Inter-facility transports

[Niftymedi911]

Hyperkalemic? Absolutely, run that 12-lead with no pulse, let me know how it turns out. Or are we not just drawing labs now, but running the tests too?

Yes, CB we are doing tests, keep up with the times,..... Read this article on point of care testing for EMS:

http://www.jems.com/news_and_articles/colu...re_Testing.html

My agency is doing a six sigma project on wether we should invest in starting the point of care blood testing for our patients. With our hospital system (6 hospitals) within the next 3 years are cutting the duplication of servcies out and creating specialty hospitals, this would make sense.

BTW, you don't need to do a 12 lead on someone on diaylsis, they often have tall actue T waves in any lead if you hook em up.

As I thought, the "Paramedics Fix Everything" attitude wasn't far behind.

I'm glad your learning, we do try to fix everything, tell me exactly what you can identify as an EMT in the field and treat besides pain ( even then it's up to the medic for Morphine or Phentanyl) and trauma.

[VentMedic]

Yes, CB we are doing tests, keep up with the times,..... Read this article on point of care testing for EMS:

http://www.jems.com/news_and_articles/colu...re_Testing.html

My agency is doing a six sigma project on wether we should invest in starting the point of care blood testing for our patients. With our hospital system (6 hospitals) within the next 3 years are cutting the duplication of servcies out and creating specialty hospitals, this would make sense.

BTW, you don't need to do a 12 lead on someone on diaylsis, they often have tall actue T waves in any lead if you hook em up.

IF the patient has a pulse, a 12-lead EKG is necessry because they are prone to ischemia and the good ole MI.

Lee County Healthcare has already streamlined their system except for a few details with the two recent additions to their family of hospitals.

And even though, Lee county is large, it would be difficult to correct electrolyte imbalances in the field as well as carry all the necessary meds and fluids to do so. Also, and especially in the dialysis patient, whatever you attempt to correct will have an effect on other systems. With the iSTAT poc you will still have just about 7 values out of a minimum of 24 needed to even begin to adequately correct. And, with renal failure on even a non dialysis patient would you know what to do or what you could do to those patients.

Yes, the POC testing is very important on specialty transports and is used regularly. But, a baseline as already been established and whatever might be needed to correct something has already been anticipated.

Your JEMS reference pretty much makes every point I would want to make about POC testing in the field. It is strange that you chose that article if you are pro POC in the field.

As far as decreasing times in the ED, not if CLIA standards are not complied with. This is the biggest thing that EMS workers have trouble understanding. Work will have to be duplicated again if the CLIA guidelines are not followed to the letter. Why do you think phlebotomists must now have 150 hrs of training to draw blood? It is easier to draw another lab than to untreat a patient who had been treated by a mishandled or mislabeled specimen. And, god bless that lab that wants to undertake the task of CLIA testing, certifying, compliance checking employees as well as QC recording each machine at least once a day all those machines on a large EMS company. How much are you going to raise the county taxes to pay for the machines and the cartridges?

Any EMS system that is good, needs to perfect some of the things they have been implementing before jumping ahead to something else. Their good reputation could easily be damaged.

[Niftymedi911]

I had just mentioned it, I didn't want to give someone something without consdiering Pro's and Con's.... that's why I picked that article.

I for one don't undertstand why we need them...... If we practice and hone our assessment skills like the article said, there would be no need for the Istat.

VentMedic- I was simply refering to the whole, hyperkalemia thing, I undertsand why and what but, I was just clearly trying to show, CB that it isn't just that, hyperactue T waves are definately a ominious sign, and warrant a 12 lead, I was just trying to show that it anit just the "save all attitude".

What you probably do not know, is Southwest Regional now owned by LHMS, will be shut down permantly once the new Gulf Coast hospital re-opens. And it is by far streamlined. The healthcare system here sucks a$$. Hell, even with our trauma center here, they still ship aortic trauma down to HealthPark, because they have no cardiovascular surgery at the trauma center. The system will be implementing the whole specialty care hospital BS once GCH opens, it will go something like this LMH- general medical, CCH- General, limited cardio/neuro capabilities GCH- All Trauma (Level 2 trauma center)/ Cardiology, Regional Women and Children Health center, Neurology (Stroke Center) HPK- Pediatrics PICU, Neonatal ICU, Cardiology, OB. And it will be nothing but transfer city. Why can't they get their head out of their a$$ and have everything at every hospital?? It makes sense but of course down here common sense isn't just that.

The project isn't going to get off the ground, and we have bigger fish to fry, like keeping the privates out of our county. Apparently AMR just went to county comission to bid on interfacility transfers in Lee County. Well, needless to say as of right now, it got shot down because we just ( As of 12/2007) implemented our very own transfer divison. We now have 2 ALS/ 2 BLS interfacility transfer trucks to supplement the ALS 9-1-1 response. Now, no more 9-1-1 trucks will be running transfers unless it's a type I (priority 1 L&S) transfer. Type II and III's will be handled by the divison. We now offically have a total of 39 trucks, 4 transfer trucks (Medic 34/35 BLS)(Medic 38/39 ALS) and 36 9-1-1 response units. 5; 12 hour and 29; 24 hr trucks.

To be honest, majority of our funds are actually from operational fees. Yes, our budget does come from the county in taxes, but we collect to offset that and last year in 2006 our re-coup rate for services rendered were close to 62%. Total budget for EMS was 22 million, we re-couped 14 million of that 22. This year, we're already at 18 million in re-coup. So techincally, we're acting and functioning like a private, but we're 3rd service.

[VentMedic]

And it will be nothing but transfer city. Why can't they get their head out of their a$$ and have everything at every hospital?? It makes sense but of course down here common sense isn't just that.

Do you realize how expensive that would be? Do you also realize how thin the doctors in the various specialities as well as nursing and other staff members that work in these specialties would be stretched? These hospitals are too close to be duplicating services.

And yes, most trauma centers bleed money. They cater to an expensive group of indigent trauma patients. Nobody gets shot and costs less than a half million dollars these days.

[Niftymedi911]

At least when I go to the other coast, it takes less then 5 to 10 minutes to offload a patient, but becuase of the powers that be here, it takes sometimes over an hour and half to offload. They need to wake up. I've waited at CCH 3 hours and 45 minutues to offload a patient in the ER. It went as far as 6 units at one time were waiting to offload there all over an hour. Normal offload is 5 to 10 minutes, but that is onl right around 0800 and between 0300 and 0700. Anytime after those your a a wall flower for 15 minutes and beyond. Reguardless of priority. I've waited 23 minutes with a priority 1 GI bleed, extreme hypotension, in the hallway for a bed.

The only thing I can say about T1's. Is at least we have one, so we don't have to ship them to the next closest which whould be 3 hours north to Tampa after they've been stablized at a local.

[marjorum]

Is not the solution to the problem of 911 vehicles transporting non emergent patients a function of dispatch triage? I'm a paramedic who has worked in an urban setting for a private ambulance company and the dispatchers were skilled at getting the appropriate "ride" for the patient. The urban setting had 911 vehicles, both EMT and paramedic, in addition to ambulettes and wheelchair transport vans. It is to the companies advantage to utilize resources appropriately. I realize operations may be different in other parts of the country, but it sure works nice in Phoenix.

[saboats]

At least when I go to the other coast, it takes less then 5 to 10 minutes to offload a patient, but becuase of the powers that be here, it takes sometimes over an hour and half to offload. They need to wake up. I've waited at CCH 3 hours and 45 minutues to offload a patient in the ER. It went as far as 6 units at one time were waiting to offload there all over an hour. Normal offload is 5 to 10 minutes, but that is onl right around 0800 and between 0300 and 0700. Anytime after those your a a wall flower for 15 minutes and beyond. Reguardless of priority. I've waited 23 minutes with a priority 1 GI bleed, extreme hypotension, in the hallway for a bed.

The only thing I can say about T1's. Is at least we have one, so we don't have to ship them to the next closest which whould be 3 hours north to Tampa after they've been stablized at a local.

Maybe someone at LCEMS should talk to the county commissioners or hospital administration about wait time. There are now "not-so-new" EMTALA/Cobra standards that dictate maximum wait times for EMS at an emergency department. If these standards aren't followed it will effect the hospitals ability to bill CMS and they can be fined. It was a bigger problem out west, where 1 hour was the normal 24hours a day for a while (holding the wall) but these new standards have fixed that problem a bit. A work in progress, but it is being addressed.

As far as EMS doing non-emergent interfacility transport: that is the system as it stands right now. The GAO just delivered a report to CMS that stated that the CMS payments for emergency medical transport are below the cost-per-call average nationally. If you want to talk about Ambulance Services not doing IFT or non-emergent work, then you have to talk about taxpayer funded, municiple 3rd service. If private EMS is still contracted to do 911, then this current system will remain the norm. If you switch to a 3rd service model, (which I think is the best, then you will see your taxes go up. Some services do off-set expenses with revenue, but this is not the norm, and the ones that do are projecting lossess in the next 5-10years because of CMS fee schedules that aren't keeping up with costs (like fuel!).

Private Ambulance/Ambulette services are not set up as "EMS" they are transport services that may have a 911 EMS contract or 2. The money isn't in 911, it's in transport - so either get the private company out of your area, and create a government based one, or you will just have to swallow the non-emergent runs. Sucks, but it's a fact.

Lastly; very early on in this thread, someone talked about not seeing PD doing private security work; ever seen a cop on the road at a construction site? :twisted: Flag men can do the same job for less, but yet there are still officers there, sitting in their car, "in case" . All public services provide some community based operations EMS is no different. And really is EMS a true Public Safety Service or a Public Heath Service? Things are interesting now in this field, for sure.

Scott, NR/CCEMTP