In response to the letter written by Mr. Russo to the Cambrian (April 7, Page 8), we would like to clarify how decisions are made to transport patients to which hospitals. There are three San Luis Obispo County Emergency Medical Services Authority policies that apply to this issue, policies No. 151, 152 and 153. The purpose of these policies is to ensure that patients are transported to the closest appropriate hospital or specialty care center based on their immediate medical needs and regardless of their ability to pay.
A patient has the right to request transport to any hospital in the county; if the patient is stable and does not require any special services, the request must be honored. If the patient is considered unstable by the paramedic and following EMSA policy, they shall be taken to the closest hospital.
In addition, there are EMSA county policies that direct where patients are to be taken in the event of trauma, or having a “heart attack,” known as a STEMI in the medical field. When a patient meets specific criteria after a trauma, the paramedics are required to transport that patient to a designated trauma center and for San Luis Obispo County, Sierra Vista Regional Medical Center is the designated trauma center.
The ambulance may bypass closer hospitals so the patient can receive specialty care at the trauma center. When a patient calls 911 and reports having chest pain, the paramedics will assess the patient and perform a 12 lead EKG; the results of the EKG will determine whether the patient must be transported to the designated STEMI center. French Hospital Medical Center and Marian Medical Center are designated STEMI Centers for San Luis County paramedics depending on the patient’s location.
Not every patient with chest pain is going to be taken to a STEMI center, and not every trauma patient is going to be taken to the trauma center if there is a closer hospital. Occasionally, additional testing at the hospital or a change in the patient’s condition will determine that a patient needs to be transferred to a hospital with a higher level of care.
If a patient is advised of a need to be transported to a specific hospital and refuses, the patient may sign an Against Medical Advice form and be transported to the hospital of their choice if they understand that their choice may not be the most appropriate for their care and could negatively impact their care.
We hope that this will help clarify for everyone some of the decision-making process that takes place as our emergency medical service personnel assist you with your emergency medical needs.
Dan McCrain is operations director and Bob Sayers is administrator of the Cambria Community Healthcare District.