DOUBLE TROUBLE

     You're on the scene of what seems to be an ordinary MVA-two drivers, both restrained sole occupants, one of whom T-boned the other in a neighborhood intersection at about 30 miles an hour. The two vehicles are moderately damaged. Other than some neck pain and a few boo-boos, both patients look OK. You're going through your usual safety, diagnostic and mechanical routine, and things are looking simple-two transports to a local community hospital.

     Because your system only has a few (busy) ambulances, you decide to transport these guys together. No need to wake up another crew. You do this all the time, and so do lots of other crews just like yours.

     You update the vitals a couple of times en route, and you're not seeing any complications. You reassure both patients, give them your destination and ETA and briefly tell them what to expect when you arrive. They're males in their mid-30s, and they answer your questions, but they don't address one another until you're just about at the ED.

     That's when things get a little more complicated. Without warning, the patient who was T-boned and is now on the cot asks you if the other one is drunk. It's a funny question, because the way he asks is like the other guy isn't there.

     Q. What can you say?
     A. The query's natural. Best answer: You don't know, and you have no way to find out. It's the plain truth.

     Q. What about suggesting he ask the other driver himself?
     A. That may not be such a good idea. It could start a discussion you can't control. There's nothing wrong with a nice, quiet ride to the hospital.

     Q. What about HIPAA? Is that a consideration when you have two patients in the same ambulance?
     A. Sure enough. Although you aren't identifying these patients to one another, if you're not careful, you could reveal information during transport that could easily be linked to their IDs later on. That could happen in the course of your radio communication with the receiving facility, during your turnover report when you arrive or even in conversation with other members of your own crew.

     Remember also, these two are potential legal adversaries. If they ever lock horns in court, guess which credible witness they'll both want to invite along for the ride? Yup. You.

     Q. So, what are we supposed to do? There are only so many ambulances and just so many crews. Some of us work in small towns that are lucky to staff one ambulance.
     A. You're right, of course. There's not one thing about multiple-patient ambulance layouts that was ever meant for the good of patients-or the safety of their crews. The predecessors of today's ambulances were designed to meet the specs (and enhance the profits) of private ambulance companies. I agree with Nadine Levick when she says we need to stop buying $150,000 boxcars and develop smaller vehicles you can work in fully restrained and facing forward. Yes, that would mean bigger fleets, but facts are facts.

     Q. Yeah, like that'll happen. What are we supposed to do in the meantime?
     A. We do have some immediate options. One is to at least try to transport potentially adversarial patients in different ambulances. Two: When we're stuck with more than one patient in an ambulance, we can be sensitive to the fact that their medical information is protected by law. And three, maybe we should consider providing some of these folks with headphones and offering them music during transport.

     Think that's goofy? Dentists have been doing it for years.

Thom Dick has been involved in EMS for 37 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at boxcar_414@yahoo.com.

Thom Dick is a featured speaker at EMS EXPO, October 11-13, in Orlando, FL. For more information, visit www.emsexpo2007.com.