Street EMS vs. Transport

[LonghornMedic]

As a brand new EMT-B, IFT can provide you with a learning curve. It's a good way to become familiar with different medications, medical diagnosis, doing thorough assessments, charting, developing patient contact skills, etc. I wouldn't want to do it for more than 4-6 months. But the experience it provides is valuable. As much as you may think you know, going straight to 911 calls can be overwhelming to an inexperienced medic. Good luck in your new career.

 

[matthewpetro]

When I first decided to get into EMS I did my first ride along with a ITF company here in Indianapolis and then I did 2 ride alongs with a 911 service. One thing that I noticed about the IFT tranports where that you were dealing with very sick patients most of the time. With 911 it was a lot more exciting because of all the lights and sirens but at the end of the day I am considering a IFT truck for my 1st job as I think it can provide me an excellant opportunity to learn some of the skills. I think it can be a great way to build my resume and experience.

 

[tony1]

Guess it depends on the area as well. Investigate what privates handle (ie do they run anything emergent or not and if so what do they do) versus the fire dept. Approach some crews and ask them and they will most likely be very frank with you. I have worked at privates and one fire dept that were ALS so I worked with a medic at those jobs. Some privates handle alot of doctor appointments and dialysis type stuff and some get good calls. My private is not 911 but we have house calls for example because of hospital preference. Most people do not like their closest hospital and usually prefer one farther than the fire dept is willing and or allowed to take them to. They will actually call us for SOB and CP from their house and take a longer ETA. This is one of the reasons why privates exist (hospital preference), at least in my state. We are also contracted with many facilities, not just nursing homes. We have drug and alcohol rehab facilities and many many psych facilities, but we do not have any hospital contracts because we do not want the BS return calls that we do not get paid for. I get very good calls actually and they just happen to be the same as when I was on the fire dept. That particular fire dept has three trailer parks in it's district so actually, the calls are pretty much the same to me as you can imagine. I am a rare breed I guess because I actually really like working for this company even though most people do not find it glamorous like a FD. I have been there and never had an interest in a full-time FD. I went through the academy etc and after a few years moved on to other things after working p/t, POC, and POP. It just all depends on what makes YOU happy. How much you learn at a private is up to you. Some people are miserable and cannot wait to quit and others like it and try to learn all they can. You can still learn alot from your regular dialysis patients too. Most of them are very sick and it's a great way to get patient contact and get familiar with meds and learn what they are for, etc. Nursing home patients are usually very ill unless they are in for rehab only maybe and when you get to the point as a basic that you can look at any med list and know what the patient's history is, then that's a great thing as well. Basically, you can learn from any type of calls.

 

[tony1]

Don't forget about special events as well. In my state, privates are contracted to handle special events in different places like Chicago for example. We do Lollapalooza, Chicago Bears games, various marathons around the city, and even the Chicago Bulls training center to name a few. We even do the bullfights in the area. Those are always fun and guaranteed to get you some interesting calls.

 

[CAOX3]

I think IFT is a great way to gain experience, you see sick people granted they may not be acute but their still sick, use them to your advantage.

You can learn something from every patient you see, well almost everyone

 

[46Young]

I think IFT is a great way to gain experience, you see sick people granted they may not be acute but their still sick, use them to your advantage.

You can learn something from every patient you see, well almost everyone

It's true that you can learn a lot about different medical conditions and pt presentations in IFT. The thing is, unless you're doing challenging critical care work, IFT present little challenge or opportunity to develop critical thinking skills. In most cases, the pt already has a diagnosis, you're told what drips to run, what type of O2 admin, etc. Unless you're a CCEMT-P, you're not titrating drips on standing orders in most places. If the pt decompensates in some fashion, most places require you to contact OLMC for anything past the ABC's and your ACLS algorithms. How's that challenging?

911 offers the opportunity to come to your own conclusions regarding the pt presentation and decide on a treatment plan without having someone else already figure that out for you. You don't typically (except for maybe a pickup at the MD office) have the benefit of labs, CT, MRI, ABG, etc. to guide your Dx and treatment decisions. You have to figure it out for yourself.

Honestly, the best answer is to do both. I was lucky in that for my first job, seven months in IFT, I mainly drove a CCMedic. I ;earned a lot right away. Then, I worked for a hospital that did both 911 and IFT, depending on the shift.

I've noticed that strictly 911 medics largely do not fully understand the long term repercussions of their treatments. They don't fully understand what happens to the pt after being dropped off. The strictly IFT medic may lack the critical thinking skills to accurately Dx and treat pts in the field when starting from scratch (no chart, dx, etc.), so to speak. They'll also be inexperienced in handling all the dynamic conditions that the streets present. MVA's, a pt crashing on the top of a five floor walkup with no help, an arrest in a tight apartment with furniture and clutter, violent pts, risk/reward of stay and play vs load and go when around the corner from a hospital, how to move an intubated pt through that tight apartment and down the stairs w/o losing the tube, doing field CPAP (I've yet to see an IFT bus carry it), why it's a bad idea to start it in the house if no easy egress, etc.

 

[46Young]

I think IFT is a great way to gain experience, you see sick people granted they may not be acute but their still sick, use them to your advantage.

You can learn something from every patient you see, well almost everyone

Double post

 

[tony1]

Lots of good ideas from everyone here. Privates in my area do carry CPAP also.

 

[46Young]

Lots of good ideas from everyone here. Privates in my area do carry CPAP also.

By privates, do you mean strictly IFT, or IFT/911 combo? The CPAP we use is intended for prehospital applications. Although, I could see it's use for the STEMI x-fer to the cath lab that has heart failure secondary to an MI with pulmonary edema.

 

[tony1]

I guess some things are different from state to state like "IFT" companies. We do not have that here. We have "medi-car" services (w/c van services) and then private ambulance companies. The privates do the IFT stuff that I guess I am reading about on this site as well as emergent calls. Some companies do more of that stuff and some do less. Best to find that out ahead of time if you want to be running emergent calls. Some have vent rigs also which are staffed by EMT-P's that are vent certified and they do alot of IFT stuff. Some have CC rigs that even have an RN riding along and they can transport pretty much anything. Some companies have hospital contracts and do tons of IFT stuff and I am working for one that has no hospital contracts. I have done that stuff before and it does get boring but is a good start for a new B that needs to get their feet wet. My company carries CPAP on the regular ALS rigs for the pre-hospital scenario. The ALS vent IFT may sound and be boring to most but good money. I have spoken to some vent medics that say their call bonus check is about 800-1000 monthly. Their hourly is very good also.

 

[chute43]

If it is possible both will do you some good, knowing every med in the world won't help you at all when you are working a 15 pt MCI and some mother is screaming at you to save their child. And the same works the other way being super macho and plugging 14g IVs in everyone won't help you at all when doing a IFT on a 8 year old on a vent and three different drips.

I was lucky enough during medic school, to be able to work a BLS IFT shift a week with the company I worked for, I believe that experience was vital in learning how to move patients, look through the one inch stack of papers and sort out stuff, as a medic student they helped me learned to document as well.

So in the perfect world doing both will make you a better rounded medic.

What I live most IFTs are handled by a group of BLS ambulances and 911 is ran single medic, Fire is BLS and there is only one ambulance company in the county and the city.

I work in a different city for a small fire department, we provide all the 911 ambulance for our city and the 250 sq miles around our city. We do transfers for the SNFs but there is no hospital in our response area.

kary

 

[tony1]

I will apologize for my ignorance with some stuff. We don't use the term "IFT" companies, and to be honest with you I had to think about IFT for a bit and guess at what it meant. We just have private ambulance companies (not FD) that run 911 only, or "IFT/911" companies, and then those that run IFT and are contracted with facilities like drug and alcohol rehab, or psych facilities, etc., and they call us versus 911. We respond the same as the FD (code 3) and treat and transfer to the desired, or closest hospital. In Chicago there are many hospitals and there is always one close by. If they are stable we will transfer to a further, desired ER. The 911 privates are not within the city of Chicago, but rather out in the more rural areas. In Chicago, privates are the nursing homes' 911 instead of calling Chicago Fire for everything. They will call us for SOB and CP and take a longer ETA rather than calling the city. We also do house calls for those who refuse to go with the city to the closest. They usually for some reason hate their closest so they call us to go to a desired/further ER. We are not 911 but we are in the phone book and to some people, that's the same thing believe it or not.

 

[tony1]

There are many different EMS systems here in IL and each one dictates if it is one B and one P or two of the same cert level. The FD I was at was a B and a P minimum. Usually three people though and the third was either a B or P. Within Chicago itself, the system is two people of the same level of cert.

 

[looker]

I will apologize for my ignorance with some stuff. We don't use the term "IFT" companies, and to be honest with you I had to think about IFT for a bit and guess at what it meant. We just have private ambulance companies (not FD) that run 911 only, or "IFT/911" companies, and then those that run IFT and are contracted with facilities like drug and alcohol rehab, or psych facilities, etc., and they call us versus 911. We respond the same as the FD (code 3) and treat and transfer to the desired, or closest hospital. In Chicago there are many hospitals and there is always one close by. If they are stable we will transfer to a further, desired ER. The 911 privates are not within the city of Chicago, but rather out in the more rural areas. In Chicago, privates are the nursing homes' 911 instead of calling Chicago Fire for everything. They will call us for SOB and CP and take a longer ETA rather than calling the city. We also do house calls for those who refuse to go with the city to the closest. They usually for some reason hate their closest so they call us to go to a desired/further ER. We are not 911 but we are in the phone book and to some people, that's the same thing believe it or not.

So you can respond code 3 to someone private house or just contracted nursing homes/drug facility?

 

[tony1]

yes, it depends on the complaint. The obvious ones of course like possible CVA, seizures, CP, SOB, etc., etc. are automatic code 3 be it a house or some facility. Also if it is a very violent psych and/or police on scene waiting for us to arrive. There are many reasons that we would respond that way.

 

[looker]

yes, it depends on the complaint.

To me that seems to be crazy system that you can respond to someone house code 3 without them going through 911 and then 911 contacting contracting agency(s).

 

[tony1]

I understand. How do you guys do it? We can since they are initiating the call and they have a legit complaint.

 

[tony1]

I have even responded on a 3 for a fall at a house due to the patient still being on the floor and unable to get up. There are tons of reasons but in my area all the privates can do that. I have worked for a few and that is one thing that is the same.

 

[tony1]

The system I work in is Chicago North EMS and we follow the same SMO's and Protocols as the Chicago FD. We carry the same equipment etc. They run BLS as well as ALS and so do we and we both pretty much operate the same. We have even taken patients from them due to the pt wanting a farther hospital. They are always all too happy to let us take one for them. They run about 25 calls in their 24 hr shift so you can see why they would be happy. I guess I never realized the differences from state to state. It's interesting to learn how other areas operate.

 

[looker]

I understand. How do you guys do it? We can since they are initiating the call and they have a legit complaint.

Depends on the area. In LA any emergency are called in to 911 and 911 dispatches either city own ambulance or one of the contracting ambulance. If contracting ambulance do not have any available units they call back up providers.

In OC nursing homes can call contracting ambulance directly.

A regular person can only dial 911 if they have an emergency to respond with lights and siren they can't just call an ambulance company and ask them to come code 3. If they need regular transport( no l & s) they can call private ambulance