How the Logics of Biomedical Practice Travel
Lenore Manderson, Elizabeth Cartwright, Anita Hardon in The Routledge Handbook of Medical Anthropology, 2016
The difficulty of enticing health care professionals to work in rural areas has been addressed in part by transporting patients to the nearest urban center with some semblance of hospital facilities. Transporting patients to urban hospitals can be difficult, dangerous, and expensive; untrained taxi and bus drivers often provide patient transport because there are no medically outfitted ambulances—let alone functioning emergency medical systems (EMS) that include medics, communication, triage and supportive medical decision making and treatment during the long hours of transport to the nearest, best-equipped hospital. Even those urban hospitals are often incapable of treating the patients that arrive at their doorsteps, due to lack of facilities, general medical staff, specialist skills, medications, and supplies. Moreover, poor conditions of employment and limited opportunities for on-the-job training make it difficult for personnel to do their jobs well. These deficiencies create clinical landscapes that have meager assemblages of possibilities—both physical and intellectual.
Organizing the community for pediatric trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Pediatric ambulance patient transport, though inherently unsafe, can be made less hazardous through use of safe driving practices and effective restraint of patients, passengers, providers, and equipment. Unfortunately, many commercially available restraint devices are ineffective, but are not known to be so because they have been subjected only to static testing at the laboratory bench rather than dynamic testing in a moving ambulance [140]. Fortunately, recent evidence suggests that safe restraint of a child occupant can be achieved through the use of a child safety seat when secured to the ambulance stretcher using two standard ambulance gurney belts [141]. Yet, the most important step in ensuring safe transport of ill or injured pediatric patients is to ensure that all personnel, most especially ambulance drivers, regularly follow the Do’s and Don’ts recently issued by the NHTSA and the EMSC, as shown in Table 2.6 [142].
A framework of models of out-of-hours general practice care
Chris Salisbury, Jeremy Dale, Lesley Hallam in 24-Hour Primary Care, 2018
The issue of providing transport services to enable patients to attend primary care centres is also contentious. Lack of transport is the most common reason that patients give for declining to attend a primary care centre. The argument for providing transport services is that this reduces the need for home visits. By contrast, it can be argued that transport is usually available from local taxi companies if not from neighbours and friends. Although it may be claimed that this is too expensive, it is no less expensive to transport a doctor to the patient. The difference is that the cost is less visible. The relevant issue is not how patient transport should be arranged, but whether patients, doctors or the health service should be responsible for the costs.
The Effect of Blood Transfusion during Air Medical Transport on Transport Times in Patients with Ruptured Abdominal Aortic Aneurysm
Published in Prehospital Emergency Care, 2022
Nancy Mikati, Amanda R. Phillips, Neal Corbelli, Francis X. Guyette, Nathan L. Liang
Patient transport should ideally be executed using a method of transportation that minimizes transit times, while considering several environmental factors (i.e., geographic distance, weather changes, traffic patterns, etc.) (4, 20). One of the recommended means of transporting aortic emergencies is using air medical transport, which minimizes time delay at the OSH, and allows for quick transport to tertiary care centers, while providing the necessary critical care during transit (15, 21). In our study, transport was accomplished using a critical care transport system, incorporating parallel processing of patient acceptance and transport team dispatch, remote management of the patient through teleconsultation from the transport crew, and pre-arrival notification of the surgical teams and blood banking resources.
Hypoglycemia Emergencies: Factors Associated with Prehospital Care, Transportation Status, Emergency Department Disposition, and Cost
Published in Prehospital Emergency Care, 2019
Michael A. Kaufmann, David R. Nelson, Puneet Kaushik, N. Clay Mann, Beth Mitchell
Among hypoglycemic EMS activations in NEMSIS, the analyses focused on two topics: 1) the use of medications such as glucagon, IV dextrose, and other treatments to quantify and understand how EMS personnel treat patients assessed as having hypoglycemia in relation to known EMS clinical guidelines; and 2) patient transport status, such as subsequent transport by emergency responders, transport by personal vehicle, or no transport to evaluate healthcare resource utilization and costs. NEDS provided the opportunity to study factors, such as diagnoses, associated with a hospital inpatient stay rather than being treated and released from the ED. NHAMCS provided estimates of the rate of arriving by ambulance. Finally, MEPS provided expenditure and charge information for ambulances, ED, and hospital inpatient.
Deployment of Alternative Response Units in a High-Volume, Urban EMS System
Published in Prehospital Emergency Care, 2020
C. Crawford Mechem, Crystal A. Yates, Maureen S. Rush, Arturo Alleyne, H. Jay Singleton, Tabitha L. Boyle
Historically there have been several barriers preventing EMS providers from treating and releasing patients or transporting them to destinations other than EDs. These include current EMS regulations prohibiting such practices, financial incentives to transport patients, and a lack of alternative sites to take patients. In Pennsylvania, according to the EMS System Act a receiving facility is a fixed structure with an emergency department staffed by a physician available around the clock (20). Regulatory changes may be necessary before ambulance transport to alternative destinations is permitted. Reimbursement for EMS care has also been traditionally tied to patient transport. Currently Medicare only reimburses for transport to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. The Center for Medicare and Medicaid Innovation’s recently proposed Emergency Triage, Treat, and Transport (ET3) Model will reimburse participating EMS agencies for transport of Medicare beneficiaries to both EDs and alternative destinations, as well as treatment and release of select low-acuity patients (21). Transporting patients to alternative destinations depends on the community having enough alternative sites, such as urgent care centers or public clinics, to make the practice beneficial.
Related Knowledge Centers
- Ambulance
- Cardiac Catheterization
- Myocardial Infarction
- Emergency Medical Services
- Clinical Commissioning Group
- Kidney Dialysis
- Casualty Movement