Cardiac Transfers - Pump to ?

[vs-eh?]

Within the last moth my service has decided to step into the 1990's and put 12 lead monitoring on the Zoll's (E series). This is to be a starting point to a relatively rapid progression of being dispatched to another hospital (approx 15 mins away from the core cardiac hospital for this study) to do these cardiac transfers (sans RN).

Now some people may be like "big deal", but for my system any inter-facility transfer that is more involved than a monitor and observe (not continuing treatment), an RN comes along and there isn't really a true transfer of care. This is regardless of the ability of the ambulance (PCP or ACP crew, CCP crew I'll leave out).

So here's the thing, while I have yet to have the CME outlining all the facets of this new "transfer system", I have been told a few things. The most surprising and head scratching is this...

We are not being educated on the use of pumps at any point in the near future (no ambulance service in Ontario uses pumps without an RN). If this cardiac patient is on a nitro drip or dopamine pump this is apparently what will happen:

The hospital will discontinue the pumps and we are to continue nitrating the patient with SL nitro spray. The dopamine pump will be discontinued and replaced by a buretrol on our end...

Now I don't know about you, but this sure as hell seems much more risky. I think it is safe to say that a nitro pump running at X mics per minute via IV is a hell of a lot more predictable in every sense of titration, absorption, distribution, etc... than (maybe) a 400 mic SL spray where the absorption, distribution, etc... is much more varied. The same can obviously be said with dopamine. Eye-balling that 5mc/kg/min on a buretrol and bumping down city streets is hardly the same accuracy one can assume with a pump.

These are the two main examples that I have heard given. I am quite concerned.

This isn't some rural or smaller service either. This is a very large (300k+ call/year) municipal system. I think we may be getting a touch ahead of ourselves with these transfers and good, safe continuity of care.

Has anyone heard of similar in yours or another system? What is your opinion?

[p3medic]

Sounds like a bad idea all around. I personally don't think a 911 provider for a city should be taken away from the taxpayers to do an IFT run. IFT jobs should be handled by a private provider, or a IFT branch of a municipal service, IMHO. If you need to do them for whatever reason, you should be afforded the same ability to administer medication as the place your tranfering them from. A patient on a NTG infusion shouldn't be d/c'd and started on sl NTG. I realize things are different in the Great White North, but it seems to be a huge liability from were I sit.

[akroeze]

vs-eh?

Isn't this what the new ORNGE trucks coming out are supposed to be for?

[vs-eh?]

Isn't this what the new ORNGE trucks coming out are supposed to be for?

You'd think that wouldn't you.

I don't know how long ORNGE is going to take to set up there land units in T.O. But from what I understand they will not be doing these IFT's. I could be wrong however, but based on the fact we already have CCTU and they are not doing them, I can't really see how ORNGE would suddenly start with them instead.

IMHO, this whole thing is being rather rushed and poorly executed, especially due to the fact that we have never done these types of IFT's without hospital staff before (minus CCTU). It's like they are seeing this as simply a 911 call that is being diverted to a more appropriate hospital. It is ruffling a lot of feathers here for ALS providers.

[akroeze]

So in your view then what WILL the roll of the ORNGE truck be? Or will it basically be a flop in your area due to the existing CCTU and this new program?

[brentoli]

IMHO

:shock: You're about as humble as Hillary Clinton is female!

Carry on.

[vs-eh?]

:shock: You're about as humble as Hillary Clinton is female!

:-s So I am humble then? Unless it is sarcasm regarding the fact that Hillary acts male or in fact isn't biologically female.

Fill me in on that one.

So in your view then what WILL the roll of the ORNGE truck be? Or will it basically be a flop in your area due to the existing CCTU and this new program?

TEMS CCTU will be phased out with attrition for sure (I think there are 20 or so left), or it might be "bought out" (I'm speculating) once ORNGE gets fully implemented.

These transfers are very narrow in scope, however it is a scope that is brand new and unfamiliar to basically everyone. CCP's of course can do these calls, but obviously can do many more involved transfers on their own that ACP's would never be able to do without the education, procedures, and hospital staff.

It's just being handled wrong and especially the continuity of (appropriate and quality) care aspect is what bothers me most. It is kind of changing the job description (adding some CCP components) without true accompanying education and pay scale evaluation. The pay in my opinion is neither here nor there (we get paid well, but I see the point), it is the lack of proper education and patient care that really bothers me. Unfortunately, because the 12 leads are seen as the starting point prehospital, it has turned many people off of their use. That is really too bad, and things need to be looked at more closely before taking things much further.

[Scaramedic]

I could see their point ten years ago when pumps were still huge and sensitive to movement/vibration. They have seemed to work out the bugs and have smaller and more stable pumps for transport.

I have a feeling it comes down to money.

1. The hospitals are afraid of letting you use their pumps and not getting them back form receiving facility. or....

2. Your service does not want to fork out the cash for their own pumps.

What about Dial a Flow? Are you using them?

[Ridryder 911]

One will see more and more IFT and actually they pay & 911 calls don't. We have pumps on each truck, no problem. No one gets micro or mini drips anymore. Few bumps and you have missed up the right dosage. No rate minders either, those are approximate drips, and the manufacture even states they are not meant for medications.

Going to give IV drips, get a pump. There are plenty of good ones out there.

R/r911

[akroeze]

Does anyone carry pumps small enough that you routinely bring them into a house? For example for that post-arrest dopamine drip you get going in the house?