EMS management/crush injury

[Bjorn, Pret]

HIPAA.  One 'A,' two 'P's.  

Context which serves to publicly identify the patient makes protected
health information subject to the statute.  A female motorcyclist
crushed by a tractor at an intersection in Keokuk, Iowa is pretty
freaking context-rich.  

I tread along the edges of HIPAA every day.  Ask your local medicolegal
counsel how much this BS might cost you in civil and federal court.

LifeFlight of Maine turns down flights quite regularly for lack of
medical necessity.  Don't paint with too broad a brush.  Many air
medical systems are safe, dedicated, systematic and ethical.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Roy Danks
Sent: Tuesday, June 12, 2007 2:11 PM
To: Trauma & Critical Care mailing list
Subject: RE: EMS management/crush injury

Pret,
 
I'm not sure we can come to any conclusion as yet.  I don't think the
EMS people communicated effectively.  The general notion that "bigger is
better" (University v community setting) has little weight.  They (EMS)
need to keep medical control informed in a situation such as this.  It
doesn't sound as if it was  moving at break-neck speed and they had a
good handle on what was going on at the scene. And, don't get me started
on helicopters.  I love aircraft of all kinds, esp rotor wing.  Aeromed
saves lives, but are, in general, over priced flying billboards for many
hospitals and for their own private gain when not affiliated with a
hospital.  Ever see a aeromed crew get to the scene and say "this pt
doesn't need us...take him by ground"???  Nope.  Doesn't happen.
 
As for HIPPA.  B.S.!  Why even bother Googling anything?  I'm pretty net
savvy and never even considered it.  I don't see any patient identifiers
AND the patient never went to Phil's hospital.  That's crap.  You sound
like one of "them" (Gov't folks).
 
But, since you went there (HIPPA).  Are you familiar with another gov't
ape known as EMTALA?  Having a surgeon or EM doc stroll out to the
helipad at the hospital  to "eyeball" the patient then send them on is,
as far as I understand it, a violation of EMTALA.  We had a surgeon do
that "Somewhere in Missouri where I trained"...meeting the ambulance in
the bay and telling them "we can't handle that here"...and were fined a
substantial penalty.  The presence of the helipad at the hospital and
using it as a "meeting point" is of concern as well.  One might argue,
convincingly: you pulled into the parking lot of a level III trauma
center, with a surgeon inside....perhaps 100? or 50? yards away and
didn't get the patient evaluated?  Ohhhhh....I don't know...sounds likes
a nice bonus for some blood sucking attorney when the patient
exsanguinates en route to the university.
 
Phil:  This is how I see it.  Sit down with EMS and talk communications.
EMS people on this thread are going to come to the defense of their
colleagues.  I'm going to play the devil's advocate and tell you that
they over-stepped their boundaries.  The reason you and your hospital
are called "medical control" is because you are there to help them make
decisions.  Not all the time...not for every patient.  This was hardly
and "every patient" encounter and they would be wise to learn from this
situation.
 
Roy
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