Transfers vs. 911

[Diazepam618]

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

Well as far as I know all medics in the US are directed by a medical director, don't really see the big deal between transfers and 911 as far as certs/ protocols, the only thing is that in some systems the privates do both or one, and the FD's do 911, and no tranfers. zi guess what it comes down to what you really want to do, if you want tranfers then work for a company that does transfers, and if you want 911 work for a company that does 911.

[CBEMT]

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 ?

Exactly the point I try to make whenever the "volunteer services must die" argument comes up. Sure, my department could be disbanded, and then they'd let the local private run the 911 calls. I wouldn't want to even get near the town if that happened.

Just because the personnel are paid doesn't mean they actually have the medications, equipment, supplies, experience, and supervision necessary to provide adequate patient care. You'd think after all the discussions we've had about horrible agencies, companies, and providers, people would realize that the closest/fastest/paid/whatever doesn't necessarily mean anything.

[oz_paramedic_chick]

Here in QLD emergency calls and transfers are all covered by the Queensland Ambulance Service (QAS). We have the paramedics which run in ambulances and then what we call patient transport officers that run in transport trucks. Some of these transport trucks are similar to the ambulances except that they have 2 stretchers. Others are mini buses that simply transfer people from their homes to hospital for treatment (eg. dialysis). Now PTO officers are not trained the same as paramedics. They are trained in CPR, advanced first aid and AED use but to the best of my knowledge that is the extent of their skill. They run 8 hr shifts either day or afternoon, monday-saturday.

Now this does not mean that we as paramedics do not do interhospital transfers. If a pt so much as has an IV line in...we generally transfer them as PTOs aren't trained to deal with them. This system seems to work reasonably well however, it can be frustrating when there are no crews in an area and comms send us on a transfer into the city (45min drive), only to have an emergency call come in and have to send a truck from another suburb because we (last truck in the area) have been sent on a transfer.

On the other hand some states in Oz, i'm thinking of victoria, the government deals with emergency calls (as in all states in australia to the best of my knowledge) while patient transport is privatised, however, once again the ambulances still transfer the more serious patients.

[medibrat]

Here, we do both as well...and the training is the same for all. However I think cos has a good point about making medics well rounded. (and I'm sure I'm going to catch flack for this). Transfers are a great way to learn how to TALK to your patients. I have seen mostly emerg services and they have little idea how to make a conversation with their patient. I have found transfers useful for learning too...lab values and rare diseases and such. And I have my days when I think I will probably cry if I do one....more....transfer... but they make you appreciate the true emergencies even more. (adrenaline junky by nature). I think the danger of an all transfer service, is that if you do nothing but transfers for several years, and then something happens and your post op patient springs a leak, or your psych patient suddenly throws a widowmaker, you end up lost. Heck, I went back to school cuz I was getting rusty...and our call volume is pretty good! Just limited on some of the stuff you see on a daily basis.

And for what its worth, some of those patients are going through some of the worst things in their lives...and a little knowledge and a little experience on both sides of the coin helps you give them a better ride. You need to know when to just sit and hold a hand...when doing nothing is the best thing you can do...and an all emerg service wont give you much opportunity to learn that....just my 2 cents...

Brat

[Kiwiology]

Here, we do both as well...and the training is the same for all. However I think cos has a good point about making medics well rounded. (and I'm sure I'm going to catch flack for this). Transfers are a great way to learn how to TALK to your patients. I have seen mostly emerg services and they have little idea how to make a conversation with their patient. I have found transfers useful for learning too...lab values and rare diseases and such. And I have my days when I think I will probably cry if I do one....more....transfer... but they make you appreciate the true emergencies even more. (adrenaline junky by nature). I think the danger of an all transfer service, is that if you do nothing but transfers for several years, and then something happens and your post op patient springs a leak, or your psych patient suddenly throws a widowmaker, you end up lost. Heck, I went back to school cuz I was getting rusty...and our call volume is pretty good! Just limited on some of the stuff you see on a daily basis.

And for what its worth, some of those patients are going through some of the worst things in their lives...and a little knowledge and a little experience on both sides of the coin helps you give them a better ride. You need to know when to just sit and hold a hand...when doing nothing is the best thing you can do...and an all emerg service wont give you much opportunity to learn that....just my 2 cents...

Brat

i agree Edited June 22, 2009 by kiwimedic

[Fignewt345]

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.

Shouldn't your education teach you all this before you go out and attempt to learn it all while already working?

In many current systems becoming a well-rounded provider may require you to work many different levels and certifications to get the whole picture. But it just seems it is best to educate providers to that level before sending them to do their job, especially in this career. This is where we should concentrate our efforts towards changing EMS, don't you agree?

Sorry if I sent this thread down a different road.

[VentMedic]

Shouldn't your education teach you all this before you go out and attempt to learn it all while already working?

EMS education is very limited from a broader view of medicine. Those that take full advantage of the learning experience of IFTs will benefit and can bring more knowledgeable/skilled care to 911.

There is very little pathophysiology taught in EMS and IFT patients provide a classroom on a stretcher as well as a quick opportunity to seek out a knowledgeable health care provider in the facilty to give an explanation.

There is also an extensive med list that can be more closely examined and understood. Various venous access ports can be examined. Too few 911 Paramedics know what to do with these devices and some end up destroying them which could be the patient's only access besides an IO. Of course, that will only be for a limited time and the patient may have to go to the OR for another port before other issues can be addressed.

There are reasons why many long term care facilities will try their best to avoid calling 911 for their patients. They may know those that work just in 911 EMS will have very little knowledge of medical devices and the various equipment that keep patients alive for the long term. 911 Paramedics may not even know these patients exist because they have never been challenged by transporting on of them. Even VAD patients or parents of children with special needs in the community try to keep the number of a hospital approved CCT or ALS transport service rather than calling 911. There is just not enough education about medically complex patients provided for those working in 911 or when there is, some show no interest because "its not a trauma". Thus, not having seen some of these complex patients, they may just pee their pants and drive real fast to the hospital when they do come across one in an emergency. Or, some just stay and play way too long trying to figure out all the accessories. Thus, some transfer experience might not be a bad idea.

I also find that the Paramedics who have been pushed through a program in the back room of the fire or ambulance station or through one of the medic mills they sponsor are at the biggest disadvantage. Unfortunately, those are the ones that may be providing 911 service. Those that at least got an education before joining will have more going for them than a few skills and trying to rely on that "street smarts" stuff to understand the medical needs of a patient.

For EMT-Bs, if they pay close attention to the patients, do a thorough assessment each time, read the H&P and med list, learn good communication skils and take advantage of being able to talk to health care professionals at the facilities and diagnostic/rehab centers the patients are transported to and from, they will have an advantage when they move on to EMT-P. However, they should be still taking classes while working as an EMT-B to continue they learning experience and not just master the skill of moving a stretcher between the time they finish EMT-B and start EMT-P.

[CBEMT]

The larger issues aside, I'd love to know where these people are who think about the education of their 911 providers before deciding to call somebody else. In my experience from both IFT and 911, the only factor in the decision-making process of the local nursing facilities is "What's the ETA of our contract private? More than 20? Ok, call 911."

Family members of special needs patients don't even spend that much time on it. If there's a problem they call 911, period.

[VentMedic]

The larger issues aside, I'd love to know where these people are who think about the education of their 911 providers before deciding to call somebody else. In my experience from both IFT and 911, the only factor in the decision-making process of the local nursing facilities is "What's the ETA of our contract private? More than 20? Ok, call 911."

Family members of special needs patients don't even spend that much time on it. If there's a problem they call 911, period.

LOL! Those are only the ones you think you know about. Do you even know how many special needs children or adults are in your community? At the hospital, we spend probably more hours than some Paramedics spend in their programs educating parents of children who are technology dependent as well the the S.O.s of patient with various cardiac devices. They know when their child or family member needs to get to a hospital and they know which hospital they need to go to. Only in rare instances will they call 911 and usually the primary care giver for that patient will instruct whoever responds what needs to be done. Very few Paramedics have had the pleasure of working a VAD patient in failure.

Edited June 24, 2009 by VentMedic

[CBEMT]

I'm not trying to pretend I know everything about the special needs patients, vent patients, etc that are out there or even the ones I've dealt with. I've transported many to routine appointments from their own homes, and yes, the families were invaluable resources.

I've also taken them back home from the hospital, where they were brought by the local 911 service, most of whom I wouldn't trust with anything more self-aware than a CPR mannequin. The families didn't know that. All they knew is that they're the guys who show up when they called 911 because the vent patient/baby on 24-7 SPO2 monitoring/etc was in trouble.

As for VADs, I showed up on my day off for a CME on VAD patients at my old job, but the guest lecturer didn't. Haven't had the opportunity since, unfortunately.

Edited June 24, 2009 by CBEMT