Going Level Zero for an IFT

[coolparamedic]

What are some of your services policies on going level zero on an IFT?

Just to give you a little history, I work for a hospital based ambulance service and we cover a 1200 square mile area. Being that we have only 1 ambulance staffed ALS, and one ambulance staffed BLS and the nearest mutual aid ambulance is 40 minutes away, we try not to go level zero for transfers if we can help it. We have a policy that states that we will not go level zero for another transfer unless the patient needing to be transfered is going to basically die if we don't take them. Don't get me wrong, I have no problem with going on a transfer that needs to go but I have a problem with a transfer that is all of a sudden an emergency after the patient has been in the hospital with his troponin climbing for the last 19 hours.

Tonight, we get a phone call from the hospital saying that we will have an ALS transfer to hospital an hour and a half away. Not a big deal. But our BLS ambulance was on a transfer and they wouldn't be back for atleast 4 hours. The nearest mutual aid ambulance was on a transfer so it would be 45-50 minutes for the next nearest ambulance to get here. I tell the nurse the situation and that they should call an air ambulance or try to find another service to do the transfer or they can wait until the BLS ambulance gets back. The nurse says ok. She calls back about 15 minutes later and says that the guy can't wait. It is then brought to my attention that the patient has been in the hospital for 19 hours and his troponin has slowly been climbing throughout the day. The nurse states the patient can't wait for a helicopter (even though the chopper would be quicker). I then call my boss and he says don't take the transfer and it is not acceptable to leave our area without an ambulance for that long.

Long story short. The CFO (Chief Financial Officer) calls the station and says that we have to take the transfer and that what my boss said doesn't mean squat. We took the transfer.

So after all this rambling, let me get to the point. This has been an ongoing battle with the hospital and the policy was signed off by the hospital, but they don't honor it. We have tried time and time again to come to a resolution with the hospital regarding this but it has fallen on deaf ears. I'm sure some of you have policies about this and I would like to hear some of them so we could maybe show the hospital admin folks that we aren't the only ones with this problem.

[AZCEP]

As reference, don't use area specific descriptions. Level zero doesn't mean anything to anyone outside of your service area.

If I'm understanding the situation, you stripped your coverage area to transport a patient that should have been dealt with much earlier by other resources. Once the CFO got involved, you were screwed. No accountant on the planet is going to put area coverage ahead of the dollar signs that are pretty well guaranteed.

The best thing you can do is do as you are told, and ask if they would like fries with their order. They are treating EMS like it is fast food, so return it in kind. Hope the CFO's family lives in your coverage area, and needs you while your resources are busy securing the greenbacks.

Karma's a cruel mistress.

[Just Plain Ruff]

yes when the CFO get's involved and see's dollar signs, to hell with the general public.

When the public calls and complains that it took 45 minutes to get em an ambulance you just tell them that the other ambulance that should have had their call was on a transfer it might start changing things.

Or you can send a carefully worded note to the newspaper editor or do a anonymous tip to the newspaper saying "this is joe citizen, I heard the ambulance service in town took a transfer to a hospital 3 hours away leaving our county without an ambulance for that long just so they could make some money on a transfer" Leave it anonymous and let the wheels of public opinion take their toll.

Karma is a queen - she tends to come back and bite people in the ass and this CFO is just doing his job.

[swn919]

Or you can send a carefully worded note to the newspaper editor or do a anonymous tip to the newspaper saying "this is joe citizen, I heard the ambulance service in town took a transfer to a hospital 3 hours away leaving our county without an ambulance for that long just so they could make some money on a transfer" Leave it anonymous and let the wheels of public opinion take their toll.

Not sure I would do this^^, but I have been in the same situation a time or two. I think that your boss was right and the hospital was in the wrong. They can either treat the pt medically until another unit becomes available or call the bird. What happens when a cardiac arrest is called and the nearest unit is 45 mins away?