You Make the Call – Exam Prep – Scenario 1

This is the first in a series of promotional exam scenarios you all sent in to help me prepare for my Captain’s exam.  Each and every one helped me and I thank you very, very much for taking the time to write and help me out.

Since I am on vacation as of today, I thought I would share some of the best scenarios that really got me thinking.

There are no right answers to these issues, each system is different.

SCENARIO 1-

You are riding EMS Battalion 34 today and are called to the local hospital well known in the system for making units wait longer than necessary to register patients.

Inside is an irate attending physician screaming that his hospital is not your dropping grounds and demands you start diverting to other receiving facilities.

Write your response to him, citing local and department policies and protocols.

Agree? Disagree? Have something to add? Why not leave a comment or subscribe to the RSS feed to have future articles delivered to your feed reader?

26 thoughts on “You Make the Call – Exam Prep – Scenario 1”

  1. I would tell the doc to put the hospital on bypass then. Here, hospitals are fair game if they’re not on bypass. And from the moment they go on, it’s announced by dispatch, and when they come off it’s announced. Scream at me all you want, but until you do something about it, you’re getting patients.

  2. I would tell the doc to put the hospital on bypass then. Here, hospitals are fair game if they’re not on bypass. And from the moment they go on, it’s announced by dispatch, and when they come off it’s announced. Scream at me all you want, but until you do something about it, you’re getting patients.

  3. I would tell the doc to put the hospital on bypass then. Here, hospitals are fair game if they're not on bypass. And from the moment they go on, it's announced by dispatch, and when they come off it's announced. Scream at me all you want, but until you do something about it, you're getting patients.

  4. I think that verbally attacking the MD isn’t the way to go. It sure as hell won’t get him to do anything about the wait times and will probably earn you a complaint to the BC (or higher). I think the way to tackle this problem is to make the MD an ally attacking the problem. Have him come up with suggestions on how the two of you can alleviate the problem. Just going on divert doesn’t address the issue. It’s a band aid on a bleeding artery. You have to get the MD to see you are on his side and are not his enemy.

  5. I think that verbally attacking the MD isn't the way to go. It sure as hell won't get him to do anything about the wait times and will probably earn you a complaint to the BC (or higher). I think the way to tackle this problem is to make the MD an ally attacking the problem. Have him come up with suggestions on how the two of you can alleviate the problem. Just going on divert doesn't address the issue. It's a band aid on a bleeding artery. You have to get the MD to see you are on his side and are not his enemy.

  6. “I understand that you’re upset about the patient load today. I want to do whatever I can to help you out. Unfortunately, unless whoever it is at your facility that makes the decision to announce your diversion status does so, our service will continue to transport here based on our existing protocols, patient requests, and the fact that XYZ Hospital is already on diversion [if applicable]. I would highly recommend talking to the person who makes your diversion decisions and explaining why you feel it’s necessary.

    In the meantime, I will see what I can do about reminding our crews that you’re not the only hospital in the area. While I’m here, is there anything we can do about the long handoff times? Our crews can’t transport to other facilities if they’re tied up waiting to offload their patients in your ED.”

  7. “I understand that you're upset about the patient load today. I want to do whatever I can to help you out. Unfortunately, unless whoever it is at your facility that makes the decision to announce your diversion status does so, our service will continue to transport here based on our existing protocols, patient requests, and the fact that XYZ Hospital is already on diversion [if applicable]. I would highly recommend talking to the person who makes your diversion decisions and explaining why you feel it's necessary.

    In the meantime, I will see what I can do about reminding our crews that you're not the only hospital in the area. While I'm here, is there anything we can do about the long handoff times? Our crews can't transport to other facilities if they're tied up waiting to offload their patients in your ED.”

  8. My response to him is simple, “Please have your administrator come down to discuss this request.”

    When the administrator comes down, include the attending MD in the conversation regarding placing the hospital on a diversion status. Make sure to point out that while this status is in effect non-critical patients wanting to come to their facility will be directed elsewhere, casually mention that the facility will be possibly losing insured admissions, but in the case of a critical patient (such as a respiratory or cardiac arrest) their facility will still be expected to accept them.

    You may also want to point out to the doctor with the administrator present that if units are held up greater than (insert number of minutes here) continually then you will be forced to place them on diversion and advice your superiors that the status remain indefinitely. While the administrator does the calculations on their potential income loss and census drop in their head, smile.

  9. My response to him is simple, “Please have your administrator come down to discuss this request.”

    When the administrator comes down, include the attending MD in the conversation regarding placing the hospital on a diversion status. Make sure to point out that while this status is in effect non-critical patients wanting to come to their facility will be directed elsewhere, casually mention that the facility will be possibly losing insured admissions, but in the case of a critical patient (such as a respiratory or cardiac arrest) their facility will still be expected to accept them.

    You may also want to point out to the doctor with the administrator present that if units are held up greater than (insert number of minutes here) continually then you will be forced to place them on diversion and advice your superiors that the status remain indefinitely. While the administrator does the calculations on their potential income loss and census drop in their head, smile.

  10. My response to him is simple, “Please have your administrator come down to discuss this request.”

    When the administrator comes down, include the attending MD in the conversation regarding placing the hospital on a diversion status. Make sure to point out that while this status is in effect non-critical patients wanting to come to their facility will be directed elsewhere, casually mention that the facility will be possibly losing insured admissions, but in the case of a critical patient (such as a respiratory or cardiac arrest) their facility will still be expected to accept them.

    You may also want to point out to the doctor with the administrator present that if units are held up greater than (insert number of minutes here) continually then you will be forced to place them on diversion and advice your superiors that the status remain indefinitely. While the administrator does the calculations on their potential income loss and census drop in their head, smile.

  11. (as neither myself, nor the EPAB in my area have time for whiney docs, it would go something like this)

    Doc,

    If you have an issue with the ER or other parts of the hospital filling up, please let us know and you will be put on divert status. However, you should know that while our crews will do their best to take patients to other ER's, their first responsibility will be to take patients to the most appropriate facility. As well, you should understand that while we inform the patients that your ER is overcrowded, in the end if they insist on coming here, here is where we will take them. We have very little choice in the matter.

    If there are any other concerns, please have your attending or department head contact the EPAB and I'm sure this situation can be worked out.

  12. (as neither myself, nor the EPAB in my area have time for whiney docs, it would go something like this)

    Doc,

    If you have an issue with the ER or other parts of the hospital filling up, please let us know and you will be put on divert status. However, you should know that while our crews will do their best to take patients to other ER’s, their first responsibility will be to take patients to the most appropriate facility. As well, you should understand that while we inform the patients that your ER is overcrowded, in the end if they insist on coming here, here is where we will take them. We have very little choice in the matter.

    If there are any other concerns, please have your attending or department head contact the EPAB and I’m sure this situation can be worked out.

  13. (as neither myself, nor the EPAB in my area have time for whiney docs, it would go something like this)

    Doc,

    If you have an issue with the ER or other parts of the hospital filling up, please let us know and you will be put on divert status. However, you should know that while our crews will do their best to take patients to other ER's, their first responsibility will be to take patients to the most appropriate facility. As well, you should understand that while we inform the patients that your ER is overcrowded, in the end if they insist on coming here, here is where we will take them. We have very little choice in the matter.

    If there are any other concerns, please have your attending or department head contact the EPAB and I'm sure this situation can be worked out.

  14. (as neither myself, nor the EPAB in my area have time for whiney docs, it would go something like this)

    Doc,

    If you have an issue with the ER or other parts of the hospital filling up, please let us know and you will be put on divert status. However, you should know that while our crews will do their best to take patients to other ER's, their first responsibility will be to take patients to the most appropriate facility. As well, you should understand that while we inform the patients that your ER is overcrowded, in the end if they insist on coming here, here is where we will take them. We have very little choice in the matter.

    If there are any other concerns, please have your attending or department head contact the EPAB and I'm sure this situation can be worked out.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>