IFT, what do you think?

[eynonqrs]

For private services IFT's are the bread and butter.

IFT's are the bottom line for private services. My services provides 911, IFT, Wheelchair services. I would say that transports makes up a good 75% of our volume. Private services can not just rely on 911's anymore. Even many moons ago when paramedics were hospital based in my area, and the City of Scranton ran 911 only ambulances, they were dumped because they were big money losers for them. IFT's are not all payers either. Believe me, I need to ask questions to the nth degree when asking why the pt needs an ambulance, make sure all the paperwork is there, etc.. It is a royal pain. I don't know if anyone has heard of a stretcher van. It was a cross between an ambulance and a wheelchair van. It was designed to do ift's for pt's that did not require an ambulance, but could not tolerate a wheelchair. It was a very complicated process, insurance companies would not pay for such a service, and actually in some areas were banned all together. I am curious to ask if anyone out there has provided such a service.

 

[DarkStarr]

we have provided a 'stretcher van' service at one point for one of our members who needed transported to 2 doctors appointments. we dont normally do transports or IFTs.

 

[exodus]

Our company has recently partnered with another company who offers 24 hour stretcher and w/c service for those who need it Including ER discharge.

 

[46Young]

Having done both a fair amount of 911 and IFT, I'll say that the IFT medic needs to know everything a 911 medic knows, and much more. The problem is, that the pure IFT medic/EMT don't have any exposure to ahistoric events. As mentioned earlier, in IFT we can be txp'ing the perinatal on a mag drip, and may in fact need that OB kit. I've had to board and collar a floor to floor transfer on the receiving MD's request on several occasions, as well as apply various splints, including traction, for the same type of txp. Any and all 911 EMT/medic skill sets and capabilities are fair game in IFT.

The IFT people need more training on pumps, vents, billing, EMTALA and such, as well as concentration on the vast array of meds past the typical 30 or so seen in 911. Most pure 911 medics have no idea what a proper loading dose of heparin by the sending facility should be, what to do if the propofol infusion bottoms out the pt, and how to address that without them becoming conscious enough to self-extubate, they have no idea what a typical range for a tridil drip is. Most vent lectures are woefully inadequate.

There is another issue with IFT. There are many subspecialties within the field (NICU, PICU, CCU, etc). Nurses specialize in each of these areas. I feel that the range of IFT is too broad to leave to medics. IFT ought to belong to RN's, who send the appropriate specialist, or a whole team for each pt, as the case may be. I feel that anything past discharges and routine txps ought to be handled by nurses with concentrated education and experience appropriate for that pt's condition. If nurses, whose education is more geared toward the in-hospital setting, need to specialize in order to do ground txp, then expecting a medic to be able to do it all is unrealistic.

Be that as it may, I feel that I had the best of both worlds at my old hospital. Several hospitals in NYC do both 911 and IFT. You can work a few shifts per week in 911, and a couple in IFT as well. I feel it's more desireable than working a shift that can do either, as call volume demands. The conflict of interest with that type of arrangement has been discussed in other threads. You get your 911 experience, and also see the in-hospital side of things. Those you work with have the same experiences and mindset. You work enough 911 to keep you motivated, and get a mental break by doing the mundane IFT's, as well as a change of pace with the not so infrequent train wrecks, such as the post-arrest STEMI txp, the vented/sedated neurosurgery txp, the baloon pump job, multi trauma x-fer, etc.