Tripping at the Hospital – A Teachable Moment for EMS

Quick: Name the safest place you can think of to have a medical emergency.

Would it be inside of a hospital? Maybe an ambulance base? Perhaps a concert venue with medical staff on site?

Back when I worked in a hospital, we used to have a procedure called a “Code Green.” We’d call one on the occasion of “A medical emergency occurring in a non-patient care area of the property resulting in a need for emergency medical care.” It was implemented in the early 2000’s in response to the disorganized response we had been seeing to on-property medical emergencies in areas such as the parking lot or the hospital lobby. Usually Code Greens would result from someone falling however they occasionally resulted from some other type of medical problem. I even think they even worked a cardiac arrest in the parking lot on a day I wasn’t on-duty. My position at the hospital was a cross between a Security Guard and an EMT as I progressed through Paramedic school. At that chain of hospitals with three campuses and around 500 beds, the Security department operated an ambulance service to do interfacility transports between the ERs and inpatient units. It was an interesting system. As Security/EMTs we naturally became the primary responders to “Code Green” calls, which seemed to happen once or twice a month in my recollection.

I was reminded of our Code Greens when I read this article coming out of Niagra Falls, Ontario (Canada) concerning an elderly woman who fell while walking out of a hospital.

According to the article from The Toronto Star, the 87 year old woman was leaving the facility after visiting her terminally ill husband when she suffered a fall and fractured her hip in the hospital parking lot. The article has a fairly critical tone towards the hospital and its staff; blasting them for having to call an ambulance and for the time it took to get the woman off of the ground. The woman, who in the article is stated to have a previously fractured arm, is reported to have laid on the ground for “Nearly 30 minutes” while waiting for the ambulance to transport her to the ER, which is stated by her son to be “only 50 yards away” from where the fall occurred.

I linked this article today because I believe the opinions expressed show a great deal of information towards the public’s perception of the roles of healthcare workers. The article seems to think that it’s quite ironic that an ambulance was called by hospital staff… to a hospital. When, according to the article there were two nurses on the scene. The article places the orthopedic surgeon who happened by “eventually” and “moved the woman into a wheelchair” as the hero of the story.

My thoughts here are that the nurses who were called to the scene of the fall most probably identified the woman as being at a high risk for further injury from additional movement as evidenced by the fact that she had a previous arm fracture and what I would guess to be an obviously fractured hip. Their concern was probably that further movement of the patient in an incorrect fashion would have aggravated her injuries and could have resulted in further damage. As far as I know, Canadian nurses (like their US counterparts) aren’t trained to move patients with potential spinal injuries and obvious hip fractures who aren’t prepackaged by EMS crews or otherwise immobilized. They also most probably did not have access to the proper equipment needed to do so. In fact, the physician who picked up the patient “with the assistance of an aide” and placed the woman in a wheelchair would have been lambasted if he were a paramedic. While I’m going to assume that an orthopedic surgeon would have extensive knowledge of the human skeleton, it’s not exactly optimal care to bend a hip fracture the 90 degrees to move a patient from a supine (or prone) position to an upright seated one. In this case, packaging the patient on a long spine board with full cervical spinal precautions would have been the best medicine. Everyone has their areas of expertise and as we’ve all observed, or at least became aware of by watching the trial of Dr. Conrad Murray in the MJ death fiasco, doctors aren’t always the best experts in emergency care. That’s what Paramedics and EMTs are for. EMS people are the “Masters of the Acute”. Our specialty is those things that are happening in the here and now. It would have been irresponsible for the nurses to move the patient in this article without having the requisite training and equipment and even the physician that did move her risked causing further injury. While the article lauds him as the hero of the situation, the headline just as easily could have been about how he paralyzed her or lacerated her femoral artery when he moved her obvious fracture 90 degrees.

In my opinion, the statement of the hospital administrator is laughable. It’s doublespeak and must have been given for purely political reasons… I hope.

From the article:

“The supervisor of the Niagara Health System said the incident stemmed from a communication problem among staff.

“We shouldn’t have called the emergency room,” said Dr. Kevin Smith, who was hired on to aid the beleaguered region at the end of August. He said when a person is hurt in hospital, staff should call a “code,” meaning a team — not necessarily in the ER — is paged to help immediately.

When asked why staff felt the need to call for an ambulance, Smith said that may have been an old rule at the hospital. He said staff has now been briefed on the correct policy and a review is underway.

He could have mentioned any of the above things that I mentioned and it would have been just fine. It might have even been a non-issue if Canada’s less-litigious society is taken into account. Instead of stating that nurses aren’t paramedics and aren’t trained to do the same things, he backpedaled and blamed “communication problems” and “old rules”. I can’t say… but maybe this hospital administrator just doesn’t get the difference in emergency healthcare professionals either.

The writer of the article sure doesn’t.

We need to get the word out that EMTs and Paramedics are highly specialized emergency healthcare professionals with expertise in handling acute emergency situations. We are not interchangeable with other healthcare disciplines. Saying that a nurse or even a physician is a good substitute for a paramedic is missing the point that emergency healthcare is different than other specialties. EMS is truly a specialty requiring expertise, practice, and study. A person cannot just be thrown into the position and be expected to perform… no matter what the setting of the emergency happens to be.

This article provides our profession with a teachable moment. I just wish we all had the ability to seize upon it and spread the right message.

The safest place to have a medical emergency? It’s right next to a paramedic. No questions here.

  • Something similar happened to me around 18 months ago as my husband and I were hurrying to his mother’s deathbed; we were in the lobby of a hospital in Tallahassee when I slipped and fell in an unmarked puddle of some clear liquid. I landed hard on my right knee. Despite the fact that my mother-in-law’s death was imminent, staff wouldn’t do anything for me except tell me that I needed to leave her side and go to their ER. 

    Finally, a nurse whose common sense and compassion overrode protocol was kind enough to at least bring me an icepack. Even with that, by the time we left the hospital my knee had a knot the size of a golfball. Paid out-of-pocket to get seen quickly at a walk-in clinic, rather than spend hours and hours in an ER separated from the rest of the family during my mother-in-law’s last moments. The whole thing left a bad taste in my mouth and a strong desire to never need hospitalization in Tallahassee.

  • Lubbockgaymale

    I fell leaving my orthopedic surgeons office (in a medical school building), and blew out my left knee while breaking the patella.  I was put out that they called an ambulance instead of grabbing a wheelchair, but reading this article I fully agree with them now.  Thanks for the education!

  • Guest

    I’m sure the administrator knows the nurses aren’t trained for it.  I’m sure he also knows the worst thing you can do is speak anything negative about nurses, whether it be true or not. 

  • Tj

    Best place to have an emergency? Ambo bay at hospital…

  • Taylor White

    I completley agree with your assessment of the sitation. We are trained differently and we all have scopes of practice for a reason. The nurses acknowledged that they were uncomfortable moving the patient and called the appropriate service.

  • Mharriman91

    I believe the movie is called fire storm (great movie big eye opener) but it’s about how backed up the ems system is in California but that’s not the part that relates. The last part was about a women who was sitting in waiting room and fell to ground dieing (I believe internal bleeding) well husband tries to get nurse to help they say they aren’t aloud to so he calls 911 they say they cant dispatch to a hospital (technically higher level of care) in the end a janitor is seen mopping around her body and people are see stepping over her. Needless to say she died and the hospital was sued and had to close for that and other reasons I believe it was called martin Luther king or something king. Im curious to see if we actually do have a written protocol either ems or hospital end on what is to be done? If anyone can share a link to a ruling or protocol that would be great.