How does IFT work?

[RedAirplane]

Hello all,

I'm a volunteer working mostly standby events, so except for my ride alongs, I haven't seen much of how IFT works at all.

For 911, typically I see that the fire department has ambulances, although in some places an ambulance company is contracted to do 911.

For IFT, how is a unit dispatched given that there are so many different companies? Does the hospital call different companies and see who is closer? Or do different companies have contracts with specific hospitals and stage near the hospitals they need to transport from?

Thanks,
Ishan

 

[DesertMedic66]

It's a mix of how units are dispatched. Some hospitals have a rotating contract. Some will use 1 company for a specific transports (psych, discharge, etc). What level of service is needed (BLS, ALS, CCT). What the patients insurance wants. Also what unit can guarantee the fastest time.

 

[Ewok Jerky]

Some facilities (hospitals, SNFs) will have a contract with a specific company. Some departments within the facility might have a preference for one company over another, maybe because they have nicer pens. Sometimes they don't like the response time and call another company. I know my former employer would field all calls from one of the larger HMOs and if we couldn't make the response time our dispatch would call other transport companies to take the call.

It really just comes down to whoever is picking up the phone at the sending facility and what their preference is, barring contractual obligations.

 

[RedAirplane]

Being a software engineer by day, I smell the opportunity for something that would make this process streamlined. Whether 911 or IFT, calling party's information is entered and the most appropriate unit is dispatched. Like an Uber Ambulance. Somehow I think that money and politics would prevent this.

 

[Akulahawk]

Money, politics, contracts, personal preferences by discharge planners or patients, insurance carrier approvals... individual crew capabilities, and even sometimes individual requests for a specific crew... those all play a role in dispatching ambulances to a given IFT call. Some of this stuff could change very quickly. I've had IFT runs where the patient was extremely stable except there was K+ running in the IV line and the line needed to be going during transport. This was supposed to be a BLS run. I had to call for CCT because at that time, no IFT company had ALS capability.

To do what you're suggesting would essentially require that all ambulance companies create a JPA-like dispatch entity and therefore give up a lot of control to that joint dispatch. It would also require that all medical entities (hospitals, SNF's, dialysis centers, etc) direct all their requests through the joint dispatch entity. This isn't an issue for 911 because of the way that system works.

In short, IFT providers (private and public) will not likely do something like this because they need to be able to retain control of their assets. Dispatch software that does most of what you suggest already exists and can be acquired from several vendors. Whatever Uber uses probably could be modified to work with existing software... but won't ever happen.

There's lots of software for 911 that does what you describe for that part of the system...

 

[RedAirplane]

Money, politics, contracts, personal preferences by discharge planners or patients, insurance carrier approvals... individual crew capabilities, and even sometimes individual requests for a specific crew... those all play a role in dispatching ambulances to a given IFT call. Some of this stuff could change very quickly. I've had IFT runs where the patient was extremely stable except there was K+ running in the IV line and the line needed to be going during transport. This was supposed to be a BLS run. I had to call for CCT because at that time, no IFT company had ALS capability.

To do what you're suggesting would essentially require that all ambulance companies create a JPA-like dispatch entity and therefore give up a lot of control to that joint dispatch. It would also require that all medical entities (hospitals, SNF's, dialysis centers, etc) direct all their requests through the joint dispatch entity. This isn't an issue for 911 because of the way that system works.

In short, IFT providers (private and public) will not likely do something like this because they need to be able to retain control of their assets. Dispatch software that does most of what you suggest already exists and can be acquired from several vendors. Whatever Uber uses probably could be modified to work with existing software... but won't ever happen.

There's lots of software for 911 that does what you describe for that part of the system...

I figured as much. I know I am an idealist, but will not stop being so. Runs like the above, where time wasn't so much of an issue, don't bother me much.

I tend to be more worried about the more time-sensitive runs. For example, on my ride along, we were taking a critical patient to a specialty hospital. We were at the origin hospital fast, but we were BLS; our RN was in a car thirty minutes away. My EMTs told me that dispatch indicated that the patient had to go ASAP. Meanwhile at least one 911 ambulance came and went. If the "distinction" didn't exist, wouldn't it have been better for the patient to just pull a 911 unit for IFT*? Isn't EMS all about "do no harm" and "patient's best interest?"

*(this also irks me in converse. I live blocks from an IFT company's station that does BLS/ALS/CCT. If I needed help, they are closeby. But the 911 provider is 15 miles away, responding in a guaranteed 8-12 minutes. That isn't bad, but seems really dumb to have resource nearby and not use it).

 

[RocketMedic]

Converse, Texas?

 

[Ewok Jerky]

As far your "asap" IFT, your patient is already in a hospital and is presumably stable enough for transport. Even on high acuity transports, it still takes a while for packaging, paperwork and reports before we can leave the sending facility. So we set a threshold for acceptability.
Waiting 1/2 an hour for a CCT unit is actually a pretty good response time.

As far as pulling 911 units for IFTs that's a recipe for disaster. I worked for a company that would that because we had a large IFT side on top of several local 911 contracts. Now you are down one unit for how long, an hour? Hour and a half? And **** inevitably hits the fan when you are down a unit. So you have to pull an IFT unit in to cover. Now your IFT side is down a unit and you have to pull form somewhere else, maybe a local 911 unit to make that pickup time somewhere else. See where in going?

 

[RedAirplane]

Converse, Texas?

I meant converse as in the other way round, sorry.

 

[RedAirplane]

As far your "asap" IFT, your patient is already in a hospital and is presumably stable enough for transport. Even on high acuity transports, it still takes a while for packaging, paperwork and reports before we can leave the sending facility. So we set a threshold for acceptability.
Waiting 1/2 an hour for a CCT unit is actually a pretty good response time.

As far as pulling 911 units for IFTs that's a recipe for disaster. I worked for a company that would that because we had a large IFT side on top of several local 911 contracts. Now you are down one unit for how long, an hour? Hour and a half? And **** inevitably hits the fan when you are down a unit. So you have to pull an IFT unit in to cover. Now your IFT side is down a unit and you have to pull form somewhere else, maybe a local 911 unit to make that pickup time somewhere else. See where in going?

The first part makes sense. I somehow thought that high priority IFT had to go within minutes like 911.

Barring politics and money, I guess my question is, wouldn't everything be better if all ambulances were put into a single big dispatch pool, and sent to 911, IFT, etc as the calls came in, based on proximity and priority? Rather than have different companies covering different parts?

 

[bushinspector]

Being a software engineer by day, I smell the opportunity for something that would make this process streamlined. Whether 911 or IFT, calling party's information is entered and the most appropriate unit is dispatched. Like an Uber Ambulance. Somehow I think that money and politics would prevent this.

What are you trying to do???Use common sense??? In our world it almost getting very rare..However I seen by the last sentence that you came back to the way that it really works..Great thought, I will give you that.

 

[STXmedic]

Converse, Texas?

What about that **** hole?

Edit: Never mind. Read the thread. It's still a **** hole.

 

[Ewok Jerky]

The first part makes sense. I somehow thought that high priority IFT had to go within minutes like 911.

Barring politics and money, I guess my question is, wouldn't everything be better if all ambulances were put into a single big dispatch pool, and sent to 911, IFT, etc as the calls came in, based on proximity and priority? Rather than have different companies covering different parts?

-Some IFT are very time sensitive, but those a few and far between.

-barring politics and money, yes you are correct. But politics and money are high priorities in EMS, ranked right up there above patient care sometimes...cough cough southern California cough cough

Also, trying to coordinate a dozen companies into an efficient response would create more problems than it solves. It's just not a practical idea.

Generally, contracts stipulate a certain level of performance and if it's not met the transport company will be out for the next rfp cycle. There is also a clause that if the contractor can't make the response time the sending facility can call someone else.

I'm no business genious but I'm pretty sure IFT contracts do not grant exclusive rights, it's just a cost saving measure to bill transports in bundles.

 

[Akulahawk]

The first part makes sense. I somehow thought that high priority IFT had to go within minutes like 911.

Barring politics and money, I guess my question is, wouldn't everything be better if all ambulances were put into a single big dispatch pool, and sent to 911, IFT, etc as the calls came in, based on proximity and priority? Rather than have different companies covering different parts?

This is just one area where IFT is a completely different animal than 911 is. Even your most unstable patient is already in a facility that likely has greater capability that most CCT ambulances. It's a very rare day when you have to pull a 911 unit for an emergent transfer. I've been on those a couple of times. I've been on some relatively high acuity transfers where the transport was the shortest part of the whole evolution... which ran 4+ hours.

As far as having a BLS/ALS/CCT station close by, that's fine. if you feel you're in deeper trouble and calling 911 would take too long, feel free to call that BLS/ALS/CCT company and hopefully they have an appropriate resource at that local station. If they do not, then your only recourse would be to call 911 and hope they have a faster response time. Also, be aware that if they send a BLS ambulance and you actually need an ALS response, they could end up sending one of their ALS ambulances instead of referring to 911, which results in a longer wait time for you... I have seen this happen. A company I used to work for dispatched a BLS ambulance to transport a patient, they arrive and determine that the patient needs ALS. They call for ALS and the company sends their own ALS ambulance (which had a 15 min arrival time at minimum) and the patient did indeed require ALS services... but a 911 referral would have been far more appropriate. I won't get into details, but suffice it to say that the patient required TCP.

 

[Angel]

Just throwing it out there, and not to offend anyone; but there's performance concerns as well. I can't imagine having a primarily/only IFT company be thrown into the 911 system. Where I used to work I'm surprised if they remembered their protocols. Their ALS transfers were 60% BLS with monitors, with the other 40% being BLS. In one year, if they started more than 4 IV's i'd be surprised, so there's also that to consider. Over time it would likely not be an issue but to throw everyone in the same pot would be a learning curve.

On the other hand, some companies have 'transfer centers' so for instance, all kaiser hospitals will call 1 number and not only will they help said patient find a bed at another kaiser (or different hospital) by getting both accepting and transferring docs on the phone, but dispatch the appropriate unit (ALS/BLS/CCT) to the hospital. Granted, it's one company doing this so as stated, it depends on crew availability, but it streamlines the entire process IMO

 

[exodus]

As far your "asap" IFT, your patient is already in a hospital and is presumably stable enough for transport. Even on high acuity transports, it still takes a while for packaging, paperwork and reports before we can leave the sending facility. So we set a threshold for acceptability.
Waiting 1/2 an hour for a CCT unit is actually a pretty good response time.

As far as pulling 911 units for IFTs that's a recipe for disaster. I worked for a company that would that because we had a large IFT side on top of several local 911 contracts. Now you are down one unit for how long, an hour? Hour and a half? And **** inevitably hits the fan when you are down a unit. So you have to pull an IFT unit in to cover. Now your IFT side is down a unit and you have to pull form somewhere else, maybe a local 911 unit to make that pickup time somewhere else. See where in going?

We're the only ALS transport in our area that will do IFT's, we are also the only 911 transport outside of fire in a select few areas. From what I have seen, all of our hospitals are very understanding with slightly extended ETA's if we don't have someone available due to a 911 call. We are also diverted from IFT's to handle a 911 if we are closer, even if it extends our ETA.

 

[drl]

Barring politics and money, I guess my question is, wouldn't everything be better if all ambulances were put into a single big dispatch pool, and sent to 911, IFT, etc as the calls came in, based on proximity and priority? Rather than have different companies covering different parts?

There's definitely also an experience/competency difference between 911 and IFT as well: most anyone can land an IFT job, whereas 911 agencies tend to weed out the most incompetent providers through the competitive hiring process (although there are always exceptions).

In CA's Santa Clara County however, ALS and BLS IFT units will get pulled into the 911 system when there are low numbers of 911 units available. For that reason, we're always required to have a working county radio and pager on us every shift, even if we won't use it 95% of the time.

 

[Akulahawk]

There's definitely also an experience/competency difference between 911 and IFT as well: most anyone can land an IFT job, whereas 911 agencies tend to weed out the most incompetent providers through the competitive hiring process (although there are always exceptions).

In CA's Santa Clara County however, ALS and BLS IFT units will get pulled into the 911 system when there are low numbers of 911 units available. For that reason, we're always required to have a working county radio and pager on us every shift, even if we won't use it 95% of the time.

"Back in the day" this used to happen daily if not several times per day. It was at the tail-end of an old AMR contract with the County and after a new contract had been signed, that changed to perhaps once every few days when there was an unusually heavy load on the system that was out of the norm. Getting pulled into the 911 system happened frequently enough that the fire departments got used to the varying quality of the IFT crews... some were outstandingly good and others, well, not so much. You could see their opinion in their body language...

Even without the 911 calls, about 1/3 to 1/2 of my calls were transports to the ED and most of those weren't because Mrs. Smith or Mr. Jones had somehow managed to dislodge their PEG tube.

 

[RedAirplane]

I'll revise my idea slightly based on what I have.

There's definitely also an experience/competency difference between 911 and IFT as well: most anyone can land an IFT job, whereas 911 agencies tend to weed out the most incompetent providers through the competitive hiring process (although there are always exceptions).

In CA's Santa Clara County however, ALS and BLS IFT units will get pulled into the 911 system when there are low numbers of 911 units available. For that reason, we're always required to have a working county radio and pager on us every shift, even if we won't use it 95% of the time.

I'm vaguely familiar with Santa Clara County. I think a similar concept applies in most of the bay area, though I'm not certain.

Does 911 dispatch know the locations of the IFT units the way they do via computer screen for 911 units? Or do they have to call the company and ask where the units are?

Here's the scenario that pops into my head: I go into cardiac arrest. My chances of survival fall 10% for every minute I'm in arrest. Just by chance, an IFT unit is on break at the Starbucks next door to my house. The fire department (five minutes away) is dispatched. The 911 contracted ambulance company sends the nearest unit from 10 minutes away. Would the 911 dispatcher see "hey, there's an ALS unit less than 5000 feet from the arrest victim" and dispatch it? Or would that information only become available if the 911 dispatcher asks the IFT compnay? This is a case of four minutes potential savings...

 

[Angel]

Are you asking specifically in Santa Clara or just in general? In my experience it's 2 completely different entities the IFT Dispatch only sees their units and same for 911
Santa Clara is all 911 IFT is in Milpitas and a couple other counties
I believe this is all due to contract and exclusive operating agreements so the IFT side would be in violation and could be sued by the 911, maybe the county as well but not sure