IFT's how do you handle them

rhan101277 said:
Yesterday I had my first transfers where I was responsible for their care. Even though it was just moving patients from place to place I took it as a big responsibility.

I assessed their LOC and did vitals on them every 15 minutes. One man I had to take about 1.5 hr. away. I checked his vitals five times, I think he was getting a little aggravated. This is how I am supposed to do it though, some people say they do it every 30 minutes, for people you are just moving from Dr.'s appt to nursing home etc. I like having a track record of vitals so I can have it to see if anything is going on. I also listen to lung sounds and heart sounds a couple times.

If they are AO, I will ask them about allergies, past history, current medical illness, medications etc. if I am taking them from nursing home to hospital for a checkup or whatnot. Some pts. come to me and they are not are alert but they can't talk etc. I try to talk to them ask them how they are doing and they shake their head they are ok etc.

How do you do yours?
Click to expand...

I always start by taking report from the healthcare provider responsible for the pt's care...even if it's just a transport to a doctor's appointment. I'd rather not be surprised by anything once we get on down the road...cuz then it'll be MY behind on the line, and often times what a nursing home nurse calls a "transfer" is really an e-call. Then I go through all of the paperwork provided to me and write down pertinent info on my PCR and ask for clarification on any information or orders that are unclear. After the pt is loaded in the truck I obtain baseline vitals MANUALLY. I verify as much of the information from the paperwork as possible with the pt...this is a good way to assess mental status. Then, depending on my assessment, my interfacility written orders and the length of the transfer, I may repeat vitals every 5 minutes or 30 minutes or somewhere in between. We are required to have at least 2 sets of vital signs on EVERY pt that is transported, whether it is 2 minutes from the hospital or 2 hours.

BLS transfers aren't the most interesting, but they are good practice. Get in the habit of doing vitals and your assessment the same every time so that it becomes 2nd nature. Then, when things go south you will be less likely to miss something important.

ALS transfers are often the sickest and most challenging patients...here, these are the ones that we take in from e-calls that are in really bad shape that end up being transferred from our local band-aid box hospital to a facility with more capabilities. Sometimes people don't take transfers seriously enough...these patients WILL go downhill on you FAST if you just take for granted that "it's just another stupid transfer."

Don't let anyone give you any crap for being thorough or tell you that you don't need to be just because it's "only a transfer." It is your job to be that patient's advocate and you do that by providing them with the highest quality care that you are capable of. Sounds like you are right on with what you are doing...keep up the good work!
 
daedalus said:
In my experiences, vital signs are rarely taken in the truck manually. If you get on a real 911 rig in ventura or LA county it just doesn't happen.
Click to expand...

This is not necessarily true. I've gotten manual signs in the truck, en route. The medic's I run with don't have NiBP on their monitors. And, well, we transport - medic as well....
 
I ll stick with the manual cuffs.
 
My view on vitals on IFTs is this:

If it is a 0.3 mi transport, a true IFT, there is no way I am getting a set. When I do the paperwork before pickup, I review the chart, and note if the vitals are normal, then will take the most recent set for my report. If there is no recent set, I take my own with the hospital cuff, etc. while still in bed. I then document the time the vitals were taken-- I dont indicate that they were taken en route if they werent.

For other, longer transfers, from SNFs to MDs or discharges to rehab, I always try to take 1-2 sets en route. I feel differently about the SNF patient who is going to their MD for an acute problem, then the stable discharge from an orthopedic hospital going to rehab. This ortho patient may only get one set-- I know they are likely in post-op pain, and I dont want to torture them unnecessarily.

Dialysis patients-- it all depends. I view them as the sickest stable patient I see during my day. They may have a laundry list of chronic conditions, ranging from the standard ESRD/CRF to HTN, DM, CAD, CHF, COPD, etc. I had one patient who's BP pre-dialysis was often 80/P, and BP after treatment could hit 200/P. She always got q5min vitals, where I have others that are very steady, and may only get on set en-route. Many of them have dialysis books for communication with their SNFs, and I often read through and take note of the trends of pre-post treatment as measured by the clinic-- and only worry if my measurement are drastically off from the baseline-- because that is the whole point of vitals-- trending.

Hope all of this helps-- I guess what I am saying is that your measurement frequencies should be highly patient dependent.

Good Luck,

Dan
 
VentMedic said:
When reading a chart for comfort care or hospice patients, one might notice that "No vitals" is part of the order set. We do not even check an SpO2 on these patients in the hospital. They are made comfortable by pharmacological means according to visual assessment.

However, there are different types of hospice and different order sets depending on the state and patient's wishes.
Click to expand...

I have seen this before! I followed the orders and than had to explain to an EMT-B supervisor why I did not take vitals. He in his infinite knowledge as a EMT decided it was BS. :sad:
Another area for improvement through education.
 
emt.dan said:
Dialysis patients-- it all depends. I view them as the sickest stable patient I see during my day. They may have a laundry list of chronic conditions, ranging from the standard ESRD/CRF to HTN, DM, CAD, CHF, COPD, etc. I had one patient who's BP pre-dialysis was often 80/P, and BP after treatment could hit 200/P
Click to expand...

What? Dialysis pts blood pressures should be reduced after treatment. What were they adding fluid to her insted of removing it?
 
Sapphyre said:
This is not necessarily true. I've gotten manual signs in the truck, en route. The medic's I run with don't have NiBP on their monitors. And, well, we transport - medic as well....
Click to expand...
In Azusa, all transports were code 3 if the medic came along (stupid policy). It is interesting to see variations in the fire medic's use of the EMT. I was told to turn on the dome lights, spike the bag, than shut up and do nothing.
 
:DI was told to turn on the dome lights, spike the bag, than shut up and do nothing.

Well that was proffesional.

After the call I would have politely stated to them. Now that we are done with pt care, would you be so kind as to meet me in the parking lot so we can discuss your comments and practise some behavior modification techniques:D
 
After the call I would have politely stated to them. Now that we are done with pt care, would you be so kind as to meet me in the parking lot so we can discuss your comments and practise some behavior modification techniques
Click to expand...

That is certainly professional as well!:rolleyes:
 
CAOX3 said:
What? Dialysis pts blood pressures should be reduced after treatment. What were they adding fluid to her insted of removing it?
Click to expand...

I cant say I understand why, but this patient was very consistent. Evidently her BP would flip flop during treatment. I do know that the clinic has refused to take her because her BP is so low-- they instructed the EMTs to take her to the ER. Nevertheless, she was back at the clinic four hours later, because she still needed to be dialized.
This patient's baseline was A&Ox1-2, and had been receiving acute dialysis for over five years. She was relieved of her pain a few months ago.
 
That is certainly professional as well!

Thank you. I try
 
JPINFV said:
How many schools require their students to take V/S in a moving vehicle forcing the students to deal with road noises and bumps?
Click to expand...

I go to EMSTA College (Until Wednesday) :D :D and we do vital in the back of the schools ambulance while driving up and down the road and making turns and going through bumps.
 
daedalus said:
I have seen this before! I followed the orders and than had to explain to an EMT-B supervisor why I did not take vitals. He in his infinite knowledge as a EMT decided it was BS. :sad:
Another area for improvement through education.
Click to expand...

For something like that I probably would have asked for a copy of the order to accompany my chart.
 
CAOX3 said:
:DI was told to turn on the dome lights, spike the bag, than shut up and do nothing.

Well that was proffesional.

After the call I would have politely stated to them. Now that we are done with pt care, would you be so kind as to meet me in the parking lot so we can discuss your comments and practise some behavior modification techniques:D
Click to expand...

It will be difficult for you to comment on this without actually working with Los Angeles County Fire paramedics. ;)

I do not think we have one member here that is a medic or EMT for that very prestigious organization.
 
I dont care it was an almighty medic from above, RN or doctor for that matter. I wouldnt talk to someone like that.

So I dont accept being talked to in that manner. I dont give a :censored::censored::censored::censored: who they are, or how many letters they have after your name.

Its about respect. You respect me I respect you or vice versa.
 
Being nice to someone who has been nice to you is easy. Maintaining your own professional demeanor and calm in the face of a bodily orifice is much more difficult and a true test of your maturity.

Just because someone acts like a jerk doesn't mean the entire conversation following has to sink to their level. If it does, you have relinquished all power in the situation and allowed them to set the terms of the exchange. Besides, not getting P.O'd generally annoys them!
 
Maybe I am missing something... Is there a fight going on? Did I insult someone? I apologise I did not even know I did so.
 
daedalus said:
It will be difficult for you to comment on this without actually working with Los Angeles County Fire paramedics. ;)

I do not think we have one member here that is a medic or EMT for that very prestigious organization.
Click to expand...

I would say, most likely not. We do however have EMTs that transport for them... I can think of 2 off the top of my head (and, several people who haven't joined, but like to read anyway, cause, well, this site is too Ricky for them to admit reading!!!)
 
daedalus said:
In Azusa, all transports were code 3 if the medic came along (stupid policy). It is interesting to see variations in the fire medic's use of the EMT. I was told to turn on the dome lights, spike the bag, than shut up and do nothing.
Click to expand...

In Baldwin Park, medic transports are code 3 as well. And, I've had medics like you experienced, and ones that actually wanted me to do some work for them.
 
You must log in or register to reply here.
Back
Top