Hello and Question about IFT

Hello,

I've been reading parts of this forum for some time, but this is the first time I am posting. I apologize if this is the wrong place/time for such a post.

I'm a Computer Scientist by training and profession (for now at least), but starting in college as a non-traditional first responder, I found myself wandering into the world of EMS.

I've been taking an EMT class because it seems that in many places, an EMT license is the minimum license to practice. My ride alongs are coming up.

I will have one shift with the company that is contracted to provide 911 services, and another shift with a BLS IFT ambulance service.

It seems that a lot of what I learn in EMT class has to do with the "E" in EMS-- emergency. Scene size-up. Call for additional resources. Rapid assessment. Transport to the nearest appropriate facility. Ringdown to advise the hospital of your arrival. Etc.

I fail to see how IFT fits into this? It certainly is an important service, but I don't understand the label "Emergency" being assigned to it? As an example, would you collect a SAMPLE history from a patient going between hospitals? It would seem redundant, given that the first facility should have taken it already, yet it is part of the things you have to do for every patient.

Sorry for the long post. Any input you have is appreciated.

Thank you.

IFT is a very different animal from "emergency" transport that you learn in EMT school. These transports are sometimes no less emergent, but there's often a bit more structure to them. They're usually more deliberate. Most of the time you'll get LOTS of patient info from the sending facility. The sending facility has already given report about the patient by the time you've arrived to transport. The receiving facility knows the patient is coming. You'll usually get a packet of paperwork. You'll be given a report about the patient from the nurse. You go in and talk to the patient and do a quick assessment yourself for two reasons. One is that while you're there, it's a nice, controlled environment so you don't have to guess about anything. Two is that you actually put your own eyes on the patient and see what fluids they've got running, what oxygen flow and method they're on, you'll see if the patient is in restraints or has mittens on, and so on. You're ensuring that the patient actually is within your scope of practice to transport. Yes, part of that is doing an assessment of the patient, including any complaints they may have right then. While you do need to get a SAMPLE history you'll find that some is abbreviated and some things can be worded differently to fit the situation.

One thing about IFT work that I enjoyed. Because the patient's packet was available, I had a good opportunity to read through it and find out what was going on with the patient beyond the immediate need for the transport. I'd find out the patient's medical history, what meds they're on, what allergies they have, the labs and so on. Then I get to actually see that stuff in front of me and over time, I might start correlating patient presentations with meds and H&P info. So then I start seeing patterns.

Later when I'm doing field work (not IFT), I'd see patients with similar appearances, symptoms, signs, and the like so now I'm not exactly flying blind. I have some clue as to what the problem is and if I can do something about it within my scope of practice. IFT can be a very good learning opportunity if you let it. It's very boring but it's a very good tool for you to learn. If you end up doing lots of dialysis calls, sure, they're really boring but you'll get to know where they usually put the shunts. You'll know to ask how much fluid was taken off. You'll know to ask about the patient's vital signs and temperature. IFTs can allow you to become complacent though. They're routine. They're predictable and boring. They're also a great chance for you to practice your skills before you really need them under pressure.

I have always approached IFTs in exactly the same way that I approached emergent calls, just at a different speed. Later that rehearsal helps you.

Lastly, what I also liked about doing IFTs is that often I got to just talk with the patient. Our older patients are living history and can tell us about the past in a very real and personal way. I very much developed my conversational skills just by striking up a conversation. (That it helps continuously monitor the patient's level of consciousness is a bonus.)

IFT is, in fact, a different job than 911, we're lumped together because the equipment is the same, and because you'd never get anyone to take a IFT medical service course.

I wouldn't say that the assessments are actually different, just the sources of information. On a 911 truck you;re dependent on the patient, on an IFT truck you have the paperwork and nursing report as a first line and the patient as a fall back.

When you're working IFT, your diagnostic skill will wither, you're handed that diagnosis on a nice silver platter. That being said, your medical management skills will blossom, the average patient acuity on an IFT truck is much higher than that of a 911 truck, moreover, if you're smart, you read the paperwork and you'll learn much more medicine.

This is a rather unpopular position, and one born out of the fact that these days I run PIFTs rather than BLS IFT, but while I do miss the occasional excitement of 911, I'm pretty sure I'd be bored out of my mind running nothing but 911. Once you make it past the diagnosis (And I don't care what your book says, we damned well do make diagnoses, you can apply whatever semantic BS you want to it, when it looks like a duck and quacks like a duck, it is, in fact, a duck.), 911 is simple, you're applying protocols, at most you'll have conflicts between one or two protocols that will require critical thinking to resolve. The kind of IFT I run is complex, when you pick up a patient running 3 antibiotics, 2 sedatives and a narcotic, there's no protocol book in the world that covers the situation, you've got to know what you're doing.

I dunno, I'm drunk, and perhaps a little defensive because I recently had my sister describe what I do as "working on a glorified ambulance service", but that's my input.

Ishan said:

It seems that a lot of what I learn in EMT class has to do with the "E" in EMS-- emergency. Scene size-up. Call for additional resources. Rapid assessment. Transport to the nearest appropriate facility. Ringdown to advise the hospital of your arrival. Etc.

I fail to see how IFT fits into this? It certainly is an important service, but I don't understand the label "Emergency" being assigned to it? As an example, would you collect a SAMPLE history from a patient going between hospitals? It would seem redundant, given that the first facility should have taken it already, yet it is part of the things you have to do for every patient.

Sorry for the long post. Any input you have is appreciated.

Thank you.

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You still have to do a scene size up (Is this patient within my scope? Do I have the appropriate equipment? What medications is the patient currently on?), an assessment (Do I need to change anything, especially to get the patient comfortable on the transport vent if applicable? Is the patient in extremis? Furthermore, you know more about your patient if you examine them instead of just examining the transport packet), transport, and depending on the patient, contact the receiving hospital (really, we may know the patient is coming, but it can help to know an ETA. "Trauma activation ETA 10 minutes" is much nicer than "Trauma activation, already in Trauma 5").

Personal opinion - while not everyone wants to stay in IFT, everyone should start there. The positives - learning your way around an ambulance, learning how to talk with patients and other healthcare providers, the greater likelihood of working as a team of EMTs rather than with a medic, etc - far outweigh the negatives, the chief of which seems to be that there's not enough swoopy-cool-blood-and-guts-lights-and-sirens action to provide an adrenaline rush.

Thank you very much for your thoughts. It's very helpful.

UnkiEMT said:

IFT is, in fact, a different job than 911, we're lumped together because the equipment is the same, and because you'd never get anyone to take a IFT medical service course.

I wouldn't say that the assessments are actually different, just the sources of information. On a 911 truck you;re dependent on the patient, on an IFT truck you have the paperwork and nursing report as a first line and the patient as a fall back.

When you're working IFT, your diagnostic skill will wither, you're handed that diagnosis on a nice silver platter. That being said, your medical management skills will blossom, the average patient acuity on an IFT truck is much higher than that of a 911 truck, moreover, if you're smart, you read the paperwork and you'll learn much more medicine.

This is a rather unpopular position, and one born out of the fact that these days I run PIFTs rather than BLS IFT, but while I do miss the occasional excitement of 911, I'm pretty sure I'd be bored out of my mind running nothing but 911. Once you make it past the diagnosis (And I don't care what your book says, we damned well do make diagnoses, you can apply whatever semantic BS you want to it, when it looks like a duck and quacks like a duck, it is, in fact, a duck.), 911 is simple, you're applying protocols, at most you'll have conflicts between one or two protocols that will require critical thinking to resolve. The kind of IFT I run is complex, when you pick up a patient running 3 antibiotics, 2 sedatives and a narcotic, there's no protocol book in the world that covers the situation, you've got to know what you're doing.

I dunno, I'm drunk, and perhaps a little defensive because I recently had my sister describe what I do as "working on a glorified ambulance service", but that's my input.

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I'm confused, having worked on a P/B IFT truck I don't really see how it's complex. Sure the meds could be complex with a lot of things going on, but they are already on their drips when you show up. You're simply monitoring them. I guess people are different but if it wernt for working 911 I would not be on an ambulance. I am grateful for what I learned while on IFT trucks, but it is truly mind numbing work.

Chewy20 said:

I'm confused, having worked on a P/B IFT truck I don't really see how it's complex. Sure the meds could be complex with a lot of things going on, but they are already on their drips when you show up. You're simply monitoring them. I guess people are different but if it wernt for working 911 I would not be on an ambulance. I am grateful for what I learned while on IFT trucks, but it is truly mind numbing work.

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Not really. Depending on the facility many of the meds will need to be adjusted, D/C'd, started ect. The problem is a lot of paramedics working ALS IFT don't realize how truly on the edge their patients are. My job for the last two years has dealt with what happens when IFT's go wrong, and it's an unfortunately common occurrence because new providers tend to let their guard down.

Chewy20 said:

I'm confused, having worked on a P/B IFT truck I don't really see how it's complex. Sure the meds could be complex with a lot of things going on, but they are already on their drips when you show up. You're simply monitoring them. I guess people are different but if it wernt for working 911 I would not be on an ambulance. I am grateful for what I learned while on IFT trucks, but it is truly mind numbing work.

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We do transfers from a critical access hospital who's first move with an obvious sick patient is to call dispatch and request an ambulance. If they get put on hold they'll cal 911 or call the station directly. I've arrived to patients where all they have is a (questionable) set of vitals and had labs drawn but not processed. Our crews have RSIed patients in the hospital, and we bring in our pump and tubing so that infusions can be started on ours since half the time it seems like the doctor is waiting for the crews OK. It's a mess and the medics have to be on their game.

Tigger said:

We do transfers from a critical access hospital who's first move with an obvious sick patient is to call dispatch and request an ambulance. If they get put on hold they'll cal 911 or call the station directly. I've arrived to patients where all they have is a (questionable) set of vitals and had labs drawn but not processed. Our crews have RSIed patients in the hospital, and we bring in our pump and tubing so that infusions can be started on ours since half the time it seems like the doctor is waiting for the crews OK. It's a mess and the medics have to be on their game.

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This. Our little community hospital acts like this on any critical walk in patient.
We don't bring them critical patients. We take them from scene ti fixed wing for that reason

TransportJockey said:

This. Our little community hospital acts like this on any critical walk in patient.
We don't bring them critical patients. We take them from scene ti fixed wing for that reason

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We don't either. They either get flown or go by ground to Colorado Springs. Occasionally we have to stop there to sort something out and take advantage of better working conditions, but that's far from common.

Wow, I guess working in Boston has spoiled me rotten.

J B said:

Wow, I guess working in Boston has spoiled me rotten.

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Right? Lol I have never seen critical patients taken from a hospital unless they were good to go in every aspect that was physically possible for them. Including the south shore hospitals. One of the hospitals wouldn't let a flight crew take their patient until all of his meds were set to go. Guess it's different everywhere.

As some of you know I also started in Boston/Southcoast and I have to agree, stabilization actually meant something there. Though Sturdy Memorial in Attleboro certainly pulled some crap on occasion.

Chewy20 said:

I'm confused, having worked on a P/B IFT truck I don't really see how it's complex. Sure the meds could be complex with a lot of things going on, but they are already on their drips when you show up. You're simply monitoring them. I guess people are different but if it wernt for working 911 I would not be on an ambulance. I am grateful for what I learned while on IFT trucks, but it is truly mind numbing work.

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Sorry, not trying to poke at you directly just using it as an example but this is a prime example of "you don't know what you don't know".

Chewy20 said:

I'm confused, having worked on a P/B IFT truck I don't really see how it's complex. Sure the meds could be complex with a lot of things going on, but they are already on their drips when you show up. You're simply monitoring them. I guess people are different but if it wernt for working 911 I would not be on an ambulance. I am grateful for what I learned while on IFT trucks, but it is truly mind numbing work.

Click to expand...

As Mr. Handsome Robb has said, this is a prime example of "you don't know what you don't know." When doing these transports, you have to know those drips. Sure, you're monitoring them, but do you know what you're looking for if something goes sideways? You have to know what's going on with your patient. You need to read the H&P, check the labs and their trend. You need to see the vitals and their trends also. You have to know what you can legally monitor. This is critical because your patient may need to have several gtts discontinued and others started just to bring the patient within your scope. This takes time and you have to know your own limits too because sometimes your only recourse is to refuse the transport because it's out of your ability to handle it. When that happens, know who you can bring in to make that transport happen. Hands-down the sickest patients I've ever had were IFT patients. Some of them were relatively stable, but far sicker than most 911 patients I've ever had.

Once the patient has been transferred to your care, you'd better know how to titrate those gtts to maintain that patient's status and you'd better know for certain that you have orders on hand to allow you to do precisely that. You'd better know how to do the same thing with your vent because chances are your vent model isn't the same one that's on the floor... Murphy's Law commands it.

You have to know where you can divert if need-be. You have to know how to make their equipment compatible with yours.

Personally, I found 911 to be relatively easy. Most patients that needed care beyond the basics only required use of one or two (at most) protocols to allow me to manage their situation. I really didn't have to think all that much because I had a recipe in front of me. Don't get me wrong, 911 is absolutely fun! but it's just not that challenging to me. If I have to do some thinking about things, I guarantee I'm working. I never work hard... always smart. While I am very present with my 911 patients and can tell you what's going on with them, most of the time, I can say what I need to and be done in about a minute. Give me a sick IFT patient and you're going to get a report that'll make you wonder about what I truly do know... under all that laid back demeanor.

The most interesting part about all the above is that I've come to embrace (quite strongly, might I add) exactly that I know that there's much that I don't know... Because of that, I strive to keep learning. The day I stop learning is the day that I become truly dangerous, no matter how good I was before I stopped learning.

Definitely agree that IFTs have generally been my sickest patients...and it's just gonna get more interesting after I finish CCEMTP and take the CCP-C

Akulahawk said:

As Mr. Handsome Robb has said, this is a prime example of "you don't know what you don't know." When doing these transports, you have to know those drips. Sure, you're monitoring them, but do you know what you're looking for if something goes sideways? You have to know what's going on with your patient. You need to read the H&P, check the labs and their trend. You need to see the vitals and their trends also. You have to know what you can legally monitor. This is critical because your patient may need to have several gtts discontinued and others started just to bring the patient within your scope. This takes time and you have to know your own limits too because sometimes your only recourse is to refuse the transport because it's out of your ability to handle it. When that happens, know who you can bring in to make that transport happen. Hands-down the sickest patients I've ever had were IFT patients. Some of them were relatively stable, but far sicker than most 911 patients I've ever had.

Once the patient has been transferred to your care, you'd better know how to titrate those gtts to maintain that patient's status and you'd better know for certain that you have orders on hand to allow you to do precisely that. You'd better know how to do the same thing with your vent because chances are your vent model isn't the same one that's on the floor... Murphy's Law commands it.

You have to know where you can divert if need-be. You have to know how to make their equipment compatible with yours.

Personally, I found 911 to be relatively easy. Most patients that needed care beyond the basics only required use of one or two (at most) protocols to allow me to manage their situation. I really didn't have to think all that much because I had a recipe in front of me. Don't get me wrong, 911 is absolutely fun! but it's just not that challenging to me. If I have to do some thinking about things, I guarantee I'm working. I never work hard... always smart. While I am very present with my 911 patients and can tell you what's going on with them, most of the time, I can say what I need to and be done in about a minute. Give me a sick IFT patient and you're going to get a report that'll make you wonder about what I truly do know... under all that laid back demeanor.

The most interesting part about all the above is that I've come to embrace (quite strongly, might I add) exactly that I know that there's much that I don't know... Because of that, I strive to keep learning. The day I stop learning is the day that I become truly dangerous, no matter how good I was before I stopped learning.

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Like I said, I know the drips can be complex. How many times have you honestly needed to stop meds and start another? I'm not coming at you I'm legimitly curious because like I also said, patients coming out of Boston hospitals are usually good to go and need no intervention because the meds they have should of been given for the right reasons. Sure you plan ahead in case things go south but that's just part of the job. I am also not arguing that 911 patients are sicker than IFT patients because that's normally not true. There's a reason they are on meds being brought to another facility. This is all talking about normal IFTs not critical care because I know that's a different animal.

Quite the enjoyable thread.

Chewy20 said:

Like I said, I know the drips can be complex. How many times have you honestly needed to stop meds and start another? I'm not coming at you I'm legitimately curious because like I also said, patients coming out of Boston hospitals are usually good to go and need no intervention because the meds they have should of been given for the right reasons. Sure you plan ahead in case things go south but that's just part of the job. I am also not arguing that 911 patients are sicker than IFT patients because that's normally not true. There's a reason they are on meds being brought to another facility. This is all talking about normal IFTs not critical care because I know that's a different animal.

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Never assume that you're being handed a stable patient. Never assume that the patient needs no intervention, if they didn't expect the possibility of needing intervention, you wouldn't have been called. Never assume that the sending facility knows what you can legally monitor. Know what might be able to be used as an alternative.

Back when I was actively working, about 10% of the time I had to do something with a gtt the patient was on so that I could transport them. That ranged from I've had to stop infusions and leave the primary running. I've had to substitute fluids. I've had to refuse transports because the patient couldn't be taken off a gtt that was out of my scope. Most of the time, no problem.