holding the wall

[Fish]

And I would argue IFT medics and emts are more qualified to deal with nursing home patients emergencies anyway as they are more familiar and comfortable with the chronic disease processes and equipment you will run into at the nursing homes. Just like 911 medics are more qualified for trauma (i will freely and unabashadly admit I suck at trauma beyond stuff like hip fractures because we don't get those calls)

I disagree, the inner workings of a nursing home are not complex enough for us to not be as familiar because we do not go there10 times a day like an IFT. We do however run 911 calls to nursing homes all the time, 911 units get more Medical than they do Trauma. Trauma is a boring easy call, how can you be bad at a Trauma call? Medical is complex, but Medical is what we mostly get and there is no way an IFT service is more qaulified for patients with multiple Chronic issues than a 911 service is. Hearing that makes me think you may not have much experience in 911, not saying that to be rude.

 

[Fish]

I've been diverted from a hospital once due to a full ER. The rest of the time we go straight to a room. When I was in Maryland it wasn't uncommon to wait 20-30 min at the bigger hospitals.

I usually call a head to try and give the ER enough time to get a bed together. When I arrive at some of the hospitals around here they already have a room assignment when we pull up.

I have been diverted with a CPR in progress. The ER had two patients on Cath tables already and one in the ER waiting.

 

[Sasha]

I disagree, the inner workings of a nursing home are not complex enough for us to not be as familiar because we do not go there10 times a day like an IFT. We do however run 911 calls to nursing homes all the time, 911 units get more Medical than they do Trauma. Trauma is a boring easy call, how can you be bad at a Trauma call? Medical is complex, but Medical is what we mostly get and there is no way an IFT service is more qaulified for patients with multiple Chronic issues than a 911 service is. Hearing that makes me think you may not have much experience in 911, not saying that to be rude.

I am not talking about inner workings I am talking about equipment and precautions the patients will be on. I would say I am more comfortable around vents, trachs, medication pumps, pleurX drains, fistulas etc then the average 911 medic. I am also more familiar with stuff like the effects of dialysis and what to expect from patients with certain chronic illnesses. I am also probably more familiar with lab values than the average 911 medic.

I am also probably more familiar with the patient because there is a good chance I've transported them before.

So yes, I would say that I am better suited to deal with nursing home patient emergencies than a 911 medic.

I have freely admitted most of my experience is in IFT.

 

[DrParasite]

Doesn't matter what you tell a nursing home they likely aren't going to call 911. Even if our call taker is strongly urging them (due to contracts we can't refuse an immediate response transport and tell them to call 911) to reconsider considering our eta is xx minutes based on the complaint

They can call another IFT company, violate their contract and still wait for txp.

that might be how it is, but it's stupid, and not being done in the best interests of the patient. I know some of the reasons they do it, and doing what's best for the patient isn't on the list.

You know people who do 3 emergent transports every shift? Nice. I know 911 medics who do nothing but neck pain, stuffy noses, tummy aches and broken toes with the occasional legitimately emergent call. I know 911 medics who will go three shifts without turning a wheel.

damn 3 shifts without turning a wheel? that gets boring, really boring.

and if you, as a paramedic, are dealing with "neck pain, stuffy noses, tummy aches and broken toes with the occasional legitimately emergent call" that I questions how good of a paramedic you can be, if you mostly deal with BS, so you don't see sick patients. and if you don't see sick patients, you don't get to use any of your advance skills, and your assessment skills degrade.

I know some paramedics that will intubate 4 people a month. how many intubations did you do last year? how many needle decompression? 2 is a lot of a 911 provider, have you ever done one? how many children have you assisted in the delivery of? how many times last year did you do CPR? any CPR saves?

Are there 911 medics that intubate 1 person a year (hello California!!!), never done a decompression, have never assisted in the delivery of a baby, and have never done CPR? sure. but they probably aren't the greatest when it comes to their ALS skills on actual calls.

And I would argue IFT medics and emts are more qualified to deal with nursing home patients emergencies anyway as they are more familiar and comfortable with the chronic disease processes and equipment you will run into at the nursing homes.

you could argue that, but you would be wrong.

IFT medics might be more qualified to deal with STABLE nursing home patients, but a 911 medic will be the expert in acute medical emergencies. and this might shock you, but not all old people live in nursing homes, and an old person with diff breathing in a private residence should be treated the same as an old person in a SNF.

Not only that, but nursing homes call 911 services too. Sometimes for BS, but we go for cardiac arrests, diff breathing and chest pains all the time. maybe not by you, but by places that realize the patient needs an ambulance NOW, not in 30 minutes one the truck gets there.

Plus, even in the big cities, a paramedic will see more serious medical calls than major trauma. every day. You ask any 911 medic, they will tell you.

"Oh you're here! We were just going to call you guys to take bed 17 here's the paperwork let's get him moved over."
"uhm... First we have to get rid of the patient currently on the stretcher...."
"Oh... You can put him in bed 17 as soon as you take that guy."

yep, that's a problem. it's cause an idiot nurse

Also I would imagine that most major cities have mutual aid contracts with the private companies in the city.

I think you would be wrong. it is a city's responsibility to handle it's call volume, using city resources. if the city is constantly taking rollover 911 calls, than it gives the city no incentive to properly staff appropriately to handle the call volume (why properly pay my own people to do the job when i can just dish the overflow to a private that pays it's people peanuts). Look at cities in NJ (Trenton, Newark, Paterson, Woodbridge, etc), NYC (they don't call anyone outside of the FDNY system, which includes the voluntary hospitals), Philly, DC, PG County MD, none of them use a private system to pick up the slack. Are there cities that do this? maybe, but I am not aware of any in the midatlantic or northeast states.

Almost every private will take roll over 911 calls if they have a unit available since they stand a better chance of making money by taking the call then just having the truck parked. Our contract is no obligation, if we don't have a unit available we don't get penalized, if we do we make money (sometimes).

maybe by you, but by me, the privates are all about making money, and that's why they do IFTs, because it's guaranteed money, and guaranteed pay for services. 911 isn't a guaranteed money, so many places don't want to get involved in it.

 

[DesertMedic66]

It all depends on how your IFT service is set up. I'm doing IFT right now (for the past 10 months) and I haven't learned anything that I wasn't taught in EMT school except that the sound of deep suction on trach patients makes me gag. Vents? Nope, never used one we just bag them to where ever they are going. Lab values? Nope, doesn't concern me in transports. Their WBC may be elevated but that's not going to change how I treat the patient. Progression of diseases? Nope, the only thing I know is that everyone dies. Most of how a disease progresses is long term issues not the 2mins-2hours I'm with a patient.

I don't mean to offend anyone. This is just my personal experience on IFTs. The only good thing about IFTs for me is it got me knowing the area and hospitals better and got better at taking vital signs. 911 is personally where I believe learning new and more things comes into the picture. But that's just me.

 

[Sasha]

It all depends on how your IFT service is set up. I'm doing IFT right now (for the past 10 months) and I haven't learned anything that I wasn't taught in EMT school except that the sound of deep suction on trach patients makes me gag. Vents? Nope, never used one we just bag them to where ever they are going. Lab values? Nope, doesn't concern me in transports. Their WBC may be elevated but that's not going to change how I treat the patient. Progression of diseases? Nope, the only thing I know is that everyone dies. Most of how a disease progresses is long term issues not the 2mins-2hours I'm with a patient.

I don't mean to offend anyone. This is just my personal experience on IFTs. The only good thing about IFTs for me is it got me knowing the area and hospitals better and got better at taking vital signs. 911 is personally where I believe learning new and more things comes into the picture. But that's just me.

Then you are seriously wasting your experience there.

I love IFT. I learn something new every single day there.

 

[DesertMedic66]

Then you are seriously wasting your experience there.

I love IFT. I learn something new every single day there.

Yeah tell me about it. But I'm soon to get moved up to 911 ALS full time. I keep my skills up by picking up a ton of overtime 911 ALS shifts and being a skills instructor.

 

[Fish]

I am not talking about inner workings I am talking about equipment and precautions the patients will be on. I would say I am more comfortable around vents, trachs, medication pumps, pleurX drains, fistulas etc then the average 911 medic. I am also more familiar with stuff like the effects of dialysis and what to expect from patients with certain chronic illnesses. I am also probably more familiar with lab values than the average 911 medic.

So yes, I would say that I am better suited to deal with nursing home patient emergencies than a 911 medic.

I have freely admitted most of my experience is in IFT.

This Leads me to believe you know or are surrounded by low grade Paramedics, because still I disagree(everything you mentioned I know, and so do the 911 service Medics I know) I would argue only someone who has received training and Cetification in Critcal Care knows those things better than an Average 911 Medic. Doctors offices, nursing homes, Reverse Code STEMI/Stroke/Trauma/Sepsis patients from ERs are calls we frequently run even as a 911 Service.

 

[Joe]

I know some paramedics that will intubate 4 people a month. how many intubations did you do last year? how many needle decompression? 2 is a lot of a 911 provider, have you ever done one? how many children have you assisted in the delivery of? how many times last year did you do CPR? any CPR saves?

.

and how many of these have you done??

 

[katgrl2003]

how many times last year did you do CPR? any CPR saves?

In one month at an IFT service, I had 3 codes, with 1 save, which is more than I have had at my 911 job.

 

[socalmedic]

Ever been to Presbyterian Intercommunity Hospital (PIH) in Whittier? 3 hours.

I am going to say that St. Frances in Lynwood is worse. when they closed King Drew (killer king) wait times where regularly 1-2 hours with 3-4 other ambulances. longest wait I had was there, 12 hours and 15 minutes, we did shift change at the hospital... they where there another 2 hours after I went home. other LA area hospitals Centinella/freeman 4 hours, gardena memorial 3 hours.

 

[DrParasite]

and how many of these have you done??

I'm a lowly basic, so they don't let me intubate. Same with needle decompressions, if I were to do that, my clinical coordinator would want a word with me.

delivered 4.5 kids, and I say 4.5, because we helped deliver 4 kids in the field, and on the last one, we were smart enough to move fast enough that she delivered no more than 30 seconds after we transferred her to the L&D bed. Usually we work quick enough to make sure they deliver on scene or in the hospital, with the latter being the preferred method.

As for me doing CPR, before I transferred to the dispatch side of the job full time, I was probably averaging between 6 and 12 times a year. in my career, I think I have 3 saves, 1 of which was a straight ACLS save (praise be the paramedics). Most old people just don't make it, no matter what you do.

There is one guy who I work with, who in 7 years here, has delivered something like 23 babies as an EMT.

Kat, if you have done CPR 3 times in a month, and saved 1, I say congrats. Most IFT people I know have done CPR, but rarely have any saves.

 

[usalsfyre]

It's highly dependent on the service and location what kind of calls you will see in a 911 vs IFT setting. My last job was a 911/IFT provider. In the areas we only did IFT you were likely to only do the discharge/dialysis derby. There's also significant logistical challenges that you often don't run into in IFT. My current job is IFT only. I see more sick patients a shift than I did doing 911, and I don't count CCT in that number, only "urgent" calls from a facility. I end up performing advanced interventions on about 90% of the calls I run.

The same goes for providers. I wouldn't trust the majority of local big-city FD "paramedics" to treat my worst enemies dying dog. I've seen too much of the back-end of their handiwork. Meanwhile, there's medics who have only done IFT I would trust with just about anything.

Getting into a p!ssing match over what type of medic is stupid and counterproductive. Everyone needs to understand each job has unique challenges.

 

[Veneficus]

It's highly dependent on the service and location what kind of calls you will see in a 911 vs IFT setting. My last job was a 911/IFT provider. In the areas we only did IFT you were likely to only do the discharge/dialysis derby. There's also significant logistical challenges that you often don't run into in IFT. My current job is IFT only. I see more sick patients a shift than I did doing 911, and I don't count CCT in that number, only "urgent" calls from a facility. I end up performing advanced interventions on about 90% of the calls I run.

The same goes for providers. I wouldn't trust the majority of local big-city FD "paramedics" to treat my worst enemies dying dog. I've seen too much of the back-end of their handiwork. Meanwhile, there's medics who have only done IFT I would trust with just about anything.

Getting into a p!ssing match over what type of medic is stupid and counterproductive. Everyone needs to understand each job has unique challenges.

Right on point.

If I could just add something?

A paramedic in the US has always been a healthcare bandaid. First it was for emergency response, later for IFT, still later for things like industrial/wilderness medicine. It seems everytime there is need of a provider, the paramedic gets thrust into that role.

Very good for employment opportunities but unfortunately does nothing to denote the quality/scope you can expect.

From my own observations, US paramedics are generally like European Physicians. There are great ones and rather questionable ones, but there is no mean or median. Specialty or environment has no bearing at all.

 

[Tigger]

I think you would be wrong. it is a city's responsibility to handle it's call volume, using city resources. if the city is constantly taking rollover 911 calls, than it gives the city no incentive to properly staff appropriately to handle the call volume (why properly pay my own people to do the job when i can just dish the overflow to a private that pays it's people peanuts). Look at cities in NJ (Trenton, Newark, Paterson, Woodbridge, etc), NYC (they don't call anyone outside of the FDNY system, which includes the voluntary hospitals), Philly, DC, PG County MD, none of them use a private system to pick up the slack. Are there cities that do this? maybe, but I am not aware of any in the midatlantic or northeast states.

Well let's see I work in such a system in the city of Boston. So I would say it exists. It's a very similar system to NYC from what I gather, we don't have hospital based EMS here we have private companies. If FDNY runs out of ambulances or has an extended eta they give the call to a voluntary provider right? That's what's done in Boston too.

 

[JPINFV]

Well let's see I work in such a system in the city of Boston. So I would say it exists. It's a very similar system to NYC from what I gather, we don't have hospital based EMS here we have private companies. If FDNY runs out of ambulances or has an extended eta they give the call to a voluntary provider right? That's what's done in Boston too.

Yep, furthermore, I'd argue that giving NYC's system a pass is disingenuous. Either the 911 provider can provide the service needed, or they can't. Why is it OK when the primary 911 provider in NYC goes outside of FDNY, but not elsewhere?

More importantly, what sort of disservice is a primary 911 provider doing to their citizens when they say, "Out sandbox. Only we can play here, even if we can't provide enough ambulances to cover the call volume."

 

[Veneficus]

Yep, furthermore, I'd argue that giving NYC's system a pass is disingenuous. Either the 911 provider can provide the service needed, or they can't. Why is it OK when the primary 911 provider in NYC goes outside of FDNY, but not elsewhere?

More importantly, what sort of disservice is a primary 911 provider doing to their citizens when they say, "Out sandbox. Only we can play here, even if we can't provide enough ambulances to cover the call volume."

Have you ever seen the movie "gangs of New York" ?

thought that was fiction did you?

 

[JPINFV]

Have you ever seen the movie "gangs of New York" ?

thought that was fiction did you?

No... I just assumed that NYC had advanced since then.

 

[Veneficus]

No... I just assumed that NYC had advanced since then.

How long have you been involved in medicine?

Surely long enough to know if you give humans the benefit of the doubt, they will fall well short everytime?

:sad:

People who think they are right or the best have no reason to change.

 

[mycrofft]

Hey, OP, still there?