My own personal rant....what are your opinions?

[MedicMal]

Well I have finished the paramedic program and have my AEMCA, but I have not worked as a paramedic yet. I have however worked for one of the GTA transfer company's you're referring to.

I do get and what you're saying and somewhat agree with it as well, but I would like to add some points.

Ambulance Style vehicles- as I was working for a company that utilizes the dodge sprinters, I have to say they're not very good. They do have lots of room, that is if you don't put 2 stretchers in them. Cuz with 2 stretchers there is about 7 inches of room between them, and doesn't make a pretty picture if you have to attend to one of the pts (because they coded or vomited, etc). Not to mention they have next to no suspension brand new that wear out altogether after about 50,000 kms, which makes for a VERY UNCOMFORTABLE ride for pts. Maybe if the company spent a little bit more to add the proper suspension and only had 1 stretcher then it wouldn't be so bad, but at the company I worked for I didn't like them.

I do not have a problem with them using the ambulance style trucks, I actually prefer them. After all they are transporting pts and are classified as healthcare professionals. I do have a problem with them making themselves look like EMS ambulances and having words like "paramedics" or "critical care patient transport" written on them, because like what was stated its a misrepresentation. Especially when you only need standard first aid and cpr certificate to work for the company. I think they should just clearly state "Non-emergency Patient Transportation" (some do).

As for the lights- It's illegal for them to have forward facing red lights. I don't disagree with them having the lights, but I do disagree with the forward facing reds that some companies don't bother to remove/change. At the company I worked for we sometimes had to pick up pts at the Airport that had to be transfered to a hospital, and to enter the runway area we had to have our emergency lights on. Not just our 4-way flashers, they wanted everything on. So having the lights on the trucks are sometimes necessary.

Uniforms- I disagree with them looking exactly like paramedics, but I don't disagree with the reflective striping. It comes in handy when you're working at night, for safety reasons (in driveways, parking lots, if you've come across an accident and you render care until EMS arrives, assisting EMS, etc). I think tac pants and a golf shirt would work good.

If you've done the paramedic program and work for a transfer company and choose to wear your utility belt and stethescope, I see no problem with this, after all they know what they're doing with them (usually lol). I do have a problem with the people who only have their first aid or EMR (remember Ontario, EMR here is a weekend course) and chose to wear these items, which most of the time is simply because they want people to think they are paramedics. I personally didn't wear my utility belt or stetchescope, but I had them in my bag in the truck just in case.

My issues with transfer services:

- the people who work for them who only have their first aid or EMR and call themselves paramedics

- trucks not being properly stocked. You want the public to view you as healthcare professionals, then you should have the supplies and equipment to back that up

- the fact that you only need first aid and cpr to get hired on with these companies. You should have at least your EMR. My true feelings are with the topics that have been discussed before about the MoH taking over transfers, almost like a sublet of EMS. Especially these days when its so difficult to get a job in EMS, pay $10 less and hire these grads to work transfers until they get a job. Not to mention regulating the system, and I could go on, but it's off topic.

Anyways, thats all I can think of for now.

[vs-eh?]

Firstly, if you are not familiar with the system in Ontario which STAT is speaking of, please refrain from commenting on them and relating them to your system. With all due respect, they are probably at least dissimilar, and at the most, services that hire paramedics to do paramedic work with paramedic equipment. In your system it may be simply a semantics issue. In Ontario, it is not.

Secondly, I basically agree with STAT on all points.

I have said this in other threads in the past. I would love to see a company convince the MOH that they should take over the entire province's system. Yes, I would be talking about a monopoly (but Ornge monopolizes air right?). Standardize vehicles, uniforms, pre-training, etc... If I had several million kicking around, I'd love to do this. I'd make some serious changes.

Some major things that bother me:

- Yup, that "A" service that states they are "critical care patient transport". Wow, does that ever bother me. I wonder what Toronto EMS' CCTU paramedics think, or the guys and gals on 799 or any other GTA helicopter. The CCP's probably don't even bat an eye to it, but it still gives a hugely false impression. The irony is that they are basically the only company (that I can recall seeing) that look the least like "real" paramedics.

- The whole stethoscope-around-the-neck-thing for these people or having any type of equipment on them. You're right, there is no real reason for them to have it. They don't take (required to take) vitals, nor will their assessment effect anything with regards to the reason they are transferring said patient. Now, that being said, I can see why PCP students may want to do this, and they should. Transfer services generally are (beyond preceptorship) the hands down best way to get patient assessment skills and vitals in the closest EMS environment you'll see. It basically won't make any difference to what happens with the patient (they will/should be stable), it gives you the practice.

- The obvious "jokers", or drop-out's, or those that are "too cool". People wearing their own jacket's, their ECKO hoodies (yet with EMS pants), playing hackey sack with a white t shirt only on and EMS pants. I could go on...

- Ambulances (that appear to be "real" ambulances that the general public wouldn't know the difference) that say "paramedic" on them. I believe a "C" service or a "P" service was the most recent transfer company that I have seen with those markings. I haven't seen them in a while, so I can't comment on if those markings still exsist as such. Yes, there are PCP's that work on tranfer services, but they do not function in EMS, and should know their limits.

- Rumour's of a certain "V" service that has run L+S at times (mainly in KW region, from what I've heard). Which is ironic, because the "V" service is probably the best one, and should be generally a model based on general public impression (and my impression).

What I would do:

- Those sprinter type vehicles (with no L+S) and marked appropriately.

- The navy/black uniforms (with EMS pants) is probably my least sticking point. Keep in mind that TTC wheeltrans operators also wear EMS type pants. As long as they had a standardized uniform (I believe a "T" service has lighter blue or maybe orange shirts) that clearly say "patient transport service" or something, I'd be cool.

- Education requirements of standard FA/CPR with EMR/MFR as minimum. Huge preference would be given to current PCP students or AEMCA's. I'd also require an F class license. I actually don't think that an F class is required for transfer services. Yes, I did work for a GTA service for a short while (couldn't do it anymore) as a PCP student, and I didn't have my F class. This was years ago though. Meh, considering we're using sprinter vehicles the F class might be awarded points, but not a requirement.

- Oxygen and a BLS jump bag (no cupboards). Whatever the scope of practice is (minus medications, MD is not worth it/too expensive) of the EMR/MFR, etc.

I dunno, that's it for now. Yes, I do work in the GTA as a paramedic.

[vs-eh?]

Two points that MedicMal stated that I didn't think of...

The airport thing...I forgot that transfer companies do airport (i.e. island and Buttonville, I assume not PIA) transfers, and are required to use "lighting". The jeeps that usually escort you only have bar lighting I believe. Fair enough, I would have dedicated vehicles (say 1 working around TIA and one near Buttonville) that would be equipped with adequate lighting. These would be the only 2 vehicles that could do these transfers. They would also only be staffed with (pref) AEMCA/PCP students WITH their F class.

The 2 stretcher transfer thing? GONE! I think it is ridiculous that it still exists, and every time I see it, I'm like wow...

[STAT]

Great! I've been watching this thread all day and waiting for some good input. Whether or not you agree with me its nice to here others opinions.

My issues with transfer services:

- the people who work for them who only have their first aid or EMR and call themselves paramedics

I totally agree with MedicMal on this one but my original thread was getting too long for me to touch on it. It seems that with some people you give them a Navy uniform and an Ambulance and they dont hesitate to call themselves Paramedics. This personally burns me and should ANYONE else whom has had to slug through one of Ontarios 2 year PCP courses. The term "Paramedic" is arbitrarily thrown around by people (mostly employeed by transfer services) whom have no idea what it takes to get that title. A police officer wouldnt stand for a $12 an hour Security guard calling himself a cop so I dont think we should have to stand for our title to be thrown around so carelessly. Becoming a Paramedic is something you earn through hard work, hours of study and months of unpaid preceptorship.

And to touch on my point about the uniforms....I have no problem with Transfer services wearing reflective striping, safety first, right? but we all know that the public doesnt look at arm flashes (most times) they see a navy uniform and an ambulance (or something that looks like an ambulance) and the immediate thought is "Paramedic". The public has no idea most times of the difference between the 2 (real MOH Ambulance and transfer companies) as an example, how many times have you been in your service uniform and had someone call you a cop? The public just doesnt look that closely. So what ends up happening is these transfer people whom look like paramedics are seen by the public not upholding the same level of professionalism that ANY good paramedic should uphold we get the bad rap for it. No wonder we have to fight for respect that police and fire get automatically! We have hundreds of psuedo paramedics floating around with no care of how they represent the profession!

[akroeze]

Same could be said of security guards though. I have been at malls where I seriously thought the security guard was a cop.... if it weren't for the lack of gun and different patches they looked identical to one.

[STAT]

but you obviously see the problem in that dont you? Its downright dangerous!

[MedicMal]

I completely agree with vs-eh on the topic of the MoH taking over the province's system and standardizing everything.

One big issue that I have with these companies employing people that only have their first aid or EMR is that they generally don't know how to recognize and evaluate a pt that isn't stable. I don't mean that ones that are obviously unstable. They're sent to pick up a pt and transfer them somewhere so that's what they do, they don't really get a history or actually evaluate if the pt is stable enough to be transfered somewhere. I've had pts more then once that were breathing greater then 40 breaths a minute, that the hospital wanted transfered home.

The sprinters can work if companies put the extra money into better suspension and only equipping them with ONE stretcher. I hate the 2-stretcher trucks, its not safe, especially when you have only one person operating a stretcher. That's VERY unsafe.

Just a side note: F class isn't required for transfer services because they aren't covered under the Ambulance Act.

[vs-eh?]

MedicMal...

And keep in mind that I will refer to all Ontario "patient transfer services" as PTS from now on.

Why would a person who transfers patients HAVE to evaluate a patient that they are transferring? You don't, that is up to the MD's, RN's, and RPN's (and others) that have handled this patient from the patient of their care to yours. You are not paid to assess patients, you are paid to transfer patients that cannot go by personal means, cabs, or wheeltrans. That is the simple truth. Now, keep in mind if you are not comfortable moving this patient (as with any of the above services), then by all means express your concern prior to transport. Please do, but realize that PTS are not bound legally under the MOH or their basehospital to use discretion when transferring patients. It's more of a moral or common sense thing (that PTS employee's should have more knowledge about).

Why would a PTS employee REALLY care about assessing a patient or "getting a history" or "evaluating" a patient. Anymore than wheeltrans or a cab? I'm being honest here, it's more of a moral obligation, than a professional one.

So if as a PTS employee you had a patient breathing at 40+ breaths per minute and (after asking the staff about their stability) you transfered them, did you call 911? Did you get into your vehicle, and then call 911? If not, then why?

[MedicMal]

vs-eh you bring up a very good point. You're absolutely right, we're not paid to assess patients. Sometimes hospitals (this is from personal experience and from hearing stories from co-workers) will send patients home who are not ready to go. I'll try to explain that better. What I mean is if we were to take them home chances are the RN/RPNs of the NH or family members would be too uncomfortable with the patient's condition and end up calling EMS to bring them back to the hospital. Or there have been situations where myself or a co-worker just felt uncomfortable transferring a patient (i.e. we were questioning whether or not the patient was "circling the drain"). More so, and I guess this is because I have the education and training, I don't want to take the patient because I know I don't have supplies and equipment to render the care needed if something were to go wrong en-route. Does this make sense?

You're right transfer services are not bound legally under the MoH or their basehospital to use discretion when transferring patients and I agree it is more of a moral thing or common sense that transfer services' employees need more of. I guess that's more of the point I was trying to make.

As for my situations I can think of 2 off the top of my head.

1. Hospital was sending elderly female back to nursing home. She had been in the hospital with pneumonia. My partner was "attending" who had also taken the paramedic program. She was looking at the hospital notes for hx and the most recent vitals. When she took a look at the patient she noticed her breathing was pretty fast. According to the notes the last set of vitals were taken an hour earlier and her breathing rate was 20 breaths per minute. My partner calculated 48 breaths a minute and then asked me to confirm, I got 44 breaths per minute. We then went to the staff to inform them of the increase in breathing rate. They still insisted we transfer her, so my partner called our dispatch and informed them we were uncomfortable transferring this patient. Our dispatch gave us permission to cancel.

2. This situation is different as we were picking up a patient from a residence to go to an appointment. Patient had a hx of lung cancer and was scheduled to get his lungs drained (what the family told us). Right away I noticed the patient was very pale and cyanotic. His breathing was very fast and laboured, 2 word dyspnea and his extremities were very cold to touch. I felt this patient was too unstable to come with us and should go to an ER so I convinced the family to call 911. I directed my partner to apply oxygen, and I gathered a complete history and whatever vitals I could get and relayed it to EMS when they got there.

[akroeze]

You guys do make a very good point. If one thinks of PTS as a horizontal taxi and not a PTS then that makes more sense and directs how things should be run.