# Long Distance Transfers



## medicdan (Sep 16, 2008)

I was just offered by the private company I work for to go on a long distance transfer with a patient, and although I had to refuse, realized I know very little about how they are done. I have done long calls before (3 hours), but nothing like this...
This call is from New England to Florida, and partially due to patient condition, partially $$, is being done by a ground ambulance. The company may try to bill medicare, but doubt they will get much money, so it is consitered a "private pay" trip. 
What are your procedures for these calls? I know every call is different, and assuming its a BLS transfer, how many EMTs do you send? How do you handle refueling? Sleep? Time "off duty"? Food? Restroom use (for yourself and the patient)? Normal medicine administration for the patient? Reseting the vehicle at the end of the run? Monitoring? Documentation? On scening something with extra crew members? Entertainment? Pay? Protocols/SOP/training/certfication in other states? 
Forgive my many questions, it seems my company does this very infrequently... 

Thanks!

DS


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## KEVD18 (Sep 16, 2008)

how many emt's-minimum three. one driving, one attending and one sleeping.

refueling- thats a tricky one. there has to be a law agiainst refuleing an ambulance with a patient on board, but there also has to be a law against unloading your patient on the cot and rolling them into a truck stop. 

meds- anthing outside the scope of the emt basic would have to be self administered or administered by somebody other than the bls crew.

on scening something else- the simplest of them all. once your out of your licensed state, you may only provide care at your level for the patient in your truck. for everybody else, you are a first responder only. depending on the state, you may or may not be required to stop.

entertainment- hope you like to read.

pay- i wouldnt accept anything less than my hourly rate for 16hrs/day for the whole trip. and of course, after fourty is 1.5 and after 80 is double. oh, and they pay you down and back and all expenses.

protocols- when doing an interstate transfer, you fall under the protocols for the state in which you and your vehicle are licensed and this only applies to the patient you are contracted to be transporting.

monitoring and documentation- just like every other call.


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## VentMedic (Sep 16, 2008)

Florida or anywhere on the East coast, check NHC/weather channel for storm potential. 

Is this a facility to facility transport?

Have contact numbers for both you MD and the rec'g facility. 

Plan your route carefully. 

Call in occasionally with your location to your dispatch. 

Know the hospitals along the route. 

If your dispatch is following your trip they may be able to help you if you need to contact a hospital or Medical Director enroute. 

Know the laws for the maximum time behind the wheel of an ambulance if applicable. 

Don't drive tired or push one driver too much if they show signs of fatique. Switch according to the comfort level of a driver and not "your turn must be 4 hours". Each driver may have different limits with distance driving. Some can drive for 16 hours straight (not advised) and have no problem. Others may get road fatique after 2 hours on distance trips. 

Know your fuel mileage for your vehicle to know where your stops will approximately be.

Know your service alternatives if you break down. (I actually had to use my AAA card once on a long distance trip.) Do not use your own credit card or money for maintenance....unless there is absolutely no alternative. (&*#$ "opinion")

Know if O2 will be required for the trip. Calculate tanks. See it you have any exchange agreements along the way in case another tank is needed to continue the route. 

Be familiar with the patient's routine medications. If the patient is conscious, you will be "assisting" at an EMT-B level, but check your protocols. 

Will the patient have an IV? Fluids? Flushing for patiency? Again check you protocols. 

Patient and staff prone to blood clots? A little planned stretching or movement if possible or alternative preparation/devices. 

Food for patient? Restricted diet? Diabetic? Insulin? Small snacks? 

Hydration? Keep a cooler with enough liquid for everyone. 

Be prepared for patient's normal bodily functions including a proper disposal bag to prevent odor. Avoid using aerosolized deodorants inside the ambulance with a patient present. 

Document patient care carefully. Keep a mileage and an expense log.

Park ambulance at stops where patient privacy is respected and comfort is considered. In other words, avoid parking in the hot sun in plain view of gawkers while staff is taking turns using the restroom. 

Do not leave the patient alone in the back whether stopped or moving. 

Remember your seatbelts.

Enjoy the scenery. Talk to patient when they feel like talking. Offer reading material to patient such as the local newspapers or magazines (which you could "borrow" on your exit from the hospital or just ask a volunteer at the front desk). Take a deck of cards just in case the patient plays.


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## mycrofft (Sep 16, 2008)

*This sounds a little "snake-bit" to me.*

Good to stay clear. 
I did a nine-hour each way interstate once, crew of two total and comatose pt, and it went smoothly in a converted Suburban. Did a four hour each way to Mayo clinic in a Beechcraft and things almost went to shinola. Risky.


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## Ridryder911 (Sep 17, 2008)

Why are they not flying the patient? In most cases it is a lot cheaper than ground transport, as well as duration of trip less stressful. 

Never heard of any laws about refueling. Even aircraft does re-fueling with the patient on-board. Why would anyone remove a patient and what roll them into the snack bar?..

Such complications and headaches is why we refuse long transports. Its not worth the hassles. 

R/r 911


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## VentMedic (Sep 17, 2008)

Ridryder911 said:


> Why are they not flying the patient? In most cases it is a lot cheaper than ground transport, as well as duration of trip less stressful.
> 
> 
> R/r 911


 
Some VA systems still ground transport their patients to various specialty hospitals for rehab. 

That's where I got my experience in "cross states" transport while moonlighting for a company that had their contract. 

There have been a couple of patients that were deathly afraid of flying that had to be ground transported. Their families paid cash for the service. 

In Florida, we did have one California resident who was in the hospital post airplane accident and was now afraid to fly. It took some coaxing and a promise that he would sleep through the fight or at least remember very little of it. But, he was going with an RN/RN flight team who could accomondate. The guy even wanted to be reintubated to be sedated heavier.
Of course, his other option was becoming a resident of Florida for another 6 months.


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## KEVD18 (Sep 17, 2008)

vent nailed it from my angle. i spent a few years doing va transfers across multiple state lines.

they have a limitless budget and couldnt possibly care what soemthing costs. they use the absolute simplest equation _for them_


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## MSDeltaFlt (Sep 17, 2008)

Ridryder911 said:


> Why are they not flying the patient? In most cases it is a lot cheaper than ground transport, as well as duration of trip less stressful.
> 
> Never heard of any laws about refueling. Even aircraft does re-fueling with the patient on-board. Why would anyone remove a patient and what roll them into the snack bar?..
> 
> ...



Why fly a BLS pt?  Also, I didn't read where anyone mentioned sleeping on those long trips.  Personally I would refuse to go on any long distance trip if the company did not finance expenses.  When I say expenses, I mean hotel rooms, all food.  You don't go "swank", but you don't go to the "dives" either.


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## mikie (Sep 17, 2008)

So, if I understand correctly, once you cross state lines, you now must follow that state's basic protocols?  

How would you know them?

What if they have differences on what BLS meds can and can't be administered?

Who's the medical director then?


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## VentMedic (Sep 17, 2008)

*Question*



mikie333 said:


> So, if I understand correctly, once you cross state lines, you now must follow that state's basic protocols?
> 
> How would you know them?
> 
> ...


 
*Answer*



KEVD18 said:


> protocols- when doing an interstate transfer, you fall under the protocols for the state in which you and your vehicle are licensed and this only applies to the patient you are contracted to be transporting.


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## mikie (Sep 17, 2008)

Ahh stupid me, I must have read that and interpreted it as each individual state!

Sorry for the mixup!

Thanks!


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## medicdan (Sep 17, 2008)

DOH!! I didnt see the above answer, excuse the double answer, and answered the question myself.


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## mikie (Sep 17, 2008)

and what about comunications?  Cell phones?  I would assume after a certain distance, radios are out of range


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## VentMedic (Sep 17, 2008)

MSDeltaFlt said:


> Why fly a BLS pt?


 
Being from an area that caters to international tourists, we have several fixed wing medical companies that specialize in cross country or cross the world medical flights. We also fly kids back to their native country that have come up for special surgery and are returning to another facility in their homeland to finish recovering. Mostly it is for comfort. We also have "medical escort" companies that have medical professionals escort people on commercial flights just to keep the staff on the plane from freaking out on a medical needs patient. Some patients are also able to be stretchered on commercial flights especially the international ones. It just depends on the airline and their plane's set up for accomondations.

mike333

Cell phones for the non-secure communications and the rest can be arranged through your dispatch if needed. Again, if it is an emergent diversion, the only communication you would need with an ED is pt coming in with C/O and present presentation (30 seconds) ...short and sweet just like when you are on your own turf. You would not have to disclose the patient's personal data. But, you should identify yourself as a BLS truck from X state in case they are puzzled by who you are and are trying to give you additional orders. If the orders are within the scope of practice from your state and are also under your medical director's protocols, you should be okay.

If you are in the middle of nowhere from a hospital, you may have to utilize the 911 system for that area and reach an ALS truck.


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## rmellish (Sep 17, 2008)

VentMedic said:


> Some VA systems still ground transport their patients to various specialty hospitals for rehab.
> 
> That's where I got my experience in "cross states" transport while moonlighting for a company that had their contract.



Oh yes, one of my services has a VA contract. It's far too common. 99% of the time they are BLS transfers to other VA facilities.


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## Jon (Sep 17, 2008)

mikie333 said:


> and what about comunications?  Cell phones?  I would assume after a certain distance, radios are out of range


Everyone around me used to use nextels... some went to radios for day-to-day transport rigs... but they keep nextels around for supervisors and the occasional long-distance run.


I've done 4-6 hour 1-way trips. They aren't that bad. I can imagine going as far as 10-12 (or a little more) hours with 2 EMT's who could switch off... then getting 8 hours of crew rest and coming back.


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## JPINFV (Sep 17, 2008)

MSDeltaFlt said:


> Why fly a BLS pt?



The same reason why anyone else might choose to fly from New England to Florida instead of driving.


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## daedalus (Sep 18, 2008)

I agree. There is no need to ground express a BLS patient (or anyone for that matter). Cheaper by air and its usually next-day. Consider fuel costs, patient comfort, the overtime incurred, the cost of the trip to the patient, crew comfort, environmental issues of burning that much diesel, etc. Add to that, the patient's condition may worsen or require the care of a nurse. It just makes more sense to ship em air.


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## MMiz (Sep 18, 2008)

Ask any private ambulance company, and they will tell you how much they love long distance transports.  The company makes loads of money with minimal costs.  The truth is, it is almost always significantly cheaper to fly the patient, and I'm absolutely sure that it would be cheaper in this case.


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## mikie (Sep 18, 2008)

How much would something (BLS tx) like this cost?  What if they were ALS (ya, that's pretty broad)?

And, seriously, don't you have to stop for gas?  Who chooses the gas station?


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## BossyCow (Sep 18, 2008)

okay, so worst case scenario, pt crumps half-way to where you are going, you are in an ambulance, but do you know the closest hospital? Do you know how to find the hospital once you get the name? When you get to the ER, how do you explain your tx of the pt to a doc who operates under a totally different set of protocols?

This would be a piece of cake as long as the excrement stays away from the ventilation equipment for the duration of the voyage.


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## KEVD18 (Sep 18, 2008)

if im out of state, my mo in the case of an emergency would be to stop teh vehicel, dial 911, do what i can until the local crew gets there.


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## rjz (Sep 19, 2008)

*we do these all the time*

I did LDT for years as a private ambulance EMT and Paramedic. All of our LDT's where 3-4 hours round trip. A moderate amount where 6-7 hours and I have done around 10 over the course of 8 years now that where in excess of 12 hours round trip. Now I have to honestly say that we did so many of these that LDT's where the one of the top three for me to go work fire and only work part time on the 'ol MICU. Of course the 96 hour work week and low rural california pay had something to do with it also. We only ran with 2 people, if it was BLS then the EMT attended if it was ALS then the Medic attended. WE usually would switch off driving on the way home, but not always. As always it just depended on crew dynamics. If we were goign very long distance we would fill up on fuel when needed. Stop at highway rest stops to use the restroom, and allow the pt. to use urinals or bedpans as needed. In all these years I never stopped to eat with a pt. on board, maybe snack on stuff but never pull in to In and Out to grab something. We would eat on the way home, but to stop and sit down someplace nice that had to be arranaged with the supervisor as they where expecting us back at a certain time as we where part of the 911 system. Trading off in the back could happen on a BLS transfer, but not an ALS one as we ran 1 EMT and 1 Medic. I have to say that it pretty much sucked all around, in fact it still does. We would drive all hours of the day or night, sometimes back to back LDT's greater then 6 hours round trip. If you where tired...Tuff deal with it and try not to wreck. You could trade off on the way back but going you just drove and talked to your partner if you needed to. I never was able to put up for the night in a hotel, and I pulled over one time to sleep because we had been running for 36 plus hours and I was written up over the incident. The working conditions always sucked and solitare ont he computer and books where your best friend. I know this sounds very very negative, but it is the experances that I had. :sad::wacko::sad::sad:


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