I was hoping the word kidnapping would come into play on THIS scenario from Friday.
The Doc doesn't want a trip to the trauma center, even though he meets the criteria that he helped create for us sad, lonely medics who can't use our own judgment.
He was separated from the bike after hitting the side of a truck somewhere a bit less than 30mph, or so he says, and there is no gray area on this one for my system.
He meets trauma criteria wether or not I think he should go. Such is the state of EMS in my system at the present time. Even though he presents alert and oriented, he himself would be the first one down our throats about how the clavicle is a distracting injury and hitting his flank could also have injured his pelvis and abdomen.
We could go on for years about wether he is or isn't injured, but there is no need. There is also only one way I can transport him to another facility outside our protocols.
Direct Medical Control.
You see, regardless of where your patient WANTS to go, it is your responsibility to make every effort to take them where they NEED to go. If Erma having the CVA demands a hospital without a scanner, call ahead and have them divert you. Taking her to the wrong place based on her request is worse than "kidnapping" I'd argue it's downright neglectful.
Imagine we take Mr MotorDoc to Saint Farthest, per his request, documenting in quotations everything he says, heck, even get a photocopy of his ID for the report. All those items will look really good blown up at the trial after his injuries turn out to be more than you thought and he cites you violated clear cut trauma protocols.
This is not a matter of Kaiser vs a Blue Shield participating Hospital, this is a matter of getting a patient to difinitive care.
So, back to MotorDoc. A simple phone call to the attending Medical Control Physician explaining our situation got the intended response. MotorDoc had to explain his injuries and his reasoning to the attending to get permission to deviate from protocol and be seen at Saint Farthest. At that point it is the Physician's responsibility should the injuries turn out to be more than we thought.
And the best part of the story? The attending wanted him to come into the trauma center and from what we could tell did everything we had already done to convince him to do so.
Destination protocols are a necessary tool to keep track of which hospitals in your area can be the best resource to your patients. Keep in mind they may not know their requested hospital can not help them and it is your responsibility to make sure they get the care they need.
If you said kick the decision upstairs, you made my call.