# IFT companies



## njff/emt (Aug 2, 2010)

Is anyone else besides myself getting really sick(more than usual) of the IFT company their working for?


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## Shishkabob (Aug 2, 2010)

They're



And yes, only because it's IFT and not because of the company.


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## DrParasite (Aug 2, 2010)

most IFT companies (at least in NJ) are :censored::censored::censored::censored:ty for-profit companies, where profits are more important that the employees, working conditions, or anything else.

I worked for an IFT company for 3 months..... I can honestly say if I never do another IFT, I will be a happy man.

Many in EMS start out in IFT, with a goal of getting hired by a 911 service.  Some hospital based services have an IFT division and 911 division, and in order to get into the 911 division, you have to do your time in the IFT section.

Do your time, make some money, but if you can, be on the lookout to get a real job doing 911 EMS


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## AnthonyTheEmt (Aug 3, 2010)

absolutely, I hate the company I work for. They care more about profit than patient care and have proven that time and time again. Last week we did a transport from San Francisco to Eureka (about 250 miles, 6 hours) and they wouldnt let us take the big box because it was not gas efficient. Not to mention, a coworker was written up because a SNF was offended by him asking for history, meds, allergies.


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## Flight-LP (Aug 3, 2010)

AnthonyTheEmt said:


> absolutely, I hate the company I work for. They care more about profit than patient care and have proven that time and time again. Last week we did a transport from San Francisco to Eureka (about 250 miles, 6 hours) and they wouldnt let us take the big box because it was not gas efficient. Not to mention, a coworker was written up because a SNF was offended by him asking for history, meds, allergies.



Why does that transport necessitate a type III ambulance? Personally, I agree with their decision. Why take a more costly and non efficient unit, if their is alternative that is perfectly adequate? Did your patients equipment needs require the additional room?

I have to laugh at many of these IFT posts. Yes, these companies are profit driven, after all they are a BUSINESS. Not all place money before the advocacy of their patients though, there are, believe it or not, those running IFT companies that do respect and appreciate the individual needs of their clients. On the other hand, there are a lot of crap operators.....

I believe many of these frustrations stem from a complete lack of understanding the business side of EMS. Regardless of your clientele or the type of business model your agency has, all must be financially judicious if they wish to survive in todays economy. All too often, ignorant EMT's who have no concept of anything EMS other than the "cool stuff", are the one's doing the complaining. Their expectations are highly unrealistic.

Since we like to eat our own and always place blame, we should start with the EMT schools that provide ZERO instruction into the business of our industry. Hell, even most Paramedic programs fail to educate on this aspect. That has got to change! (Of course, so does the unneeded supply of minimally trained technicians being pumped out of schools every month, but I digress.........)


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## Aidey (Aug 3, 2010)

While I mostly agree with you, there is a difference between business and borderline defrauding insurance companies. I don't blame people when they get frustrated at the latter.

Grandma has a broken hip and needs to go from her SNF to the ER? Ok, valid.

Grandma's son drove her to the hospital for foot pain, and forgot to grab her O2 tank when he left. Even though he drove her to the hospital without it ok, the hospital won't let him take her home without it. Son refuses to go get one, so the hospital calls an ambulance.

I know in that case it is the hospital initiating the transport, but the company, knowing full well that it will be rejected as not medically necessary should have a obligation to make sure the hospital and pt/family know that instead of doing the transport and then surprising them with a bill in 6 weeks. 


Or even better, the medical director for a private company is also a practicing family practice MD that has a large number of patients in SNFs and such. No matter what the doctor ALWAYS orders transport for those patients when staff call him with some concern. Even if they are hospice or comfort care or whatever you want to call it. Questionable much?


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## Flight-LP (Aug 3, 2010)

You are correct, there is a huge difference. However, that was not the complaint presented.


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## 46Young (Aug 3, 2010)

There are a few legitimate issues with some IFT companies. Bouncing paychecks. Inaccurate hours. Sending someone home after a few hours w/LWOP if their partner bangs in. Pt steering to the hospital that benefits the sending MD instead of the closest appropriate in the emergent situation. Encouraging fraudulent billing to show medical necessity when there is none. Punitive measures toward employees that refuse to steer pts and or refuse to be pressured into fraudulent billing practices, such as write ups, LWOP, reduction of hours, schedule changes, termination. Punitive measures towards those who use sick time. Inadequate supplies and equipment. Failure to back their employees during a dispute with a contract facility when they're in the right. Poor or no pay progression. A lower rate of pay than was agreed upon during the interview, when you get your check. Mandated working holidays with little to no additional pay, certainly not 1 1/2 to double time, as is the industry standard. No uniform allowance. No deferred comp. No medical insurance (yes, there are a few that give no benefits whatsoever).

Many IFT companies are guilty of at least a few of these examples, and some are guilty of a good many of them.


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## JPINFV (Aug 3, 2010)

Aidey said:


> Grandma's son drove her to the hospital for foot pain, and forgot to grab her O2 tank when he left. Even though he drove her to the hospital without it ok, the hospital won't let him take her home without it. Son refuses to go get one, so the hospital calls an ambulance.
> 
> I know in that case it is the hospital initiating the transport, but the company, knowing full well that it will be rejected as not medically necessary should have a obligation to make sure the hospital and pt/family know that instead of doing the transport and then surprising them with a bill in 6 weeks.


I would agree that it's fraud, if the dispatcher or crew knew the background. However, I'm pretty sure that most of the information gleaned from the call taker is along the lines of pick up, drop off, insurance, C/C, and medical necessity (in this case oxygen use). The nurse is going to sign the declaration of medical necessity, which will appease the crew. Patient gets transported. If no one knows that the patient is safe to go the short time without oxygen, then it's hard to say that it's fraud. 



> Or even better, the medical director for a private company is also a practicing family practice MD that has a large number of patients in SNFs and such. No matter what the doctor ALWAYS orders transport for those patients when staff call him with some concern. Even if they are hospice or comfort care or whatever you want to call it. Questionable much?


So the EMT, dispatcher, or the call taker are supposed to second guess the physician's transport order? Also, what happens if there is something going on with a hospice patient that warrants treatment, but needs to be hospitalized for a few days? This seems to be more of a problem with SNFs than with ambulance companies.


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## Aidey (Aug 3, 2010)

In the first example you're forgetting that both the patient and son are (and did) able to say "we don't need the ambulance." In my reports I always say "The patient is being transported by ambulance because  _____________", and I'm not about to lie or leave out info.

As for the second example, I could get into it more, because the situation truly was wrong in a number of ways. It wasn't about all SNFs, it was about the fact that the _Medical Director of a private ambulance_ was ordering multiple questionable transports for his patients. It is hard to explain without getting way more into it than I want to. But in the long run it was the ER docs complaining that ended the situation.


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## Sassafras (Aug 4, 2010)

Hmmm, I'm still new at my IFT so I can't complain yet LOL. Really though they do seem to care about their employees, and they really push positive customer relations which is right up my alley being in retail as long as I was.


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## ochacon80 (Aug 4, 2010)

I'm at the brink of frustration with my IFT company. I enjoy most of the people I work with and I have developed a good relationship with some of the ER staffs in Long Beach, but my company is starting to feel like a sinking ship. I think the two things that piss me off the most are Marketing department and the loss of seniority. 

We are a small company so we only have, or HAD two marketers. One would get us legit calls with patients who needed an actual ambulance. The other marketer is ridiculous! she has turned us into a taxi service giving us patients with no complaints whats so ever, most of them damn near jog to my rig. 

The second is the worse of all, seniority has been taken aways due to our companies new recruiting strategy. Promising new people flexible scheduling, while the established EMT's work the weekends and nights.


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## firetender (Aug 4, 2010)

*IFT; the grease that turns the wheels*

Guaranteed payment. That is what allows many private ambulance services to respond to emergencies. IFT as a stand-alone business is subject to all of the "cut-corners" and minimization of employees as exists wherever the management are hacks. Some actually pride themselves on doing good work.

But as has already been pointed out, IFT is VERY much a part of what we do and it's more than just hauling around flesh and bones. I think a lot of us are guilty (I certainly was, far too often!) of looking at IFTs as "have-tos" just UNTIL that "real" emergency comes up. It's an integral part of the job and deserves more attention because, believe it or not, those are times when we get to act as healers. 

Do you understand the power of connection as a tool of healing? It's as important as anything in your drug box. It is so important it can determine the positive course of a call and favorably affect the rest of the patient's life. IFTs are where you get to practice the art, and see results immediately.

Why would you choose not to grow in ALL aspects of the "care and transportation of the sick and injured"? If I remember correctly, that's what the whole EMT program was about; pre-paramedic, but it has always been the foundation of the biz.


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## ochacon80 (Aug 4, 2010)

Even though I am IFT I take pride in my patient care, I assess patients and look for signs of seriously potential problems, my patients are in good hands, it's just the management side of things that has be burnt on my company. 

I have a question of ethics though. According to my training a chief complaint is defined as the reason we (EMS) were called, or what is wrong with the pt. Now I have been given a couple of warning because on my PCR I wrote Pt has no medical cc. The pt is one of our regular dialysis pts and there seriously is never anything wrong with him, he has htn, DM, and anemia, but whenever I see him he is alert, orientated, and all signs point to him being in no distress, yet I am told to find a reason!!!


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## JPINFV (Aug 4, 2010)

Dialysis patient going to/from dialysis? C/C is often renal failure and the reason for transport is dialysis. 

Technically speaking, the "chief complaint" is what ever the patient says it is. However I agree that it is also often acceptable to list the working diagnosis, especially when the staff given CC doesn't match up at all with patient presentation.


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## ochacon80 (Aug 4, 2010)

Yeah but Renal Faliure is a dx and I have been told that can't be used as a cc so I refuse to make one up or go with the  "general weakness"


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## Aidey (Aug 4, 2010)

That is where "presenting problem" works better than "chief complaint". 

Example 

Presenting problem: Renal Failure needing dialysis.

HX: The patient is a 40 year old male with ESRD who is being transported to his dialysis appointment. The pt is being transported via ambulance because he had recent back surgery and needs to lay flat.


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## Shishkabob (Aug 4, 2010)

C/C of "can't pee".


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## firetender (Aug 4, 2010)

*A Humanistic Outlook*



ochacon80 said:


> I have a question of ethics...He has htn, DM, and anemia, but whenever I see him he is alert, orientated, and all signs point to him being in no distress, yet I am told to find a reason!!!



ETHICALLY there's nothing wrong with offering recumbent transport to an individual with a multiplicity of medical problems to assure his comfort while going to and returning from a medically prescribed PROCEDURE.

_*Of course he's in no distress, he's with YOU!*_ Betcha a buck it'd be a whole lot different cramming him into Sister's Toyota where he'd then have to worry about Spontaneous Acceleration!


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## ochacon80 (Aug 4, 2010)

firetender said:


> ETHICALLY there's nothing wrong with offering recumbent transport to an individual with a multiplicity of medical problems to assure his comfort while going to and returning from a medically prescribed PROCEDURE.
> 
> _*Of course he's in no distress, he's with YOU!*_ Betcha a buck it'd be a whole lot different cramming him into Sister's Toyota where he'd then have to worry about Spontaneous Acceleration!



Depending on who the driver is, spontaneous acceleration in the ambulance is always possible lol.


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## Aidey (Aug 4, 2010)

You know, I've never heard a normally WC bound patient say that the gurney is more comfortable. I see your point, but I don't know that saying ambulance transport is more comfortable is a good argument. Sure there are some, like the hip fractures and such, but for those who can sit, probably not so much.


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## njff/emt (Aug 4, 2010)

wow, didn't expect to get so much replies., i'm getting sick(er) of mine mainly because of certain dispatchers., I would also like to have a permanent partner., Right now i have 5 partners, i'm cool with all, but it meant i had to get used to their styles, plus 2 of em drive the rig as if it was a drag racer., I am currently working on getting a real ems job, the only reason i started at an IFT company was simply because i was jobless and had alot of bills to pay., Anyway gettin back to the dispatchers, here's an example, they wanted me and my partner to go from Toms River to New Brunswick in a 1/2 hour when it takes at least 2 hrs depending on traffic., Plus one of them is also starting to get into a silent dispatching phase, and on top of that, acouple of crews brown nose to the dispatchers so they get sent where ever they want., Lastly our manager favors our north office, he sent a majority of new rigs up to them meant for us, we actually take care of our stuff, i can't even count how many times i go up there and see a newer truck with a ton of dings and dents in it.


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## MDA (Aug 4, 2010)

Patient care is patient care (to an extent).
Working IFT's you'll see all kinds of really sick people.

However I'm personally thankful I see transfers once in a blue moon.

On the other hand, working 911 only I see my fair share of b.s. calls that are equally frustrating... and don't get me started on dispatch, lol.


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## njff/emt (Aug 4, 2010)

MDA said:


> Patient care is patient care (to an extent).
> Working IFT's you'll see all kinds of really sick people.
> 
> However I'm personally thankful I see transfers once in a blue moon.
> ...



I hear ya, i notice alot of pts i take are the nicest people, and yet have had a hard life(medically speaking), and yet the ones that waste their life away has minimal problems., As far as 911, majority of the IFT "emergencies" are b.s., real 911 at my squad have been some major ones, and of course the occasional lonelyitis/incarceritis here and there.


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## DrParasite (Aug 5, 2010)

njff/emt said:


> wow, didn't expect to get so much replies., i'm getting sick(er) of mine mainly because of certain dispatchers.


don't complain about dispatch until you have actually been in their seat.  their job tends to suck, and everyone hates them, even though they are only doing their job as your bosses expect them to do.  Or even better, ask your boss to train you to dispatch, it's often an eye opening experience to see why they do certain things that make field people hate them.





njff/emt said:


> I would also like to have a permanent partner., Right now i have 5 partners, i'm cool with all, but it meant i had to get used to their styles, plus 2 of em drive the rig as if it was a drag racer.


permanent partners are awesome, assuming you have an awesome partner who knows what they are doing and whom you get along well with.  if you have a sucky partner, being permanently assigned to them, well, sucks. and if your partner drives like a drag racer, and it's unsafe, tell a supervisor.  maybe they can correct the problem, but I have had the multiple partners where some scared me when they got behind the wheel.  even worse when certain people insist on text messaging while driving.





njff/emt said:


> I am currently working on getting a real ems job, the only reason i started at an IFT company was simply because i was jobless and had alot of bills to pay.


nothing wrong with that, many people start out in IFT before going to 911.  if I can help you with that, drop me a PM. 





njff/emt said:


> Anyway gettin back to the dispatchers, here's an example, they wanted me and my partner to go from Toms River to New Brunswick in a 1/2 hour when it takes at least 2 hrs depending on traffic.


you can only go so fast, and you should never speed.  if it takes you 2 hours, it takes two hours.  if supervisors ask why it took 2 hours, you have a reason.  don't stress it.  you can only handle one job at a time, it's dispatch's job to handle the schedule, yours is to do the job as safely, efficiently, and properly as possible. 





njff/emt said:


> Plus one of them is also starting to get into a silent dispatching phase, and on top of that, acouple of crews brown nose to the dispatchers so they get sent where ever they want.


silent dispatching?  what is that?  they give you a job, you acknowledge it, not exactly rocket science. and if dispatch is doing something they shouldn't, or not doing something they should, write it up and give it to a supervisor.  As for the whole brown nosing comment, maybe you should try that?  if you get coffee or breakfast, ask them if they want anything.  I remember when I used to dispatch, and I would be so happy when a crew was getting food and asked me if I wanted something.  esp when I am alone in dispatch, can't go out to get food, can barely go out to pee since i'm solo for 12 hours.  I know of companies that have rules against having dispatch asking crews to pick up food for them, but if you offer, they will be happy, trust me, been there and done that. 





njff/emt said:


> Lastly our manager favors our north office, he sent a majority of new rigs up to them meant for us, we actually take care of our stuff, i can't even count how many times i go up there and see a newer truck with a ton of dings and dents in it.


hmmm sounds like you work for alert or able lol.  just for the record, I bet they say the same thing about you and your crews.


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## 46Young (Aug 5, 2010)

Silent dispatching is communicating with crews without going over the air, so no one knows who's doing the most jobs and who's not doing any. That way, no one can say that unit one did 10 jobs while unit two did 1, nor can they see a pattern of favoritism between dispatchers and crews. That's how they work at my IFT per diem job.

Anyway, I've seen dispatchers at work and I'd never want to do that. It's too high stress, especially with supervisors breathing down your neck. At my county, there's a fairly constant turnover in dispatch, even with the pension, benefits, etc.


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## njff/emt (Aug 5, 2010)

parasite thanks for the constructive criticism, i was venting(had a really bad day), as i mentioned only certain ones, the two main are pretty cool, but their backups kinda suck, probably cause they dont do it alot, anyway about the long distance i called up dispatch and explained how long it was gonna take and they told me keep them posted., 46 nailed the silent dispatching dead on, we use PTT cellphones, majority of the time they're pretty decent, theres only one-two dispatchers that do that, the worst was when the sent over a run on the toughbook never sent the text and asked us if we were on the floor, then they insisted they sent the text which benefit of the doubt the system had a hiccup., I also appreciate the gesture, i'll keep it in mind., As for the IFT co i work for its a pretty big one, i dont wanna say the name simply cause i dont know if my bosses even know this site exists, so i aint taking any chances., As far as doing dispatching, i told my supervisor several times i would do it, but its a really long drive for me., And as for the brown nosing, theres a big difference between doing something out of kindness and being in a little clique, some of the northern crews are really close to the dispatchers., I also forgot to mention they scam medicaid by having my partner thats not certified for logisticare do the run anyway and have someone else who is certified sign it., Another reason why i cant wait to get out of this IFT company.


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