County, EMS develop checklist after controversy




After hearing from a concerned Garden City woman who transported her husband to Wichita for urgent medical care in March, Finney County Emergency Services and Finney County commissioners have developed a checklist for thoroughly checking weather conditions and detailing reasons for acceptance or denial of emergency transfer requests.

In light of concerns expressed by Nancy Wilken at the May 6 county commission meeting about Finney County EMS' denial of an out-of-county transport request for her husband, Harold Wilken, the FCEMS, county commission and St. Catherine Hospital personnel have developed a transfer checklist to ensure that road and weather conditions are being checked thoroughly and that acceptance or denial of transfers are being more thoroughly documented.

"We've had a meeting with the commissioners and the hospital, and we've put in place a transfer checklist so that if there is a denial, we have documentation of exactly why it got denied. We're also going to have quarterly meetings," said County Administrator Randy Partington. "There's a committee that will probably consist of the EMS director, the three field training officers and the medical director for EMS to make sure we haven't missed something."

Joe Hopkins is the FCEMS director, Dr. Harold Perkins is the FCEMS medical director and emergency room physician at St. Catherine, and the three FTOs are the supervising paramedics for FCEMS during their respective shifts.

Wilken took her husband to Wichita on March 23, after being advised by the hospital physician that he had a brain bleed and needed to be seen by a neurologist or neurosurgeon as soon as possible.

As is standard practice, the hospital physician contacted EMS to see if it could provide transport to Wichita for Wilken, but because of forecasts for icy roads, the FTO on duty at the time declined to do so. Wilken questioned this decision after driving her husband to Wichita herself, noting that road conditions were clear. She told commissioners she was concerned and wanted to prevent something similar from happening to another Finney County resident.

At the commission meeting, County Commissioner Dave Jones told Wilken he understood her concerns, but that transfers from St. Catherine were not an absolute guarantee and that the first obligation of EMS is to get the injured or ill to St. Catherine or another local facility.

In a separate interview, Jones said that as the means and opportunity are available, EMS also will provide transports to Wichita or other cities.

"But we don't always have the means, and certainly not always the opportunity, so that causes a bit of concern. I understand, having some experience of my own with having to transfer somebody to Wichita, I know the high anxiety that one feels, but on the other hand, we don't want to lose an EMS crew and a patient out in the middle of a storm somewhere if we can keep from it," Jones said.

In a separate interview, Hopkins said that at the time of the request, an FTO made the decision to decline transfer based on forecasts for possible freezing rain, ice and blowing snow.

"I think it was two hours later that it was taken from a warning to an advisory, and an hour after that, it was cleared," he said.

In a separate interview, Wilken said she and family members began checking with 511 and other weather outlets while still at St. Catherine Hospital, and the information they received indicated that there was no threat of inclement weather, prompting her to transport her husband herself.

The new transfer checklist will be filled out by FTOs or the FCEMS director when determining whether to accept or deny transfers to other facilities based on staffing or weather conditions. For the latter, it requires the FTO or EMS director to check with the Kansas Department of Transportation, the Kansas Highway Patrol, the National Weather Service and 511 before making a decision to accept or decline a transfer due to weather. Denial of transfers may be made in the event of wind advisories, winter weather advisory/warnings, weather not clear at destination of transfer, or severe weather warnings at or en route to and from destinations.

Wilken said while she is happy to see progress is being made in addressing transfers, more needs to be done to ensure that Finney County residents receive the care they need.

"I think the transfer checklist is a huge improvement, and I'm very pleased that they're doing something about it. But it doesn't seem to me to be written from a 'how can we get this done' aspect, but from a 'how can we avoid it' aspect," Wilken said.

Hopkins said that as part of their quarterly quality assurance meetings, the new transfer checklists will be reviewed to ensure that refusals to transport are uniformly done and to see if any adjustments need to be made to the checklists.

The Finney County EMS transfer policy reads as follows: The weather, road conditions, and if needed, the availability of a third crew member, will be considered in the decision of accepting or refusing a transfer.

This policy, previously written by Hopkins, also states: "With the addition of another crew on each shift and the change in schedule, we are revising our transfer policy. Effective Jan. 3, 2011, we will switch to a 48/96 schedule, which will put each team on for 48 hours and then off for 96. This, along with the new crew, will make us more available for transfers out of, or to, your facility. Our new policy will follow the guidelines listed below:

* Transfers leaving before 12 a.m. will be taken as long as all three teams are in town. This means that if the transfer team is out, we will not be able to take another transfer until they return.

* Transfers after midnight will be taken at 7:30 a.m., unless absolutely medically necessary.

* The medical necessity of the transfer shall be properly documented and explained to the patient, along with the risks and benefits of the transfer by the transferring department."

Additionally, the policy states that its aim is to improve patient care, while providing a safe working environment for the technicians and patients.

Hopkins said the possibility of inclement weather and poor road conditions is important in considering transfers for both the safety of EMS personnel and the patient.

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