How does IFT work?

DieselBolus

Forum Crew Member
80
33
18
I'll revise my idea slightly based on what I have.


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...
While 911 and IFT crews both have the same pieces of paper in their pockets and have lights on the roof, for the sake of your question, think of them as separate industries. I may be wrong, but I recall reading that research in Phillly indicated that GSW victims do similarly well in police cars as they do ambulances. That doesn't mean ambulance dispatchers necessarily see PD on their screen

To my understanding, companies that run 911 ALS and CCT/ALS/BLS IFT will often have separate medical direction for each service, even if said service is in the same city.

This isn't to say that IFT agencies dont run 911 backup, but that's almost exclusively in extenuating circumstances.

Is it ideal? Many would say no, but there's no research. Common sense and reality often differ.
 
Last edited:

Tigger

Dodges Pucks
Community Leader
7,843
2,794
113
I'll revise my idea slightly based on what I have.


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...

That isn't really in the IFT company's best interest though. The IFT company spends a great deal of time trying to pinpoint the number of ambulances it needs to satisfy the needs of their contract. If their ambulances can suddenly be pulled into the 911 system, they now are potentially unable to meet their contractual obligations. This of course costs them money, and that is what IFT companies are after, plain and simple.

In an ideal world, the closest ambulance would always be sent. Meanwhile, the IFT companies have to make money, which kind of precludes this.

Even in places where there is one ambulance provider for an area in its entirety there are often distinctions between the IFT and 911 side. I work part time for an AMR operation that is for all intents and purposes the only ambulance service provider in the county. The ambulances designated for transfers stay out of the 911 loop unless there are no available 911 cars. The company has an obligation to its contracted facilities, and this is how they meet it.

In New Zealand (for a worldly example haha), there is one ambulance provider for 90% of the country. They have 911 (111) ambulances and Patient Transfer Service ambulances but there is no overlap between the two as they both have separate obligations to meet.
 

drl

Forum Lieutenant
102
23
18
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...

SCCo is one of the most heavily regulated (ie best funded) EMS agencies in the Bay Area (partly due to the massive fines that R/M has been paying), and so they have the best integration of IFT units in the 911 system. Even then, 911 dispatch does not have GPS tracking of IFT units. Heck, in my company, even our dispatch doesn't have GPS tracking of most of the rigs.

In your scenario, unless the IFT ALS unit next door has been pulled into the 911 system due to low levels of 911 rigs available, they would not be asked to respond to the 911 call.

Angel is correct that it would violate the terms of the 911 contract. Unless the IFT rigs are pulled in due to low levels (in which case they are treated like any other 911 rig), they cannot transport the patient unless they are within 9 minutes of the nearest ER, from first contact to arrival at the ER (basically impossible unless you're literally right across the street).
 
OP
OP
RedAirplane

RedAirplane

Forum Asst. Chief
515
126
43
The postal service historically signed contract with airlines to carry mail. Today, with technology, the government signs and cancels contracts with airlines on a minute by minute basis, based on pricing, availability, weather, delays, etc.

Based on your all feedback, here's what I'm envisioning.

Imagine that instant auction with EMS. Privates can compete for an instant contract from a sending hospital. Privates are happy because of the efficiency and knowing that stationing units correctly will yield business.

Rather than pay an operator to do 911, the municipality can enter the calls into this system with a high bonus, so privates want to take them.

And the technology to do all this won't be very expensive, in my best estimate.

Everybody wins?
 

RocketMedic

Californian, Lost in Texas
4,997
1,461
113
Nope, most lose. Remember that the airlines only fly mail because they are already going to fly the flight. Most transfers are either relatively low-paid (insurance, facility, self-pay, etc) or are done at a loss (most 911s, IFTs taken for contractual reasons, etc).

IFT is really only fiscally sustainable if the contract is pre established, transports are at least partially guaranteed and the expectations are not staggering. 911 is only really sustainable if it's prepaid by taxes or subsidies; direct billing is profit at best.
 
OP
OP
RedAirplane

RedAirplane

Forum Asst. Chief
515
126
43
Nope, most lose. Remember that the airlines only fly mail because they are already going to fly the flight. Most transfers are either relatively low-paid (insurance, facility, self-pay, etc) or are done at a loss (most 911s, IFTs taken for contractual reasons, etc).

IFT is really only fiscally sustainable if the contract is pre established, transports are at least partially guaranteed and the expectations are not staggering. 911 is only really sustainable if it's prepaid by taxes or subsidies; direct billing is profit at best.

Curious. The total number of ambulance calls would be the same, so how would the profit change? If anything the move is closer to a free market.
 

Tigger

Dodges Pucks
Community Leader
7,843
2,794
113
The postal service historically signed contract with airlines to carry mail. Today, with technology, the government signs and cancels contracts with airlines on a minute by minute basis, based on pricing, availability, weather, delays, etc.

Based on your all feedback, here's what I'm envisioning.

Imagine that instant auction with EMS. Privates can compete for an instant contract from a sending hospital. Privates are happy because of the efficiency and knowing that stationing units correctly will yield business.

Rather than pay an operator to do 911, the municipality can enter the calls into this system with a high bonus, so privates want to take them.

And the technology to do all this won't be very expensive, in my best estimate.

Everybody wins?

Where will the money come for this bonus?
 

RocketMedic

Californian, Lost in Texas
4,997
1,461
113
Curious. The total number of ambulance calls would be the same, so how would the profit change? If anything the move is closer to a free market.

Your assumption is that all calls pay. Most do not pay at all, and those that do generally pay at a dramatically lpwer rate than you would expect. Medicare and insurers literally pay pennies on the dollar for most bills as a reaction to overbilling. IFT companies are profitable only as long as they avoid losing units for 911 coverage. Most companies that venture into 911 are doing it for recruitment (since it takes a lot of interest away from people to go all-IFT), exclusive contracts for service (local de facto monopolies), guaranteed income from county or city contracts or a genuine sense of self-interest and unit hour maximization of potential profit.
 

RocketMedic

Californian, Lost in Texas
4,997
1,461
113
The thing is that 911 and IFT are both all-consuming beasts in terms of their respective call loads. My employer at present does both, but prefers transfers, since they are generally at least somewhat compensated and are easy to schedule in advance. 911 calls, by definition, are unpredictable.
 

Ewok Jerky

PA-C
1,401
738
113
The money that would have been used for paying an exclusive 911 operator, I'd imagine.
Probly not much of an incentive when spread out over a year among N companies.

If your primary concern is response time for "man down"s, I think the best bang for your buck would be CPR training for lay responders and AEDs for cop cars, and the like.
 

Tigger

Dodges Pucks
Community Leader
7,843
2,794
113
The money that would have been used for paying an exclusive 911 operator, I'd imagine.

Many municipalities have contracts in which the contractor is not paid at all, but instead has free reign over the billing process. I have no idea what the breakdown is nationwide, but it is very common in urban areas. Even worse, some private companies now pay franchise fees to the municipality to be allowed to run the 911 service.
 
OP
OP
RedAirplane

RedAirplane

Forum Asst. Chief
515
126
43
Many municipalities have contracts in which the contractor is not paid at all, but instead has free reign over the billing process. I have no idea what the breakdown is nationwide, but it is very common in urban areas. Even worse, some private companies now pay franchise fees to the municipality to be allowed to run the 911 service.

Interesting. I didn't know that.
 
OP
OP
RedAirplane

RedAirplane

Forum Asst. Chief
515
126
43
Probly not much of an incentive when spread out over a year among N companies.

If your primary concern is response time for "man down"s, I think the best bang for your buck would be CPR training for lay responders and AEDs for cop cars, and the like.

Being a Computer Scientist, in addition to the issue of response times, I'm also motivated by the apparent irony of having two ambulances cross paths on the way to calls. I suppose it's an obsession with efficient allocation of resources.
 
OP
OP
RedAirplane

RedAirplane

Forum Asst. Chief
515
126
43
Probly not much of an incentive when spread out over a year among N companies.

If your primary concern is response time for "man down"s, I think the best bang for your buck would be CPR training for lay responders and AEDs for cop cars, and the like.

But I like your point. I'd love to see first responder become part of the high school diploma.
 

RocketMedic

Californian, Lost in Texas
4,997
1,461
113
Franchise fees are paid because the only way that this business is profitable is to establish at least some form of monopoly.
 
Top