ALS IFT?

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BayEMTmaybeP

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Hi all, I was wondering if someone could give me an example of an ALS IFT? What would be Paramedic interventions during the transfer? I just don't really understand what they would do, or what the difference would be of having an ALS transfer vs a CCT?

Thanks
 
I don't have to do interventions, I just keep whatever the hospital has set up. Vent patients, and then pumps with meds like Cardizem, heparin, etc. A lot of lower acuity stuff too, like peds or IV's with fluids going, but the former are fairly common.

My service only has 2 CCT trucks and sometimes none are in service, one is more common. On the other hand, we have something like 14 or so ALS truck in service. We do get calls that would go to them normally, but that isn't often. Either way, not every person needs a CCT truck. The biggest difference I know of is the CCT trucks have better vents, paralytics, and a few extra meds like insulin and levophed.
 
Greatly depends on the call. The IFT I used to work for would do monitored transports from hospital to hospital, in which I basically just checked the monitor and vitals, and maintained any pumps/meds/O2 that was already going. The rules on what was ALS, CCT, SCT was always a little unclear but monitored transports were easy.

But we also did immediate responses. Which were calls from nursing homes or treatment centers (usually) that didn't really need a 911 truck but needed something quicker than 'whenever you guys get around to it'. On calls like that I could use all my ALS skills. Starting lines, interpreting rhythms, giving meds/fluids, etc. Most often though it was starting a line and calling the ER to let them know we where coming.

CCT for us usually involved blood products, a few meds, and sometimes vents (although a normal ALS truck could get trained to take a vent, since it's not rocket surgery).
 
We don't adjust the hospital's pump unless it's nitro, fluids, or have orders to do so. We can still treat the patient within our own guidelines without the sendings orders. Lots of sick transfers up where I'm at, though way more just useless transfers.
 
We have the same sort of thing. Some transports that are dispatched as ALS are simply a monitor and NS running at 125 an hour on a pump. Others are complex medical patients that are on multiple vasoactive drips, vented with a sedation package and are really unstable
 
SunshineCamo said:
sometimes vents (although a normal ALS truck could get trained to take a vent, since it's not rocket surgery).
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Admittedly it's not, nor is it rocket science.

What it also isn't is just pushing a few buttons, dialing some knobs, and resetting the silent alarm the whole trip. You can do a lot of harm not knowing what you don't know.
 
Every answer is possible.

One of the "hospitals" in my area(the hospital is closed, the ER is open as a standalone; so no inpatient care whatsoever) sends a staggering percentage of their transfers out als, not because they need it but because it eliminates their liability. Ive seen them hang a bag of saline just to make it als(bls in ma can transport locked IV's). It's kind of insane really, but what can you do?

From there, anything is possible. Monitor only for a real or imagined cardiac problem, IV ABX(that are normally done before we get there, or 2 minutes into transport), vents, stemis going to a catch lab, all the way up to and beyond critical care calls. I took a patient a few months back that the sending facility so desperately wanted to fly they called two out of state HEMS services(after calling the two in state) to try to find her a ride. We ended up taking her on my 911 truck 45 miles to the city with all kinds of stuff going on.

The short answer is if the sending physician decrees that the patient is to receive any monitoring or intervention beyond the scope of the emt, then it goes als, regardless of whether or not its really necessary.
 
VentMonkey said:
Admittedly it's not, nor is it rocket science.

What it also isn't is just pushing a few buttons, dialing some knobs, and resetting the silent alarm the whole trip. You can do a lot of harm not knowing what you don't know.
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I say "Rocket Surgery" all time as well...mostly to inject/infuse humor, sarcasm and see if the person is paying attention. :)
 
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I used to do transports from small hospital to large hospitals for cardiac cath (my personal best was 8 times in 12 hours from the same hospital 25 miles one way). This particular small hospital always had 'good patent 24 g IV's in place' (per transferring nurses: ICU would pull the IV started in the ED or the field and replace it with a 24g). I would always start at least one more line, tried for 18's, but if not smallest I would do is a 20. They need them for Cath, and it the patient needs a cardiac cath, they may crash on us and need fluids and meds, and 24 g isn't much good for that.
 
hometownmedic5 said:
The short answer is if the sending physician decrees that the patient is to receive any monitoring or intervention beyond the scope of the emt, then it goes als, regardless of whether or not its really necessary.
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Honestly, I am convinced that many sending physicians don't know the difference between ALS and BLS, so if you ask them why they need paramedics, and they can't give you a good answer, the patient can normally go via BLS (and when you explain it, they will have no problem with them going BLS)
 
DrParasite said:
Honestly, I am convinced that many sending physicians don't know the difference between ALS and BLS, so if you ask them why they need paramedics, and they can't give you a good answer, the patient can normally go via BLS (and when you explain it, they will have no problem with them going BLS)
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I think it has a lot less to do with that than liability coupled with having zero responsibility in regards to resource management. They say "als" and an als ambulance appears. So if they can get an als ambulance, why not send the pt als and eliminate liability.

If they send a pt by bls and they box en route, that doctor might end up in court trying to explain that decision. If they send the patient als and nothing happens, as of right now nobody is going to say anything to them.

The many, many conversations I've had with sending facilities on this topic have lead me to this opinion. They come up with the most ridiculous justifications, which only make sense on paper. Perhaps someday Medicare et al will realize how much money their spending on nonsense ambulance rides and will require an actually justifiable reason for the ride; but until then Med flight will be flying als patients, medics will be taking bls patients, and bls will be doing wheelchair runs.

Here's the thing though. If they ever do get their act together, at least half of us are going to be out of work....
 
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