Related but unrelated, I frequently have trouble with EMS bringing inappropriate patients to my facility. My facility: rural hospital, surgery, telecardiology, but "we can give tPA" for strokes. Only 20 miles from two hospitals that are massive stroke centers and have interventional neurology. EMS will pickup a massive stroke, outside of tPA window, but within 24 hours onset, and drop it off with us. Our CT is slow, we have to upload the CTA head/neck remotely, get on phone with remote radiologist, then arrange transfer and wait on EMS to bring the patient to the appropriate facility. So we end up having these patients hours while their fucking brain is infarcting waiting to get transferred for a thrombectomy. All because our EMS is, I'm sorry, too stupid and/or lazy to bring to the appropriate facility to actually treat the patient. It's well known that EMS doesn't want to go to "big city" because their dispatch will keep them in the big city running calls instead of sitting on their butts in rural town.

I'm at the point where I'm going to start asking EMS for their names and documenting it in the chart because their decision to bring to us is absolutely without a doubt killing these patients. And my biggest fear is a loved one has a legitimate medical problem and a lazy EMS person will dump them at a rural hospital because they don't want to get stuck running pickups in a busy city.

I've had similar problems with them with OBVIOUS intracranial hemorrhages (EMS story: patient sitting on couch, suddenly goes unresponsive, has that obvious hemorrhage snore, BP 240/130, oh we gave him narcan lol no response.) Only intervention is craniotomy. So bring to a rural hospital with nothing while the patient herniates. Makes me livid.