Paramedic to Paramedic handoff?

Posting this to see what you guys think of this...

I work for a Fire Department in my hometown for the past 13 years. Even this one was a first for me. There is a private service that runs the county to the north of us, as well as another private service that helps out in our county. Transports to our hospital are usually around 30 mins or so. Our fire department employs staff 7a-7p usually an ALS crew also is the only medic on the north end of the county. We mutual aid several surrounding departments. We take around 700 calls a year.

So, the private ambulance to the north of us breaks down in our village limits on a transfer from their small hospital to our county's larger hospital. Somehow they get the idea to call us to finish the transfer. We are a 911 fire and ems service. We get on scene and the EMT driver states to me, we just blew the boot off the turbo and our supervisor had you guys dispatched to finish our transfer. I asked, transfer to the ED? He said no to the floor. I said I'm not sure we can do that, we may have to call the other private ambulance company to complete your run. Just then the medic peeks her head out and states I have to go with you guys. I asked why? She said I've been with the pt the whole time so I have to (rudely). I said that doesn't make sense but whatever. Our captain shows up on scene and he wasn't sure as well if we could complete their transfer. He also agreed with me that the private ems medic could give me a report and we can just finish the transport. Their director ended up getting involved and said that their medic needed to complete the transfer. I said whatever, transferred the pt to our cot, and made my basic partner ride in the back with the private ems medic.

One little bit of information, both my captain and I work at the private ambulance company up north.

Is this a billing thing so that the private ems can bill for the entire mileage, or is a medic to medic handoff not good enough or not accepted? There was no downgrade in pt care, the other medic didn't push any drugs... so I don't get it? Their transfer was going for a urology consult not provided at their hospital.

My captain and I were brainstorming afterward because we weren't sure how this is going to be billed, we often catch calls after dropping off at the ER. Their medic was now a liability of our fire department. I should have left her at our hospital and their supervisor could have picked her up.

I don't know, what do you guys think?

They probably needed to stay with the patient to be able to bill for the run. A paramedic to paramedic handoff is acceptable and happens on occasion. But yeah it will be sketchy to bill for the run period since they didn't technically complete the entire trip. If the patient was stable baring a real long eta for another one of their ambulances they should have waited for one of their own.

I believe this is so they can bill, which is sketchy and also means your service can't bill.

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GMCmedic said:

I believe this is so they can bill, which is sketchy and also means your service can't bill.

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Oh we will be billing them

When we do transports of flight crews, even though they remain in charge of patient care, we still bill.

DesertMedic66 said:

When we do transports of flight crews, even though they remain in charge of patient care, we still bill.

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Same, we have a contract with our local helicopter to transport them in case of no flight. They have to remain in charge of pt care. CCT team hand off to medic would be a EMTALA or COBRA (can't remember) violation in downgrade of Care.

Carrie Lendon said:

Same, we have a contract with our local helicopter to transport them in case of no flight. They have to remain in charge of pt care. CCT team hand off to medic would be a EMTALA or COBRA (can't remember) violation in downgrade of Care.

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What? No it would not. I have been handed off a patient from a flight team before ans there's no problem. Might wanna look up what those acronyms stand for because neither one has anything to do with this topic.

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TransportJockey said:

What? No it would not. I have been handed off a patient from a flight team before ans there's no problem. Might wanna look up what those acronyms stand for because neither one has anything to do with this topic.

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*shakes head* ugh... this reply doesn't even need response. Just an eye roll.

Carrie Lendon said:

*shakes head* ugh... this reply doesn't even need response. Just an eye roll.

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Actually TJ is right. Think about what medications or equipment a flight crew might commonly use.

Ventilator - paramedic scope*
Blood already running - paramedic scope*
Pretty much all of the medications - paramedic scope*
Pump - paramedic scope*


*result may vary by state

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EMTALA might, might, be able to be stretched if it is a hospital based flight team, but even then it's not likely. Cobra has absolutely nothing to do with this.

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Likewise, as a ground medic I've taken handoffs from Flight CCT Medics and RNs....
As a flight medic, my outfit does not allow it as standard.
I'd have to get medical director approval, and it would have to be a true basic paramedic level patient (as in that a local scope medic could continue any treatments we've started). If we were to transfer CCT to CCT level, I think I'd get denied simply because they wouldn't want to lose the opportunity to bill and to collect; I work for a for-profit outfit.
That has a lot to do with it.

It's amazing how this private profession has went from taking care of people to doing thing more for a 'billing' purpose. Even when I was in a large Columbus city based hospital in 2013 they were on the nurses for start and stop times on IVs. Supposed they were losing 200k revenue because nurses weren't charting it.

Carrie Lendon said:

My captain and I were brainstorming afterward because we weren't sure how this is going to be billed, we often catch calls after dropping off at the ER. Their medic was now a liability of our fire department. I should have left her at our hospital and their supervisor could have picked her up.

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Depends on how much of a **** they were. Personally, if they were rude to me, and if they bullied me into doing something questionable, then I would have no qualms leaving their medic at the hospital, and telling them to call their supervisor to pick them up.

Now if they were nice, and if they understood that if we got a call, they were coming on it with us as an observer, I would have no problems giving them a ride back, if they asked. But their supervisor should have been the one to meet us at the hospital to pick up their medic and say thank you for helping them out of a jam.

And it's definitely a HIPAA question...

Carrie Lendon said:

It's amazing how this private profession has went from taking care of people to doing thing more for a 'billing' purpose. Even when I was in a large Columbus city based hospital in 2013 they were on the nurses for start and stop times on IVs. Supposed they were losing 200k revenue because nurses weren't charting it.

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It's all about the money and mitigating the risks of liability.

I wouldnt attempt to bill the patient. I would send the BLS bill to the other service. Perfectly acceptable to expect compensation for your time and fuel.


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Far as I see it your bill goes to the other service. They can go ahead and bill the Pt, it really doesn't matter. I personally could care less who gets billed. I do the best I can for the Pt and before I leave I get whatever billing and personal info I can. Then it is up to the billing Dept. As far as the other medic, I see no reason for them to travel after the hand off. I have been on the receiving end and all I got was a verbal report and some paperwork. I have also had Fire Fighters drive me and my partner in on a bad call and their Lt met us at the hospital to pick up his guy (they didn't need to do that, they wanted to get their man back to work). You helped them out of a jamb, seems to me that it would be neighborly for them come pick up their people.

TransportJockey said:

What? No it would not. I have been handed off a patient from a flight team before ans there's no problem. Might wanna look up what those acronyms stand for because neither one has anything to do with this topic.

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It certainly could be considered a downgrade in the level of care. Depends on the circumstances. It can also make billing difficult. In order to avoid any problems and keep it simple, many places simply adhere to a "bedside to bedside" policy.

Just curious in what situations are paramedics receiving transfer of care from a flight team? Once i assume care of a patient I am with them until we get to a capable/appropriate facility.

Chase said:

Just curious in what situations are paramedics receiving transfer of care from a flight team? Once i assume care of a patient I am with them until we get to a capable/appropriate facility.

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I've seen it in the case of a no-go. I've seen a flight crew take a patient, and then land 20 seconds later because the aircraft was over on hours (big oops.) Or in the case in which the patient codes before the flight team could load, etc. I have yet to see or have anyone be able to cite anything that says a flight crew is a higher level of care. At least in MO, RN is not a higher license level. Now I could see why air medical agencies would push that as they get to bill if they go with ground.

truetiger said:

I've seen it in the case of a no-go. I've seen a flight crew take a patient, and then land 20 seconds later because the aircraft was over on hours (big oops.) Or in the case in which the patient codes before the flight team could load, etc. I have yet to see or have anyone be able to cite anything that says a flight crew is a higher level of care. At least in MO, RN is not a higher license level. Now I could see why air medical agencies would push that as they get to bill if they go with ground.

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That's how it is here. RNs are certified as EMS RNs.
They are the highest level of care. In cases of us landing and supposing it will be a cancel for whatever reason, usually we send the medic out to make contact... because once the RN makes patient contact they are unable to relinquish care to a ground medic.
Tradecraft