IFT where you had to do an intervention

[rhan101277]

I was just curious how many of you have had an IFT where you had to do something for the patient. I am not talking about taking vitals or reviewing cardiac monitor etc. An IFT, where you had to push a med or do some ALS procedure.

 

[abckidsmom]

I've done critical care IFTs with patients with drips that needed monitoring and titrating. Also have administered pain meds on IFTs, and monitored vented patients.

Is that what you mean?

 

[rhan101277]

I've done critical care IFTs with patients with drips that needed monitoring and titrating. Also have administered pain meds on IFTs, and monitored vented patients.

Is that what you mean?

What about starting new drips or adjusting vent settings?

 

[JPINFV]

I've had penty of IFTs (RN, RT, or both) where settings were changed. It occured most often with RT transports since patients don't always tolerate the transport vent (my first company used Newport HT50s), which required the RT to fine tune the settings.

 

[abckidsmom]

What about starting new drips or adjusting vent settings?

No, the CCT IFTs were mostly people who were relatively stable for transport. The couple that were on any vasoactive drips were just on dopamine or maybe dobutamine or amrinone. I wouldn't necessarily titrate all of them in the ambulance with limited hemodynamic monitoring, but if there were pressure issues, I may have bumped up the pressors if necessary.

I don't remember any of the tranport vents we worked with having the capability of setting much more than the rate, a little peep, and the fiO2...if the patient desatted, we manually ventilated for a little bit, and then tried again.

All of our CCT runs were under an hour transport time. I guess there would have been more possibility for interventions in a longer transport.

 

[jjesusfreak01]

I was just curious how many of you have had an IFT where you had to do something for the patient. I am not talking about taking vitals or reviewing cardiac monitor etc. An IFT, where you had to push a med or do some ALS procedure.

You say you are a medic, so the posters are correct in assuming you are asking about CCT transports gone bad, not EMT level IFTs?

 

[rhan101277]

You say you are a medic, so the posters are correct in assuming you are asking about CCT transports gone bad, not EMT level IFTs?

Yeah that is correct. I know this also may seem like a dumb question. What if you believe they are not stable enough to transport. Do you call med control and get permission to not transport?

I am a fresh new medic and I know the IFT's we take are ill, but there is only so much you can do for them in the back of an ambulance.

 

[abckidsmom]

Yeah that is correct. I know this also may seem like a dumb question. What if you believe they are not stable enough to transport. Do you call med control and get permission to not transport?

I am a fresh new medic and I know the IFT's we take are ill, but there is only so much you can do for them in the back of an ambulance.

Depends on the reason for transport. When I worked in our area's level 1 trauma center, we recieved a ton of patients into the STICU whose cases were so complicated that they really needed to be OUT of the community hospitals they had come from. So the risk/benefit analysis comes into play: is it worth the risk to the critically ill patient to be in the ambulance for 45 minutes in order to recieve the medical care they need?

I would certainly clarify with the sending physician any orders that needed to be made, any special drugs that needed to be sent (there were a list of meds we could bring with us for that patient only, with written transfer orders), and make sure that there's an extra crew member if needed.

We didn't always have a nurse or RRT ride with us, but sometimes they did, and always if we were using their vent. Mostly, we worked hard at packing up the patient and getting everything labeled and just right, and then drove them to the other hospital, writing down vital signs on the way.

 

[JPINFV]

Yeah that is correct. I know this also may seem like a dumb question. What if you believe they are not stable enough to transport. Do you call med control and get permission to not transport?

I am a fresh new medic and I know the IFT's we take are ill, but there is only so much you can do for them in the back of an ambulance.

1. Why would you need medical control to tell you if a patient requires care beyond your ability?

2. As mentioned earlier, if the patient isn't stable, does it make sense to keep the patient at a facility that can not stabilize the patient?

 

[rhan101277]

1. Why would you need medical control to tell you if a patient requires care beyond your ability?

2. As mentioned earlier, if the patient isn't stable, does it make sense to keep the patient at a facility that can not stabilize the patient?

Well I was just thinking about covering my back. I see what you are saying in point number 2, if they are that unstable then I would probably recommend helicopter transport. They can monitor A-lines and do much more than ground units.

 

[MasterIntubator]

Back in the day, had a few that needed intervention. Many of the complicated cases, we were given non-routine medications/orders just in case per the transfering physician. Siezure control seemed to be the one that sticks out themost in my head. I think the most kewl ones have been the IABP transfers.

 

[Akulahawk]

I rarely had to do much beyond monitor the patients. I was always ready should the patient start to have problems. That being said, when I was NOT part of a CCT crew, I was also very much aware and careful NOT to take a patient that was beyond my ability to mange. Like others here, our transports were rarely longer than an hour. Many times we'd spend more time at the pick-up or destination locations than we actually would during transport.

 

[WTEngel]

I was on the CCT team with Children's Medical Center in Dallas. We frequently intubated, started antibiotics, initiated medicine drips, changed what the hospital had going, tweaked vent settings etc.

Most of our patients were not stable when we arrived, hence why we were called. We also discontinued the care the referring facility initiated more often than not and started care that was in line with what our facility wanted for their ICU and NICU patients.

We were allowed to do UACs and UVCs, assist with central lines, arterialmsticks for blood gases, just to name a few.

This transport team was the exception, not necessarily the rule. We were hospital based, and we had ground, rotor, and fixed wing transport. So it wasn't your standard IFT setup.