burning hatred for transfers

[Shishkabob]

And i still call shenanigans

Hey, cool, you don't have to believe me. Not like I have a reason to lie over something insignificant.

Youre trained in emergencies? Hot damn i was educated in medical care.

EMT BLS discharge transfers... that can hardly be called medical care.

 

[Rykielz]

I can see where everyones coming from on this. Yes IFT's aren't that enjoyable, and I didn't like them at first either. But you can learn a lot from them if you allow yourself to (i.e. Patient interaction skills, chronic illnesses, meds, etc.) since you normally have some time with the PT to look at their packet. The IFT's pay the bills and each PT deserves the highest level of care possible regardless of the reason. 9-1-1 is where all the action is, sure you don't save a life everyday but you get to use the skills that you were trained to do. I don't think anyone can tell me an IFT medic/emt is going to have the level of experience that a 9-1-1 medic/emt will. Their two separate environments and you need a little of both.

 

[46Young]

I'm not disputing that with IFT, you learn comfort care, and learn about various medical conditions, how they present, what concominant conditions typically appear in a certain pt's Hx, what meds they're typically on, etc. The problem is, most people enter into EMS to play "street doctor," which means they want to figure out what's wrong with each pt, not be handed a pt that's already had a workup and usually a Dx by a physician. That takes all the "fun" out of it. An IFT medic may help out on a good CC job, or run a sick MI pt to the lab on a couple of drips, but maybe 90% of their call volume is stable ALS transfers and a bunch of BLS transfers and discharges. That's not going to work long term for the typical EMS employee, who's more often than not an "A" type personality, or got into the field for the promise of excitement. That's not how we should wiew the paramedic profession (job?), but this is how people think about EMS on the average.

I was fortunate in that after only six months of working private IFT, I was hired by a hospital that did both urban 911 and IFT. I got the IFT experience as above, for two days, then I got to play city 911 for the other two, plus OT.

I've found that further down the line, EMT's and more so medics gravitate towards the IFT side of a 911/IFT dept, because it's easier and less stressful. In my case, I actually like IFT in small doses, such as with a per diem position. I'd rather run all ALS 911 jobs as a first choice, but I'd much prefer IFT over running 80% of the medicaid/taxi rides, other forms of non-acute 911 abuse, and any MVA that's not a pin job, ejection, or other form of multi trauma. Seriously, I think BS neck and back MVA's are at the top of many people's lists of undesireable calls. I'd much rather take an elderly pt home from the hospital, get them comfortable, and get some thanks from the family, than board and collar a low speed fender bender pt looking for money. It's a pain to board them, we run the risk of being hit by a car, and we need to make new towel rolls for their head, clean off a board, fold up spider straps, etc. Besides some vomiting that we're ready for, I can't think of any IFT txp's that I had to clean up a bunch of blood, feces, urine and everything off the cot, bench, floor, door handles, etc. A dialysis transfer is much easier. You can also hit a 7-11 or a pizza joint on the way (if it's in and out) if you need to.

Edit: You all ALS depts don't know what you're missing: In NYC, when you become a medic, you no longer have to run MVA's, sick jobs, abd pain, conscious drunks, injuries, or EDP's.

 

[rhan101277]

My service does transfers and 911, I think it is a perfect mix. Doing 911 constantly is more stressful, have a few pre-scheduled transfers throw in helps I think. Be thankful you got your foot in the door, it is still providing care to someone.

 

[NomadicMedic]

I think it's funny. I give morphine, zofran, albuterol, NTG and ASA every shift. Why would Linuss lie about treating his patients? If you're in a busy 911 system, you use drugs.

 

[firetender]

Vulnerability; the forbidden word

FNG's with visions of glory enter EMS only to find that much of their time is spent as a horizontal taxi service. They realize they have been trained to be "attendants" rather than "medics" which means, to them, they're not really doing what they were trained to do.

In a sense, that is the absolute truth because what they're not terribly well trained in is dealing with human beings, which is the bottom line of the job. IFT's are perfect routes to learn how to "reach" people.

I was very happy to hear that so many of you find some satisfaction and even stimulation in providing that service. I even heard lots of affirmative perspectives, AND running through it all were statements that intimated that learning to connect is as valuable a skill as knowledge of drug dosage: WOW!

AND, I also want to acknowledge that a part of transfers involves relentless exposure to the debilitated, easily misinterpreted as hollow shells. If you look a little deeper, perhaps you can see how easy it is, after continued exposure, to build resentment -- NOT for the patient, him or herself -- but for having to play witness to the terror of end stages. With enough exposure, it feels like that's all there is. And the logical conclusion...that's where I'M gonna end up too!

This is something few talk about or acknowledge. One of the elements of burnout includes constant exposure to debilitation and impending death, making it easy to begin to feel that's all there is. The more of this you're exposed to, the more crazy-making it can all become.

This is just one aspect of the job, lurking underneath the surface, that combines with a litany of other world-rocking exposures that makes the work amongst the most demanding of professions. The real dangers we expose ourselves to, are often those we are groomed to NOT take a good look at.

 

[HotelCo]

Look at my recent posts... I too HATED those prescheduled BLS transfers. I found them boring, and a waste of my time. It was only recently (last week) that I came to realize what a great opportunity doing those provided me. I get the opportunity to work with nurses and physicians who I'm freely able to ask questions to about the patients illness. That alone would be great, but I've also realized that doing all of those transfers has made me great at assessing patients.

So remember, the transfer may be boring to you, but don't waste that opportunity to learn.

 

[Veneficus]

Look at my recent posts... I too HATED those prescheduled BLS transfers. I found them boring, and a waste of my time. It was only recently (last week) that I came to realize what a great opportunity doing those provided me. I get the opportunity to work with nurses and physicians who I'm freely able to ask questions to about the patients illness. That alone would be great, but I've also realized that doing all of those transfers has made me great at assessing patients.

So remember, the transfer may be boring to you, but don't waste that opportunity to learn.

Precisely!

Sooner or later, we all figure it out.

Have you ever thought about the training of a classical musician, a ballet dancer, or a surgeon? It is years of mindnumbing repetition of the very basics before moving on to "advanced work." It is made such so that certain aspects are so ingrained they are done without conscious thought freeing up your mind for other tasks.

Why is it EMS providers think they can gain these abilities overnight because they have an "intensive training." The above are just as intensive and for longer!

Hate to break the news, but superman when finished with paramedic school a person is not. It will take many more years of either intensive amounts of patient contact or even longer if not as intensive to get basic skills to the subconcious level. Probably why people say it takes an average of 5 years to build a competant medic?

Alas, 0 to hero, 3 years topps.

 

[46Young]

FNG's with visions of glory enter EMS only to find that much of their time is spent as a horizontal taxi service. They realize they have been trained to be "attendants" rather than "medics" which means, to them, they're not really doing what they were trained to do.

In a sense, that is the absolute truth because what they're not terribly well trained in is dealing with human beings, which is the bottom line of the job. IFT's are perfect routes to learn how to "reach" people.

I was very happy to hear that so many of you find some satisfaction and even stimulation in providing that service. I even heard lots of affirmative perspectives, AND running through it all were statements that intimated that learning to connect is as valuable a skill as knowledge of drug dosage: WOW!

AND, I also want to acknowledge that a part of transfers involves relentless exposure to the debilitated, easily misinterpreted as hollow shells. If you look a little deeper, perhaps you can see how easy it is, after continued exposure, to build resentment -- NOT for the patient, him or herself -- but for having to play witness to the terror of end stages. With enough exposure, it feels like that's all there is. And the logical conclusion...that's where I'M gonna end up too!

This is something few talk about or acknowledge. One of the elements of burnout includes constant exposure to debilitation and impending death, making it easy to begin to feel that's all there is. The more of this you're exposed to, the more crazy-making it can all become.

This is just one aspect of the job, lurking underneath the surface, that combines with a litany of other world-rocking exposures that makes the work amongst the most demanding of professions. The real dangers we expose ourselves to, are often those we are groomed to NOT take a good look at.

Well, you really hit the nail on the head. I've often remarked to family about how, on the job, I routinely see how the elderly end up. I've always remarked that if I were facing the prospect of entering a NH, I'd find a way to off myself. Probably by drug OD or gun. Also, even if my pt is apparently obtunded or otherwise unable to interact, I'll still speak to them, explain what's going on, and not in a cutesy voice like you speak to a two year old, either. I don't see how someone who lived through the Great Depression, and may have served in a war or two, be spoken to like a child.

I don't know how seeing human suffering, and people decrepit and at the end of their life on a routine basis doesn't affect you, at least just a little. I'm as kind to my patients, especially the chronically ill, as I can be.

 

[boingo]

And i still call shenanigans

Thats because in Florida any 911 call equals a fire truck and ALS, therefore the 90% of patient who only need a ride get it via the ALS truck. If only 10% of my calls ended up with an ALS intervention, I would agree with your position, however your experience with EMS is different than mine. I work in a tiered system where based on complaint the patient may get just BLS. We have 4 times the number of BLS trucks to ALS, so our ALS crews take care of patients needing ALS intervention.

 

[Meursault]

I get the opportunity to work with nurses and physicians who I'm freely able to ask questions to about the patients illness.

Lucky you. Most of the time, I have to engage in chart-mining. Occasionally, someone's nice and gives me report.

That alone would be great, but I've also realized that doing all of those transfers has made me great at assessing patients.

So remember, the transfer may be boring to you, but don't waste that opportunity to learn.

That's what I'm coming to think, too. If nothing else, it's a chance to work on your assessment skills in a low-pressure environment, but a lot of the time, it's a chance to see what certain conditions look like and to read about how they get handled in hospital. Many of my transfer patients presented to the ED by EMS a few days ago, and if you have a couple minutes to comb through their charts, you can follow their clinical course right up to the time they ended up on your stretcher.

 

[HotelCo]

Lucky you. Most of the time, I have to engage in chart-mining. Occasionally, someone's nice and gives me report.

Oh, that's what I usually do, but when I do have a question, they're always more than willing to answer it, and some will even go into a lot of detail about the illness.

That's what I'm coming to think, too. If nothing else, it's a chance to work on your assessment skills in a low-pressure environment, but a lot of the time, it's a chance to see what certain conditions look like and to read about how they get handled in hospital. Many of my transfer patients presented to the ED by EMS a few days ago, and if you have a couple minutes to comb through their charts, you can follow their clinical course right up to the time they ended up on your stretcher.

People can tell you this a hundred times, but you have to come to realize it for yourself before you believe it, right?

 

[katgrl2003]

I've worked IFT for almost 5 years now. Had a burnout episode a few years ago, and took some time off, but other than that I love IFT. I recently got a job at a 911 service, and landed on the only IFT truck in the service. We still do 911 runs when we don't have a transfer, but it's usually only on the weekend. The docs and nurses here usually give us a good report, and we get a chance to see lots of disease processes. This is probably the reason I prefer medical runs over trauma.

 

[thegreypilgrim]

I've learned to enjoy IFT, despite being of the original standard-issue EMS mentality that such things were beneath me and that I needed the adrenergic surge of the quasi-mythical "true emergency". Over time, I've come to appreciate the opportunities afforded by doing IFTs that others have already listed here: ability to do assessments on patients with confirmed types of illnesses, being able to see patients with certain disease processes I'd likely never see in a 911 context (or if I did, I wouldn't know that's what I was dealing with), and gaining a sense of "hospital operations" - that is, getting a sense of risk stratification, what certain patients are going to need down the line, etc.

We also get to occasionally play doctor when we get calls out of nursing homes and urgent cares which should have been 911 activations from the get-go, but for whatever reason was decided to treat as non-emergent. I've gotten to the point of treating all of those runs as though they're 911 calls, so at least there is that opportunity.

The problem is, with my current job, the truly medically interesting cases and triages to a higher level of care are few and far between. The bulk of our call volume consists of needless insurance repatriations the whole "ALS" aspect of which is hardly more than a facade erected for legal purposes. That kind of stuff is certainly not ideal.

 

[ffemt8978]

When I started in EMS, it was only doing 911 calls with a FD. I thought I knew enough about EMS to basically not kill my patients before I got them to the hospital and was satisfied with the "load and go" mentality.

It wasn't until I went to work for an IFT company that I actually realized how little I know about EMS and medicine in general. The "load and go" view, while basically the job description for IFT, was wholly inadequate in accomplishing the job. The experience I gained, particularly in documentation history taking, along with a better understanding of disease processes and how the entire EMS system is supposed to work makes me a better patient advocate and hopefully a better EMS provider in general.

Now I'm back to doing 911, but I continue to learn from my IFT experience.

 

[Meursault]

People can tell you this a hundred times, but you have to come to realize it for yourself before you believe it, right?

Yes and no. I can't recall hearing positive things about IFT more than once or twice in 4 years as an EMT student and non-private-service EMT. On the other hand, I think it's something one will arrive at as long as he shows up with a bit of medical knowledge, a decent amount of curiosity, and a willingness to do a little extra work.

Unfortunately, those are not things EMTs are known for. As thegreypilgrim mentioned, "the standard-issue EMS mentality" is kind of a barrier to this. I think that if you catch someone in an EMT class, before their delusions are dashed against the realities of EMS, you can get them interested and educated enough to arrive at this independently.

 

[18G]

Granted all of my Department's IFT's come from the hospital ED and are acute cases that I may have taken in earlier, but I actually love IFT almost more then I do 911! I find it to be a much better learning experience and can apply my knowledge more. It's nice to have the patient's diagnosis, talk to the transferring dr, the RN's, read the lab report's, the physician's report, etc. It really ties it all together.

I have learned quite a bit in a short time just by doing IFT. My advice is to not treat your nursing home calls and other IFT's as BS calls. Approach them the same as any other patient that would have called 911. Their physical location does not make them any less of an important patient (nursing home vs residence). 911 can be largely BS too so keep that in mind. It's not as glamorous as you may think. I enjoy both and am glad I get a mix of both but I don't see myself getting burned out from doing IFT 100% of the time as long as the patients are acute cases that require ALS monitoring, etc.

Now doing BLS IFT for patients who need feeding tubes replaced, etc... eh... yeah that would drain me I think but only because I want more of a challenge for myself professionally and want to utilize my skills and knowledge.

I get what the OP is saying.... sounds like he is just a bit jaded right now and wants a better opportunity where he can apply himself and the education he gained by becoming a Paramedic.

And its real easy to tell someone to quit when they dont like their job... if only they could quit their bills at the same time, right?