# IFT's how do you handle them



## rhan101277 (Feb 6, 2009)

Yesterday I had my first transfers where I was responsible for their care.  Even though it was just moving patients from place to place I took it as a big responsibility.

I assessed their LOC and did vitals on them every 15 minutes.  One man I had to take about 1.5 hr. away.  I checked his vitals five times, I think he was getting a little aggravated.  This is how I am supposed to do it though, some people say they do it every 30 minutes, for people you are just moving from Dr.'s appt to nursing home etc.  I like having a track record of vitals so I can have it to see if anything is going on.  I also listen to lung sounds and heart sounds a couple times.

If they are AO, I will ask them about allergies, past history, current medical illness, medications etc. if I am taking them from nursing home to hospital for a checkup or whatnot.  Some pts. come to me and they are not are alert but they can't talk etc. I try to talk to them ask them how they are doing and they shake their head they are ok etc.

How do you do yours?


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## daedalus (Feb 6, 2009)

Honestly Rhan, you are going to upset your patients if you check their vitals every 15 minutes on a stable IFT. Unless they are going somewhere for urgent or emergent medical services they cannot get at their sending facility (like SNF to ER, or hospital with no surgical capabilities to one with, etc), than you do not need to be up on them. I personally take a set at the sending facility, interview them in route, and take a last one at the destination. 

Than again, they have no right to be upset. If they just took a taxi like they should have and did not abuse the Medicare and healthcare industries by using an ambulance when they did not need one, they would not have to worry about getting their vital sings taken.


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## JPINFV (Feb 6, 2009)

Did you also go through the paperwork that went with the patient? Most emergency calls and discharges that I've transported has included a history and physical which is a great source for history and allergies. In addition there should be a medications administration record (MAR) with those patients. I wouldn't imagine that most SNF patients know their three pages worth of mediciations off the top of their head. 

For dialysis transports, a face sheet can be your best friend since they normally include a limited histroy ("admiting dx" and "secondary dx"), allergies, demographic, and insurance data. Just make sure to leave it with the dialysis clinic so that the return crew has access to it. 

Taking vital signs every 15 minutes is good, but if you're on a long transport and the patient is starting to get aggrevated, then you can always increase the time to, say, q20 minutes. If the patient refuse vital signs, then they refuse and just document that ("V/S monitored, BP UTO due to patient refusal"). 

Stable interfacility patients are great practice. These patients, while stable, are always sick in their own, multisystem way. In addition, you'll be taking multiple sets of V/S while the unit is moving, which will give you the ability to nail down taking a B/P with road noise as well as taking a proper history.


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## Sasha (Feb 6, 2009)

Oh rhan! Aren't IFTs great? I LOVE doing IFTs as you have a great chance to work on your assement and learn about some really neat procedures and diseases and the like that you really wouldn't get exposed to doing 911. If you're doing an A/B trip to take a patient to a procedure, sometimes they'll let you watch!

Keep in mind, your patient has probably had their vitals taken a thousand times already that day, so they are likely to get annoyed. Don't take it personally, they're just tired of having their arm squeezed or wrist held! I always grabbed a face sheet, flipped through the chart (and stole a sticker due to the requirement of my former company to have the patient's ID number located somewhere on the paper after someone took the wrong patient.) and got a PTA and an on scene set of vitals. Normally the transfers weren't long enough to get more than one enroute set, but if they were longer transports, I gauged the patient's behavior. If they were up and talking it's "Hey! I know I just took this like 20 minutes ago, but I'm gonna get another set of vitals, okay?" While grabbing the cuff. If they wanted to sleep, and I'd already taken a set myself, eh, I'd let them sleep and take a last set when we arrived. I also tried to confirm their history and allergies that I got from the chart with them in case it didn't include everything (and sometimes it doesn't!)

Talk to the patients about what they got, or what they've had done, if they're up to it. You'll learn so much!



> Than again, they have no right to be upset. If they just took a taxi like they should have and did not abuse the Medicare and healthcare industries by using an ambulance when they did not need one, they would not have to worry about getting their vital sings taken.



At least around here, IFTs are usually arranged by the nurse or discharge planner. The patients don't really have a choice how they want to get home or get to the hospital, cut 'em some slack!


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## daedalus (Feb 6, 2009)

Around here, a patient whines about how to get home in an ER, a nurse will call an ambulance as her own little taxi service. 

Now, however, I can demand that a MD sign a prescription of sorts for ambulance transportation since medicare is just not paying out on those sketchy calls anymore. Not a lot of self respecting doctors will sign a paper that says the patient would be placed in unacceptable danger using another form of transportation.

I am not sure how getting vital signs in stable patients is great practice. You should already know how to do that :glare:. I am going to be honest, IFTs have given me nothing, and I get no credit with schools or other companies for my time on an IFT ambulance.


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## rhan101277 (Feb 6, 2009)

I did look at the face sheet, it didn't have much information.  I found out about the asthma myself.  There was some stuff from the hospital in a manila envelope, I thought that might be something I didn't need to look at.  Anyhow thanks for the input so far.


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## JPINFV (Feb 6, 2009)

Always look at the stuff in the manila envelope. Also, if your company has large envelopes and you have time, move all of the documents from the hospital envelope to your company's envelope (advertising for the company makes your company happy).


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## JPINFV (Feb 6, 2009)

daedalus said:


> I am not sure how getting vital signs in stable patients is great practice.



How many schools require their students to take V/S in a moving vehicle forcing the students to deal with road noises and bumps?


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## daedalus (Feb 6, 2009)

JPINFV said:


> How many schools require their students to take V/S in a moving vehicle forcing the students to deal with road noises and bumps?


In my experiences, vital signs are rarely taken in the truck manually. If you get on a real 911 rig in ventura or LA county it just doesn't happen. 

Most decent medics demand a manuel blood pressure on scene, which I will as well when I become a paramedic. Since this is when an impression of the patient and a treatment plan is formed, you need an accurate BP. A good assessment also includes feeling the pulse with your own hands, placing that stethoscope on the body, etc. After that, when transporting, its more important to monitor for changes. Thats when EKG, pulse oximetry, and NIBP are completely acceptable as tools to monitor your patient, along with looking at your patient with your own eyes. Since all 911 transports around here are under 10 minutes, there is no logical reason to get a additional set of manuel blood pressures etc on most calls.

I was taught how to take vital signs in a moving noisy environment in class. I do not need any more practice. Lets see IFTs as they are. IFTs.


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## Sapphyre (Feb 6, 2009)

JPINFV said:


> How many schools require their students to take V/S in a moving vehicle forcing the students to deal with road noises and bumps?



I know of one in SoCal.  There could be others....

As far as IFTs, if the patient is getting aggravated at the repeated blood pressures, they get wider and wider apart.  If they flat refuse, that is documented.  Always read the stuff in the envelope.


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## JPINFV (Feb 6, 2009)

daedalus said:


> . Thats when EKG, pulse oximetry, and NIBP are completely acceptable as tools to monitor your patient, along with looking at your patient with your own eyes. Since all 911 transports around here are under 10 minutes, there is no logical reason to get a additional set of manuel blood pressures etc on most calls.
> 
> I was taught how to take vital signs in a moving noisy environment in class. I do not need any more practice. Lets see IFTs as they are. IFTs.



May I put forth that most EMT-Bs don't have NiBP, pulse oximetry (which should be used to measure pulse anyways since the pulse rate is more to verify that the reading is correct), or ECG available to them? May I also put forth that if you are working on an IFT that you might as well get what you can out of it, even if it isn't necessarily the best place to be? May I finally put forth that not everyplace has a transport time of less than 15 minutes? Don't get me wrong, I'm not against V/S, say, q20 or 30 minutes. It's not like the act of moving the patient from the hospital (where V/S might be q___hours instead of minutes) to the ambulance all of a sudden makes the patient unstable. Similarly, I don't believe that the patient is going to similarly crash just because the V/S were taken at 20 instead of 15. That said, I'm not going to advise a new EMT-B to go against their training until they are comfortable with monitoring their patient with their eyes and ears instead of their tools to get numbers that they are comparing against ranges for normal healthy people.


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## Jon (Feb 6, 2009)

JP... you mean "Shouldn't"... correct? Please don't tell me you think the Pulse Ox is the best toy on a BLS ambulance since the MAST Pants!

Anyway - To the OP: Check your local protocols, and your companies documentation standards. Where I work 911... the minimum is 2 sets of vital signs per call, and we don't have a strict time limit... some places have a q5 unstable, q15 stable documentation standard... so you could get jammed up if you don't document it that way - and don't you DARE falsify documents by fudging the times/inventing numbers - that is asking for trouble.


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## JPINFV (Feb 6, 2009)

Jon said:


> JP... you mean "Shouldn't"... correct? Please don't tell me you think the Pulse Ox is the best toy on a BLS ambulance since the MAST Pants!



Doh. Yes, I meant "shouldn't."


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## vquintessence (Feb 6, 2009)

While the IFT's aren't the most exciting, and hell, vitals every 15 minutes can be frustrating for the frequent flyer pt as well as you convincing them, the important thing is that they're required (at least here) every 15 min by our state agency.  Documenting "pt refused" on nearly every tx could raise eyebrows towards ya.

I know nothing about you, but what I do know is that you love EMS (the post where you said you took time off your fulltime job to volly at EMS job).  It'd be a shame to see you get jammed up because of well meaning (hell truthful) advice.  _Get vitals as frequently as mandated but take into equal consideration your pts needs._

Ex:  Took an IFT ways back as a EMT where a relatively young pt had (among many other things) breast ca that matastecized (sp?) to the point where her chest and arms were necrotic.  She was in such a miserable state that she was being taken from home hospice to a full-time hospice facility because of the open wounds and emotional devastation of family.  Moving her to the stretcher was horrendous, every bump she moaned or cried out.
Anyways, she had the bilat necrosis on her extremities and was frankly miserably ending her existence... and because of that, I refused to take a BP even once.  Sorry for the long explanation... that IFT will just always stay with me.


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## Veneficus (Feb 6, 2009)

vquintessence said:


> Anyways, she had the bilat necrosis on her extremities and was frankly miserably ending her existence... and because of that, I refused to take a BP even once.  Sorry for the long explanation... that IFT will just always stay with me.



Sounds like excellent clinical judgment to me. If she is going to hospice and vitals tank, so what? 

But back to the OP: that is what automated bp cuffs are for


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## jochi1543 (Feb 6, 2009)

The only V/S I have a hard time getting in a moving truck is lung sounds. Then again, none of my patients so far have had major SOB issues, so maybe when I get someone with serious wheezes/crackles, I'll catch that despite the truck noise. I was worried about doing manual BPs on the move, but it turned out to be pretty easy (I practiced on myself a few times while accompanying a sleeping patient before doing it on a patient). I've never done it with lights and sirens on, though, that would definitely be a challenge. But I do normally use the machine, I just do manual BP when the machine #s seem suspicious, to double-check.


Our PCRs have 5 spots for vitals, I generally make sure I have at least 2 sets of vitals done on a stable transfer. If it's a longer transfer, I will do 3 or 4, which means getting vitals every 45 mins or so. If you have them hooked up to the machine, it shouldn't take you long (or bother the patient too much). Pulse ox and heart rate will show up on the monitor without you having to bother the PT. BP cuff gotta inflate, but you can leave that up to the machine. Resps can usually be observed without bothering the PT. We don't normally take temp and only take BGL 1x unless the PT is a diabetic. I only do pupils once in a medical where there's no possibility of stroke or other neuro issues. So it turns out that the patient doesn't need to be poked and prodded an awful lot for you to gather the vitals required for your PCR.


That said, I once only did 1 set of vitals on a 2.5-hour stable transfer because it was a 3 AM call and the PT had not slept for something like 40 hours straight. He was dozing off and I didn't wanna bother him (he got visibly annoyed when I did vitals on him, even though he cooperated). I got crap for that one. The other day my partner was attending to an epileptic child who also had a fever and was very upset. He was crying for about 2 hours straight, then finally fell asleep, and my partner woke him up to take his BP, after which he proceeded to cry and scream for another hour....I would've definitely NOT done vitals in that situation unless the child seemed to be getting worse.


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## rhan101277 (Feb 6, 2009)

We don't have auto cuffs on any of our trucks, if we did I am sure only medics could use them.  I take down all of my assessment stuff on a paper patient care report sheet and then put them on the computer, that way I get the times right and all the info on there.  I see most that have been working there a while just write in on their glove and then put it in the computer.  I think I am going to get in the habit of using that paper report and transferring it makes me feel better and lets me know I am being as accurate as I can.


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## rhan101277 (Feb 6, 2009)

I also wanted to know I took of my full-time job, to work at my paid EMT job.  It doesn't pay much, I could probably make the same flipping some burgers.  This job has much more to offer than the burger job though and I really enjoy it.


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## VentMedic (Feb 7, 2009)

vquintessence said:


> Ex: Took an IFT ways back as a EMT where a relatively young pt had (among many other things) breast ca that matastecized (sp?) to the point where her chest and arms were necrotic. She was in such a miserable state that she was being taken from home hospice to a full-time hospice facility because of the open wounds and emotional devastation of family. Moving her to the stretcher was horrendous, every bump she moaned or cried out.
> Anyways, she had the bilat necrosis on her extremities and was frankly miserably ending her existence... and because of that, I refused to take a BP even once. Sorry for the long explanation... that IFT will just always stay with me.


 
When reading a chart for comfort care or hospice patients, one might notice that "No vitals" is part of the order set. We do not even check an SpO2 on these patients in the hospital.  They are made comfortable by pharmacological means according to visual assessment.

However, there are different types of hospice and different order sets depending on the state and patient's wishes.


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## emtfarva (Feb 7, 2009)

daedalus said:


> In my experiences, vital signs are rarely taken in the truck manually. If you get on a real 911 rig in ventura or LA county it just doesn't happen.
> 
> Most decent medics demand a manuel blood pressure on scene, which I will as well when I become a paramedic. Since this is when an impression of the patient and a treatment plan is formed, you need an accurate BP. A good assessment also includes feeling the pulse with your own hands, placing that stethoscope on the body, etc. After that, when transporting, its more important to monitor for changes. Thats when EKG, pulse oximetry, and NIBP are completely acceptable as tools to monitor your patient, along with looking at your patient with your own eyes. Since all 911 transports around here are under 10 minutes, there is no logical reason to get a additional set of manuel blood pressures etc on most calls.
> 
> I was taught how to take vital signs in a moving noisy environment in class. I do not need any more practice. Lets see IFTs as they are. IFTs.



I don't trust automatic b/p cuffs for emergencys. I like to hear what the  B/p sounds like. and if you had a pt with a b/p in the toilet it could 10 mins to get a b/p. If you do it manual, it shouldn't take more than a min. plus I tend to find people that I guess are in afib by taking a blood pressure. I am 10 for 10. Not that afib is a big deal.
As for transfers. VS at sending facility, one b/p in route and maybe one at destination, for stable pts only. more for unstable pt's. D/c usally only get one set unless transport is more than a half hour.


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## FireCPT11 (Feb 7, 2009)

rhan101277 said:


> Yesterday I had my first transfers where I was responsible for their care.  Even though it was just moving patients from place to place I took it as a big responsibility.
> 
> I assessed their LOC and did vitals on them every 15 minutes.  One man I had to take about 1.5 hr. away.  I checked his vitals five times, I think he was getting a little aggravated.  This is how I am supposed to do it though, some people say they do it every 30 minutes, for people you are just moving from Dr.'s appt to nursing home etc.  I like having a track record of vitals so I can have it to see if anything is going on.  I also listen to lung sounds and heart sounds a couple times.
> 
> ...



I always start by taking report from the healthcare provider responsible for the pt's care...even if it's just a transport to a doctor's appointment. I'd rather not be surprised by anything once we get on down the road...cuz then it'll be MY behind on the line, and often times what a nursing home nurse calls a "transfer" is really an e-call. Then I go through all of the paperwork provided to me and write down pertinent info on my PCR and ask for clarification on any information or orders that are unclear. After the pt is loaded in the truck I obtain baseline vitals MANUALLY. I verify as much of the information from the paperwork as possible with the pt...this is a good way to assess mental status. Then, depending on my assessment, my interfacility written orders and the length of the transfer, I may repeat vitals every 5 minutes or 30 minutes or somewhere in between. We are required to have at least 2 sets of vital signs on EVERY pt that is transported, whether it is 2 minutes from the hospital or 2 hours. 

BLS transfers aren't the most interesting, but they are good practice. Get in the habit of doing vitals and your assessment the same every time so that it becomes 2nd nature. Then, when things go south you will be less likely to miss something important. 

ALS transfers are often the sickest and most challenging patients...here, these are the ones that we take in from e-calls that are in really bad shape that end up being transferred from our local band-aid box hospital to a facility with more capabilities. Sometimes people don't take transfers seriously enough...these patients WILL go downhill on you FAST if you just take for granted that "it's just another stupid transfer."

Don't let anyone give you any crap for being thorough or tell you that you don't need to be just because it's "only a transfer." It is your job to be that patient's advocate and you do that by providing them with the highest quality care that you are capable of. Sounds like you are right on with what you are doing...keep up the good work!


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## Sapphyre (Feb 7, 2009)

daedalus said:


> In my experiences, vital signs are rarely taken in the truck manually. If you get on a real 911 rig in ventura or LA county it just doesn't happen.



This is not necessarily true.   I've gotten manual signs in the truck, en route.  The medic's I run with don't have NiBP on their monitors.  And, well, we transport - medic as well....


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## CAOX3 (Feb 22, 2009)

I ll stick with the manual cuffs.


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## medicdan (Feb 23, 2009)

My view on vitals on IFTs is this:

If it is a 0.3 mi transport, a true IFT, there is no way I am getting a set. When I do the paperwork before pickup, I review the chart, and note if the vitals are normal, then will take the most recent set for my report. If there is no recent set, I take my own with the hospital cuff, etc. while still in bed. I then document the time the vitals were taken-- I dont indicate that they were taken en route if they werent.  

For other, longer transfers, from SNFs to MDs or discharges to rehab, I always try to take 1-2 sets en route. I feel differently about the SNF patient who is going to their MD for an acute problem, then the stable discharge from an orthopedic hospital going to rehab. This ortho patient may only get one set-- I know they are likely in post-op pain, and I dont want to torture them unnecessarily. 

Dialysis patients-- it all depends. I view them as the sickest stable patient I see during my day. They may have a laundry list of chronic conditions, ranging from the standard ESRD/CRF to HTN, DM, CAD, CHF, COPD, etc. I had one patient who's BP pre-dialysis was often 80/P, and BP after treatment could hit 200/P. She always got q5min vitals, where I have others that are very steady, and may only get on set en-route. Many of them have dialysis books for communication with their SNFs, and I often read through and take note of the trends of pre-post treatment as measured by the clinic-- and only worry if my measurement are drastically off from the baseline-- because that is the whole point of vitals-- trending.

Hope all of this helps-- I guess what I am saying is that your measurement frequencies should be highly patient dependent. 

Good Luck,

Dan


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## daedalus (Feb 23, 2009)

VentMedic said:


> When reading a chart for comfort care or hospice patients, one might notice that "No vitals" is part of the order set. We do not even check an SpO2 on these patients in the hospital.  They are made comfortable by pharmacological means according to visual assessment.
> 
> However, there are different types of hospice and different order sets depending on the state and patient's wishes.



I have seen this before! I followed the orders and than had to explain to an EMT-B supervisor why I did not take vitals. He in his infinite knowledge as a EMT decided it was BS. :sad:
Another area for improvement through education.


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## CAOX3 (Feb 23, 2009)

emt.dan said:


> Dialysis patients-- it all depends. I view them as the sickest stable patient I see during my day. They may have a laundry list of chronic conditions, ranging from the standard ESRD/CRF to HTN, DM, CAD, CHF, COPD, etc. I had one patient who's BP pre-dialysis was often 80/P, and BP after treatment could hit 200/P



What?  Dialysis pts blood pressures should be reduced after treatment.  What were they adding fluid to her insted of removing it?


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## daedalus (Feb 23, 2009)

Sapphyre said:


> This is not necessarily true.   I've gotten manual signs in the truck, en route.  The medic's I run with don't have NiBP on their monitors.  And, well, we transport - medic as well....


In Azusa, all transports were code 3 if the medic came along (stupid policy). It is interesting to see variations in the fire medic's use of the EMT. I was told to turn on the dome lights, spike the bag, than shut up and do nothing.


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## CAOX3 (Feb 23, 2009)

*I was told to turn on the dome lights, spike the bag, than shut up and do nothing.*

Well that was proffesional. 

After the call I would have politely stated to them.  Now that we are done with pt care, would you be so kind as to meet me in the parking lot so we can discuss your comments and practise some behavior modification techniques


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## BossyCow (Feb 23, 2009)

> After the call I would have politely stated to them.  Now that we are done with pt care, would you be so kind as to meet me in the parking lot so we can discuss your comments and practise some behavior modification techniques



That is certainly professional as well!


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## medicdan (Feb 23, 2009)

CAOX3 said:


> What?  Dialysis pts blood pressures should be reduced after treatment.  What were they adding fluid to her insted of removing it?



I cant say I understand why, but this patient was very consistent. Evidently her BP would flip flop during treatment. I do know that the clinic has refused to take her because her BP is so low-- they instructed the EMTs to take her to the ER. Nevertheless, she was back at the clinic four hours later, because she still needed to be dialized. 
This patient's baseline was A&Ox1-2, and had been receiving acute dialysis for over five years. She was relieved of her pain a few months ago.


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## CAOX3 (Feb 23, 2009)

*That is certainly professional as well!*

Thank you.  I try


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## exodus (Feb 23, 2009)

JPINFV said:


> How many schools require their students to take V/S in a moving vehicle forcing the students to deal with road noises and bumps?



I go to EMSTA College (Until Wednesday)    and we do vital in the back of the schools ambulance while driving up and down the road and making turns and going through bumps.


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## JPINFV (Feb 23, 2009)

daedalus said:


> I have seen this before! I followed the orders and than had to explain to an EMT-B supervisor why I did not take vitals. He in his infinite knowledge as a EMT decided it was BS. :sad:
> Another area for improvement through education.



For something like that I probably would have asked for a copy of the order to accompany my chart.


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## daedalus (Feb 23, 2009)

CAOX3 said:


> *I was told to turn on the dome lights, spike the bag, than shut up and do nothing.*
> 
> Well that was proffesional.
> 
> After the call I would have politely stated to them.  Now that we are done with pt care, would you be so kind as to meet me in the parking lot so we can discuss your comments and practise some behavior modification techniques



It will be difficult for you to comment on this without actually working with Los Angeles County Fire paramedics. 

I do not think we have one member here that is a medic or EMT for that very prestigious organization.


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## CAOX3 (Feb 23, 2009)

I dont care it was an almighty medic from above, RN or doctor for that matter.  I wouldnt talk to someone like that.  

So I dont accept being talked to in that manner.  I dont give a :censored::censored::censored::censored: who they are, or how many letters they have after your name.

Its about respect.  You respect me I respect you or vice versa.


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## BossyCow (Feb 23, 2009)

Being nice to someone who has been nice to you is easy. Maintaining your own professional demeanor and calm in the face of a bodily orifice is much more difficult and a true test of your maturity. 

Just because someone acts like a jerk doesn't mean the entire conversation following has to sink to their level. If it does, you have relinquished all power in the situation and allowed them to set the terms of the exchange. Besides, not getting P.O'd generally annoys them!


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## daedalus (Feb 23, 2009)

Maybe I am missing something... Is there a fight going on? Did I insult someone? I apologise I did not even know I did so.


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## Sapphyre (Feb 23, 2009)

daedalus said:


> It will be difficult for you to comment on this without actually working with Los Angeles County Fire paramedics.
> 
> I do not think we have one member here that is a medic or EMT for that very prestigious organization.



I would say, most likely not.  We do however have EMTs that transport for them...  I can think of 2 off the top of my head  (and, several people who haven't joined, but like to read anyway, cause, well, this site is too Ricky for them to admit reading!!!)


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## Sapphyre (Feb 23, 2009)

daedalus said:


> In Azusa, all transports were code 3 if the medic came along (stupid policy). It is interesting to see variations in the fire medic's use of the EMT. I was told to turn on the dome lights, spike the bag, than shut up and do nothing.



In Baldwin Park, medic transports are code 3 as well.  And, I've had medics like you experienced, and ones that actually wanted me to do some work for them.


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## medic417 (Feb 23, 2009)

Sapphyre said:


> cause, well, this site is too Ricky for them to admit reading!!!)



Who's Ricky?  And why don't they like him?


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## CAOX3 (Feb 23, 2009)

BossyCow said:


> Being nice to someone who has been nice to you is easy. Maintaining your own professional demeanor and calm in the face of a bodily orifice is much more difficult and a true test of your maturity.
> 
> Just because someone acts like a jerk doesn't mean the entire conversation following has to sink to their level. If it does, you have relinquished all power in the situation and allowed them to set the terms of the exchange. Besides, not getting P.O'd generally annoys them!



Thats why it would take place in the parking lot.

But hey you have your way I have mine.  Im sure we both arrive at the same place.  Just take different ways to get there.


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## daedalus (Feb 23, 2009)

Sapphyre said:


> In Baldwin Park, medic transports are code 3 as well.  And, I've had medics like you experienced, and ones that actually wanted me to do some work for them.



Hey Saph,

Do your medics transport code all the time, even for trivial things? Have they ever punted a BLS to you that turned out to be serious? I have had doctors get mad at me for the medics decision. Forgive me if I came off harsh, I have tremendous respect for you and all of our LA brothers and sisters who deal with the toxic private ambulance environment down here. 

BTW, I am about to move to MedResponse. My current employer (you know who) is not working out. I would love to move back to AMR but I have a pretty rigid school schedule.


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## fortsmithman (Feb 23, 2009)

We only have 2 health care facilities in town 1 is our hospital and the second is the a special care facility.  When we do transports between then it only take 1 to 2 minutes as the special care is only around the corner from the hospital.


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## Sapphyre (Feb 23, 2009)

daedalus said:


> Hey Saph,
> 
> Do your medics transport code all the time, even for trivial things? Have they ever punted a BLS to you that turned out to be serious? I have had doctors get mad at me for the medics decision. Forgive me if I came off harsh, I have tremendous respect for you and all of our LA brothers and sisters who deal with the toxic private ambulance environment down here.
> 
> BTW, I am about to move to MedResponse. My current employer (you know who) is not working out. I would love to move back to AMR but I have a pretty rigid school schedule.



I've rode medics in code on a cough/cold.  I've also had the medics contact, decided to ride it in, and request code 2 transport  (that's an interesting radio report, "XXXX, we're code 2 code 5 to xxxxx hospital with squad XXX")

I've also had a severe resp distress pt that I rode in BLS cause the medic, without even putting his ears on, decide that it was simply a case of constipation  (huh??????, I came in at the transport decision portion of the assessment), which the doc almost tubed upon our arrival at the ED.  That one was courtesy of our resident Frank Pierce firemedic.

Sorry to hear the current employer isn't working out, better luck on the new one.  You wouldn't get in with AMR anyway, they're not hiring right now.


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## rmellish (Feb 23, 2009)

Rhan

One of the only things I gained from doing BLS nonemergent trips for appts, releases to residence, dialysis, etc was lots of practice talking to patients. Good interview skills, heck good people skills, can't be taught in a classroom. Since these runs comprised the vast majority of my patient contact at my first job, I got plenty of practice talking to patients. 

Practicing vitals is good as well, but don't get too carried away. 

I also make it a point to read the manilla envelope if I have time, you can learn a lot from this paperwork.

Urgent IFTs on a paramedic unit are an entirely different story. There are many things to be learned there. 

Private transport services are an excellent starter job in the field. You can get plenty of experience with driving, vitals, and patient skills. Unfortunately, many of your skills will magically disappear if you don't practice them.


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## JPINFV (Feb 23, 2009)

daedalus said:


> Forgive me if I came off harsh, I have tremendous respect for you and all of our LA brothers and sisters who deal with the toxic private ambulance environment down here.



The environment in So Cal doesn't hold a candle to the stupidity of Massachusetts. Every shift out here has me rolling my eyes and wishing I was back a part of the Lynch Mob(tm).


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## daedalus (Feb 24, 2009)

JPINFV said:


> The environment in So Cal doesn't hold a candle to the stupidity of Massachusetts. Every shift out here has me rolling my eyes and wishing I was back a part of the Lynch Mob(tm).



Does lynch still run 911 in OC?


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## Sapphyre (Feb 24, 2009)

daedalus said:


> Does lynch still run 911 in OC?



Negative Ghost Rider.  That seems to be primarily the domain of the Care Bears, and a few others, that is, when the FD doesn't transport.


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## daedalus (Feb 24, 2009)

Sapphyre said:


> Negative Ghost Rider.  That seems to be primarily the domain of the Care Bears, and a few others, that is, when the FD doesn't transport.


I was at a hospital in east LA county the other day and a Care EMT had the nerve to tell me that I should use the parking lot next time because HE ran 911 in that area.

Ugh.


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## DavethetrainWreck (Feb 24, 2009)

Honestly, I just check their mental status and vitals once to see how thier condition is and I just keep an eye on them the rest of the way incase anything changes. However, it is ok to talk to them even if they're not all there mentally. Just make pollite short conversation to take the edge off because even inter facillity transport can be a little overwhelming to many patients. I believe that your primary concern should be to keep an eye on thier overall condition and make them as comfortable as possible.


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## Sapphyre (Feb 24, 2009)

daedalus said:


> I was at a hospital in east LA county the other day and a Care EMT had the nerve to tell me that I should use the parking lot next time because HE ran 911 in that area.
> 
> Ugh.



Ug, east LA county????  Um, care to share the hospital?  Can go PM if you'd like.  Cause, last I checked, *I* run 911 in east LA County, further east is Shaffer.  Care's more in west and south.


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## JPINFV (Feb 24, 2009)

daedalus said:


> Does lynch still run 911 in OC?



Lynch never ran primary 911, but we did have a handful of backup contracts. Of course backing up Care is an exercise in futility, so the only city that ever called us was Costa Mesa, which is now run by Care.


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