Transfers vs. 911

[cosgrojo]

I just might get killed on this one... but I haven't taken a good beating in while, and I think it's time to shake off the rust.

It was said in a previous thread:

You could accomplish the same thing, without the negative effects, by simply separating the EMS and non-emergency transport industries once and for all. No crossover. Neither has any business doing the other.

I happen to disagree with this statement thoroughly. Now everyone reading this remember that my lowly Basic certificate keeps me from understanding the complexities of EMS the way that a medic/RN/or MD does... but I'll try nevertheless.

It is my contention that the integration of non-emergent and emergent calls into ones career and into a system is vital to competent personnel, quality EMS, and a well-rounded industry. Transfers and 911 is not akin to church and state... there is no fundamental reason to separate them. There is a lot of tangible knowledge and skill to be learned on transfers, and those skills and knowledge translate to better 911 care and ability. Having experience in both realms gives the provider a great advantage over those that just do one or the other. It allows you to see the whole picture. By doing the transfers and getting reports from Nurses and MD's, reading discharge summaries, H&P's, emergency room reports, and reviewing med lists... you increase your knowledge of the patients condition, and you get to add depth to your understanding of an illness. You get to increase your knowledge in patho-physiology, pharmacology, and fill in the blanks that you were unable to fill in when you responded to the original 911 call.

All of this information translates to a better 911 provider. When responding to calls you are able to pull from your experience to know what is likely going to happen to this patient once they get to definitive care. You will have an idea of what happens to them in the hospital, what the plans for discharge is and even follow-up with rehab. It will allow you to make smarter decisions for the patient as well as allow you to have the confidence of knowing what the future may hold for this patient. Receiving reports during transfers from different points of view and levels of care will also give you a better understanding of how they think, and will ultimately allow you to have better communication skills within the medical community.

Some of the sickest people I have met have been on transfers. Without having done transfers, I would have never heard of Esophageal atresia, would never have transported a patient with Menky Kenky syndrome, and wouldn't know that Shy-Drager syndrome means orthostatic hypotension. Those with experience in both worlds are able to have more interesting medical discussions, and are more likely to make a positive impression on others in the medical community.

Separation of these two sides of EMS is stupid for other reasons as well... it promotes segregation between ourselves and breaks us up into factions, causing back-stabbing, in-fighting and professional hatred. Instead we should be striving for a sense of community so that we can overcome our history of the red-headed bastards.

Non- emergent, or emergent, they are all in the same industry. What happens to a transfer medic who has never had 911 experience when during a long distance transfer the patient crumps on them? Under a separated system, the medic will be over their head, and the patient will suffer. What if a piece of information on a discharge summary one day led to you figuring out how to save someones life on a 911 call?

It is asinine to believe that these sides of the same world should be separated. ALL of the good medics that I have seen and worked with, were proficient in both worlds (and don't give me the crap of "a Basic can't possibly know or understand what Medics understand," I know when I see good EMS, and I can recognize quality when I see it). If we purposefully brought transfer and emergency together you would build a superior kind of EMT. One that has acute understanding of the medical community and can seamlessly transition from scenario to scenario while slowly gaining the acceptance and respect of the professional medical community, and general public et al.

Thank you for your time... I will appreciate any and all debate on this subject.

cosgrojo

[Richard B the EMT]

Currently, and locally by me, training, for both transfer and 9-1-1 ambulance crews, is exactly the same.

My concern is, will you cause delay in starting care by insisting your 9-1-1 responder ambulance be the emergent responder, even with a similarly trained crew on a "transfer truck" being much closer to an emergency scene?

[Eric]

i worked for a place that is all over ky IN and tenn they all do 911 or transfers or just one

but in louisville,ky we some time well hear 911 crews go out on a run and if we are closer we will go and and let the 911 cerw know whats going on and if they need to slow down or even show up if we can take it

[VentMedic]

This doesn't just apply to the EMT and BLS. We have ALS transfer trucks and even some that call theselves CCTs using "CCEMT-P" labels that call for the FD Rescue to provide 911 care if they find the patient at the LTC facility in more need than just hooking up a cardiac monitor or monitoring a medicated IV. They should be able to at least get some emergent things started but some believe "if it ia a true emergency" then the FF/medics must handle it.

[Diazepam618]

I too agree that transfers and 911 should not be seperate, and maybe in a perfect world they would not be. I can tell you that it wouldn't hurt me to pick up a medical chart, hook up some drips and go but where I work and live the privates do all the inter-facility stuff.

[crotchitymedic1986]

The problem with your premise is that you assume all ambulances, emts, paramedics, and systems are the same, and interchangeable. Are all cars the same; is a kia as good as a lexus ? both are cars that will get you from point a to point b, but if your life depended on it, which car would you choose ? So just because private company ABC has a closer ambulance, does that make it the best to send ? Do they have the same level of equipment as the local 911 provider, do they have the experience and expertise of the 911 provider, do they have the same level of investment, insurance, and employee training ?

Now if you took a geographic region or state, and said all ambulance services and 911 services will have the same type of vehicle, the same insurance, the same training program, the same equipment list, the same protocols, and staffed at the same level, I might agree that the closest ambulance should run the call.

[VentMedic]

The problem with your premise is that you assume all ambulances, emts, paramedics, and systems are the same, and interchangeable.

Exactly!

You wouldn't expect a FF/Medic from Southern CA to work as a FF/Medic in Miami, Ada County Idaho or any other progressive system. You also wouldn't expect them to be able to work at the acuity of most ALS IFT transfers which is why MICNs are used in CA and not Paramedics.

[ncmedic309]

I might be straying a little off topic here with this rant, but I believe it's related to the topic nonetheless...

I don't feel that they should be completely seperate, but they should be organized within divisions in any EMS department that provides 911 services. You should have at least two seperate divisions, one that does strictly 911 and the other that does NET. It's fine with me for the crews that work one to work the other and vice versa, but we shouldn't be putting 911 trucks on non-emergent transfers. Our 911 systems are already overwhelmed these days and some areas struggle to get units out on emergency calls. I can speak from experience, that the non-emergent side has and continues to delay emergency care when those calls tie up 911 units. One of the services I work for does both, but it's still a common occurence that we reach a low system status (almost no trucks available) and you have multiple units busy doing non-emergent calls. This is one of our biggest failures and another reason you'll hear some providers calls for the complete seperation of the two. I agree it's beneficial for the provider to have experience doing both sides but to a degree they should be kept seperate.

[cosgrojo]

The problem with your premise is that you assume all ambulances, emts, paramedics, and systems are the same, and interchangeable. Are all cars the same; is a kia as good as a lexus ? both are cars that will get you from point a to point b, but if your life depended on it, which car would you choose ? So just because private company ABC has a closer ambulance, does that make it the best to send ? Do they have the same level of equipment as the local 911 provider, do they have the experience and expertise of the 911 provider, do they have the same level of investment, insurance, and employee training ?

Now if you took a geographic region or state, and said all ambulance services and 911 services will have the same type of vehicle, the same insurance, the same training program, the same equipment list, the same protocols, and staffed at the same level, I might agree that the closest ambulance should run the call.

Under no circumstances am I advocating blowing up whatever response paradigm your system has in place just to satisfy experience for transfer medics. I'm actually intimating that primarily 911 medics and techs should get transfer experience to help them be more well rounded. I'm not saying that 911 trucks should be running transfers, they should be covering the community, but if the medic is experienced on both end, I believe them to have an advantage over techs with only having experienced one side of the world.

But to address your point... when a system does go down to zero level and a truck primarily responsible to provide non-emergent transfers gets called into 911 action... it would be nice to expect that they will be able to perform at the same high level of care as the same level of medic on the 911 truck. A medic should be a medic, regardless of the shift they happen to inhabit at the time.

I make no assumptions about EMS's interchangeability... I am spouting off about my own personal vision of EMS utopia. My utopia is obviously going to be different from yours. But your points about staffing levels and insurance and training etc... are valid and an appropriate concern for many systems that have multiple levels and agencies running calls in them. I cannot argue those points (and I can argue most everything). Well done.

cosgrojo

[Eric]

i did not read where your from but here the training is the same for borth 911 and transfers same gear and level of care only thing is diff is how you get the call