COVID Non-Emergency Calls (Transfers) | Medic Scribe




In case you work in industrial EMS, you’re additionally prone to do what we name transfers.  These are non-emergency calls the place you are taking a affected person to a vacation spot that’s not the emergency division.  This could be a journey to dialysis, from a hospital or nursing house to a house or from a house to a direct admit at a hospital or a visit to a physician’s workplace.  If the affected person goes to a physician’s workplace or to a hospital for a process that doesn’t take too lengthy, you usually wait with the affected person after which return them to the place they began.  These journeys are known as wait and returns.  Dispatch tries to present them to the essential ambulance crews  as a way to depart the paramedic ambulances accessible to take 911 calls, however on days when the paramedic rooster is full, medics could be requested to assist out with the switch load.

Within the age of COVID, there are actually COVID transfers.  I’ve been concerned in just a few of them.  Again shortly after the epidemic started within the spring the state began opening expert nursing services (SNFs) solely for recovering COVID sufferers.  A number of instances I’ve transferred a affected person from Hartford to a SNF over a hour’s drive away.  I drive whereas my BLS companion sist within the again with the coughing COVID sufferers, except after all the affected person wants ALS monitoring, by which case I’m within the again.  This occurred as soon as.  You’ll be able to’t preserve six ft of distance from a affected person behind an ambulance.  You simply robe up, activate the exhaust vents and hope for the very best.  Our PPE (private protecting tools) should not self-contained biohazard fits, and though the affected person is sporting a surgical masks, they usually have dementia or generally a easy unwillingness to maintain their masks on correctly, and even when they do have their masks on, COVID can nonetheless get round it.  The crew member is principally trapped in a COVID soup for the size of the journey.  Sixty minutes is simply too lengthy.

I don’t suppose the system has had time to correctly course of what a COVID switch means.  This one didn’t occur to me, however I’ve heard of it occurring to 2 different crews.  Within the hospital sufferers are sometimes stored on COVID wards the place every room is biocontained.  Meaning, the medical workers dons PPE in a lobby, enters the room, treats the affected person after which doffs their  PPE within the lobby earlier than returning to the hallway and medical employee’s stations.  You’ll be able to’t put on PPE within the hallway.  Now enter the EMS crew.  EMS dons their PPE within the lobby, enters the room, places the affected person on their stretcher, after which exits.  They’re requested to take away their PPE.  No.  However you possibly can’t be within the hallway with PPE on.  Nicely, how the hell do you get the affected person all the way down to the ambulance?  You’ll be able to’t put on PPE within the hallway.  You’ll contaminate the remainder of the constructing.  Do you have got a chute we are able to put the affected person in that may robotically ship the affected person into the again of our ambulance?  As a result of in any other case we have to stroll by the hallways to get again to the ED and our ambulance.  Put a clear sheet on the affected person.  And what about us?  You’ll be able to’t put on PPE within the hallway of this ward.  We’re not taking our PPE off.  Goodbye.  (I heard {that a} compromise was later reached on one ground the place EMS doffs the PPE they wore within the room, then instantly places on a brand new set of PPE and are permitted to go away enter the hallway with the affected person who is roofed in a clear sheet, besides after all for his or her face coated with a surgical masks.)

Within the meantime within the ER, EMS crews donned in full PPE with their COVID sufferers, wait in the identical triage line snaking out the door as do crews with solely surgical masks on with COVID destructive (based mostly on screening questions), and as soon as assigned an area, the PPE coated EMS crews and their sufferers maneuver their stretchers down ED hallways with common overflow sufferers sitting in chairs or mendacity on beds.  That is against the early days of the epidemic the place all doable COVID sufferers entered the ED by a separate decontamination room.

Then there are the COVID wait and returns—calls in which you’ll be able to be with the identical affected person for a number of hours.  I did one in every of these just lately.  The affected person wanted to go to the hospital for a process.  Taking a affected person to a hospital for a process can contain many stops as you’re directed from one ground to the subsequent.  No, that is the mistaken ground, it’s essential to be in radiology, that’s down a ground, take a left whenever you get off the elevator, go down a hallway, flip proper, undergo the double door, after which it’s your subsequent left. These sorts of instructions are frequent.

So think about this.  An ambulance crew absolutely gowned in decontamination gear with a coughing COVID constructive affected person on oxygen on their stretcher wandering the halls of a hospital.  I want I had a digital camera to report the phobia on individuals’s faces.  We went to admissions the place we had been informed they’d ship somebody down with a mattress to take our affected person, as a substitute we have been despatched to a different ground.  After a number of stops we lastly ended up the place we have been purported to be, which was a hospital workplace ready room.  I waited with the affected person within the hallway, whereas my companion checked the affected person in.  Recognizing that the COVID affected person was a possible hazard to the others within the hallway in addition to the ready room per their coverage, we have been escorted right into a small room off the ready room.  The appointment was not for one more hour and a half so that they wished us to attend there till with the affected person till they have been prepared.  That is one other frequent difficulty with wait and returns.  The nursing houses usually schedule the pickups early compensating for the instances the ambulance is late resulting from 911 name volumes, so we regularly find yourself arriving on the vacation spot solely to seek out we’re an hour or two hours earl for his or her true appointment.  Our dispatchers don’t like us to attend greater than twenty minutes.  Usually we are able to unload the affected person onto a hospital mattress to attend for his or her appointment and ship one other crew to choose them up when prepared, however the hospitals and the physician’s places of work  can’t at all times accommodate this.  They attempt to hold us there by saying they’re virtually prepared and it shouldn’t be lengthy, however the time retains ticking away and we’re caught there.  On this name, the workers got here again moments later and mentioned not solely did they not have a mattress we might transfer the affected person too, however they requested us to shut the door to the room the place we had the affected person as holding it open was in violation of their coverage.  The room was not a affected person room, however a closet sized seek the advice of room with barely sufficient room to suit the stretcher.  I informed them if I closed the door if could be hazardous for my companion and I.  We mentioned it and I requested them to name a member of their security staff.  The staff member who was very nice defined the explanations the door needed to be stored shut.  I perceive these, I mentioned, however do you imagine it’s secure for my companion and I to be on this confined area with this affected person for an hour?  What concerning the ambulance? the protection particular person mentioned.  Aren’t you confined there?  Nicely, we’ve exhaust vents and we’re normally not in with the affected person for an hour.  Level taken.  They moved us to a different room which was bigger.  By this time we have been near operating out of oxygen, after which the room that that they had moved us to, the workers who usually used the room have been uncomfortable with us being in there with a COVID affected person, so we have been moved once more to the hallway (ready an extra answer) the place we stood and watched different guests scurry previous us.  In the long run the hospital cancelled the process and we returned the affected person to his facility with directions to reschedule and to have the nursing facility ship somebody with the affected person subsequent time who might wait with him in no matter area they’d attempt to determine that they may safely border a COVID affected person whereas ready for his process.

After we returned to the SNF the place our journey started, the guard on the door took all our temperatures per the ability coverage earlier than permitting us entry.  Luckily none of us had fevers so we have been allowed to go down a hallway, up an elevator, down two extra hallways and thru a set of double doorways the place we finally got here to the affected person’s hallway, discovered his room, and returned the affected person to his mattress.

How seemingly have been we to get COVID from this affected person?  Nicely, I used to be simply vaccinated, however solely with the primary shot and my companion had already been out for just a few weeks with COVID pneumonia a number of months again, however they are saying it’s doable to be reinfected.  We stored our PPE on the total time.  (I doffed mine every time I drove, after which needed to placed on a brand new set to reengage the affected person).  I used to be glad the hospital security officer was understanding and acknowledged the hazard to us and responded to it.  No means was I going to shut that door.  Scene security always.

I’m glad Connecticut has acknowledged EMS as a precedence 1A group in danger for COVID publicity. 

COVID has been onerous on everybody, and persons are doing their greatest, adapting to the challenges.

 

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