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I would say Yes to all of your "Should/Would" scenarios. It all depends on how much you want to do in the PED. Transfuse there vs floor vs back of the 'bus'. 

 I am sure your critical care transport team could handle blood transfusion complications; but, do want them handling that in the back of a 'bus'? That is my only question. We don't generally transport patients, even within the hospital, who are receiving blood unless it's while running to the OR.

Moving to the Netherlands, although I've only been in an airport there, sounds like a nice option too. They have excellent beer. That sometimes helps when dealing with admin. I'm sure they just have a different set of headaches. 

Anthony Pohlgeers, MD
Mobile Device

> On Aug 19, 2017, at 00:00, PED-EM-L automatic digest system <[log in to unmask]> wrote:
> 
> There are 3 messages totaling 130 lines in this issue.
> 
> Topics of the day:
> 
>  1. IN ketamine
>  2. EMTALA, transfers, insurance (2)
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ----------------------------------------------------------------------
> 
> Date:    Thu, 17 Aug 2017 22:33:54 -0400
> From:    Rick Place <[log in to unmask]>
> Subject: IN ketamine
> 
> Is anyone using IN ketamine or does anyone have a protocol for this?
> 
> There are plenty of other options, but every case is unique.
> 
> I see literature from 1mg/kg to 9mg/kg. Seems like a crazy dosing range.
> 
> Anyone with any direct experience with this?
> 
> Rick Place
> 
> Inova Fairfax
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> Date:    Thu, 17 Aug 2017 17:00:22 -0400
> From:    Jacob Snow <[log in to unmask]>
> Subject: EMTALA, transfers, insurance
> 
> Question for the group.  
> 
> I had a discussion today with hospital executives about a case in which one of our providers transferred a patient to another hospital in town on account of the patient's insurance not being contracted.  The transfer was lateral with regards to the medical capacity of the facilities involved.  
> Clinically, the patient was hemodynamically stable but had anemia requiring transfusion(s) and if admitted to our facility would have gone the the general pediatrics unit.  The anemia was not due to acute blood loss or acute hemolysis/consumption.  
> Our provider arranged for our pediatric critical care transfer team since the PRBC transfusion was already infusing.  The insurance is now arguing that the patient should have been transferred by a lower cost transport option, BLS or ALS.  
> 
> The question arises was the child even "stable" for transfer?    
> 
> Should (could) the provider deem the patient "unstable for transfer" given the need for PRBC and admit for transfusions at our hospital?  
> 
> Should (could) the provider delay the transfusion, which the child needed, in order to accommodate a BLS/ALS transfer to an insurance contracted facility?
> 
> Should (could) the provider just move to the Netherlands and not worry about any of this ever again?  
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> Date:    Fri, 18 Aug 2017 08:44:36 -0400
> From:    Daniel Thimann <[log in to unmask]>
> Subject: Re: EMTALA, transfers, insurance
> 
> I don't think this is a medical or EMTALA question this is an insurance over reach question. We should come together donate to our PACs so we can claw back some of the over power and over reach and regulatory stuff that the insurance companies make us do. It should be what's in the best interest of the patient not what is best or less expensive for the insurance. 
> 
> I don't think BLS is capable of treating a transfusion reaction including TACO or TRALI, so critical care would be the right answer for me and I don't think it is within their scope of practice to transfuse anyone.
> 
> No, keep the PRBCs, fight the insurance company, and move to Netherlands 
> 
> Thank you
> Daniel Thimann MD
> Wolfson children's Hospital
> Jacksonville Fl
> 
>> On Aug 17, 2017, at 5:00 PM, Jacob Snow <[log in to unmask]> wrote:
>> 
>> Question for the group.  
>> 
>> I had a discussion today with hospital executives about a case in which one of our providers transferred a patient to another hospital in town on account of the patient's insurance not being contracted.  The transfer was lateral with regards to the medical capacity of the facilities involved.  
>> Clinically, the patient was hemodynamically stable but had anemia requiring transfusion(s) and if admitted to our facility would have gone the the general pediatrics unit.  The anemia was not due to acute blood loss or acute hemolysis/consumption.  
>> Our provider arranged for our pediatric critical care transfer team since the PRBC transfusion was already infusing.  The insurance is now arguing that the patient should have been transferred by a lower cost transport option, BLS or ALS.  
>> 
>> The question arises was the child even "stable" for transfer?    
>> 
>> Should (could) the provider deem the patient "unstable for transfer" given the need for PRBC and admit for transfusions at our hospital?  
>> 
>> Should (could) the provider delay the transfusion, which the child needed, in order to accommodate a BLS/ALS transfer to an insurance contracted facility?
>> 
>> Should (could) the provider just move to the Netherlands and not worry about any of this ever again?  
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> End of PED-EM-L Digest - 17 Aug 2017 to 18 Aug 2017 (#2017-166)
> ***************************************************************

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