Designating Transfer Trucks: Research Project Please Give Feedback!

Do you think that it would be beneficial to designate transfer trucks to handle all IFT calls?

  • yes

    Votes: 8 72.7%

  • no

    Votes: 3 27.3%
  • Total voters
    11
A

aggieEMTB

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I am currently an EMT-B student. I have gone on ride outs with multiple different EMS services, some of which have designated BLS-operated transfer trucks for inter-facility transfers, and others who have not had this protocol in place.
I have been assigned to work on a research project relating to this issue and would greatly appreciate any feedback or professional opinion you have to offer. If you would please respond with your level of training: EMT-B, EMT-I, number of years in the field, and any feedback you have to offer, I would greatly appreciate it!
What would be some pros and cons of designating BLS-operated transfer trucks in an EMS system? If you have experience with a program that has already implemented something similar, please let me know how it works and how it was begun. If you have not worked for a program with specified transfer trucks, do you think that implementing such a protocol would be beneficial to the program? Would it help cut down costs and the use of resources?
Thank you for your help!
 
Many calls, particularly transfers, have literally no risk of deterioration and can be safely handled by BLS personnel. Psychiatric transfers and quite a few medical complaints come to mind. A BLS truck is cheaper to staff, equip and field and leaves paramedic units available for more acute calls.
 
One my employers does it and it's a great help to the system. There are two BLS cars on every day from 9-21 and 16-4. They can take BLS transfers, provide lift assists at facilities, bring out the bariatric ambulance, and take patients directly from the scene to detox. Most of our wheelchair vans are also equipped for detox transports, they have a cage in back and the EMT driver will do an detox appropriateness assessment on scene with the responding ambulance before taking them to detox. We also transport cooperative psych/alcohol/drug patients from the ED to inpatient facilities in these vehicles as well.
 
It sounds like what you are referring to is the patient transport service?

PTS is essentially a van that has no lights or siren. It has a standard first response pack and an AED. The personnel who staff it are First Responders. It is just like one of those shared ride shuttles you take to the airport. It transfers discharges, outpatients from hospital to home etc.

I know some of PTS operates in normal road ambulances for urgent transfers that need urgent driving. Again these are staffed by a First Responder. The clinical escort comes from the hospital either A-Zero/Flying squad or the PICU/NICU transfer people.

Acute admissions (Card 35) is handled by the regular emergency road ambulances.

I can't see why this would be a bad idea?
 
lvl: EMT-B
exp: 1.8 yrs

I have been a part of both the transfer side and 911 side, My first 1.3-1.5 years of my career was spent working the inter-facility transfer side of the EMS world. When your asking for pro's and con's im not really sure what exactly you are meaning...... so im just gonna throw some "bird shot" at this question and see what hits.

From the business side of things. Some of the pro's would be that, you now have another viable source of income for your company to help you stay afloat because honestly 911 doesn't pay like IFT's, I as an employer can get new EMT's experience with patient interaction and knowledge of how to do things on the truck and experienced EMT's i can "test run" so to speak to see if they are going to work out or if their is a reason why they are looking for a job and not working, as well as Incresead public preception as being part of the community and their to help.
The con's from the business side are the standard ones that come with the territory 911 service only or 911 and IFT.

From an Experience stand point for EMT's i will just list the pro's their is not really a con to working "IFT" so to speak other than i would say some people have what it takes to run 911 calls and some people don't. Everyone who has ever gotten into this field wants to run lights and sirens and take care people in their time of need...... But Im not trying to be an elitist its jus a simple fact of life if you freeze or can't think while on a emergency scene, your not solving problems, your making them.

Any way without further delay here is my list of things "new" EMT's can learn while doing IFT's

1. patient interaction
2. common drugs and their uses
3. vital signs (when normal and when not)
4. protocols for your area
5. sharpen your skills
6. PCR writting
7. local facility specialties (if you have multiple hospitals in your area)
 
What type of research project are you doing?
 
IFT patients have virtually no risk of getting worse? You must work for a nice company that screens their patients well.

I have transported:
Dialysis patients on a 15 minute transport that the 2nd set of VS, the BP dropped from 110/70 to 48/20.
A patient going from ECF via WC van to doctor office who half way said that he wished the nurse had given him more NTG since the dose she gave him helped the chest pain. (the medic was upset when I called for intercept until they put him on a monitor and he went straight to the cath lab for MI).
A patient going for Dialysis who would seize upwards of 10 times per transport ( we finally got orders to stop diverting to the closest hospital) in a 98 mile transport. (each way) 6 times a week.

I learned more EMS doing IFT than 911. Most IFT patients have lots more wrong with them than 911 patients; I had a program on my PDA then phone that I could look up Medications and if I put them all in it would give me possible interactions. That was great, surprising how many times you would take a patient to the hospital because their new med didn't like the rest of them.
Plus alot of IFT patients don't talk to you so you can't really ask them what is wrong. You actually have to try and figure it out yourself.
 
Paramedic, 8 years of EMS

I am guessing you are talking about when a 911 agency also does IFT. Sorry if this is not what you are asking for.

I do believe it can be beneficial to have an extra car on the road during the day to handle IFT, but to just designate them to IFT I do not think it is a great idea. Our agency had an extra car on to handle primarily IFT but they also responded to 911 when needed. This car originally staffed with EMT and Advanced, now is staffed with a EMT and Paramedic. When we changed to EMT Paramedic car, we did our first 24 on the IFT/Backup 911 car, than we were Primary 911 for the second 24. This worked great for our agency, but our agency was set up for it. Also, if there was just a straight up Basic Transfer we would send our to EMT to the hospital for the transfer and our other truck out of that station would turn into a duel medic truck until they returned. We were a smaller agency with 3 full time cars on the road at all times which included the IFT/Backup 911.

I do know that the agency to the west of us would just add a 12 hour car on during the day to help handle the extra call volume from IFT but all the units did IFT and that worked well for them.
 
I think the basic philosophy here is flawed. You don't need dedicated BLS IFT units, you need BLS units.

In my system we have ALS and BLS responding to 911 calls. BLS responds to Alpha, Bravo, and some Charlie calls. ALS respond to the remaining Charlie, Delta, Echo, and Omega.

Transfers are handled by available units, preferably of the appropriate level (ALS/BLS).

Dedicated BLS IFT units can be great for the system, but in my experience are bad for the provider. They allow for an environment where the EMT can allow his or her skills to degrade without use. Yes, you CAN use skills on IFT, but in my experience most people tend to be lazy about it. I also know people tend to burn out faster on IFT units.
 
NPO said:
I think the basic philosophy here is flawed. You don't need dedicated BLS IFT units, you need BLS units.

In my system we have ALS and BLS responding to 911 calls. BLS responds to Alpha, Bravo, and some Charlie calls. ALS respond to the remaining Charlie, Delta, Echo, and Omega.

Transfers are handled by available units, preferably of the appropriate level (ALS/BLS).

Dedicated BLS IFT units can be great for the system, but in my experience are bad for the provider. They allow for an environment where the EMT can allow his or her skills to degrade without use. Yes, you CAN use skills on IFT, but in my experience most people tend to be lazy about it. I also know people tend to burn out faster on IFT units.
Click to expand...
There are many, many systems that require a paramedic on every ambulance, so BLS transfer trucks are a way to cut down on using an ALS 911 ambulance for a stable transfer. It's also nice to have designated transfer trucks that cannot be touched by 911 to keep transfers punctual, which is often part of the contract. If the purpose of a transfer ambulance is to alleviate stress from the 911 system having to also pick up transfers, they need to be available for transfers and not on 911 calls.
 
I think having BLS transfer units that can also take the BLS level responses is the way ahead. It should help reduce the IFT burnout, plus it would take the strain off of the ALS units, while essentially adding more system units at less cost.
 
I believe dedicated IFT trucks are a smart idea, as long as the business has enough consistently scheduled IFT and the IFT dispatcher and hospital discharge planners work together to keep the schedule fluid.

Scheduling routine hospital to SNF runs in the downtime between dialysis drop off and pick up is a smart use of resources.

Scheduling planning meetings between the various stakeholders can reduce the IFT congestion significantly, once everyone realizes the limitations.
 
We don't have any dedicated IFT or 911 units. Everyone is fair game for anything. Sometimes we have 5 BLS units posting, sometimes none. But BLS transfers are rarely late or handled by an ALS unit. It works for us.
 
DEmedic brings up a good point that I forgot to mention.

Having an IFT contract with local hospitals is a good way to secure revenue as they have a high reimbursement rate and can take some of the financial strain off the 911 provider.
 
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