Are Private ambulance really EMS?

Jim37F

Jim37F

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Not every IFT is a sick patient CCT or ALS... Depending on where you are, the IFT business may easily be dominated by BLS level transports that are hospital to SNF discharges, transfers to and from dialysis, doctors appointments, Hospital A isn't in their insurance network so they're being transferred to Hospital B....

Yes the medical transport business is important. No it is in and of itself not EMS. Sure the patient got loaded up in an ambulance and has an EMT in the back with them...doesn't automatically make it EMS....sure they got vitals taken every 15 minutes, sure they had someone talk to them and mentally asses their ABCs and all that, but guess what? So did the nurse at the SNF or the hospital before they ever even though of calling for you for the discharge....does that make them EMS? Does the fact that they were loaded into a vehicle that has emergency warning equipment installed, but the siren is never chirped and the lights are only turned on for 30 sec at the start of shift to check the box on the morning checkout form, but otherwise there was no difference between the BLS transport and a gurney van transport.

If you are they one who perceives this as an insult against you, you are the one who has a problem not me. There are tons of people who prefer working IFT to working 911. Lots of folks are using EMT as a stepping stone to go nursing or PA or MD/DO, etc route, and like the fact that they don't have the same pressures of a 911 call, they're in complete charge of the patient (not following the orders of a fire department paramedic or whoever). The patient is already diagnosed, they can read the transfer packet and correlate patient presentation to their diagnosis and medical history and why they're taking the meds they do (or don't). It's an important service that needs to be done, since even though hospitals can be big places, you can't build one building that houses everything every patient needs. Sure it's not Hollywoods image of an EMT on an ambulance, sure you can remove the lights and sirens and call your company "XYZ Medical Transport" instead of "XYZ EMS" and do the exact same thing. There is absolutely nothing wrong with that or anything about that that makes it somehow "less" than 911 EMS services.
 
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Qulevrius

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Jim37F said:
Does the fact that they were loaded into a vehicle that has emergency warning equipment installed, but the siren is never chirped and the lights are only turned on for 30 sec at the start of shift to check the box on the morning checkout form, but otherwise there was no difference between the BLS transport and a gurney van transport.
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I think the main difference between gurney van transports and BLS transports is that at any given moment, the BLS crew is (theoretically) equipped to respond to an emergency. Whether or not they still remember how to do it, is another story.
 
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AfxEMT

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The general consensus here seems to be that Private EMS really isn't EMS.
Then Medics & EMTs who work for them like I do aren't really professional healthcare workers?
Now Police do police things.
Firefighters fight fires & do rescue 911.
Private ambulances does transport & discharges & our "911" is " if it's that bad they'd be calling 911"
If I become a Paramedic for the company I'm working for, am I short changing myself for calling myself a Paramedic or even an EMT when we barely do EMS stuff?? I'm confused & conflicted.
 
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gotbeerz001

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EMT-B and EMT-P are certifications. Certification simply confirms that you have demonstrated knowledge/skills at or above a given standard. It is accurate to say that you are EMT certified but also is understood when you say "I am an EMT". EMTs (B or P) can work in hospitals, IFT, 911 or private security (etc).

In short, you are overthinking this issue. Do what you enjoy; either way u are an EMT


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johnrsemt

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I worked both while working in Indianapolis: Working Private or IFT service I did more 'emergency' transports than I did working 911. ECF to ED, for everything from MI, strokes, diabetic emergencies, Renal Failure, etc.
Little hospital to big hospital (sometimes a couple hundred miles) for the same things, and to have surgeries that the little hospital couldn't handle; plus emergent OB/GYN (28 weeks pregnant, with twins, with a foot and placenta sticking out), or 28 weeks pregnant in active labor in a hospital (she walked in) that couldn't handle a baby that preemie.
Little hospital to big hospital post cardiac cath for open heart surgeries (a lot of those).
Lots of prisoner transports straight from prison to the county (state) hospital (or from small hospitals by prisons to large state hospital) had to bag one prisoner for 158 miles.

IFT you have to figure out more what might be wrong with the pt from your assessment, v/s and medications than you do with 911. A lot more altered patients that you can't get good reports from the patient, no family around to ask and good luck getting a decent report from the ECF staff.

All IFT runs: do a full assessment, full sets (multiple sets for longer transports {should be doing v/s every 10-15 minutes}) of vital signs, check medications (get a smart phone app that will tell you what meds are for what) and do a complete run report.
Surprising what you can learn that will help you with other patients: I had a few patients that were 'not acting right' that turned out to be interactions with new medications: that the doctor and staff and pharmacy from the ECF didn't catch.
 
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Tour 1

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911 is EMS.
IFT is not EMS.

Also, 911 is not critical care, but critical care, being IFT, is more complex and 'hairy'.

By my definition, CCT is not EMS either, but requires more education and skill.
 
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Tour 1

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AfxEMT said:
The general consensus here seems to be that Private EMS really isn't EMS.
Then Medics & EMTs who work for them like I do aren't really professional healthcare workers?
Now Police do police things.
Firefighters fight fires & do rescue 911.
Private ambulances does transport & discharges & our "911" is " if it's that bad they'd be calling 911"
If I become a Paramedic for the company I'm working for, am I short changing myself for calling myself a Paramedic or even an EMT when we barely do EMS stuff?? I'm confused & conflicted.
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I didn't become a paramedic to work for a private ambulance doing IFT.
Everyone in my medic school most certainly were shooting for a 911 gig and couldn't wait to 'get out of the privates'
Do 911 for some years for the experience. You definitely won't regret it.
 
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usalsfyre

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Tour 1 said:
I didn't become a paramedic to work for a private ambulance doing IFT.
Everyone in my medic school most certainly were shooting for a 911 gig and couldn't wait to 'get out of the privates'
Do 911 for some years for the experience. You definitely won't regret it.
Click to expand...


I routinely saw more (both in numbers and acuity) critical patients doing IFT than 911 in a metro area, as the 911 providers didn't service SNFs. Throw in CCT and the IFT gig I worked was more stimulating mentally than some 911 jobs I've worked.

Unfortunately because it was "just IFT" sick patients often went unrecognized because new kids had this attitude. More than a couple had a bad outcome as a result.
 
Akulahawk

Akulahawk

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I would suggest that EMS isn't actually what we think it is. If you really think about what's being offered/done, both 911 and IFT services (either can be public or private) do Medical Transport. The only real question is which "side" of MTS you do. You may primarily work 911 or primarily work IFT. Either way you work for a MTS. We traditionally think of 911 as EMS and IFT as "not EMS" but they're just different parts of the same coin. They do require different skillsets and their goals are a bit different.

We pretty much understand that 911 does more trauma and concentrates primarily on immediate stabilization of patients along with transport to a medical facility for further care and stabilization. We also understand intuitively that IFT work concentrates more on continuing care that has already been initiated at a medical facility along with transport to another facility for the purpose of continuing that care. The receiving facility can be a higher or lower level of care, depending upon what's needed by the patient. What throws us for a loop is we sometimes don't realize just how sick those patients are and we get complacent because it's "just" an IFT run and of course the patient is going to be stable...

As usalsfyre above stated, often you see much more high acuity patients when doing IFT than you would when doing 911. You're forced to think more about your patient and what you must do to keep your patient alive on a more frequent basis.

Of course, what also gets lumped into the IFT side of things is what probably best could be described as a "Medical Shuttle Service" where you're simply moving patients around that don't need much more than a taxi but, for whatever reason, aren't able to use one and need some level of medical monitoring to ensure that the patient left one place alive and arrived at the destination (often NOT an acute care hospital or tertiary care center) also alive and not a zombie.

Everyone must acknowledge that MSS type services are crucial because they're the folks that clear out the beds in hospitals and tertiary care facilities to make room for those patients that need the services as the patients that the MSS transport no longer need such services and only need to go somewhere else for monitored long(ish) term recovery. Without them, everything else backs up horribly. You see this when you work in a small facility where transport is limited and beds are even more limited...
 
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Qulevrius

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Akulahawk said:
I would suggest that EMS isn't actually what we think it is. If you really think about what's being offered/done, both 911 and IFT services (either can be public or private) do Medical Transport. The only real question is which "side" of MTS you do. You may primarily work 911 or primarily work IFT. Either way you work for a MTS. We traditionally think of 911 as EMS and IFT as "not EMS" but they're just different parts of the same coin. They do require different skillsets and their goals are a bit different.

We pretty much understand that 911 does more trauma and concentrates primarily on immediate stabilization of patients along with transport to a medical facility for further care and stabilization. We also understand intuitively that IFT work concentrates more on continuing care that has already been initiated at a medical facility along with transport to another facility for the purpose of continuing that care. The receiving facility can be a higher or lower level of care, depending upon what's needed by the patient. What throws us for a loop is we sometimes don't realize just how sick those patients are and we get complacent because it's "just" an IFT run and of course the patient is going to be stable...

As usalsfyre above stated, often you see much more high acuity patients when doing IFT than you would when doing 911. You're forced to think more about your patient and what you must do to keep your patient alive on a more frequent basis.

Of course, what also gets lumped into the IFT side of things is what probably best could be described as a "Medical Shuttle Service" where you're simply moving patients around that don't need much more than a taxi but, for whatever reason, aren't able to use one and need some level of medical monitoring to ensure that the patient left one place alive and arrived at the destination (often NOT an acute care hospital or tertiary care center) also alive and not a zombie.

Everyone must acknowledge that MSS type services are crucial because they're the folks that clear out the beds in hospitals and tertiary care facilities to make room for those patients that need the services as the patients that the MSS transport no longer need such services and only need to go somewhere else for monitored long(ish) term recovery. Without them, everything else backs up horribly. You see this when you work in a small facility where transport is limited and beds are even more limited...
Click to expand...

It's the same as the 'combat units vs support units' mindset. Every new guy wants to be a cool 11 Bang Bang and these who make it there, start looking down on everyone else because they think that trigger pullers are the real deal. Yes, they are - in certain situations. Too bad they don't know/forget/choose to ignore that the vast majority of servicemen are in support units and without them, all that 'look at me, I'm a real sojer' flare would wither and die. People - especially the younger folks - just have to show off, 'tis the way it is and always been.
 
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Chewy20

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Qulevrius said:
It's the same as the 'combat units vs support units' mindset. Every new guy wants to be a cool 11 Bang Bang and these who make it there, start looking down on everyone else because they think that trigger pullers are the real deal. Yes, they are - in certain situations. Too bad they don't know/forget/choose to ignore that the vast majority of servicemen are in support units and without them, all that 'look at me, I'm a real sojer' flare would wither and die. People - especially the younger folks - just have to show off, 'tis the way it is and always been.
Click to expand...

POG
 
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Jn1232th

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i worked both IFT and 911 as an emt. also doing CCT in back with a nurse. out of all the 911 calls I ran, I say maybe 50% were actual emergencies. the calls I got from the SNF's to ER (on the IFT side) were more emergent than some of the 911 calls 0_0. CCT is a whole other side of things which I loved ( never got aortic dissections in 911 side but i'm a magnet for them on CCT side along with strokes). these were all with a private service. so I say private service are EMS. now if your just doing dialysis and doctors visits then your just a medical transport, but still an EMT none the less.
 
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johnrsemt

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Justin: if 50% of your 911 calls were true emergencies, you win, that is the highest I have ever heard of; I maybe hit 10-20% (except here, but here we only have about 2 EMS runs/transports a month)
 
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Jn1232th

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johnrsemt said:
Justin: if 50% of your 911 calls were true emergencies, you win, that is the highest I have ever heard of; I maybe hit 10-20% (except here, but here we only have about 2 EMS runs/transports a month)
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hahhaa no I wish. I meant to say 50% were 911 criteria, like I can see why the patient felt to call 911.. probably 10% were actual life threatening haha. I should of re- phased that.
 
Tigger

Tigger

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usalsfyre said:
Yes there's fraudulent companies out there. Doesn't mean every IFT company is. IFT is probably more essential than 911 in some areas, no matter how bad EMTs seem to hate it.
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I think much of EMS is unaware of how the trauma system is set up in more rural states. The trauma system in our state relies on some degree of transfer infrastructure. Most of these transfers are not of critical patients but they still can't be managed by a tiny four bed ED in the middle of nowhere. Relying on the local 911 system to do this is an awful idea as they are rarely adequately staffed and often lack the clinical ability to make these trips, not to mention the resource depletion issues.
 
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usalsfyre

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If every 911 ambulance were to magically disappear people would still manage to get to an ED. If every IFT ambulance were to do the same things would get a lot more interesting.
 
MackTheKnife

MackTheKnife

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Tour 1 said:
911 is EMS.
IFT is not EMS.

Also, 911 is not critical care, but critical care, being IFT, is more complex and 'hairy'.

By my definition, CCT is not EMS either, but requires more education and skill.
Click to expand...
Wrong. It's not if you're IFT you're not EMS. If you're an EMT or EMT-P, you're EMS. Hence the first letter in the certification, E. That stands for Emergency. A pt in IFT can go sour just as the 911 call you responded to.What you say is equal to saying volunteers are not EMS. Not true.
 
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