Cruz Roja policy on critical emergency transport

This afternoon a patient arrived with a dislocated shoulder but shortly after his arrival he started to hemorrhage internally (complication of alcoholism, often fatal) . We called the Cruz Roja but they would not even come get him until they had an authorization code from SEPU ( or something like that) . They provided the phone number but the doc had to make the call himself and they kept him on the phone for a long time while the patient was bleeding out ... It was hideous. This is a general practitioner office, not set up for emergencies like this but the doc did everything he could with what he had to stabilize him. The ambulance didn't arrive until over an hour after the first call to Cruz Roja and even then they were told to take him to the Cruz Roja first to stabilize him further not take him to the hospital. He had already lost what seemed like a couple of liters, he didn't have much time left.

We were shocked. It's not the fault of Cruz Roja, I don't think. It's a policy that they are obliged to follow. I don't know how they would have handled it had the call come from a private home instead of a doctor or if the patient had insurance but we will find out. I know this sort of thing has been discussed before but I can't remember where. I want to know everything there is to know about how this works.
We have called the Cruz Roja before but for much lesser emergencies and they always came.

Sigh. I've experienced this as well and it is not fun. I've seen pts writhe in pain or actually lose their lives while awaiting the SAMU code.
Sounds like what you were waiting for was an authorization code from SAMU to accept your pt at the hospital in Guadalajara. Sam spelled this out some time ago, here are the details:

". . .or if you and your personal doctor already know you need hospitalized, you can pay for private transport to a private hospital in Guadalajara (keep in mind that private hospitals want proof you can pay). Also, if the patient goes to the Cruz Roja, and it is determined that the patient needs hospitalization, the same applies in that you can go to a private hospital. You can also sign a release and go to a government-subsidized hospital by your own personal transportation or taxi. However, taking you to a government-subsidized hospital such as Hospital Civil by ambulance is not an immediate option because it is illegal without permission by S.A.M.U. (Servicio de Atencion Medica de Urgencias). We must be given a permit number to take any patient to any government-affiliated hospital. There are more people needing “free” emergency care than there are doctors and hospitals to treat them. S.A.M.U. determines who gets permission based on need and ability to benefit. Those with government insurance get permission fast because there are simply more insurance hospitals. IMSS has 7 major hospitals in Guadalajara, ISSSTE has one, etc. Without insurance most everyone will go to one of the two Civil Hospitals, and space is limited. Those who would die without rapid attention, and who will probably live after treatment are at the top of the list. Non-emergencies and patients with chronic conditions, who would probably die even with rapid treatment, are near the bottom. Everyone else is somewhere in between, but not at the top, and depending on your condition and how many new patients make the top of the list while you are waiting, the waiting time could be hours, days, or weeks."

http://www.insidelakeside.com/t6862-lakeside-emergency-response-system

I had a much better experience - not a fatal accident. Friend fell and broke his leg (I didn't know it was broken). My doctor came immediately and said it's probably broken and to call Cruz Roja which I did - they came immediately. He was taken to Green Cross in Joco - it was closer. Leg was broken and he was taken to Sta. Margarita Hospital in Guadalajara with a call by my GP to orthopedic doctor who would see him there. Friend has no credit card. The hospital admitted him. I had to go get money since he has no credit card, drive into Guad. and make a deposit at the hospital (but they had already admitted him).  The ortho and his cardiologist were both there when I arrived with the money.  Then I went back and pay the final hospital bill which was negotiated by the doctor. Possibly the orthopedic doctor called the agency mentioned above but it happened very fast. I was impressed by how quickly. But this wasn't a bleed out situation and there were no delays. All transportation including return home was provided by Cruz Roja at 1,500 per trip.

I went to the Cruz Roja today and it seems that there was a miscommunication between the Dr. And the dispatcher. It was the dispatchers understanding that the Dr. Wanted the CR to take the patient to Guadalajara and they can't do that without the code from SAMU. The patient did need to go to the hospital but we really just wanted the CR to send an ambulance and take the patient to the Cruz Roja and do what they could do for him there until they got the SAMU code because the PT was so critical .

What we learned from this is, in the case of an indigent and uninsured patient is to NOT mention that the patient will require hospitalization or simply make it clear that you are requesting an ambulance to take the PT to the Cruz Roja only and let them take it from there.
I was assured that the ambulance should have/ would have come for him right away regardless of ability to pay and regardless of the fact that he was with a private doctor and in critical condition , but the misunderstanding got in the way of that.

Or put the pt in a private vehicle and transport.