ALS IFT Vs. 911

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RickyRescue562

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Greetings brethren, i'm confused. Im an EMT and i had an interesting conversation with my operations Manager. I asked whats the difference between ALS IFT and 911 (Fire Medic). I work in LA/Orange County. I know for BLS, we cant transfer pts that aren't in our scope. If our pt crashes, we pull over and call 911 for a Fire Medic (Jurisdiction Protocols), unless 5 minutes away from Destination. Lets say a IFT Paramedic transfer a pt. and they crash, my Manager told me they still need to pull over and call 911. My question is why? There's a Medic in the back already. Doesn't make sense to me to waste resources and time? If anyone could clarify please help.

-Much Thanks RickyRescue (Aspiring Paramedic)
 
In LA county (and maybe OC, wouldn't surprise me, in many ways they're worse) an ambulance isn't truly considered ALS unless they have 2 medics. Also, depending on who your employer is, many IFT companies operate under restricted ALS protocols compared to 911/FD agencies.

I'm sure the fire departments will say that this is to ensure the best care for the patient, but my belief is that it's politically motivated.
 
I know for LA Co, protocol explicitly states if you're closer to the hospital than ALS intercept, you're supposed to keep going to the hospital...

Also some time ago when OC started allowing private ALS take IFTs (instead of BLS or CCT Nurse only)...there was a thread on this very site discussing it and I remember distinctly it being said that once the private medic takes the patient, it's their patient, and they don't have to involve fire at all.

I would suggest you go looking through your county(s) protocols. I'm willing to bet they trump your companies policies...
 
Jim37F said:
I know for LA Co, protocol explicitly states if you're closer to the hospital than ALS intercept, you're supposed to keep going to the hospital...
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This is correct. But like everything in LA, it's greyish.

The black and white of it is, if you're closer than ALS intercept, proceed to the nearest ED.

The grey of it is, if you do that too much LACO DHS comes a knockin'. I know this from experience.

My guess is, many of these companies have decided they don't want to be under the microscope and have issued policy stating to call for fire since that's what the people behind the desks at the buildings with the red trucks want.
 
I will say that when I occasionally did ALS IFT as an EMT chauffeur in LA, the handful of times things started to get squirrely in the back the medic started talking about upgrading, I don't recall anyone of those medics suggesting we call Fire..the one time I was on a BLS IFT AMD things were getting squirrely there was thought to that (but we were only a min or 2 from the hospital so we continued in).

Those were at fairly reputable companies, so idk. I do know I'm not in LA/OC where I dont have to deal with that nonsense anymore lol
 
NPO said:
The grey of it is, if you do that too much LACO DHS comes a knockin'. I know this from experience.
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So what's wrong with that? Are you operating in a shady manner? are you not following the rules as set forth by the DHS? if your doing your job like you should, it shouldn't matter if DHS shows up at your scene; just do your job like you are supposed to, no need to be scared of the big bad DHS guys (who, more often than not, are more interested in catching big bad guys who are breaking the law than nitpicking over stupid stuff, although you can draw the short straw and catch an inspected on a really bad day)

If the rules say if the hospital is closer, go to the hospital, do it. if DHS wants to ask why you did it, the response of "because your protocol tells us to" is a more than valid answer. It's better for the patient (they get definitive care quicker), it doesn't delay patient care, and what can a fire paramedic do that an ambulance/IFT medic can't?
 
I don't have a problem with DHS poking around. My work was always on the up and up. But my company didn't love it, although they maintained the policy of closest resource (ALS/ED).

I'm just trying to find an explanation for what some companies may be doing. With many of these companies in LA if you look hard enough you'll find things wrong. Many, you don't have to look for long.
 
It's amazing how different things are throughout the country. When I worked in Massachusetts our dispatchers would laugh at you if you asked for municipal ALS unless you were working an arrest or something like that. Getting one of our own ALS trucks was less than 50/50 as well.
 
It's fire based EMS, aka where they don't trust anyone running 911 medical calls until they have superior hose dragging skills.
 
DrParasite said:
So what's wrong with that? Are you operating in a shady manner?
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"What's wrong with that" is that hard-working, generally rule-following folks shouldn't need to fear being harassed by unproductive officials poking around looking for a reason to cite a crew or agency just because that crew or agency exercised some basic judgement more than once.

And no one needs to be "operating in a shady manner" for DHS to find some BS reason to cite you.
 
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I worked at an OC private ALS company and we didn't need to involve fire unless we needed manpower. I did CPAP and other ALS interventions multiple times and we just ran it with the two of us. The shady thing with the company was that we'd get stroke like symptoms/chest pain/insert acute medical problem here dispatches to nursing homes with 30-40 minutes etas. These clearly should have been 911 activations.

When I was in LA, if you didn't have two medics you couldn't carry narcs, thus wouldn't be a transporting ALS unit, only assessment. If you were dial medic then you could transport ALS patients without issue.
 
Uclabruin103 said:
I worked at an OC private ALS company and we didn't need to involve fire unless we needed manpower. I did CPAP and other ALS interventions multiple times and we just ran it with the two of us. The shady thing with the company was that we'd get stroke like symptoms/chest pain/insert acute medical problem here dispatches to nursing homes with 30-40 minutes etas. These clearly should have been 911 activations.

When I was in LA, if you didn't have two medics you couldn't carry narcs, thus wouldn't be a transporting ALS unit, only assessment. If you were dial medic then you could transport ALS patients without issue.
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Where were you working? I left LA County about six years ago and as a one to one Paramedic I carried narcotics on duty all the time. We just had to do the narcotic sign off every morning with the oncoming crew so there were two paramedics to witness the narcotics being changed over between crews.
 
The is what we did as well
luke_31 said:
Where were you working? I left LA County about six years ago and as a one to one Paramedic I carried narcotics on duty all the time. We just had to do the narcotic sign off every morning with the oncoming crew so there were two paramedics to witness the narcotics being changed over between crews.
Click to expand...
 
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