HomeMy WebLinkAbout810490.tiff ItteaCCIETTGEflERAL HOSPITAL MEDICAL STAFF
E C� .f e of the medical st. MELD COUNTY COMMISSIONERS
JERRY WEI L,M.D. ('p D CEI V E' G A. MASTERS, M.P.H.
Chief of Staff 1J 01 '`/` rector of Medical Affairs
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JERRY R.CREWS,M.D. •-
Vice Chief of Staff
ROY H.SHORE,M.D. SEP 2 1981
Secretary-Treasurer GREELEY, COLD.
27 August 1981
Weld County Commissioners
915 10th. Ave.
Greeley, CO 80631
Dear Gentlemen:
In compliance with the State of Colorado I am enclosing the Medical Ad-
visory Group endorsed Destination Policy.
In doing so I would like to expound on several points which may, on the
surface, appear out of line with the purpose of providing ambulance
service to the southern part of the county.
It is the accepted policy of the Physicians Advisory Committee to the
Colorado Medical Society that patients be transported to the facility
which is capable of handling that particular emergency.
As specialists in the field of emergency medicine our group realizes
that not all facilities are capable of handling all emergencies. This
is especially true of major trauma and neurotrauma. It is therefore
in the best interest of the patient that we have a destination policy
which provides for optimal care to the critical or unstable patient.
It is possible to have excellent pre-hospital care result in tradegy if
the patient is transported to a facility not equiped to handle the emer-
gency. This is totally unacceptable to me. We are far removed from the
days when ambulance services offered no more than transportation, and
the nearest hospital was as good as any other. This gentlemen, is the
main reason that the State Department of Health requires a destination
policy established by the medical advisor.
A few objections were raised by Jerry Wones regarding destination policy,
specifically Jerry's desire to transport the patient to the hosptial of
the patient's choice. After discussing this problem with him I felt a
satisfactory compromise had been reached. The proposed solution would
allow patients who desired to go to Denver, to be transferred there via
back up crew after initial transport to the nearest hospital. This
would allow time to mobilize other units and not remove the ALS unit
from the southern county area.
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Am t O sixteenth street and seventeenth avenue-greeley,colorado 80631 -phone 303-352-4121 ext. 1711, 1703, 1630
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Following this our group received a letter from Jerry Wones stating
the County would accept liability for Denver trips not following
the above destination policy.
I wish to make my position on the matter clear. Denver transports are
not in our destination policy unless unusual circumstances prevail and
then the decision is to be made by the Emergency Medicine physician
at the hospital - not by the paramedic. Our reasons are as follows:
1. Removal of ALS unit from area for an unacceptable
period of time
2. Leaves area with inadequate ALS coverage during
absence
3. Volunteer BLS service is not an acceptable substitute
for ALS coverage
4. Even if the chances are remote that emergency would
arise during absence of crew to Denver, we can not
gamble with human lives
Finally, it must be made perfectly clear that our policy is not all
black and white as you may have been led to believe. The policy
allows for indivival discretion of destination by Emergency Medicine
physician on duty. We accept this responsibility and in doing so re-
mind you that our interests and responsibility to Weld County Ambulance
Service involves quality medical care and professional liability. Our
protocols protect WCAS and your governing body.
Accordingly, I hope you will reconsider your decision regarding the
destination policy we have proposed. If you would like further per-
sonal consultation regarding this problem please contact me and I
will be happy to meet with you to help resolve this issue.
Sincerely,
6i J�9n M. Nieto, M.D.
_ ��Emergency Department
JMN/cmr
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