It is the hospital that chooses the means of transport if a patient is to be transferred. For a patient with a low-risk, the hospital may call for a private, cheaper means of transport to move a client between medical facilities. In most of Canada a 'patient transfer vehicle' is regulated by the provincial ministries of health. Not so in Ontario. Tina Pittaway produced a CBC documentary about unregulated private companies hired by hospitals to move patients (see link below).
What is the difference between transporting a patient in an ambulance or and private company, like AmbuTrans?
Items such as proper restraints (suitable for a child, for example), hospital-standard clean linens, gloves, and highly qualified paramedics who can contain an emergency medical situation.
Now, in the case of a private company, like Ambutrans, personnel have 40 hours Emergency First Responder training, and Level 'C' CPR and first aid.
Who decides to choose a patient transfer vehicle over an ambulance, with paramedics?The hospital decides and the responsibility for choosing a method of transporting a patient.
The 1993 ECRI (US) Task Force document, Transporting Critically Ill Patients, explaines the parameters by which one assesses a means of transport for the very ill. One would think that even the moderately ill would require particular standards of care.
- Pretransport coordination and communication.
- Personnel accompanying the patient. (At least two people, including a nurse)
- Equipment accompanying the patient. (defibrillator/monitor, airway management, oxygen supply, standard resuscitation drugs, and a blood pressure cuff, ample supply of IV fluids)
- Monitoring during transport.
Real stories about real emergenciesThe sad story about the child who fell ill being transported between facilities is a perfect example. The mother would have know to raise a fuss if she had known that the child was NOT in the hands of expert emergency medical care, something we are used to in Ontario. All taxpayers are screaming for tax cuts, and we need to be prepared for situations like this one. This is a way to cut health care costs, but at what expense?
Real stories by real employeesNot only does her documentary include information by those who were victims of this type of service, she talked to a former employee. Christopher Day, a brave whistleblower who stood his ground, says,
In fact that's the reason why I left AmbuTrans. It was a situation just like that where we were forced to transport patients on a thirty-five degree Celsius day in a truck with no air conditioning in the back. Patients and nurses who were transporting complained vehemently about the heat
He refused calls he felt were unsafe, a child with a full-leg cast, and a frail, aging patient with respiratory issues, cannot be transported in a vehicle without a/c.
The other issues include lack of education and/or preparation for employees around the issue of Superbugs (hospital acquired infections like MRSA and C. Difficile). This worker identified in the study told Tina that they did not have access to clean linens, gowns, masks and gloves. Their budget does not cover such, as is the case with more expensive ambulance paramedics. We know that even Pet Therapy dogs, as well as linens, can spread MRSAs.
Ontario Ministry of Health Response
Tina Pittaway's documentary says that in 2002 the Ontario Ministry of Health hired IBI Group to look into the patient transfer business. IBI's report warned about the risks to patients because of the lack of standards. It documented the frustrations of hospitals and municipalities forced to use patient transfer.
Insist that you understand if your family is being transported in an ambulance or a patient transfer vehicle. If it is the latter, be prepared to call for help. Be an advocate for your family member, travel with them, call for a real ambulance if you think one is required. If you wanted a truck, hire a fast truck driver. But be aware and be vigilant.
Pittaway produced for CBC Radio.
Risky Business Transcript.doc
Risky Business Transcript.doc