re: My EEEE ARE story. Asking for the MDs and ER RNs thoughts.

So nothing like BR

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But if the freestanding ER does not have the capability of making the diagnosis, isn’t it better to transfer the patient?

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That’s why I’m saying we need more information. If it was a suspected heart attack based on symptoms, history, etc. then sure transfer them to a place with a cath lab.

But if someone truly just dropped down in the lobby with no history why would sticking them in an ambulance be best for them? They need CPR and hopefully return of vital signs and then some sort of diagnostics to start to understand what is going on. EKG, vital signs, etc.

You can start to make a differential diagnosis based on that.

If he transferred before any of that I could understand why people were pissed

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That’s why I’m saying we need more information. If it was a suspected heart attack based on symptoms, history, etc. then sure transfer them to a place with a cath lab.

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Family with her suggested MI by story. That's the theory we ran with.

You did literally exactly what you were supposed to do. Your bosses are all about money and could give a shite about the patient. Ignore them. They need you a lot worse than you need them believe me.

We’re these the types of people who are often overly sensitive to discrimination?

Don't provide medical care. Used to shedule Covid vaccines over the phone for about a year, so I'm not an authoritative force. But isn't one of the requirements of EMTALA (or whatever the acronym is) is that a patient be stabilized - not dead - before they are transferred?
I only answered phones, remotely, and never saw a patient, but I think that was covered in my training.

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This is a freestanding ER. The code begins in the ER lobby. Loaded into a stretcher. Taken to the back got her back once very briefly. I decide to call 911 as this woman needs more than we offer. They arrive 911 takes her. Doc agrees get her out.

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First, you did the right thing. Second, in a limited care facility, planning for that kind of circumstance should have been in place, and in policy. I'd bet it is.

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How could HE be the one who transferred her if he's the nurse?

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I pretty much blurted out “call 911” to ancillary staff. Doc was behind me and did not protest.

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Also, don't go to an "ER" that needs to call 911.

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I think going to one that does not appreciate its limitations can be worse. Had this woman come in having contractions with a foot/leg “presenting” 911 would be called and nobody would say shite.

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Securing a proper transfer is 3-4 phone calls and after that you are still calling 911 to not have a wait time of 30-60 minutes for a transfer ambulance. Thats one hour without breaking a sweat. The sad truth is that this makes just "calling it" more appealing, and less worrisome from a job retention standpoint. Which blew my mind.

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I think this is what people often forget about those of us working at freestanding ERs. Our hands are kind of tied when it comes to these sorts of transfers because you want to stabilize the patient but you also want to get them the hell out of there ASAP. If you try to stabilize the patient before calling for transfer there is a chance the patient decompensates prior to transfer. If you call for the transfer early then there is the chance EMS shows up while you’re still trying to get the patient stable. There’s not a great solution.

At the end of the day y’all probably did what y’all felt was best for the patient. Next time this happens I would probably ask EMS for their help running the code if you need more hands. Hopefully stabilize the patient prior to transfer for EMTALA sake.