Hello, I am about to start work as BLS Transport, first job...fresh out of EMT school. In class we always practiced our assessments as if we were arriving to a 911 call, never practiced as if we were going to a scheduled BLS transport. My question is, what does everyone do differently, if anything, when doing a pt. assessment on a BLS transport compared to 911 call? I just want an idea mostly on how I would begin my pt. contact on a BLS transport. Should I still arrive at the pt. and say something to the like of "Hello, I am a EMT, what is the problem today?" and go right into a rapid assessment or SAMPLE...even though I would already have a good idea why we are there for transport.....sorry if that does not make any sense.
IFT Patient Assessment?
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rmabrey
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Usually I do a quick assessment to make sure they meet medical necessity and someone didn't lie on a PCS. Other then that I have paperwork from the hospital to tell me what I need to know as far as Hx, medications, allergies etc. etc. If they are alert I just make small talk while I do my paperwork and ask questions as needed.
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I don't know about a "rapid assessment"... You're in no hurry. Just go talk to 'em. Introduce yourself, tell them/confirm where you're taking them. Find out why they're going. See if they have any complaints, and look for anything out of the norm (shunts, foleys, PICCs, amputations, etc). You can confirm most of what you're told from paperwork, the nurse, or family (especially if they can't verbalize themselves)
As rmabrey said... you're going to get a lot of your patient's PMH, Meds and allergies, as well as billing and demographic information from paperwork-- either from the patient's SNF file, dialysis paperwork, hospital charts, etc. You should always be doing an initial (primary) assessment on your patients, asking or determining whether any think's different from the baseline, and asking your pertinent negative questions in some form or another.
IFT calls are generally slower pace, but not necessarily lower acuity. You are likely to be transporting complex medical patients, some barely stable, and being transported to receive treatment they need to stay alive. You can learn an enormous ammount by reading up on some of your patient's conditions, asking questions of doctors and nurses, and talking to patients.
Good Luck!
IFT calls are generally slower pace, but not necessarily lower acuity. You are likely to be transporting complex medical patients, some barely stable, and being transported to receive treatment they need to stay alive. You can learn an enormous ammount by reading up on some of your patient's conditions, asking questions of doctors and nurses, and talking to patients.
Good Luck!
saskgirl
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I agree with PoeticInjustice, introduce yourself and your partner, ask where they are going and ask why they are going (I've had tons of pts that have no clue why they are being transferred).
I work in a service that does both emerg calls and IFTs and I find that the IFTs are where you get to improve on your pt interaction skills.
I work in a service that does both emerg calls and IFTs and I find that the IFTs are where you get to improve on your pt interaction skills.
FourLoko
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Not a bad noobie question, shows how skewed the EMT-B training is and I experienced similar. Hospital discharges are where you'll see more variety of diagnosis. Then again, after a while, you'll think everyone in the world has HTN. Your particular company will have a range of vitals that are ok to transport. Whether or not they actually tell you that range is a mystery and eventually you'll start ignoring it. Again, everyone in the world has HTN.
A simple, how are you doing or how are you feeling is a good start. Then I usually ask "Are you ready do get out of here?" Sometimes you'll get no answer other time the patient will start throwing of covers eager to jump outta the bed.
Ask about any new or different pain they might be feeling, any shortness of breath, make sure they aren't bleeding or leaking anything. Then as mentioned look around for fun things like foley caths, heplocks, bandages and such.
The fun part is when you tell the PT where you'll be taking them and they actually recognize it and HATE it and you get the banshee screams "I DON'T WANT TO GO THERE, DON'T TAKE ME THERE!!!"
A simple, how are you doing or how are you feeling is a good start. Then I usually ask "Are you ready do get out of here?" Sometimes you'll get no answer other time the patient will start throwing of covers eager to jump outta the bed.
Ask about any new or different pain they might be feeling, any shortness of breath, make sure they aren't bleeding or leaking anything. Then as mentioned look around for fun things like foley caths, heplocks, bandages and such.
The fun part is when you tell the PT where you'll be taking them and they actually recognize it and HATE it and you get the banshee screams "I DON'T WANT TO GO THERE, DON'T TAKE ME THERE!!!"
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Underoath87
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SAMPLE is generally useless for IFT.
The trick is just getting your routine down and learning what forms you need for which situations. IFT involves getting a lot of MANDATORY signatures and paperwork that they don't teach you about in EMT class.
Whatever you do, don't rush into the pt's room and ask why they called and what their emergency is, because they most likely didn't call and you will scare and confuse them.
The only time you may run into an emergency is if your pt starts crashing during transport or if a nursing home calls you when they should have called 911 (and this pt will almost always be altered, so you won't gain much by asking them questions anyway).
Oh, and they'll most likely have you ride along with an FTO (training officer) and his/her partner for your first few days, so just watch what they do and make sure you ask questions.
The trick is just getting your routine down and learning what forms you need for which situations. IFT involves getting a lot of MANDATORY signatures and paperwork that they don't teach you about in EMT class.
Whatever you do, don't rush into the pt's room and ask why they called and what their emergency is, because they most likely didn't call and you will scare and confuse them.
The only time you may run into an emergency is if your pt starts crashing during transport or if a nursing home calls you when they should have called 911 (and this pt will almost always be altered, so you won't gain much by asking them questions anyway).
Oh, and they'll most likely have you ride along with an FTO (training officer) and his/her partner for your first few days, so just watch what they do and make sure you ask questions.
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How is SAMPLE useless on IFT's? I did them for 10 years and used it with every patient
S=Signs/Symtpoms: "how do you feel? do you hurt anywhere" (Symptoms). Do I see anything wrong (Signs)
A=Allergies: get it from paperwork, but check with patients: surprising how many times the patient states different than paperwork.
M=Medications: Paperwork usually
P=Pertintent (sp?) medical history: "why are you going to doctor/ hospital?". "what is wrong today; and basic hx off of paperwork
L=Last intake (Not just oral; feeding tubes and IV's).
E=Events leading up to today or this transport.
If you do this with all of your patients; it helps when you do the 911 patient or the true emergency IFT.
S=Signs/Symtpoms: "how do you feel? do you hurt anywhere" (Symptoms). Do I see anything wrong (Signs)
A=Allergies: get it from paperwork, but check with patients: surprising how many times the patient states different than paperwork.
M=Medications: Paperwork usually
P=Pertintent (sp?) medical history: "why are you going to doctor/ hospital?". "what is wrong today; and basic hx off of paperwork
L=Last intake (Not just oral; feeding tubes and IV's).
E=Events leading up to today or this transport.
If you do this with all of your patients; it helps when you do the 911 patient or the true emergency IFT.
mycrofft
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SAMPLE is good but just cool the urgency bit.
Why not certify transport technicians as a separate category? Or add one day to EMT-B about IFT's, their needs as patients and people, the generic admin picture?
And I NEVER recommend adding another layer of EMT-XYZ.
Why not certify transport technicians as a separate category? Or add one day to EMT-B about IFT's, their needs as patients and people, the generic admin picture?
And I NEVER recommend adding another layer of EMT-XYZ.
I think transport tech needs to be separate.
The purpose of an educational curriculum is to prepare people for the employment environment.
Most EMT’s now find themselves in IFT. Everything from the mnemonics to the focus on acute emergencies in patients with multiple coexisting pathologies is still based on an idea that the most common need for EMTs is for the victim of a car accident.
I think a nurse would be much more suited to the IFT environment than an EMT.
Will that cut into IFT company profits? Absolutely.
But it is also my opinion that IFT should not generate a bill at the BLS or ALS rate unless that knowledge and skill is specifically needed for the patient.
I have been around long enough to know that most IFT bills for service are trumped up to make it through the medicare/medicade pay system.
A very few companies and people have been prosecuted for fraud, but even the most reputable agencies I worked for that did IFT, set up their trip sheets to make patients look sicker than they actually were on paper.
The current reimbursement for BLS and non-emergent IFT is nothing less than waste and abuse of tax dollars.
Thriceknight
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Your FTO will show your the ropes and what the company expects. Other than that all the other advice is spot on. I was the same way. Only thing taught was 911 no mention of IFT. But basically: General impression,Any new pain?,get YOUR OWN SET OF VITALS before u decide to transport and check the chart for trending. Then get your paper and signatures and be on your way.
If your company is upstanding enough to have an FTO.
Many IFT companies give you a week or two ride with somebody who has been in the company long enough to know how to fill out the paperwork.
No coaching, no mentioring, etc on anything but making sure the documentation says the magic words to get the bill through without audit or denial.
"Hi, I'm (blank) we're here to break you out of here. We're going to take you to SNF/Renal Clinic/MDs Office/Level 1 for rehab/dialysis/get those scabs looked at/Have your heart replaced. How are you feeling? Did they tell you you were leaving? Did the staff take out your IV/give you your pain meds/pack your teeth? The PCS says you can't stand, please stop dancing. Ok, let's go!"
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jjesusfreak01
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Difficult to read this with a straight face...the day I see an honest PCS is the day pigs will rise from the dead and fly out of the bbq pits.