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Sat Mar 3 22:28:51 GMT 2007

In a message dated 3/3/2007 4:17:19 PM Central Standard Time,  
marty_munro at yahoo.ca writes:

Although this is normal that patients will sit with EMS crews for hours at a  
time around the area that I work in, most other areas find this to be unheard 
 of. With the aging population and the hospitals being overcrowded, the 
problem  is probably going to increase. One of the other problems that I have  
encountered is that the ER staff will use the paramedics as extensions of the  
emergency room. I am not just coming up with this on my own, I have been told  by 
E.R. nurses outside of work that they do this on purpose. They say "why  
would I want to give your patient a bed and make one of my nurses have to  attend 
to them when they are in your care and you can attend to them?"   Clearly, it 
is not understood that although we would love to be of assistance  to the E.R. 
staff, we have a job to do in the community.  I think this  would be an issue 
for hospital management and EMS management to discuss.  

One lever that is not used enough in the US (not applicable for our  
neighbors to the North) is the 'on campus' provision of EMTALA...problem being  that 
not enough EMS administrators are willing to submit documentation to the  
appropriate authorities because of possible repercussions...

One of the main problems that I have seen in big city hospitals is that the  
hospital administration is not willing or able to staff sufficient floor and  
intermediate (monitored care) beds to relieve the crunch on the ED and  
critical care units. This causes the ED to loose active beds and tie up nursing  
staff providing care to patients on 'bed hold' status instead of being available  
to see new patients.

I can do something about that in the smaller hospitals I normally work at,  
but the big city ED directors that I've interviewed with don't seem to have any 
 way to overcome the institutional inertia causing this problem.

ck
Charles S. Krin, DO FAAFP
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