# Interfacility Transport



## Sasha (Jun 14, 2009)

I saw this on a thread, and rather than hijack it, I decided to start up a thread for it all it's own.

From the fingers of Miss VentMedic


> The mentality for IFT is one that if it doesn't bleed or is a "trauma" there is little need to assess any further than the patient information sheet for billing info and a diagnosis.



I disagree. Some may take a rather blasé approach to patients, but I feel that IFT provides exposure to diseases, disorders and conditions that one might not run on frequently on a 911 truck. I believe some people actually take the job seriously and asses the patient to a greater extent than browsing the chart and copying a face sheet.

So I'm wondering, how many of those who do both 911 and IFT are lax with their assesment for an IFT patient??


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## EMTinNEPA (Jun 14, 2009)

Every patient that I am ever in the back of an ambulance with gets a full set of vitals and the most thorough assessment that I, as an EMT, can perform (providing for patient modesty when it doesn't interfere with patient care).  Altogether, I check blood pressure, pulse, respiratory rate, SpO2, mental status and orientation, skin temp, skin color, skin moisture, pupils, checks for JVD, tracheal deviation, and equal chest rise and fall, auscultation of lung sounds, palpation of the abdomen, assessment of PMS, cap refill, and check for pedal edema.  Anything of note, right down to lacerations less than a centimeter in length, is documented.  Altogether, I do this at least three times in your typical call: once upon first patient contact, again upon our departure from wherever we picked the patient up, and then every fifteen minutes (for stable patients) until a final assessment just before arrival at the facility.  The only difference between my treatment during a BLS 911 and my treatment during a BLS IFT is that on a 911 I call the hospital and give a report.


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## downunderwunda (Jun 14, 2009)

If people choose to ignore their patient on an inter-facility transport, then they should find another job. 

Regardless of what is wrong with the patient, _they are in your care_, so when it all goes belly up, who is the retard then?

How do you handover to the receiving facility if you have not observed your patient? do you give them a handover verbatim of the original facility? 

Most transfers go OK, but i have had a few go real bad real quick. 

Laziness & lack of professionalism is what causes people to not want to observe their patient.


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## VentMedic (Jun 14, 2009)

We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.   

I'll start another thread about the show.


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## Shishkabob (Jun 14, 2009)

EMTinNEPA said:


> Really long post



Pretty much what I do.


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## emtfarva (Jun 14, 2009)

I do a mix of 911 and BLS / ALS IFTs. I work with a medic partner. On a BLS d/c back home or to a SNF or Rehab Hosp I review the Pt's paperwork. I will do a more focused assessment. Even on ALS IFTs, I do an assessment even though I am not in the back of the ambulance with the Pt. I will report my findings to my partner.


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## Sasha (Jun 14, 2009)

VentMedic said:


> We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.
> 
> I'll start another thread about the show.



It's sad, but that mentality is rampant. Not necessarily as punishment, but that those who work IFT are there because they wouldn't hack it on a 911 truck, they are lesser EMTs/Medics.

While there are those poster children for IFT who are sloppy, lazy, bad EMTs/Paramedics and treat it is a sit and stare, there are also those who take it seriously and as an opprotunity to learn and improve.


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## Ridryder911 (Jun 14, 2009)

Amazing is that many of our IFT are really the "worst" patients. I grew up a long time ago, believing that those of the "street" is going to challenge most of my medical education. In reality, it is those of the IFT that we see have a known PMHX and presentations are challenging hence: the reason for transfer. 

Once one has began to understand medicine, you will see the need for the understanding of lab and x-ray interpretation. The importance of receiving a full history and review of the chart. Again, what one may perceive as boring if done properly will require more in-depth education and clinical practice than most of the simple MVC, falls, chest pains routine medical calls.  

It is the mentality of those that have to have emergencies that will not last long in this business. After a while even good crashes and simple AMI's become typical and boring.


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## Hockey (Jun 14, 2009)

I chose: I assess the patient, just not as well as I do 911 calls.  


But, every situation and every patient is different.  I use the whole common sense approach


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## EMTinNEPA (Jun 14, 2009)

VentMedic said:


> We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.
> 
> I'll start another thread about the show.



Sadly, this is the case for some people.  I work with a certain EMT who is the most confident thing in the world on an IFT, but completely falls apart even on 911s for your typical little old lady fall down go boom.  Would be somewhat understandable if she were on the BLS truck, but "I've been here for eight years, I should be with the medic!"

<_<


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## exodus (Jun 14, 2009)

I do a full assessment on every single patient. It's good practice if anything when you get onto 911 calls (which we do backup, so we get those).  I also refuse to leave a facility until a nurse gives me a full report, and I do a verbal assessment through the nurse as well. Asking and veryfying Hx, Allergies, and Meds. Checking DNR status. Their normal mental status, I also require the last baseline vitals before leaving the facility so I know if what I get on thet rig is normal. And we also can't Tx systolic under 90. That goes to CCT.

Edit: And I've had several nurses that complain about me wanting all that. And I tell them, if something happens on the transport, I need to know all this. You can take 2 minutes out of your schedule to let me know what's going on with this patient.  There's also the nurses I love who give full reports without even asking. They're the best ones :]


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## VentMedic (Jun 14, 2009)

EMTinNEPA said:


> even on 911s for your typical little old lady fall down go boom.


 


Ridryder911 said:


> It is the mentality of those that have to have emergencies that will not last long in this business. After a while even good crashes and simple AMI's become typical and boring.


 
What some don't realize is that the AMI patient can be out of the hospital in 2 - 4 days. The elderly lady who falls may require 2 - 4 weeks in the hospital and placement in a NH which forever changes or ends her life. There is a lot more to medicine than just the obvious and the adrenaline rush.


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## Sasha (Jun 14, 2009)

> I also refuse to leave a facility until a nurse gives me a full report, and I do a verbal assessment through the nurse as well. Asking and veryfying Hx, Allergies, and Meds. Checking DNR status. Their normal mental status, I also require the last baseline vitals before leaving the facility so I know if what I get on thet rig is normal. And we also can't Tx systolic under 90. That goes to CCT.



Why don't you do that through the patient???


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## EMTinNEPA (Jun 14, 2009)

I'm not talking about the impact on the patient's life.  I'm referencing how the certain EMT I was talking about handles and performs on 911 calls, and as far as 911 calls go, elderly people who fall down are pretty straight forward, for the most part.


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## exodus (Jun 14, 2009)

Sasha said:


> Why don't you do that through the patient???



I do that through the patient during transport. I get the SAMPLE from the nurse at the facility because they are a more reliable source of information most of the time for getting everything quickly where it's understandable. And usually if we're tx'ing out of a facility it's to the ER, so the PT is sick and wants to just rest.


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## VentMedic (Jun 14, 2009)

EMTinNEPA said:


> and as far as 911 calls go, elderly people who fall down are pretty straight forward, for the most part.


 
Which is why some end  up on life support before you get your truck out of the ED driveway.  

There is rarely anything simple about an elderly person's fall.  Of course for prehospital probably the best thing you can do is get them to the ED where they can receive the care needed.  They are complex as well as what is obviously broken often distracts from other breaks and bleeds.  As well, cardiac conditions are often overlooked which may also be the reason the person fell in the first place.  The elderly, diabetic and female may be in the process of having an MI but due to their sensory perception of pain, it is not immediately noticed.   Thus, you have the reason these patients who fall get an EKG on arrival to the ED.


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## Sasha (Jun 14, 2009)

> Which is why some end up on life support before you get your truck out of the ED driveway.



I think that's slightly exaggerated.

But that being said, I understand the seriousness of a fall and how many do not recover from it. However, there's little one can do prehospital wise for a fall besides monitor, splinting and pain control.


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## EMTinNEPA (Jun 14, 2009)

VentMedic said:


> There is rarely anything simple about an elderly person's fall.



Really?  So nobody trips over anything or slips on anything?  Nobody on the planet misses their chair when they go to sit down or just loses their balance because they have an abnormal gait?


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## Sasha (Jun 14, 2009)

EMTinNEPA said:


> Really?  So nobody trips over anything or slips on anything?  Nobody on the planet misses their chair when they go to sit down or just loses their balance because they have an abnormal gait?



I don't think she's referring to the reason the patient fell but the ramifications of the fall.


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## EMTinNEPA (Jun 14, 2009)

Sasha said:


> I don't think she's referring to the reason the patient fell but the ramifications of the fall.



Really?  Because the second half of her post...



VentMedic said:


> As well, cardiac conditions are often overlooked which may also be the reason the person fell in the first place.  The elderly, diabetic and female may be in the process of having an MI but due to their sensory perception of pain, it is not immediately noticed.   Thus, you have the reason these patients who fall get an EKG on arrival to the ED.



Sounds like she's talking about the reason for the fall.


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## VentMedic (Jun 14, 2009)

EMTinNEPA said:


> Really? So nobody trips over anything or slips on anything? Nobody on the planet misses their chair when they go to sit down or just loses their balance because they have an abnormal gait?


 
Now that you mentioned it...

Why do they have an abnormal gait?

What meds are they taking that may affect their balance?

What other medical conditions that affect their balance?

What electrolyte imbalances cause dizziness?

What cardiac conditions can cause momentary weakness or dizziness?

What medical conditions can cause sudden changes in BP?

Geriactric medicine is very complex which is why it is a medical specialty.


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## Sasha (Jun 14, 2009)

EMTinNEPA said:


> Really?  Because the second half of her post...
> 
> 
> 
> Sounds like she's talking about the reason for the fall.



She never said all patients fall because of heart problems, hypoglycemia, etc. She said a fall is rarely simple, which it's not. That doesn't mean the cause has to be complicated, but have you ever paid attention to the before and afters? The patients who never make it out of the hospital due to complications? While it may not be an "emergency" to some providers falls can be quite serious.


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## EMTinNEPA (Jun 14, 2009)

Sasha said:


> She never said all patients fall because of heart problems, hypoglycemia, etc.



But she doesn't acknowledge the 95% of them that fall simply because they're old and frail and invalid.


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## Sasha (Jun 14, 2009)

EMTinNEPA said:


> But she doesn't acknowledge the 95% of them that fall simply because they're old and frail and invalid.



Sources for that?


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## EMTinNEPA (Jun 14, 2009)

VentMedic said:


> Now that you mentioned it...
> 
> Why do they have an abnormal gait?
> 
> ...



They could have an abnormal gait due to a neurological condition, an amputation, maybe because of previous musculoskeletal injuries, or maybe just because they're OLD.

I don't know much about medications or electrolyte imbalances, I will admit.

Intermittent v-tach?  Cardiac trigeminy or bigeminy?  Cardiac pause?  Various heart blocks?

Or maybe the vast majority of them just fall down BECAUSE THEY'RE OLD.

And I'm walking away from this thread before you try to turn me into a bad guy again.


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## EMTinNEPA (Jun 14, 2009)

Sasha said:


> Sources for that?



My personal experience.


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## exodus (Jun 14, 2009)

Lolllllllllll! This turned entertaining.   Some people just aren't made out for education :]


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## VentMedic (Jun 14, 2009)

EMTinNEPA said:


> Or maybe the vast majority of them just fall down BECAUSE THEY'RE OLD.


 
But for doing a patient assessment, that is the difference between thinking like a taxi driver and a medical professional.


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## EMTinNEPA (Jun 14, 2009)

VentMedic said:


> But for doing a patient assessment, that is the difference between thinking like a taxi driver and a medical professional.



Did you miss my first post in this thread?


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## VentMedic (Jun 14, 2009)

EMTinNEPA said:


> Did you miss my first post in this thread?


 


EMTinNEPA said:


> Every patient that I am ever in the back of an ambulance with gets a full set of vitals and the most thorough assessment that I, as an EMT, can perform (providing for patient modesty when it doesn't interfere with patient care). Altogether, I check blood pressure, pulse, respiratory rate, SpO2, mental status and orientation, skin temp, skin color, skin moisture, pupils, checks for JVD, tracheal deviation, and equal chest rise and fall, auscultation of lung sounds, palpation of the abdomen, assessment of PMS, cap refill, and check for pedal edema. Anything of note, right down to lacerations less than a centimeter in length, is documented. Altogether, I do this at least three times in your typical call: once upon first patient contact, again upon our departure from wherever we picked the patient up, and then every fifteen minutes (for stable patients) until a final assessment just before arrival at the facility. The only difference between my treatment during a BLS 911 and my treatment during a BLS IFT is that on a 911 I call the hospital and give a report.


 
You can assess VS but if you are still thinking like a taxi driver that this is just an old person that "fell and go boom" you may still miss the bigger picture. The mentality of "BLS" IFT skews ones judgement for thinking as a true medical professional that doesn't think in terms of "ALS or BLS" when it comes to assessing medical situations.

However, it is good to see you are at least assessing your patient.  Some don't and it becomes obvious if you read some IFT patient care reports.


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## emtfarva (Jun 14, 2009)

*What do you consider an IFT???????*

I have question for Vent, RR, and Sasha:



What do you consider an IFT?


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## exodus (Jun 14, 2009)

IFT is:

Any Discharge
Dialysis
Doctors Appointment

Pretty much anything where you are not going into an ER. That is considered emergent / Code 2

Edit: 
This is part of a PM convo I had. I have removed a few things that are not about this convo, if the person i had wants me to add them back, just lemme know and I'll do it :]


 Sure, maybe a geriatric fall may just be a trip. But when people get older they become extremely more sensitive to infections, or any types of sickness. And pretty much any infection can lead to dizziness. If you ask the patient, how did you fall, or were you feeling dizzy. Many times they will just say I dont know or no. But if you ask more about their history and assess them more. You may come across finding out that they recently had an infection, commonly UTI, which will cause extreme dizzines, and make it harder for them to remember.

So old people falling isn't just a straight up simple call. You are being paid to be an EMT, and you should do a full assessment, and assess every patient the same. You get paid the same no matter what. Even if the reason they fell is just mechanical, who cares? It gives you practice for assessments and patient contact. It allows you to learn more about how a patient reacts, so when something bad does happen, you will be able to react to it better. If you think of possible chemical causes of what might cause it. Then when you go over what you did, you can think of what might happen next time, and how you will react to the situation therefore providing better care.


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## EMTinNEPA (Jun 14, 2009)

VentMedic said:


> You can assess VS but if you are still thinking like a taxi driver that this is just an old person that "fell and go boom" you may still miss the bigger picture. The mentality of "BLS" IFT skews ones judgement for thinking as a true medical professional that doesn't think in terms of "ALS or BLS" when it comes to assessing medical situations.
> 
> However, it is good to see you are at least assessing your patient.  Some don't and it becomes obvious if you read some IFT patient care reports.



I thought that getting the patient's medical history, list of medications, etc. went without saying?

Occam's Razor says that the simplest answer is probably the correct one until you uncover something that suggests otherwise.  If I have a patient that presents as a fall, the simplest answer is that they fell because they tripped or slipped or something.  If they say that they became suddenly dizzy or had a syncopal episode, that takes "just fell" off the table and opens up new and more serious possibilities.


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## Sasha (Jun 14, 2009)

emtfarva said:


> I have question for Vent, RR, and Sasha:
> 
> 
> 
> What do you consider an IFT?



I consider IFT to be anything that goes from one facility to another.

Could be HEMS taking from a little general to a level I trauma center, stroke center, hospital with cath lab. Ground transport for those previously mentioned. Nursing home to ER. Hospital to nursing home`, nursing home to dialysis, dialysis to nursing home, dialysis to private residence.


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## VentMedic (Jun 14, 2009)

I will add that for a helicopter, in some states a separate cert/license for that helicopter is required to do scene response and IFT. 

We have had a couple of HEMS helicopters that could use the hospital helipad to pick up a patient from the ground EMS crew but if a member of the hospital staff made any contact with the patient it would be considered IFT and the helicopter could not legally transport the patient if their agency did not have the correct cert. 

Some areas also contract "emergency" responses to LTC facilities to private ambulance companies and do not want these facilites calling 911. Technically they are an "emergency" but they are also considered IFT and may have the same stigma as if it was a "routine" jsut because of where the patient happens to live.


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## marineman (Jun 14, 2009)

We have a few of those nursing contracts set up here where the nursing home calls our dispatch (private service) directly rather than going through 911. We will still respond emergently if appropriate but it saves a fire engine since there are already nurses there with patient care the EMT's on the engine beating us by 30 seconds is kind of a waste. 

I look at an IFT as any call that doesn't come from the 911 com center but it really doesn't make any difference. When we're paged for a call all I listen to is the address and the response code. I don't like when dispatch tells us a chief complaint because too many people get locked into that and dispatch is often wrong. The other day we responded (911) to a possible stroke patient who actually had his arm caught in the PTO on a tractor. IFT vs 911 should be the same as BLS vs ALS, there is no difference it's all patient care and all patients deserve the best care that you can provide within your scope.


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## BLSBoy (Jun 15, 2009)

marineman said:


> IFT vs 911 should be the same as BLS vs ALS, there is no difference it's all patient care and all patients deserve the best care that you can provide within your scope.



Challenge flag is out. 
The psych hold that should be walked to the truck, who is cooperative, but going through a rough time, and merely choose the "wrong" ER to go to does not need a a head to toe physical, and vitals q15 min. 
A comfy seat, and the reassurance that you are there to help, or talk to if they so choose. 

Gather the hx from RN and pt to see what lead to the event, and to see if you might need to take extra precautions (flight risk, violent, triggers, etc)

The little old lady who FDGB, has a brain bleed, is on Coumadin, has a fx hip, and AMS DOES get the full ride. I would be the one doing the initial assessment, making sure shes properly C-Spined, on the monitor, drips switched to our pump, and then my MICN would assume care as soon as he/she is done getting report. 

Granted, those are the extremes that I mentioned, just to play devils advocate, but you get the point.


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## TransportJockey (Jun 15, 2009)

I run IFTs like any other call. Every patient deserves a full and complete assessment. The only thing I would tend not to do is poke too many holes in them, CBG excepting.


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## djmedic913 (Jun 15, 2009)

Sasha said:


> I saw this on a thread, and rather than hijack it, I decided to start up a thread for it all it's own.
> 
> From the fingers of Miss VentMedic
> 
> ...



I don't lax on any call. I tell all new Basics that IFT is a great experience for them. this is their chance to practice all their skills. take BP's while the ambulance is in motion. listen to lung sounds. At the Paramedic level IFT's become more interesting. there is usually a bit to do and stay on top of. but the best part of an ALS IFT is the patient's records/file. I don't say this to violate HIPPA. but I advise reading the Patient's chart. learn and understand why the Pt is being transferred. Some transfers can teach more than others...

But there is always something to learn, or practice, or keep an eye on on all transfers, from critical to mundane


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## TransportJockey (Jun 15, 2009)

djmedic913 said:


> I don't lax on any call. I tell all new Basics that IFT is a great experience for them. this is their chance to practice all their skills. take BP's while the ambulance is in motion. listen to lung sounds. At the Paramedic level IFT's become more interesting. there is usually a bit to do and stay on top of. but the best part of an ALS IFT is the patient's records/file. I don't say this to violate HIPPA. but I advise reading the Patient's chart. learn and understand why the Pt is being transferred. Some transfers can teach more than others...
> 
> But there is always something to learn, or practice, or keep an eye on on all transfers, from critical to mundane



What is there to violate HIPPA by looking at the chart? As the person assuming care for the pt you are entitled just as much as the pts nurse in the hospital to look at that chart and get a complete history on your pt before you recieve care


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## Sasha (Jun 15, 2009)

jtpaintball70 said:


> What is there to violate HIPPA by looking at the chart? As the person assuming care for the pt you are entitled just as much as the pts nurse in the hospital to look at that chart and get a complete history on your pt before you recieve care



On IFT I never take a patient before looking at the chart, especially if they're demented. Some nurses are reluctant to give citing HIPAA, but once you remind them that you're an EMT and involved in the patient's care until they reach the next facility ( NICELY and politely.) they USUALLY are compliant.

And yes, I assess and talk to my patient about their condition, but I'd like to read up on why they were there and what happened incase the recieving facility didn't get a report.


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## djmedic913 (Jun 15, 2009)

jtpaintball70 said:


> What is there to violate HIPPA by looking at the chart? As the person assuming care for the pt you are entitled just as much as the pts nurse in the hospital to look at that chart and get a complete history on your pt before you recieve care



I know....


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## VentMedic (Jun 15, 2009)

Hospitals have to be protective of this information and suspicious of people. We get well over 100 ambulances per day and that may just be in the ED.  The hospitals get anyone from taxi drivers, van drivers to family members wanting access to a chart. You would also be surprised at how many family members will dress up in their hospital or ambulance uniform from another employer and pretend they work at a facility to gain access to information. What they don't realize they just have to ask the patient to grant permission to see the chart and most of the information is available to them.


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## JPINFV (Jun 15, 2009)

Sasha said:


> On IFT I never take a patient before looking at the chart, especially if they're demented. Some nurses are reluctant to give citing HIPAA, but once you remind them that you're an EMT and involved in the patient's care until they reach the next facility ( NICELY and politely.) they USUALLY are compliant.



What I love is when they give the chart in a sealed envelope with a face sheet attached. This becomes a "nod my head and say yes" with the chart making it to the facility in the ambulance company's envelope rather than the hospital's envelope.


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## TransportJockey (Jun 15, 2009)

JPINFV said:


> What I love is when they give the chart in a sealed envelope with a face sheet attached. This becomes a "nod my head and say yes" with the chart making it to the facility in the ambulance company's envelope rather than the hospital's envelope.



I've actually opened it up right then and there before we move the pt to my gurney. It does tend to annoy some staff


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## Sasha (Jun 15, 2009)

VentMedic said:


> Hospitals have to be protective of this information and suspicious of people. We get well over 100 ambulances per day and that may just be in the ED.  The hospitals get anyone from taxi drivers, van drivers to family members wanting access to a chart. You would also be surprised at how many family members will dress up in their hospital or ambulance uniform from another employer and pretend they work at a facility to gain access to information. What they don't realize they just have to ask the patient to grant permission to see the chart and most of the information is available to them.



I understand but when you have been on that floor four times that day and you're wearing an EMT uniform, with photo ID tag, one patch with the company name, one state EMT/Medic patch, your partner is standing there next to you with the stretcher against the wall I'm kind of hard pressed to believe that they think you are a family member, taxi or van drivers. The services that run vans here work solo and wear polos and push wheel chairs.


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## Tincanfireman (Jun 15, 2009)

Just my .02 to add:

I did IFT work for nearly two years after I recerted for my -B the last time, then moved over to 911 after getting my -I cert back in '07. There is not one shift that goes into the books where I do not use something I learned in my IFT days to provide better care for my 911 patients. Doing IFT's gives you the opportunity to sharpen your diagnostic skills, along with seeing the progression of a condition, disease, or illness. People need to remember that patient care is a continuum, and both 911 and IFT is a part of that continuum. I know some 911 people who are excellent providers, but won't do IFT because they don't want to be cooped up in the back of the unit with the same patient for several hours. I also know some superb (competition award-winning) IFT folks who have no interest in 911. My advice is do what you want to do, and be the best provider you can be. All the patient (and their family) cares about is that they receive the best possible care, and it doesn't matter a hoot to them what the paint job on the outside of the box looks like.


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## djmedic913 (Jun 15, 2009)

Tincanfireman said:


> All the patient (and their family) cares about is that they receive the best possible care, and it doesn't matter a hoot to them what the paint job on the outside of the box looks like.



Actually, the family doesn't even truly care that they get the best, but the perception of care.

They say you give bad care but good customer service and treat the Pt and family with dignity and politeness and it will be excuse...
But if you give the best care ever from anyone but are short, crass and demeaning, the family will complain and sue


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## VentMedic (Jun 15, 2009)

Sasha said:


> I understand but when you have been on that floor four times that day and you're wearing an EMT uniform, with photo ID tag, one patch with the company name, one state EMT/Medic patch, your partner is standing there next to you with the stretcher against the wall *I'm kind of hard pressed to believe that they think you are a family member, taxi or van drivers.* The services that run vans here work solo and wear polos and push wheel chairs.


 
Ever hear of blending?   Some of the EMT(P)s do have family members in the hospital and are occasionally asked to check on them or even neighbors.   We have so many different transport companies as well as FFs walking around the hospital and students in various uniforms, it is difficult to know who is who sometimes.   We also get transports from other parts of FL and other states or even other countries.    

We do have to keep an eye on the name tags since some do wear tags from other employers to look official but keep them turned away from view. Usually our security will catch those.  

The van drivers for various appointments from the clinics to dialysis come for the condo communities to commercial companies.  We may get 200 - 300 of these transports per day easily if not many more.   Again, it is hard to keep track of all the polos or uniforms from everyone.  And yes, we get a large number of taxis dropping off and picking up.


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## Shishkabob (Jun 15, 2009)

jtpaintball70 said:


> I've actually opened it up right then and there before we move the pt to my gurney. It does tend to annoy some staff



I've had a doctor almost get in an argument with me and my partner because he refused to sign the PCS form and put a reason as to why the pt needed to be transferred, because he didn't think we needed to know that info, as we "weren't privy" to it.


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## Sasha (Jun 15, 2009)

VentMedic said:


> Ever hear of blending?   Some of the EMT(P)s do have family members in the hospital and are occasionally asked to check on them or even neighbors.   We have so many different transport companies as well as FFs walking around the hospital and students in various uniforms, it is difficult to know who is who sometimes.   We also get transports from other parts of FL and other states or even other countries.
> 
> We do have to keep an eye on the name tags since some do wear tags from other employers to look official but keep them turned away from view. Usually our security will catch those.
> 
> The van drivers for various appointments from the clinics to dialysis come for the condo communities to commercial companies.  We may get 200 - 300 of these transports per day easily if not many more.   Again, it is hard to keep track of all the polos or uniforms from everyone.  And yes, we get a large number of taxis dropping off and picking up.



Perhaps where you work, but I was referring to my own experience where it's not nearly as busy as you describe, and there are three IFT companies. One hospital based, and two privates. The unifors from those companies are very similar except for shirt color. The companies are small and employees know many of the nurses on common pick up floors by name, and nurses know many of the employees by name.

Truly the ones who give the most trouble are the people who aren't even nurses, I don't know who they are or what they are but they sit and answer phones and will snatch a chart from you in a heart beat and you have to go hunt the nurse down again to get it back.

I'm not bashing nurses by any means who are trying to protect their patients privacy. Good for them. But once the emt calmly and respectfully explains who they are and what they need, that should be the end of it. They ARE involved with the care of the patient and should see the chart, especially if the patient is demented and can't answer for themselves.


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## djmedic913 (Jun 15, 2009)

Linuss said:


> I've had a doctor almost get in an argument with me and my partner because he refused to sign the PCS form and put a reason as to why the pt needed to be transferred, because he didn't think we needed to know that info, as we "weren't privy" to it.



Our company policy is, if the PCS is not filled out appropriately and completely then we don't take the Pt.


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## marineman (Jun 16, 2009)

BLSBoy said:


> Challenge flag is out.
> The psych hold that should be walked to the truck, who is cooperative, but going through a rough time, and merely choose the "wrong" ER to go to does not need a a head to toe physical, and vitals q15 min.
> A comfy seat, and the reassurance that you are there to help, or talk to if they so choose.
> 
> ...



I didn't say that every patient needed to get a full head to toe, I said every patient should get the absolute best possible care you can provide. There are some patients like you mentioned that will be better off if you leave them alone for the most part. Using your example that doesn't excuse you from checking the psych patient for anything treatable that could be causing the psych issue but if they're already having psych issues and it makes them worse when you keep checking vitals and such then yes by all means watch them for any obvious signs of deterioration but don't keep coming at them with the BP cuff and stethoscope just for practice. If you leave them alone because it's the best thing for them aren't you still providing the best care possible within your scope?


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## Guardian (Jun 16, 2009)

Sasha said:


> From the fingers of Miss VentMedic




who is miss ventmedic?  is our ventmedic a woman or is there another ventmedic?


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## JPINFV (Jun 16, 2009)

There can be only 1 Ventmedic...


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## Guardian (Jun 16, 2009)

VentMedic said:


> We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.
> 
> I'll start another thread about the show.



Yea, they need a good technical advisor.  I think they're mistaking "IFTs" for RRTs.


In reality, they're more right than wrong.  Most "inter facility" (nursing home transfers for example) transports that are done throughout the country don't even remotely resemble an emergency.  Yet, most of the time they are staffed with emts and have trucks with emergency equipment on them.  Doesn't make much sense to me.  Who are they trying to fool?  The patient, the insurance company, the public, or themselves?


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## VentMedic (Jun 16, 2009)

Guardian said:


> who is miss ventmedic? is our ventmedic a woman or is there another ventmedic?


 
After 2 years of debating each other you haven't figured that out? This could be the reason, other than just my education and experience, why I won most of our debates.


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## JPINFV (Jun 16, 2009)

Oh, now that's a low blow. At least the good driving gene is on the Y chromosome.


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## Sasha (Jun 16, 2009)

VentMedic said:


> After 2 years of debating each other you haven't figured that out? This could be the reason, other than just my education and experience, why I won most of our debates.



You know, after you posted on the bra thread I thought most people would get that you're indeed a female...


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## TransportJockey (Jun 16, 2009)

Sasha said:


> You know, after you posted on the bra thread I thought most people would get that you're indeed a female...



We had some males posting on it too... not that I went in there or anything


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## Sasha (Jun 16, 2009)

jtpaintball70 said:


> We had some males posting on it too... not that I went in there or anything



But the males were just being hormonal, not offering advice on bras. Vent's post talked about actually wearing a bra.


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## JPINFV (Jun 16, 2009)

Maybe they owned a Bro?


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## Sasha (Jun 16, 2009)

JPINFV said:


> Maybe they owned a Bro?



Mind bleach.... need the mind bleach.


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## hrmeeks (Jun 17, 2009)

Ridryder911 said:


> The importance of receiving a full history and review of the chart.



That can be real hard to come by here in Memphis,  alot of chips on sholders towards the "ambulance drivers".  Goes as far as inorging your reports or you when you ask for information.


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## Guardian (Jun 17, 2009)

VentMedic said:


> After 2 years of debating each other you haven't figured that out? This could be the reason, other than just my education and experience, why I won most of our debates.



No, I can't believe it!  Next they'll be telling me ridryder is a man.


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## Aidey (Jun 17, 2009)

I didn't pick an option because in my area there are really two totally different types of IFTs. 

1. Transfers from facilities to regularly scheduled MD appointments. These are flat out stable patients that for whatever reason need to be in an ambulance. For example they have a recent hip fracture and need to lie flat, or are on 2lpm of O2, or have dementia and need supervision. ie Saint Mary's facility to Dr. Joe Schmoe, Optometrist. 

In these cases it is "sit and watch" (or sit and chat depending on the pt) because we are simply the transport agency, we are not providing that patient any medical care really (aside from continuing O2 therapy which they are already on). If they are being transported by ambulance because of an injury that necessitates they lie flat, or lie down, I (or my partner) will re-assess the injury after moving the pt to make sure everything is still ok. 

These calls are almost always taken by the EMT in my system. 

2. Pts with newly changed conditions. These are the pts that spiked a fever, or had an LOC change, or fell, or developed a rash, or have abnormal vitals or any other number of things that the facility (or the doctor they contacted) feels needs to be evaluated at an ED. These pts get the full work up indicated for whatever symptoms they have. 

Some may end up being taken by the paramedic, some by the EMT, but the paramedic always does the initial assessment. Often times if the pt has a "No interventions, no CPR" DNR the EMT takes their care because there is no difference between the care the EMT and the care the paramedic can provide at that point. 

In my area if the pt has one of those, legally we are supposed to call for orders just to administer oxygen if the pt isn't on it already.


That all being said, we ALWAYS get a full set of paperwork on the pt. Meds, past history, allergies, and their most recent H&P, and if they were admitted to the facility for short term rehab, a hx of what the incident was that necessitated the rehab. Occasionally if the pts situation is serious and we need to leave and they don't have the paperwork ready we will forgo the H&P and tell the facility to fax it to the hospital. I think that has only happened once or twice to me though. Most facilities have someone call 911/our dispatch while someone else gets the paperwork ready because they know we want it ASAP. 

Guardian - Where I work we are the only company. We do all the IFTs and 911 calls, and we use the same ambulances for both, meaning that even on an IFT a fully stocked ACLS capable ambulance will arrive. We aren't trying to "fool" anyone, we just don't have the resources (staff and spare ambulance wise) to have an IFT only non-stocked ambulance.


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