# Street EMS vs. Transport



## ZombieEMT (Sep 2, 2010)

I am a newly certified EMT-B in NJ and I am looking to find a career position. I know that many rescue squads and street ems do not hire a lot of new EMTs due to lack of experience, and I was told that volunteer and transport is the best way to get the experience. Now don't get me wrong, because I am willing to start at the bottom if need be, but not really what I was interested in.

My real question is how does street ems compare to transport. I have heard from a few people but I would like some more opinions. If I go the transport route, I want to be useful and do the job I was trained for. I just want to know from people who have done it, if they felt more like an emt or a glorified taxi driver.


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## JPINFV (Sep 2, 2010)

What exactly is "street EMS?"


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## Shishkabob (Sep 2, 2010)

I think he means 911 vs IFT.


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## ZombieEMT (Sep 2, 2010)

Exactly what I meant, sorry. My instructors called it street EMS, I guess its for this area.


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## Shishkabob (Sep 2, 2010)

Don't know about you but I got in to EMS for 911.  Granted we deal with a lot of the same BS in 911 as we do in IFT, it's the perception that I'm actually making somewhat of a difference, even if only a slight bit more, doing 911 on the off chance of getting a serious call over the norm of taking granny to her doctors appointment because her family didn't want to do a taxi or take her themselves.  



That's just me.


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## ZombieEMT (Sep 2, 2010)

911 was the reason I got into EMS and transport is always an option. I appreciate your input, I am trying to see what everyones opinion is on how much the two relate, that is 911 and transport.


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## JPINFV (Sep 2, 2010)

It's going to be really system dependent. In Southern California where skilled nursing facilities (SNF) rarely call 911, a lot of "emergency calls" coming out of SNFs get handled by BLS units. These calls can be anywhere from something minor to circling the drain. A lot of the time, this was because the IFT companies didn't run (or weren't allowed to run) paramedic ambulances. However, anyplace with a lot of paramedics working IFT will have the EMT IFT units doing very little emergencies. So, in general, yes. 911 is better than IFT (however there are plenty of 911 EMT units who are nothing more than gurney pushers for fire medics), however I'm not entirely sure where I would place critical care transports (CCT) in comparison to 911.


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## Shishkabob (Sep 2, 2010)

CCT is about the only way I can see myself doing IFT after October 26th.


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## MrBrown (Sep 2, 2010)

Here we have the Patient Transfer Service (IFT) and the Emergency Ambulance Service (111/911).  The two are totally different, PTS vehicles are crewed by an advanced first aider and you have to be so stable to go home via PTS its not funny whereas to work on EAS you really need a Bachelors Degree from 2012.

Once you are too old and burnt out for EAS you can slip into PTS until retirement


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## DrParasite (Sep 2, 2010)

HaleEMT said:


> I am a newly certified EMT-B in NJ and I am looking to find a career position. I know that many rescue squads and street ems do not hire a lot of new EMTs due to lack of experience, and I was told that volunteer and transport is the best way to get the experience. Now don't get me wrong, because I am willing to start at the bottom if need be, but not really what I was interested in.


Transport won't exactly get you "experience" that will help you in the street EMS world,  but rather get your that 1 or 2 years experience to make it past the HR gate keepers on your resume.  Having volunteer experience can sometimes help, but it all depends on which agency you want to work for; some it will be beneficial, others it will be viewed as detrimental.  The biggest thing volunteering does do (aside from learning how to operate on a 911 calls) is you ability to network with two hatting people, as well as meet career providers on scenes or at hospitals, and start to network and make connections.  this will be the most beneficial to getting a career in EMS, at least in NJ, and at least in the beginning.


HaleEMT said:


> My real question is how does street ems compare to transport. I have heard from a few people but I would like some more opinions. If I go the transport route, I want to be useful and do the job I was trained for. I just want to know from people who have done it, if they felt more like an emt or a glorified taxi driver.


it's BORING!!!!!!  you will meet some cool people, and some retards in the IFT world.  IFT is much more laid back, less stressed, and taking granny to the doctor.  Many in IFT are volunteers as well (or used to be), while some are just getting a paycheck.  

I took my core 13 class with an IFT company in North Jersey.  No one was a volunteer on the side, they all worked for the company.  The people (including the owner/supervisor) could not do basic skills, could not do an assessment, and I wouldn't even trust them to take my BP.  They were all cool people, and I would go drinking with them any time, and after the second day, the owner offered me a job there, but it was scarily obvious that they didn't deal with sick patient, and would not know what do with them if they encountered one.

I did IFT for 3 months several years ago, and while I met some cool people, I was bored out of my skull most of the time.  about 5 years ago, I was hired by an IFT/911 service, and found it to be most enjoyable, since we got to deal with many municipal 911 calls.  now I work for an all 911 service in a busy city (as a button pusher, needed a change after 10 years), and still work my old IFT/911 job, but only in the 911 division.  

While you get a lot of  BS/taxi calls with municipal 911, there is a greater chance of dealing with a sick or injured patient, instead of just taking granny from one bed to another.


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## WTEngel (Sep 2, 2010)

I think there is something to be learned from both IFT and 911. 

Granted, we all really got into EMS for 911 right? I think IFT can teach you a lot about charting and healthcare facility operations...

911 obviously teaches about street level operations. I have heard from some friends who work IFT that at some of these transfers then patient may as well be sick and in a ditch, because they are in such bad condition, in which case you need to be as on toomof your game in IFT as you are in 911.

In the end you get what you put in to every job. Get some IFT experience, build your resume, and take some experience and references away from that job. The way the job market is in some areas these days, I wouldn't pass up a job if ome was offered. It is always easier to get a job when you have a job, if that makes any sense.


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## medicman90 (Sep 2, 2010)

Linuss said:


> CCT is about the only way I can see myself doing IFT after October 26th.




Why is that?


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## WTEngel (Sep 2, 2010)

It is probably because CCT is like the 911 of IFT, if that makes any sense...

I did CCT for almost 2 years at Children's in Dallas. It was probably one of my favorite jobs so far, although I have really enjoyed everything I have done up until now.

Anyway, there is nothing wrong with being well rounded, and IFT, 911, CCT, all of these things lead to a really well rounded understanding of how everything works together in this crazy little world of ours.


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## medicman90 (Sep 2, 2010)

WTEngel said:


> It is probably because CCT is like the 911 of IFT, if that makes any sense...
> 
> I did CCT for almost 2 years at Children's in Dallas. It was probably one of my favorite jobs so far, although I have really enjoyed everything I have done up until now.
> 
> Anyway, there is nothing wrong with being well rounded, and IFT, 911, CCT, all of these things lead to a really well rounded understanding of how everything works together in this crazy little world of ours.



CCT? IFT? I don't know what those are. Could you unpack those acronyms for me please?


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## DrParasite (Sep 2, 2010)

CCT=Critical Care Transport
IFT= Interfacility Transport


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## medicman90 (Sep 3, 2010)

DrParasite said:


> CCT=Critical Care Transport
> IFT= Interfacility Transport


 

Thanks 

Makes sense now!


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## 46Young (Sep 3, 2010)

Some say that you'll learn a lot from doing IFT, and that's true up to a point. When you start, you'll be eager to learn about various pt conditions, and notice common presentations with pts having a similar medical hx. Pretty quickly, IFT becomes mundane, lackluster, boring, and other descriptions that cause complacency and apathy for the job. You'll eventually end up doing half an assessment (if you're lucky) on the umpteenth NH discharge or BLS IFT for an MRI, dialysis, or something, having worked for hours on end w/o any kind of break. Your assessment skills and critical thinking will atrophy.

This is why most people have a goal of working for a 911 company. 80-90% of your calls dont really need an ambulance, are just taxi rides, but at least you're doing an assessment and making a provisional diagnosis. You'll actually be dealing with the occasional sick or injured pt, without the crutch of a diagnosis by an MD prior to pt contact. 911 has the potential to be exciting, or at least something different each day. In IFT, you'll always have that same Monday 0730 dialysis x-fer, a round trip or two to the off campus MRI building, and a couple of NH discharges. The faces may change, but your day is more or less the same, boring day in and boring day out. 

The misconception of EMS being exciting, constant action, with life saving and other hero stuff, and video game-like emergency driving, is what draws many to EMS. The "boring stuff" in the eyes of EMS hopefuls is more of what appeals to nursing students, I think. Boring as in routine care, pt comfort, empathizing with the pt and actually caring about their emotional needs, and such. EMS, at least in the U.S. attracts a large percentage of type-A personalities, who tend to be thrill seekers. Routine IFT is not a good fit for this type of person. 

When I hear of CCT, the common thought is "As a CCM I actually get to use my skills. I'm using my skills on critically ill pts at that". This is why CCT is seen as the 911 of IFT. CC medics at my old hospital ran baloon pump jobs with only another medic, same for the vented sedated pt, a pt receiving 3 or more drips, the post arrest vented x-fer, to name a few things. They also had standing orders to titrate tridil or propofol w/o OLMC, for example. The CCM was typically kept available for only these type of calls. No dialysis, NH discharges, discharge to residence, MRI txp's, etc. They may do the occasional ALS txp if no medics are available, such as a "cardiac rescue", which is a pt with an active MI going to the cath lab. If they're post arrest it's a CCT anyway. Our field supervisors were mostly CCM's, so they could do a CCT if a CCM is unavailable.


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## WTEngel (Sep 4, 2010)

I will also add that is CCT transport is called, it is almost always emergent. So you may only get three calls or so per shift, but most of those may take 2-3 hours and be very sick patients.

In fact, in my experience, when we go to most referrals, everyone, including the physicians pretty much disappears, as they are happy to have us come fix their really sick patient and dint want to have anything to do with what is going on...so yeah, it is pretty rewarding.


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## EMTMama (Sep 8, 2010)

I work for an IFT service. On busy days we'll get 6 patients. On not so busy days, we'll get 2.

For me IFT so far seems to be a good step to have taken - to get my name out there in the (small) EMT community, to learn how to do basic things like work the gurney, get used to doing rapid patient assessments. I had zero patient care experience and am still getting used to how things are done (I've only been working 3 weeks now). But yes, in a lot of ways, I do feel like a glorified taxi service, rather than an EMT. But oh well, everybody's gotta start somewhere, right?


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## slb862 (Sep 8, 2010)

*IFT or 911*

Wow, I have done both.  If I had to chose it would be 911 calls.  Those are always fun and every call if different.  These 911 pt. can challenge your skills and knowledge.  Then you transport.  Then you are done with the patient.  IFT- these calls are long and medically challenging.  I didn't mind the challenge, I don't like the long transport.  Also these pt. are already hooked up to equipment, intubated, IV lines in, and so on...  I prefer to do all that myself.  Make your decision on honesty and comfort level.  Then go for it.


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## LonghornMedic (Sep 9, 2010)

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.


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## matthewpetro (Sep 12, 2010)

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.


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## tony1 (Sep 18, 2010)

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.


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## tony1 (Sep 18, 2010)

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.


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## CAOX3 (Sep 18, 2010)

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


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## 46Young (Sep 19, 2010)

CAOX3 said:


> 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.


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## 46Young (Sep 19, 2010)

CAOX3 said:


> 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


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## tony1 (Sep 19, 2010)

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


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## 46Young (Sep 19, 2010)

tony1 said:


> 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.


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## tony1 (Sep 19, 2010)

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.


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## chute43 (Sep 19, 2010)

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


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## tony1 (Sep 19, 2010)

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.


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## tony1 (Sep 19, 2010)

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.


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## looker (Sep 19, 2010)

tony1 said:


> 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?


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## tony1 (Sep 20, 2010)

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.


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## looker (Sep 20, 2010)

tony1 said:


> 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).


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## tony1 (Sep 20, 2010)

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


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## tony1 (Sep 20, 2010)

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.


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## tony1 (Sep 20, 2010)

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.


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## looker (Sep 20, 2010)

tony1 said:


> 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


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## looker (Sep 20, 2010)

tony1 said:


> 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.



What stops private ambulance from running every call as code 3? It seems like there is no check and balance. Should there not be one controlling system for emergency calls?


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## tony1 (Sep 20, 2010)

Ok I get it. I guess they just bypass some steps out here because honestly the people that call us are doing so because they want a particular ER. They have usually been down that road with the city before and know that CFD will go to the closest ER and most people have an issue with their closest and will sign AMA with the city because they do not like that ER.

Also, people usually run down the list in the phone book before they get to us because most companies will refuse house calls either by saying no rigs are available and/or by recommending they call 911. Some refuse house calls so as not to tie up a rig for a long time because they have contracts to service. Some refuse house calls if the person has only public aid also. We have actually had no rigs for people and they will call repeatedly, like every half hour harassing the dispatcher, even with SOB being the complaint.


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## tony1 (Sep 20, 2010)

looker said:


> What stops private ambulance from running every call as code 3? It seems like there is no check and balance. Should there not be one controlling system for emergency calls?





Good question. We have the honor system I guess you could say. Also the fear that another crew will see them and the fear that if they have an accident code 3 and it is not legit, they are screwed.


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## JPINFV (Sep 20, 2010)

looker said:


> 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.



To add to this, Riverside County requires specific complaints to be transferred to the 911 agency at the dispatch level. So if a private party calls a non-911 agency (which is everyone except a couple fire departments and AMR) for, say, shortness of breath, the private company isn't even supposed to dispatch an ambulance. As someone who has seen this sort of insanity (in fact compounded by the fact that the only paramedics were with the fire department. This leads to the following situation, "So your SNF patient is altered with a BP of 70/40? By all means, we'll send a BLS ambulance right over. We'll be there is 20 minutes!") first hand, I fully support systems requiring that the 911 system be utilized for life threatening emergencies. 


http://www.rivcoems.org/downloads/downloads_memos/2009/BLS_Ambulance_Usage_Guidelines.pdf


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## tony1 (Sep 20, 2010)

The city runs everything as a 3 but we run alot of the same minor calls that they do and not as a 3.


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## looker (Sep 20, 2010)

JPINFV said:


> To add to this, Riverside County requires specific complaints to be transferred to the 911 agency at the dispatch level. So if a private party calls a non-911 agency (which is everyone except a couple fire departments and AMR) for, say, shortness of breath, the private company isn't even supposed to dispatch an ambulance. As someone who has seen this sort of insanity (in fact compounded by the fact that the only paramedics were with the fire department. This leads to the following situation, "So your SNF patient is altered with a BP of 70/40? By all means, we'll send a BLS ambulance right over. We'll be there is 20 minutes!") first hand, I fully support systems requiring that the 911 system be utilized for life threatening emergencies.
> 
> 
> http://www.rivcoems.org/downloads/downloads_memos/2009/BLS_Ambulance_Usage_Guidelines.pdf



I do not currently operate in Riverside so forgot about that. What confused me about that directive is what if a company runs both bls and als? I assume they still want you to transfer to 911 if ALS is needed regardless if you have one available as you would need to run code 3?


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## tony1 (Sep 20, 2010)

JPINFV said:


> To add to this, Riverside County requires specific complaints to be transferred to the 911 agency at the dispatch level. So if a private party calls a non-911 agency (which is everyone except a couple fire departments and AMR) for, say, shortness of breath, the private company isn't even supposed to dispatch an ambulance. As someone who has seen this sort of insanity (in fact compounded by the fact that the only paramedics were with the fire department. This leads to the following situation, "So your SNF patient is altered with a BP of 70/40? By all means, we'll send a BLS ambulance right over. We'll be there is 20 minutes!") first hand, I fully support systems requiring that the 911 system be utilized for life threatening emergencies.
> 
> 
> http://www.rivcoems.org/downloads/downloads_memos/2009/BLS_Ambulance_Usage_Guidelines.pdf





Gotcha. Well, I understand that and yes, it can happen but that BLS crew needs to make a determination as to if they can handle it or not, and if no ALS from their agency is available, they can transport to the closest if it is within 5 minutes, or they can call 911 for an ALS intercept, but honestly it is way quicker to go to the closest. I have been sent to what should have been ALS, got on scene and the guy's house was across from a comprehensive ER, he refused transport there, requested a farther ER for his many issues which included a sugar of 575, since he was competent, med control told us to have him sign against medical advice that he wanted the farther and knew the risks and instructed us to take him there. It sounds crazy to everyone who does not live in this area I'm sure and sometimes it is a bit. Earlier tonight I was dispatched to an altered mental status and I am a BLS unit. You have to get on scene, determine what is really going on (cuz nursing homes are unreliable) and then decide if you are going to the desired, the closest, calling med control or not, etc etc. Incompetent basics do not last long in this system. The ones that are unsure of their skills and panic end up sounding like an idiot to med control, and sound panicky are told to just call 911. We have this "5 minute rule" in this system to get the pt to definitive care quickly. Waiting for an intercept is often longer than just going. I am sure people are going to hit the roof over this post but this is how the system in this city works. I know how NY city works, and I was told it is one dispatch and whichever rig is closest gets the call, no matter what company or hospital rig or city rig or whatever and that seems like a better system to me.


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## JPINFV (Sep 20, 2010)

I honestly have no clue. I worked for 2 years with a company in OC that had a handful of units (RivCo licensed) based out of Hemet and remember the dispatchers (who were also based in OC) keeping a log of calls that they had to refer to AMR.


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## tony1 (Sep 20, 2010)

Med control will first ask us how far our own ALS is and that is the first choice for a code 3 intercept. Our ALS units run pretty much everything on a 3 just like the city rigs do.


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## JPINFV (Sep 20, 2010)

tony1 said:


> Gotcha. Well, I understand that and yes, it can happen but that BLS crew needs to make a determination as to if they can handle it or not, and if no ALS from their agency is available, they can transport to the closest if it is within 5 minutes, or they can call 911 for an ALS intercept, but honestly it is way quicker to go to the closest.



Here's the problem. There's absolutely zero reason a BLS unit should be dispatched for abnormal vital signs, ALOC, or a handful of other complaints. If a BLS unit is getting a page for a patient in a nursing home who's ALOC and hypotensive (that 70/40 was *the chief complaint* on the pager for a call I was actually on), then the system is failing that patient. I fully understand if what was dispatched and what was found was different. I fully understand if the patient's status changed. However if the complaint is, for example, "congestion" (nursing home speak for acute pulmonary edema secondary to congested heart failure normally), then there shouldn't be a BLS unit on scene deciding whether they should transport or call for paramedics. Paramedics need to be a first response, not a second response to these calls. 





> (cuz nursing homes are unreliable)


I find them very reliable once you understand the buzz words and can normally predict the calls that will require paramedics, emergency transport, or the calls where 911 was called sometime between being dispatched and arriving.




> I am sure people are going to hit the roof over this post but this is how the system in this city works. I know how NY city works, and I was told it is one dispatch and whichever rig is closest gets the call, no matter what company or hospital rig or city rig or whatever and that seems like a better system to me.



No one's going to hit the roof over EMTs deciding to transport to an ER in light of calling paramedics. The one caveat I'd argue is if the patient is a canidate for a specialty center (i.e. stroke, trauma, cardiac cath, etc). Then the response time for paramedics and direct transport to a specialty center is shorter than EMT transport, evaluation and "stabilization" at a non-specialty center, response of a CCT unit, and then transport to the specialty center.

However, just because the EMTs should be able to recognize that they should transport to the closest ED instead of calling paramedics doesn't mean we shouldn't examine why a BLS unit is on a call that they shouldn't have been dispatched to.


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## tony1 (Sep 20, 2010)

I hear you and agree with you. I just do my best and use my best judgement until the city makes changes to this system. I agree it is flawed but I have had to adapt to this and do what I can.


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## bstone (Sep 20, 2010)

looker said:


> What stops private ambulance from running every call as code 3? It seems like there is no check and balance. Should there not be one controlling system for emergency calls?



Management and self-policing. I worked with tony1 for a while and we used professional knowledge when to go Code 3 or not. We would for the guy who was SOB w/chest pain, but Code 2 for the cellulitis at 3am.


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## looker (Sep 20, 2010)

bstone said:


> Management and self-policing. I worked with tony1 for a while and we used professional knowledge when to go Code 3 or not. We would for the guy who was SOB w/chest pain, but Code 2 for the cellulitis at 3am.



Would management not want you to go code 3 all the time being that they can get extra calls in during the shift? I can under self-policing by the unit but it's kind of you either do it or we will find someone else that will.


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## bstone (Sep 20, 2010)

looker said:


> Would management not want you to go code 3 all the time being that they can get extra calls in during the shift? I can under self-policing by the unit but it's kind of you either do it or we will find someone else that will.



Management wouldn't last too long until the Dept of Health shut them down and yanked the ambulance license. There is the state license, the county license, the city license, etc. Lots and lots of gov't eyes looking to make sure we don't screwed up.


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## bstone (Sep 20, 2010)

JPINFV said:


> Here's the problem. There's absolutely zero reason a BLS unit should be dispatched for abnormal vital signs, ALOC, or a handful of other complaints. If a BLS unit is getting a page for a patient in a nursing home who's ALOC and hypotensive (that 70/40 was *the chief complaint* on the pager for a call I was actually on), then the system is failing that patient. I fully understand if what was dispatched and what was found was different. I fully understand if the patient's status changed. However if the complaint is, for example, "congestion" (nursing home speak for acute pulmonary edema secondary to congested heart failure normally), then there shouldn't be a BLS unit on scene deciding whether they should transport or call for paramedics. Paramedics need to be a first response, not a second response to these calls.


Believe it or not, BLS crewed are regularly, often and very consistently paged out for these calls.




> I find them very reliable once you understand the buzz words and can normally predict the calls that will require paramedics, emergency transport, or the calls where 911 was called sometime between being dispatched and arriving.


Then you work in the EMS System from Heaven. The NHs on Chicago's northside are notorious for killing their patients. When they decide to finally call for help (hopefully before rigor has set in) they give the absolute worse reports one can possibly imagine. Ever.

Gosh, I recall one call tony1 and I did. Paged out as a "fever". We got there and the guy was COOKING, clearly pneumonia, lungs filled with fluid, mostly dead. Yet it was paged out as "fever".

We were within 5 of the ER so we did high flow O2, cooled him off and did a "load and go".


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## looker (Sep 20, 2010)

bstone said:


> Management wouldn't last too long until the Dept of Health shut them down and yanked the ambulance license. There is the state license, the county license, the city license, etc. Lots and lots of gov't eyes looking to make sure we don't screwed up.



Well compare to California it for sure work totally different. In California emt's, medics etc are licensed by the state. Company them self are only licensed by the city's, with exception of vehicle inspection by state police there are no other license from the state. There are licensed that emt's and medics get from the city but those just dot permits. I guess having many eyes on you makes you responsible.


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## tony1 (Sep 20, 2010)

bstone said:


> Believe it or not, BLS crewed are regularly, often and very consistently paged out for these calls.
> 
> 
> 
> ...



Bstone,...it has been a while. I am now on the south side. The north side is heaven compared to this. We walked in to pick up a pt for general weakness and they were dead. The south side is sooooo much worse. I just do what I can man.


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## bstone (Sep 20, 2010)

tony1 said:


> Bstone,...it has been a while. I am now on the south side. The north side is heaven compared to this. We walked in to pick up a pt for general weakness and they were dead. The south side is sooooo much worse. I just do what I can man.



See what I mean! A dead pt does not have general weakness. They have complete, irreversible weakness!


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## tony1 (Sep 20, 2010)

Oh bstone,.... what they call in to our dispatch. I went to an altered mental status tonight due to no ALS available and the guy was completely unresponsive! I have no clue what goes through their heads. They call in SOB and the pt is has resps of 18 and is 99% on RA!!!!! Most of our stuff that gets called to dispatch as ALS turns out to be BLS. It's cuz they want a faster response! They have told me this! When they say CP we get there quicker they say! It's more insane than you realize. The south side is a sewer. But i still love my job, go figure. Then when they called me for a g-tube the pt was agonal when I arrived and coded on me! WTF!


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## tony1 (Sep 20, 2010)

Hey bstone, the feds shut down Somerset. Now they are going after all these places. They are so bad that they are trying to close them all.


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## JPINFV (Sep 20, 2010)

bstone said:


> Believe it or not, BLS crewed are regularly, often and very consistently paged out for these calls.


The question is not whether they are paged out, it's whether they should be paged out for it. If you're loved one was symptomically hypotensive, would you be happy with someone besides an EM physician working your loved one up at the ER? Oh, sure, the EM physician is available, we just don't want to disturb him for you. 



> Then you work in the EMS System from Heaven. The NHs on Chicago's northside are notorious for killing their patients. When they decide to finally call for help (hopefully before rigor has set in) they give the absolute worse reports one can possibly imagine. Ever.
> 
> Gosh, I recall one call tony1 and I did. Paged out as a "fever". We got there and the guy was COOKING, clearly pneumonia, lungs filled with fluid, mostly dead. Yet it was paged out as "fever".



...but he did have a fever, correct? Sure, the pager says "congestion" but that coming from a SNF is not going to make me thing "slight cough and sneeze" like what I would define as congestion for myself.


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## JPINFV (Sep 20, 2010)

bstone said:


> See what I mean! A dead pt does not have general weakness. They have complete, irreversible weakness!



What's your definition of generalized? Dead is definitely not focal weakness and what sort of "generalized weakness" are you expecting from a SNF instead of ALOC? I'm not arguing that you can take SNF CCs at face value. Just that once you realize that you can't take them at face value they make perfect sense.


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## bstone (Sep 20, 2010)

JPINFV said:


> The question is not whether they are paged out, it's whether they should be paged out for it. If you're loved one was symptomically hypotensive, would you be happy with someone besides an EM physician working your loved one up at the ER? Oh, sure, the EM physician is available, we just don't want to disturb him for you.


Come and work in the Chicago system for 3 months and you'll understand what we're talking about. You'll probably pull out all your hair from the frustration. We just kinda shrug and do our jobs the very best we can.


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## tony1 (Sep 20, 2010)

I don't think anyone is saying it is right that BLS units get dispatched to these calls, but it is what it is in this system and all we can do is go one day at a time. The nursing homes and half-way houses, and psych facilities and all the rest of them refuse to call 911. I have been told directly by police that I had to call to the scene, that the city keeps records of stuff and the nursing homes do not want records kept. If the private company has no ALS available, and they hold the call until an ALS clears up, it will be a long time with no response at all. Believe me I have worked in other systems in IL and it is not like this. I do however love my job and I like this company alot. My current partner is an RN student and has only one semester left and can't wait to get away from this stuff.


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## bstone (Sep 20, 2010)

tony1 said:


> I don't think anyone is saying it is right that BLS units get dispatched to these calls, but it is what it is in this system and all we can do is go one day at a time. The nursing homes and half-way houses, and psych facilities and all the rest of them refuse to call 911. I have been told directly by police that I had to call to the scene, that the city keeps records of stuff and the nursing homes do not want records kept. If the private company has no ALS available, and they hold the call until an ALS clears up, it will be a long time with no response at all. Believe me I have worked in other systems in IL and it is not like this. I do however love my job and I like this company alot. My current partner is an RN student and has only one semester left and can't wait to get away from this stuff.



Pretty much the hammer on the nailhead.

No one says it's good to call BLS for these calls. But if we get paged out and have a critical patient, what should we do? ALS is times 40 minutes away and we're 5 minutes load-and-go to the ER.


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## JPINFV (Sep 20, 2010)

tony1 said:


> I don't think anyone is saying it is right that BLS units get dispatched to these calls, but it is what it is in this system and all we can do is go one day at a time. The nursing homes and half-way houses, and psych facilities and all the rest of them refuse to call 911..



...which is why I support dispatch protocols requiring referral to the 911 system for specific calls. It takes out the problem of not calling 911 for the patient with chest pain when every call taker outside of the 911 system refuses the call _at the dispatch level_. 




bstone said:


> Pretty much the hammer on the nailhead.
> 
> No one says it's good to call BLS for these calls. But if we get paged out and have a critical patient, what should we do? ALS is times 40 minutes away and we're 5 minutes load-and-go to the ER.



Show me where anyone has argued that an EMT unit on scene shouldn't transport. Argued that ideally they shouldn't have been dispatched? Yes. Argued (minus the caveat about specialty centers) that EMTs shouldn't transport? No.


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## tony1 (Sep 20, 2010)

That's all I am saying. I am not trying to start a debate, or defend this system, I was merely informing people of how it is within this system. I have been in person to the system office and voiced my concerns on more than one occasion. After explaining how my company operates, and the types of calls I run, and how I have to run them, I was told by the RN educator that I have obviously figured out how to work effectively in this system and if it was still a problem for me then maybe I should consider going to another company in another system. That was the last conversation I have had with them. This is my secondary system but as I said I do love my job and this company and I do not want to leave.


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## clibb (Sep 20, 2010)

JPINFV said:


> Here's the problem. There's absolutely zero reason a BLS unit should be dispatched for abnormal vital signs, ALOC, or a handful of other complaints. If a BLS unit is getting a page for a patient in a nursing home who's ALOC and hypotensive (that 70/40 was *the chief complaint* on the pager for a call I was actually on), then the system is failing that patient. I fully understand if what was dispatched and what was found was different. I fully understand if the patient's status changed. However if the complaint is, for example, "congestion" (nursing home speak for acute pulmonary edema secondary to congested heart failure normally), then there shouldn't be a BLS unit on scene deciding whether they should transport or call for paramedics. Paramedics need to be a first response, not a second response to these calls.



What would a Paramedic do different to a patient with Pulmonary Edema due to left sided CHF than a EMT-B? The only thing you can do is apply positive pressure ventilation. 
If that patient is going to die from the left sided CHF at that moment you respond to this call. Well, the only thing you can do is load up and hope he'll make it to the hospital so that the physician can do something about it. 
Oh and in our system Paramedics are almost ALWAYS second to respond. Here Fire Dept and Ambulance are two separate agencies. Fire are almost always on scene first because we have 14 fire stations and only 4 ambulance stations. 
BLS saves lives.


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## looker (Sep 20, 2010)

tony1 said:


> That's all I am saying. I am not trying to start a debate, or defend this system, I was merely informing people of how it is within this system. I have been in person to the system office and voiced my concerns on more than one occasion. After explaining how my company operates, and the types of calls I run, and how I have to run them, I was told by the RN educator that I have obviously figured out how to work effectively in this system and if it was still a problem for me then maybe I should consider going to another company in another system. That was the last conversation I have had with them. This is my secondary system but as I said I do love my job and this company and I do not want to leave.



So basically it sounds like they are saying it's our way or the highway.


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## jjesusfreak01 (Sep 20, 2010)

clibb said:


> What would a Paramedic do different to a patient with Pulmonary Edema due to left sided CHF than a EMT-B? The only thing you can do is apply positive pressure ventilation.
> If that patient is going to die from the left sided CHF at that moment you respond to this call. Well, the only thing you can do is load up and hope he'll make it to the hospital so that the physician can do something about it.
> Oh and in our system Paramedics are almost ALWAYS second to respond. Here Fire Dept and Ambulance are two separate agencies. Fire are almost always on scene first because we have 14 fire stations and only 4 ambulance stations.
> BLS saves lives.



I don't know if this is what you were referring to by PPV, but a paramedic could pull out a CPAP and give nitro for the edema, when an EMT usually can't use CPAP, and can't give nitro without chest pain.

That said, we page out fire to most ALS level calls here. They almost always arrive first and (since they usually have at least one EMT on a crew) can give nitro and do compressions on an arrested patient. They aren't going to transport anyone, but they provide a valuable service and are probably responsible for some of the saves our system gets every year. The same could be said of a BLS unit responding to an ALS call. How can you argue its not good to send them if they can get their first and start treatment, and then either maintain the patient while awaiting ALS or transport more quickly than ALS could get there. It all comes down to what type of system you have and the response times for each type of unit, but in the end earlier access to trained providers is better than waiting for ALS.


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## tony1 (Sep 20, 2010)

Correct, their way or that's it. I didn't mean to start such a fuss over this but maybe I can expain it a bit more for those not from here. So you have the FD's and their ambulances and then the private companies. Privates are contracted with facilities. Each one chooses the type they want to be contracted with and the number of. It's all about the almighty dollar so when that CP call comes in and the ALS rigs are all busy, they are not going to refuse the call, but I understand the other guy's post about why they should. I understand that it should go to another provider who can respond ALS, but unfortunately due to it being a for-profit situation, they are not going to risk losing that account. If they start refusing calls the account will seek another provider that can service them better. This is how we got our accounts and the other guy gets his and so on. The facilities are always looking for that perfect company that responds quickly and makes them happy. Unfortunately if all that is available is BLS, they are going to get dispatched. We use radios at this company BTW, not pagers. The company hopes that the BLS can "first respond" and assess the pt and if ALS is close behind and still needed, the BLS can package the pt and meet the ALS downstairs. What ends up happening is the ALS is either far behind and it's not worth waiting, or they slow their roll because they know that the BLS will most likely take the pt and that is one less call for them. I know that sounds terribly negative but I know this to be a fact. The whole issue is that these companies will put the B in a sticky situation where they have to not only CYA, but look out for the pt also. It's a tricky balance because you have to cross the t's and dot the i's and the best way is to call the resourse hospital and tell them what's up and get permission to transport. Once they give their blessing, you are covered as far as having the ALS pt in your care and transporting them. Now, if there is no time to make a call and that happens alot due to a very crappy pt (possible CVA for example), one is driving and the other is doing pt care and as long as you can show it was best for the pt to load and go w/o a phone call, you are ok but you must justify that decision. 

Not all privates in my area are like this. There are many that serve the city of Chicago, and they are in all different systems. Some systems are suburban hospitals but the company can operate in Chicago and they have different rules and different equipment etc. Not all privates will even allow a BLS to transport into an ER. Suburban hospitals out here do not recognize BLS ambulances and if you call in a run to them they will flip but then we have to explain that we do not operate in their system and we have our own resource hospital and they say it's ok and we follow their SMO's. This system I am in secondary allows us to check b/s as a BLS unit. My primary system says that's an ALS skill and does not allow glucometers on BLS rigs. Huge differences from system to system and hospital to hospital and definitely from city to suburban. One big thing is that other systems do not have a BLS protocol. This system I am in is the only I have found out here that has an actual written BLS protocol. 

I inquired about employment a few years ago with Superior. I asked them flat out what systems they operate in and "pretty much all" was my answer because they are so big and spread out. I then asked which of them has an actual written BLS protocol and they told me "none". The system I am in has only 3 companies in it but I am glad to have an actual BLS SMO's packet and protocol packet to follow. Other companies do not have that and their BLS rigs are basically what everyone on here calls IFT rigs. They do dialysis and hospital returns and believe it or not some companies I worked for do not even carry an AED or combitube becuse the system does not require it. Basically they have oxygen and linen and are a glorified medi-car that lets the pt lie down on a cot.

As far as any facilities calling 911, they do not want records kept on their facility and will not use them. We are their 911 service. As far as house calls, if someone calls us directly with a complaint, it's responded to the same way as if it were a nursing home. We can recommend to them to call 911 but they already have their mind made up not to call 911 because they do not want transport to the closest, they have a preferred destination and believe me people are stubborn with this. B's,....and even p's, also have to try to always get the pt to the desired if possible because believe me too many diversions and the MD will yell at the NH who will yell at the company who will not let that B or P risk losing the account so his/her career may end abruptly. It all rolls down hill. This is why I said it's a fine line and you have to balance and CYA in addition to your pt care. Lots of politics also I guess you could say.

Well I just came off a 24 and have been up for about 48 so I probably seem rambling to some but I wanted to clear this up if possible. Thanks.


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## JPINFV (Sep 20, 2010)

clibb said:


> What would a Paramedic do different to a patient with Pulmonary Edema due to left sided CHF than a EMT-B? The only thing you can do is apply positive pressure ventilation.


Nitro and c-pap comes to mind off the top of my head yet, and I haven't even had resp yet.



> If that patient is going to die from the left sided CHF at that moment you respond to this call. Well, the only thing you can do is load up and hope he'll make it to the hospital so that the physician can do something about it.
> Oh and in our system Paramedics are almost ALWAYS second to respond. Here Fire Dept and Ambulance are two separate agencies. Fire are almost always on scene first because we have 14 fire stations and only 4 ambulance stations.
> BLS saves lives.



Are you talking about second response as in "paramedics arrive second" or second response as in "paramedics aren't even dispatched until the fire department is on scene." There's  a big difference between those two types of "second response."

As far as "BLS saves lives." Well, POV saves lives too, so let's encourage everyone to throw patients into POVs instead of calling an ambulance.


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## JPINFV (Sep 20, 2010)

jjesusfreak01 said:


> That said, we page out fire to most ALS level calls here. They almost always arrive first and (since they usually have at least one EMT on a crew) can give nitro and do compressions on an arrested patient. They aren't going to transport anyone, but they provide a valuable service and are probably responsible for some of the saves our system gets every year. The same could be said of a BLS unit responding to an ALS call. How can you argue its not good to send them if they can get their first and start treatment, and then either maintain the patient while awaiting ALS or transport more quickly than ALS could get there. It all comes down to what type of system you have and the response times for each type of unit, but in the end earlier access to trained providers is better than waiting for ALS.



Few quick points.

First, see note above about the difference between "ZOMG send EMT first response to save 40 seconds!" and "send EMTs to determine if paramedics are needed." 

There are systems that allow nitro administration by EMTs in patients with pulmonary edema? Interesting.

"How can you argue its not good to send them if they can get their first and start treatment"

Simple. If it's routinely happening, especially routinely happening with EMT transport due to extended paramedic response time, then that's a big indication that the system needs more paramedics. More paramedics means less need for an EMT first response as a replacement for paramedic response.


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## bstone (Sep 20, 2010)

One thing that must be said- if the City of Chicago were to require that all ambulances be BLS, then about half of the ambulances on the road (if not more) would disappear. Response times would go way, way up and you'd see a lot more taxis blowing through red lights.


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## tony1 (Sep 20, 2010)

Well bstone you and I know how this city and particular system work and we know it is not going to change any time soon. Again it's all money so there won't be a huge increase in additional ambulances being purchased and there will not be a huge number of additional medics getting hired anytime soon.


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## bstone (Sep 20, 2010)

tony1 said:


> Well bstone you and I know how this city and particular system work and we know it is not going to change any time soon. Again it's all money so there won't be a huge increase in additional ambulances being purchased and there will not be a huge number of additional medics getting hired anytime soon.



That's true. A way to get rich is to open a private ambulance service in Chicago.


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## tony1 (Sep 20, 2010)

Hmmmmm, when are you going to have your MD bstone? Travis is one semester from his RN. Look at that, we are on our way to a new company. We can add one more to the long list of existing ones. You can be the Medical Control. Then we can steal accounts too,lol.


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## bstone (Sep 20, 2010)

tony1 said:


> Hmmmmm, when are you going to have your MD bstone? Travis is one semester from his RN. Look at that, we are on our way to a new company. We can add one more to the long list of existing ones. You can be the Medical Control. Then we can steal accounts too,lol.



Hah! I am not TOO far from the MD, but then there is residency, fellowship, etc. Don't count on me for about, oh, 10 years!!


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## tony1 (Sep 20, 2010)

ok, I will prepare. Since I have phlebotomy experience, I would like to mount a centrifuge in the ambulance so I may draw labs and spin tubes while en-route. I am thinking of maybe also an x-ray machine. Let's just use a semi and have a rolling lab also. I will let Travis drive and when I need medical control I will call his cell and he can simply tell me what to do under your license,lol.


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## bstone (Sep 20, 2010)

X-Ray? No dude, my ambulances will have MRI.


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## tony1 (Sep 20, 2010)

I love it. Maybe your aunt will finance this and be our silent partner. We won't even need to transport. We can just park the mobile ER outside the NH and treat and release.


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## bstone (Sep 20, 2010)

I imagine it'd be more fun if we had semi-trucks with jacuzzis and MRIs built into them. I'll ask my aunt if/when we get to that point.


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## looker (Sep 20, 2010)

tony1 said:


> I love it. Maybe your aunt will finance this and be our silent partner. We won't even need to transport. We can just park the mobile ER outside the NH and treat and release.



I am curious what is the start up cost in Chicago?


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## tony1 (Sep 20, 2010)

I myself really have no idea but bstone can probably find out since his aunt owns a company.


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## bstone (Sep 20, 2010)

tony1 said:


> I myself really have no idea but bstone can probably find out since his aunt owns a company.



Hey! That's supposed to be our dirty secret.

I'll ask her about it sometime.


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## Millerblade (Oct 17, 2010)

*Transport vs 911 ( very opiniated, watch out)*



HaleEMT said:


> My real question is how does street ems compare to transport. I have heard from a few people but I would like some more opinions. If I go the transport route, I want to be useful and do the job I was trained for. I just want to know from people who have done it, if they felt more like an emt or a glorified taxi driver.




First, I have been a transport medic and a 911 medic, and the two are very different in nature, but in my opinion have a very important role in the EMS provider that wants to learn what they are doing, why they are doing it, and makes you a better EMT. ( In this case, I will be using the term MEDIC, but this goes for basics and medics.)

I have seen people go from basic to medic in a very short time period, and I see clearly ( What's in it for me? attitude) This is going to produce terrible medics in the long run. Now that I have your attention, please read on. 

I am a firm believer that basics that learn how to do transports properly are better groomed, have better mental skills ( come on, is it that hard to start an IV or intubate someone?) It's more important to understand WHY you need the IV, or intubate vs just doing the skill. When your doing transports, you have a choice of how you treat your position. 
1. Are you going in with the attitude of, I don't want to do anything? ( Yeah, that will win hearts and minds with your future employers!)
2. Go in with the attitude that MOST people go through this process, although repeatitive, I can learn something new with each patient you come accross. THIS is the experience that people that move way to fast from EMT to Medic loose. THIS IS HUGE.

If you take the time to master your patch ( all medics perform as EMTs first) know what you can do, when to do it, and most importantly, WHY your doing it. This will set you up for a sucessful future. 
How do you know that your transfer won't go south? 
When I do transfers, ( yes, I still do them too) I may have to share that the patient is NOT ready to go, and might need more care before tranfering them to a nursing home/rehab. 

Honestly, I wish in the state of Texas, we had a clause that EMT must work at that level for 6 months before moving to Paramedic. I DON'T LIKE THE SCHOOLS THAT PROMOTE "QUICKLY GETTING YOUR MEDIC." See, it's a money thing, they don't care about what they turn out. 

Unfourntually, If I get one a new member of our department, or a new paramedic student, I don't change my mind set. YOU chose to move from one patch to the other one without mastery, however, that was your choice. I expect and demand that you know everything about being an EMT on top of your newest training as a paramedic. 

I get a lot of slack about this, but if you were hurt on the street and you had breathing problems, and the new medic is having starting a IV, do you see this as a problem?   

Bottom line, I have way more respect for the new medic that spent some time in the ditches and teach them new things, vs, someone trying to waste my time to skate through, have no clue how to do basic things like: bandaging/splinting, the correct direction of a nasal cannulla. Some actually hope and pray that I pencil whip them through training. NOPE!

THINK.....doctors take the time to be a medical student then a resident. After that they become a doctor. 
Learn your craft. 


Peace! Off Soap box....Please be safe out there!


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## firecoins (Oct 17, 2010)

Millerblade said:


> THINK.....doctors take the time to be a medical student then a resident. After that they become a doctor.
> Learn your craft.



Technically they are a doctor once they graduate medical school and are allowed to call themselves doctor if they do no further medical studies. They become licensed after a 1 year internship which is usually included in the residency.  Some people who complete medical school go into research and never actually practise medicine.


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## Millerblade (Oct 17, 2010)

see.....old people need to be corrected sometimes....Thanks fire coins!


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## Sasha (Oct 17, 2010)

> My real question is how does street ems compare to transport.



Both have their unique challenges, perks, and learning experiences. I prefer IFT to 911, but I know many who couldn't hack it. It takes a dedicated person to do IFT and not get lazy and complacent and to deal with critically sick and injured for more than five minutes at a time, interrupted with moments of extreme bordeom of nursing home discharges and dialysis transfers.


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## Sasha (Oct 17, 2010)

> THINK.....doctors take the time to be a medical student then a resident. After that they become a doctor.
> Learn your craft.



Medical Student is to Doctor as Paramedic student is to Paramedic. Medical student is not the "Big dog" version of an EMT. Nurses aren't CNAs before they become nurses, PAs aren't PCTs before they move on to their future goal.

Not to brag, but I had very little time between emt school and medic school, and I'm generally respected as a "good medic"


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## Aidey (Oct 17, 2010)

That argument works for requiring paramedics to have a longer education, not for longer time between EMT school and Paramedic school. The entire time a medical student is in their education and residency they are learning. There is nothing guaranteeing an EMT isn't working in a coffee stand in the time between EMT school and Paramedic school


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## jjesusfreak01 (Oct 17, 2010)

firecoins said:


> Technically they are a doctor once they graduate medical school and are allowed to call themselves doctor if they do no further medical studies. They become licensed after a 1 year internship which is usually included in the residency.  Some people who complete medical school go into research and never actually practise medicine.



Right, they are an MD, but not a physician. I learned this from the show "Trauma", from which I get all my medical and EMS knowledge.


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## JPINFV (Oct 17, 2010)

jjesusfreak01 said:


> Right, they are an MD, but not a physician.


No, they are a resident physician, not an attending physician. They are still, though, a physician with an unrestricted license to practice medicine.


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## himynameismj (Oct 17, 2010)

HaleEMT said:


> I am a newly certified EMT-B in NJ and I am looking to find a career position. I know that many rescue squads and street ems do not hire a lot of new EMTs due to lack of experience, and I was told that volunteer and transport is the best way to get the experience. Now don't get me wrong, because I am willing to start at the bottom if need be, but not really what I was interested in.
> 
> My real question is how does street ems compare to transport. I have heard from a few people but I would like some more opinions. If I go the transport route, I want to be useful and do the job I was trained for. I just want to know from people who have done it, if they felt more like an emt or a glorified taxi driver.



Oh damn, here comes the soap box. "Street EMS" is literally a figment of some lazy crap EMT's imagination. The reason we have "Street EMS" is because most of today's EMS students think they're doctors post-initial training and refuse to actually learn the book right. That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training. You should be appreciative that doctor's even took the time to recognize our importance back in the mid-60's which allowed us to grow. If you learn that book right (Especially Pt Assessment), you will be way ahead of your peers. If you are doing EMS in general, you need to be the best you can be. Learning that book is just a starting point in being the best that you can be. Follow up training involves CEU's on what you identify as your weak points, and continually practicing skills. "Street EMS" is literally a way of saying "I could be held accountable if something goes wrong here, but it makes my life easier". Examples include letting patients walk down the steps, walk long distances, doing rapid extrications for non-critical pt's (not using the KED), "forgetting" you have something called a scoop stretcher, "forgetting" you have a backboard for elder fall victims, taking the nursing home's vitals instead of your own and calling it a base, sitting behind the pt during transport, avoiding the splint of a fx, etc. This is stupid stuff. Practicing "Street EMS" makes you crap, so my answer is.. do things the way the book says so. Your partner may look at you like you're WASTING HIS / HER TIME, but the truth is you're saving his *** from liability. LEARN PT ASSESSMENT.


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## firecoins (Oct 17, 2010)

jjesusfreak01 said:


> Right, they are an MD, but not a physician. I learned this from the show "Trauma", from which I get all my medical and EMS knowledge.



I get mine from "House"


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## JPINFV (Oct 17, 2010)

himynameismj said:


> Oh damn, here comes the soap box. "Street EMS" is literally a figment of some lazy crap EMT's imagination.



Actually, I will argue that there's a difference between the actual practice of medicine and what is actually taught. Simply put, patients and situations don't read textbooks. Ideally, for most patients, that difference should be null, however health care providers, regardless of the level, need to be able to know when to improvise and make changes from the ideal treatment plan. Variation isn't bad, but "street EMS" doesn't give carte blanche to do anything and everything, but deviating from the cookbook isn't necessarily a bad thing.  

On an additional note, there's a significant amount of utter bull excrement included in EMT training. The most significant of such is the elevation of supplemental oxygen as some sort of cure all to only be administered via NRB at a flow rate of 15 liters per minute. As a comparison, Harrison's Internal Medicine (essentially the bible of general medicine) addresses the use of oxygen in STEMI patients as the follow, "In patients whose arterial O2 saturation is normal, supplemental O2 is of limited if any clinical benefit and therefore is not cost-effective. However, when hypoxemia is present, O2 should be administered by nasal prongs or face mask (2–4 L/min) for the first 6–12 h after infarction; the patient should then be reassessed to determine if there is a continued need for such treatment."

Tintinalli's Emergency Medicine (one of the major emergency medicine text books, the other being Rosens) addresses oxygen in ACS with " Supplemental oxygen may reduce ST-segment elevation in patients with acute myocardial infarction (AMI). It is therefore reasonable to provide 2 to 4 L of oxygen routinely by nasal cannula, even to patients with normal oxygen saturation. In patients with unstable angina or NSTEMI, O2 should be provided in patients with signs of hypoxia." Notice no mention of a NRB, no suggesting for NSTEMI/UA patients, and even the recommendation of oxygen for STEMI patients is very weak. 

So maybe if EMT training was so poor, I'd be able to argue against going against the text book treatment, but there is simply too much "thou shalt do ___ regardless of assessment."

Edit: Just checked Rosen's Emergency Medicine (I have access to a bunch of textbooks through insitutional subscriptions online via Access Medicine and MD Consult), and Rosens doesn't address the use of oxygen at all. Those terrible emergency physicians, denying life saving oxygen to their patients. 



> The reason we have "Street EMS" is because most of today's EMS students think they're doctors post-initial training and refuse to actually learn the book right. That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training.



 h34r:


> Learning that book is just a starting point in being the best that you can be. Follow up training involves CEU's on what you identify as your weak points, and continually practicing skills. "Street EMS" is literally a way of saying "I could be held accountable if something goes wrong here, but it makes my life easier".



What's the purpose of CMEs if you can't implement what is learned because that means moving away from the textbook. That's a conundrum that I've realized exists in EMS. CMEs are supposed to expand a provider's knowledge base, which means that different providers are going to approach a given situation differently based on education and experience. However deviation from the cookbook protocol or textbook is treated as being bad, which is completely counter to the point of CMEs. 




> Examples include letting patients walk down the steps, walk long distances,


Depends on the situation



> "forgetting" you have a backboard for elder fall victims


Should depend on the providers assessment taking age into consideration, and not a "well, the patient fell and is over ___ age." 



> sitting behind the pt during transport


Except it is perfectly possible to monitor a patient from the jump seat and the jump seat is the safest location to be in in the back of an ambulance. 



> do things the way the book says so.


As discussed above, the EMT textbook is often blatantly wrong and bad medicine. Unfortunately, too many in EMS prefer emotional based medicine over evidence based medicine.


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## DrParasite (Oct 17, 2010)

JPINFV said:


> As discussed above, the EMT textbook is often blatantly wrong and bad medicine. Unfortunately, too many in EMS prefer emotional based medicine over evidence based medicine.


and yet.....





himynameismj said:


> That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training. You should be appreciative that doctor's even took the time to recognize our importance back in the mid-60's which allowed us to grow. If you learn that book right (Especially Pt Assessment), you will be way ahead of your peers.


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## JPINFV (Oct 17, 2010)

Actually, while most books have a medical director, they aren't written by physicians. None of the 3 authors for Mosby's EMT-B are physicians. Additionally, the curriculum for EMS providers isn't exactly written like the providers being trained have, or need, a good grasp of actual medicine and the science underpinning it. Basically, it says that the physicians writing it don't think you can identify a hypoxic patient if the hypoxia slapped your head and stole your significant other.


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## jjesusfreak01 (Oct 17, 2010)

JPINFV said:


> No, they are a resident physician, not an attending physician. They are still, though, a physician with an unrestricted license to practice medicine.



Ahh, but what if you are not in a residency, as is the case with the girl in "Trauma"? I assume without the residency, you are not a resident physician, are not licensed by the state, and cannot practice medicine.


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## JPINFV (Oct 17, 2010)

jjesusfreak01 said:


> Ahh, but what if you are not in a residency, as is the case with the girl in "Trauma"? I assume without the residency, you are not a resident physician, are not licensed by the state, and cannot practice medicine.




However she wasn't practicing as a physician. In most states, first year residents work under a limited license to practice where they are limited to practicing only in their training program. During the first year of residency, physicians take Step 3 of the licensing exam (COMLEX or USMLE depending on DO or MD respectively) and following completion of post graduate year 1 (PGY 1, AKA internship), the resident becomes a fully licensed physician. Since essentially all physicians complete a residency, they are still residents learning a specialty. This is essentially what makes it lunacy that she would complete medical school, but decide to go into another health care provider field other than complete a 3-4 year residency (for emergency medicine), or even 1 year and become a fully licensed physician. 

Now there are some physicians who never do residency or internship and instead do research or something else. I'd argue that they are still physicians due to their education. Does one become not a paramedic when their license lapses, or do they just become an unlicensed or retired paramedic?


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## Sasha (Oct 18, 2010)

> sitting behind the pt during transport



I will unashamedly admit that I sit in the airway chair during most transports unless I NEED to be at the patients side for a procedure/treatment.

I work in a vanbulance, the walls are curved, my transports span anywhere between 5 minutes to 5 hours. Sitting with your back curved constantly really hurts and makes me cranky, and I can do my job effectively from the airway chair most times.


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## himynameismj (Oct 18, 2010)

I work in a vanbulance too. I'm 6 ft. 2. I always sit next to the patient. There's a reason dialysis centers have a lot of 911 calls. Dialysis is brutal on the body and those pt's are unstable. Just saying, it's gonna suck when you find out that post-dialysis nap was a silent arrest and you're 20 minutes too late.


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## TransportJockey (Oct 18, 2010)

himynameismj said:


> I work in a vanbulance too. I'm 6 ft. 2. I always sit next to the patient. There's a reason dialysis centers have a lot of 911 calls. Dialysis is brutal on the body and those pt's are unstable. Just saying, it's gonna suck when you find out that post-dialysis nap was a silent arrest and you're 20 minutes too late.



That is why if I have a long transport with a patient, they are at the minimum hooked up to SPo2 monitoring. You are more than welcome to risk you back in an accident, but I side with Sasha on this one. I sit in the airway chair, belted in, as much as possible. I value my life pretty heavily, and want to have the best chance out there of walking away if we get in an accident


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## usalsfyre (Oct 18, 2010)

himynameismj said:


> Examples include letting patients walk down the steps, walk long distances, doing rapid extrications for non-critical pt's (not using the KED), "forgetting" you have something called a scoop stretcher, "forgetting" you have a backboard for elder fall victims



Show me where ANY kind of spinal immobilization has made a difference in outcomes. Unless I find something hinky on assesment, I rarely board patients, and the KED sits quitely gathering dust in a compartment where it belongs. Most of the time more movement occurs when placing the patient in a KED than a smooth, controled move to a board (if a board is even needed). 



himynameismj said:


> taking the nursing home's vitals instead of your own and calling it a base,



The NH or hospital vitals may be important clues in what's going on. Look at trends, not individual numbers 



himynameismj said:


> sitting behind the pt during transport



I try to sit cotside on my criticals, but look at ambulance safety issues to see why I don't dog anyone for sitting in the airway seat. 




himynameismj said:


> avoiding the splint of a fx, etc. This is stupid stuff. Practicing "Street EMS" makes you crap, so my answer is.. do things the way the book says so. Your partner may look at you like you're WASTING HIS / HER TIME, but the truth is you're saving his *** from liability. LEARN PT ASSESSMENT.



Your right, learn assesment. Along with that, don't take EMS textbooks as dogma. ALOT of what we do is complete and utter crap with no scientific base behind it other than some guy saying "yeah that seems like a good idea" or a salesman selling his product. Street EMS may be an an excuse to be lazy, but "limiting your liability" is often an excuse to do useless/painful/harmful stuff to patients because people are too set in thier ways to look at current practices.


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## usalsfyre (Oct 18, 2010)

himynameismj said:


> I work in a vanbulance too. I'm 6 ft. 2. I always sit next to the patient. There's a reason dialysis centers have a lot of 911 calls. Dialysis is brutal on the body and those pt's are unstable. Just saying, it's gonna suck when you find out that post-dialysis nap was a silent arrest and you're 20 minutes too late.



If these patients are truly unstable, then why are they being discharged HOME? Dialysis is a safe procedure, done daily. If people were dropping like flies post-dialysis, don't you think someone woulda noticed?


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## Shishkabob (Oct 18, 2010)

If the situation warrants me sitting on the bench, I'll sit on the bench, such as giving a med.  However, most of the things I do, even ALS level monitoring with an EKG, can be done from the captains seat, and so that's where I spend most of my time, belted in.


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## 46Young (Oct 18, 2010)

himynameismj said:


> Oh damn, here comes the soap box. "Street EMS" is literally a figment of some lazy crap EMT's imagination. The reason we have "Street EMS" is because most of today's EMS students think they're doctors post-initial training and refuse to actually learn the book right. That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training. You should be appreciative that doctor's even took the time to recognize our importance back in the mid-60's which allowed us to grow. If you learn that book right (Especially Pt Assessment), you will be way ahead of your peers. If you are doing EMS in general, you need to be the best you can be. Learning that book is just a starting point in being the best that you can be. Follow up training involves CEU's on what you identify as your weak points, and continually practicing skills. "Street EMS" is literally a way of saying "I could be held accountable if something goes wrong here, but it makes my life easier". Examples include letting patients walk down the steps, walk long distances, doing rapid extrications for non-critical pt's (not using the KED), "forgetting" you have something called a scoop stretcher, "forgetting" you have a backboard for elder fall victims, taking the nursing home's vitals instead of your own and calling it a base, sitting behind the pt during transport, avoiding the splint of a fx, etc. This is stupid stuff. Practicing "Street EMS" makes you crap, so my answer is.. do things the way the book says so. Your partner may look at you like you're WASTING HIS / HER TIME, but the truth is you're saving his *** from liability. LEARN PT ASSESSMENT.



It would appear that you didn't read posts #2-4 on this thread. It was clarified that the OP was asking about 911 (street EMS) vs IFT (transport). What you're referring to is being lazy and/or burnt out, and that happens in both 911 and IFT. I don't understand the point of your post.


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## himynameismj (Oct 18, 2010)

Why does everyone keep saying that the EMT textbook is not written by doctors? The most frequently published textbook, "Transportation of the Sick and Injured" (AAOS) was written by Dr. Eugene Nagel and colleagues. It has been edited multiple times since initial publication, but the fundamentals were in fact written by a doctor.

And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.


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## JPINFV (Oct 18, 2010)

1. The profession has supposively evolved past ambulance drivers who load, go, and provide an NRB to every single patient as they race to the hospital. 

2. Care to compare the first edition to the current edition? 

3. To be honest, in current times I'd argue that a bunch of orthopedic surgeons are writing a book targeting a field outside of their speciality. EMS isn't about trauma anymore. 

4. So because 1 physician was involved that physician speaks for all physicians?


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## himynameismj (Oct 18, 2010)

Not at all, but I'm clarifying the book was indeed, written by a doctor. Multiple posts said it wasn't. Obviously, multiple edits probably make today's version look like a separate book all together. And absolutely no, one physician does not represent the entire bunch, however a little respect should be given (at the least, know his name) to the doctor who saw hope in our field.


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## TransportJockey (Oct 18, 2010)

himynameismj said:


> And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.



ALS pt in the emergency setting? Funny I don't think a tubed pt that you're bagging is going to care one way or the other (which by definition is an ALS emergent call). 
I've sat airway on long distance transports every time, even if the patient is perfectly with it, not just senile. I don't text usually I'm charting, and still talking to the patient. I explain to them that while they are strapped in and safe, if I'm sitting on the bench it's less safe for me than if I was riding in the captains chair.. They usually understand.


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## himynameismj (Oct 18, 2010)

We share different views, obviously. I'm going to continue to acknowledge my patients.


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## TransportJockey (Oct 18, 2010)

himynameismj said:


> We share different views, obviously. I'm going to continue to acknowledge my patients.



That we do. And keep in mind I keep talking and having a running dialog with my patients the entire way. I just like being able to walk away from an accident if one happened while I'm attending.


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## JPINFV (Oct 18, 2010)

himynameismj said:


> And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.



If you text in the back of my ambulance with a patient on board I'll write an incident report. I don't care how new or old you are. 

Why is it unprofessional for paramedics in the 911 setting? Does the emergency physician sit in the same room as the patient for the entire time the patient is in the ER?


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## LonghornMedic (Oct 18, 2010)

himynameismj said:


> We share different views, obviously. I'm going to continue to acknowledge my patients.



Obviously you have not seen the multitude of ambulance crash test videos with crash test dummies flying forward and impacting cabinets at even low to moderate speeds. Or maybe you haven't seen the inside of the patient compartment after an MVA with crap strewn everywhere. Unless that patient requires me to be constantly providing patient care, I move to the airway seat and buckle in. In no way does it affect patient care and most importantly....*it keeps me safe*. I'm guess I'm just selfish in wanting to go home safe and sound after every shift.


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## MrBrown (Oct 19, 2010)

himynameismj said:


> Why does everyone keep saying that the EMT textbook is not written by doctors? The most frequently published textbook, "Transportation of the Sick and Injured" (AAOS) was written by *Dr. Eugene Nagel* and colleagues. It has been edited multiple times since initial publication, but the fundamentals were in fact written by a doctor.



Um, wasn't "Emergency Transportation of the Sick and Injured" written by Nancy L. Caronline MD on behalf of the American College of Orthopaedic Surgeons?

We here in New Zealand threw out using the Prehospital Emergency Care textbook because it was absolute rubbish.

Just because something is written by a doctor does not make it correct.  If the consortium of physicans wouldn't cop so much flak from the shortsighted Paramedic/EMT student who just wants to learn the minimum possible and not all that "hard stuff" the books would be ten times as thick.


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## himynameismj (Oct 19, 2010)

"Emergency in the Streets" is Nancy L. Caroline, M.D. She wrote the Paramedic Book.


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## JPINFV (Oct 19, 2010)

Isn't that the one with Sidney Sinus because cardiology is too complicated?


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## himynameismj (Oct 19, 2010)

I'm not sure, haven't hit that chapter yet. I'm reading "Cardiology Made Ridiculously Simple".


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## MrBrown (Oct 19, 2010)

The problem with medicine is that it cannot be made "ridiciously simple"

How in the bloody hell you can expect to produce competent medical professionals without even requiring a basic chemistry or anatomy/physiology class is beyond me.

Perhaps that is why you get all these hillariously silly concepts and notions that try to boil everything down for the lowest common denominator.

I am not arguing that everybody will have various methodologies of learning but rather teaching silly concepts like Sidney Sinus and how lidocaine numbs the heart just drives me crazy.


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## Shishkabob (Oct 19, 2010)

himynameismj said:


> And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.




Even the sickest patients in the ICU don't have a provider next to them all the time...  why do they need it in the (M)ICU?




If the patient is somewhat 'with it', I'll do what I have to do at the bench, then tell them "I'll be sitting in this chair right behind your head seatbelted in for my safety, let me know if you need anything" and continue to do my job from the safety of the front.


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## JPINFV (Oct 19, 2010)

MrBrown said:


> The problem with medicine is that it cannot be made "ridiciously simple"



That line of books is useful as a supplement to a full education, not as a replacement. However, I'd argue that they still have a use.


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## BLSBoy (Oct 20, 2010)

Linuss said:


> If the patient is somewhat 'with it', I'll do what I have to do at the bench, then tell them "I'll be sitting in this chair right behind your head seatbelted in for my safety, let me know if you need anything" and continue to do my job from the safety of the front.



Dude, I use that exact line. 

to the OP, go down to Atlantic City. Exceptional Medical Transportation runs it. They will hire anyone with a card and a pulse. Hope you can learn quick. 

If you need contact numbers, PM me.


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## xrsm002 (Oct 26, 2010)

*Ift*

Not sure about anyone else, but in both my EMT-Basic and Intermediate class, the patient documentation is mainly for the 911 or taking a patient from nursing home to dialysis, doctors appt etc.  However I find it harder to write a PCR, when taking a patient from the hopsital (after being discharged for whatever they went in there with) back to their Nursing home or some cases homes.  Any suggestions?


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## EMTMama (Oct 26, 2010)

xrsm002 said:


> Not sure about anyone else, but in both my EMT-Basic and Intermediate class, the patient documentation is mainly for the 911 or taking a patient from nursing home to dialysis, doctors appt etc.  However I find it harder to write a PCR, when taking a patient from the hopsital (after being discharged for whatever they went in there with) back to their Nursing home or some cases homes.  Any suggestions?



I look at it like a CYA sort of thing. Keep in mind I've only been doing this a very short period of time (2.5 months), but here's what I do:

History of present illness, past medical history (relevant or not - if it's mentioned in the patient's H&P then it goes in my PCR), then my assessment. I do a real thorough physical exam and comment on any findings and pertinent negatives (patient denies pain, nausea, headache, etc.) I paint a picture of what I find - any bruises, stages of healing, any DC'ed IV lines, foley caths, adult diapers, whatever. If I see/hear/smell it, it goes in my PCR. I even document any ID bands the patient is wearing, what position they're lying in, etc. Unfortunately  nursing homes get a lot of lawsuits brought against them, so the more thoroughly you paint the picture of the patient, the better for you.

ETA: of course I list medications, vital signs, allergies, etc. as well.


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