IFT paramedics

[ParamedicStudent]

How is working IFT ALS like? Is it just like IFT BLS but with ALS equiptment? Such as lines, meds, monitoring? Do IFT medics respond to emergencies? Code 2/Code 3?

I heard stories of IFT medics losing a big chuck of their knowledge due to not practicing paramedicine to their highest potential. Woudnt this not be the case since they're working as a medic everyday?

 

[SunshineCamo]

If you're transporting from a hospital to another location you may have patients who need cardiac monitoring, have medications running, or otherwise require ALS intervention. This isn't even getting into CCT or ventilator transports which are a different level all together.

If you're transporting to a hospital, you can be called upon to use all the ALS level skills. Lines, meds, monitor etc etc. Most of the time these are fairly uneventful calls that ALS is more a precaution than anything. You do however occasionally see serious calls that need rapid transport. They aren't the norm (at least from my experience) but you do see them. Personally I think the thing IFT Medics lose the most is trauma skills. I can't really think of a time doing IFT that I had to do more than simple bandaging.

 

[Akulahawk]

How is working IFT ALS like? Is it just like IFT BLS but with ALS equiptment? Such as lines, meds, monitoring? Do IFT medics respond to emergencies? Code 2/Code 3?

I heard stories of IFT medics losing a big chuck of their knowledge due to not practicing paramedicine to their highest potential. Woudnt this not be the case since they're working as a medic everyday?

Doing IFT is a different beast than doing "traditional" EMS. You get more patients that are often much more sick than you'd get in 911, but the patients are often a bit more sorted out. You know their problem(s). You have time to dig into their H&P. You have time to converse with the patient's nurses at the sending location. They can often tell you how the patient is responding to the various drips. In short, IFT patients can be much more complex than you might otherwise think.

Yes, it's often true that an IFT medic loses a lot of the refinement of trauma skills, and a lot of the speed... but the IFT medic is quite often a thinking Paramedic because they've got their head well into the pathophys game of what's going wrong with this patient and how can I stop the train wreck from happening while this patient is with me right now. They're constantly looking for subtle signs that the patient is about to crump and may actually pick up on that long before it shows up definitively on a monitor. The really good IFT medics are going to be thinking well outside the protocol box for how to best care for their patient because it's quite likely their patient doesn't fit any protocols.

Most of the time, much like doing 911, it's just boring...

 

[SeeNoMore]

IFT is a diverse world.

By in large, a lot of ALS IFT is somewhat routine but even at private services you get the occasional pt which requires some management. A good example might be a STEMI going to a cath lab (possibly s/p ROSC) or a Trauma Transport.

I don't know what practicing paramedicine to it's highest potential means, but certainly ALS interfacility work does little good for maintaining psychomotor skills like IV insertion and intubation. You will likely gain at least some rudimentary knowledge of care beyond an emergency response time frame and learn to use pumps w/ whatever meds are allowed by your state/service. Most ALS Transport services don't routinely respond to emergencies but there are also systems which have units which do both. Often these are RN/Medic and can fill both an ALS and SCTU role.

Critical Care Transport as part of a Ground/Flight Team where you take care of very acute patients and have practice under a mixture of your judgement and broad guidelines/protocols is a very different matter. Even then, unless you take scene calls regularly you may still lose a degree of comfort with the average 911 call. This is why I supplement my full time job with a per diem Medic gig.

 

[Fire19Medic]

How is working IFT ALS like? Is it just like IFT BLS but with ALS equiptment? Such as lines, meds, monitoring? Do IFT medics respond to emergencies? Code 2/Code 3?

I heard stories of IFT medics losing a big chuck of their knowledge due to not practicing paramedicine to their highest potential. Woudnt this not be the case since they're working as a medic everyday?

I'm a FF/Medic but work IFT as a part time gig. I have to say it has been helpful to me as a medic and furthering my education. I've learned a lot about different lab values and how they affect the body, learned more about pathophysiology and different treatments and care for a variety of injuries and illnesses. I enjoy it, it is kind of a break from the fast paced 911 world and I can almost "relax" in a sense because the patients are typically stable.

 

[18G]

I have worked as an IFT paramedic for the past five years. I can honestly say that I've learned more doing IFT than I ever did 911 in the same amount of time. I work for a service that does critical care transport so I am called to manage some really sick patients (i.e. multiple vasopressors, vented, etc). If you really want to be a healthcare provider then IFT is where its at. I have done more pharmacologically speaking than you ever will as a 911 provider. As for psychomotor skills, I definitely get my fair share of IV insertions. There is nothing like getting a vented patient with a single 20g peripheral IV so I pop in a second line quite often. And we get called to the Urgent Care my hospital owns to take patients to the ED so they get the full workup with IV, meds, 12-lead, blood draw, etc. And we get called to nursing homes for everything from sepsis to chest pain to abd pain. I've done EJs working IFT. Intubation skills take a hit because our patients are already intubated but if you work 911 part time somewhere you can make up for that.

The benefit of working IFT is knowing your patients diagnosis and being able to correlate it to what you see in front of you. You will learn labs like the back of your hand. IFT is a great environment for learning to be a clinician. I would never say your knowledge base takes a hit. In fact, I would say the opposite. You will grow your knowledge base tremendously especially if you're working for a company that does critical care transport and doesn't rely on a nurse.

With all of that said though I definitely recommend getting some solid 911 experience. 911 and IFT are completely different worlds. I feel that working as an IFT provider has made me a better pre-hospital provider. This has been my experience, others may be drastically different.

 

[nater]

I agree with the others and don't have anything else to add. Working critical care transports has greatly increased my clinical knowledge and I am able to apply that when I work on scenes as well.

On the ground, skills like intubations and IVs can be more difficult because there is usually a reason they were not done if they were needed. Sometimes, we are behind a little because other attempts have been made and failed.

Just like on the streets, it is important to keep your brain and skills sharp. We can always assist in the ER during downtime which helps stay up on intubations, chest tubes and IVs. We also make good use of OR or ICU rounds and simulation labs.

 

[johnrsemt]

I started more IV's working IFT than I did 911 (even taking into consideration that I worked FT+++ IFT, and 24-36 hours a week 911).
I intubated about the same amount.
1 of 2 crichs that I did was IFT, and the 911 crich had 4 medics on scene.
Needle decompressed more with 911.
Narcan admins was about the same.
Most med pushes was more IFT.
More critical patients IFT

 

[ParamedicStudent]

I have a question thats non-related. If you were to run a trauma call, but figured that it was a medical that caused the trauma, do you go to a trauma center or an appropriate facility (cva, MI, )

 

[RocketMedic]

I have a question thats non-related. If you were to run a trauma call, but figured that it was a medical that caused the trauma, do you go to a trauma center or an appropriate facility (cva, MI, )

Most trauma centers are also more than capable of handling these complaints, but on the off chance that they're not, it's a circumstantial event. Dude stroking out looked funny at a gangster and got popped in the chest? I'd probably go to the stroke center if he was stable-ish. Trucker having a STEMI passes out, wrecks and breaks an ankle? Cath lab.

 

[ParamedicStudent]

Also, lets say you go on a scene call. And you determine that the pt is unstable. Do you load and go, or call for "911" ALS? My logic is that they can do everything you do, and vice versa, just a matter of having the same equipment. On the opposite hand, do hospitals get mad if they have a pt that is not brought in my county? Like why did this IFT medic unit brought in this pt when they should of gave it to county? Also on that note, what about code 3 returns? Can IFT medics return code 3 without needing to contact county dispatch?

 

[TransportJockey]

Depends. On location mainly.

 

[STXmedic]

It should also be noted that, while what the previous posters have mentioned about IFT critical patients and the care they get to provide can be accurate, it is highly dependent on your system.

The good IFT agencies are as described, and I can agree with what's been said. I had far sicker patients more frequently doing IFT than I do with 911.

At the ****ty services, you're basically just a taxi and will rarely so much as give a med. Unfortunately, there are far more ****ty services than good ones. Do your research before you apply- and if you get stuck at a ****ty service as your first gig, know that the grass can be greener elsewhere and do what you have to to get to one of the good services.

 

[nater]

1. We rarely make scene calls. When we do, it is usually a mutual aid call or an intercept request. If we were to witness an accident, I will provide care and attempt to contact the local agency as well. We would probably need at least PD and Fire on scene anyway. I don't want to jump a call or delay care. If the patient is unstable, I would load and go and advise dispatch of the situation. A phone call to the area agency after dropping off the patient would be appropriate to exlplain a unique situation.

2. I have never known a hospital in our area to get upset about which crew brought a patient in as long as appropriate care was provided. I have heard some question BLS providers why ALS was not called, but there could be plenty of good reasons for that.

3. We can run lights and sirens when it is appropriate without calling anyone. It is a decision we make between the three of us crew members. Typically we only use them when our patient will receive immediate intervention such as the cath lab, IR for a stroke or trauma surgery.