c+Licensure%2c+and+Registration&L3=Occupational+and+Professional&L4=Emergency+Medical+Technicians+(EMT)&sid=Eeohhs2&b=terminalcontent&f=dph_emergency_services_p_complaints&csid=Eeohhs2

      1. Reread your state protocols EMTdan, you are not forbidden to walk patients to the cot or ambulance. introduction, page vi section 15. “EMTs are reminded not to allow patients with significant medical or traumatic conditions to walk, or otherwise exert themselves.”

        The only other time walking is mentioned is when reminding you not to walk hypothermic patients.
        You ARE, according to the published online state protocols effective january 2010, allowed to walk appropriate patients to a cot or ambulance in the state of Massachusetts.
        Ask your bosses about that before doing it of course, but the protocol is clear.

  11. I am not an EMT or paramedic, but I have some thoughts from the patient’s point of view. When I was in labor with my second child, I arrived at the hospital and was required to sit in a wheelchair to be moved upstars to the labor and delivery area. For me, sitting increased my labor pains tenfold. Labor hurts, but standing I could handle it. I wanted to walk, I begged to walk, but I was forced to sit down “for liability reasons.” Healthcare providers should put their patient’s needs and wishes first; if the patient is able to walk and wants to walk, they should be allowed to.

  12. I am not an EMT or paramedic, but I have some thoughts from the patient's point of view. When I was in labor with my second child, I arrived at the hospital and was required to sit in a wheelchair to be moved upstars to the labor and delivery area. For me, sitting increased my labor pains tenfold. Labor hurts, but standing I could handle it. I wanted to walk, I begged to walk, but I was forced to sit down “for liability reasons.” Healthcare providers should put their patient's needs and wishes first; if the patient is able to walk and wants to walk, they should be allowed to.

  13. Reread your state protocols EMTdan, you are not forbidden to walk patients to the cot or ambulance. introduction, page vi section 15. “EMTs are reminded not to allow patients with significant medical or traumatic conditions to walk, or otherwise exert themselves.”

    The only other time walking is mentioned is when reminding you not to walk hypothermic patients.
    You ARE, according to the published online state protocols effective january 2010, allowed to walk appropriate patients to a cot or ambulance in the state of Massachusetts.
    Ask your bosses about that before doing it of course, but the protocol is clear.

  14. As Mrs Happy already has, I would also like to put in a patient’s viewpoint. I recently spent some time in hospital, not because I was critically ill, but because I was thought to present an infection risk to others. I felt well and had come into hospital (on my own two feet) at a pre-arranged date after happily looking after myself at home for a week. Yet the day after my admission I was told firmly that I had to be wheel-chaired to the X-ray department. Considering the age of the guy pushing me, I think I was possibly fitter than he was! I found it ridiculous and embarrassing.

  15. As Mrs Happy already has, I would also like to put in a patient's viewpoint. I recently spent some time in hospital, not because I was critically ill, but because I was thought to present an infection risk to others. I felt well and had come into hospital (on my own two feet) at a pre-arranged date after happily looking after myself at home for a week. Yet the day after my admission I was told firmly that I had to be wheel-chaired to the X-ray department. Considering the age of the guy pushing me, I think I was possibly fitter than he was! I found it ridiculous and embarrassing.

  16. could not agree more…..pts walk in to er’s on the own accord all the time don’t they?
    i have even had a pt. chest pain (mind you no major distress…probably better to say chest discomfort refuse the gurney) so do i argue with him and stress him out i.e. serious chest pains require no suggestions

    for sure ambulatory is not a no, no….ems just doesn’t do emerg calls just like every person sitting in the emerg is not emergent – same thing different place

  17. could not agree more…..pts walk in to er's on the own accord all the time don't they?
    i have even had a pt. chest pain (mind you no major distress…probably better to say chest discomfort refuse the gurney) so do i argue with him and stress him out i.e. serious chest pains require no suggestions

    for sure ambulatory is not a no, no….ems just doesn't do emerg calls just like every person sitting in the emerg is not emergent – same thing different place

  18. could not agree more…..pts walk in to er's on the own accord all the time don't they?
    i have even had a pt. chest pain (mind you no major distress…probably better to say chest discomfort refuse the gurney) so do i argue with him and stress him out i.e. serious chest pains require no suggestions

    for sure ambulatory is not a no, no….ems just doesn't do emerg calls just like every person sitting in the emerg is not emergent – same thing different place

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