This is the part I don't get when some say doing 911 calls is better than IFT especially if the FD makes you wait before entering the scene. I also take it the FD medic will be on board if the patient if ALS is required. Hence, you end up being the fetch it guy for the FD. On an IFT, you can take the initiative to do some excellent assessments and interview the paitents instead of just standing in the background waiting for the Fire Medics to say you can load and go now.
The bar appears to be set lower at transfer companies because of the "its not 911" attitude displayed by the employees themselves. Somewhere the patient care concept is missed. Thus, if may not be the company that sets the bar but the EMTs with the company recognizing this to use for their own gain when it comes to wages and equipment. Why spend much if you know your employees are only waiting for a glamourous job as the "load 'em up" boys and girls for the FDs?
Only two FD's (that I know of) require staging. The 911 experience gained IS offset by never running assessments on critical patient. That's why I don't really recommend it.
Depending on your service area at other companies, you may be first on-scene over half the time. This would be your chance to assess critical patients.
***Now, whether you have to stage for FD or not, you'll be getting a large number of BLS patients handed off to you. That's where most of my assessment practice come from. It's just me in the back. I can go nuts from listening to heart sounds to asking about every risk factor and family history related to chief complaint. As a "bonus" you often get "BLS patients" who should really be ALS (though usually not as obviously unstable).***
I admit IFTs give you a good number of ALS patient assessments, since many nursing homes try to send their patients BLS to the ER to avoid a 911 activation. But the variety might be limited and interspersed with so many routine hospital-to-hospital transfers, regular dialysis visits, and hospital discharges. So many are altered mental status as baseline and stable, so you're limited in the practice you get out of those (reading their discharge papers is interesting/educational I do admit).
My disclaimer is I haven't actually worked for a primary IFT company...though I have done many in between the 911 responses.
As far as the lower bar at IFT companies. Yes, it's likely management allowing it to get the kind of people who will "do their bidding". I'm worried about having a brand new EMT go into that environment, since he won't know any better. He can definitely rise above the rest, but it will be hard for him to know where that bar should actually be. Higher chance of not having good role-models.
When I was new, I kept thinking I was the best, then would work with someone who was way more on top of this stuff than I. The next few months would be spent surpassing that level....until I found someone better. If I had never seen that caliber of work performance, I wouldn't know any better.
Lastly, 911 experience offers the chance to develop quick thinking and quick acting during critical and stressful situations. While EMS doesn't always have to be "go go go", one certainly need to have the ability for it. You want to be able to a have patient vomit, turn the board and suction, while you spike the IV line, and navigate your driver if needed with background noise.
So, in the end, there are definitely trade-offs. I side with 911, because I consider them EMS entities. It would make sense to get one's EMS experience with an EMS company. I definitely acknowledge the valuable experience from IFT's too.
