On Fri, 4 Sep 1998, MARTIN I HERMAN wrote:
> I would agree that transport to the nearest facility would be appropriate
> for a child in distress.especially with airway compromise and the other
> situations cited.I do have confidence that any residency trained emergency
> doc should be able to stabilize a children distress. Telephone consults are
> easily obtained and if the emergency physician needed any advice from the
> PCCC , he /she could call..
> Why would anyone leave a patient in jeopardy during along transport when
> competent help is nearby??
As a paramedic, I take the position of "transport to the nearest
appropriate facility." This sometimes entails passing other hospitals
that may be able to provide the care, but in passing them I am going to a
hospital that CAN provide the care. Not all ED's staff pediatric
personnel, or even have on call specialists that might be needed. It is
the duty of the paramedic or EMT to know what resources a particular
hospital has available.
If I had a sick child, it would benefit that child to go to an ED with
pediatric practioners. If I can provide life-supporting care to
facilitate that extended transport, I will. If the care can not be
provided, I divert to the nearest facility. In the latter case, if need
be, the child can later be transfered to the better facility.
As far as telephone consultation goes: In the emergency medical services
are specially trained physicians whose job is to provide on-line support
for field personnel. These doctors help us determine the best course of
treatment, give us orders, and sometimes act as a resourse when we are
stumped. Every EMS system has in place a 'medical control' system.
Through off-line protocols and on-line support they extend the physician
into the field. (A paramedic is a physician extender).
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