Interfacility Transport

[Sasha]

I saw this on a thread, and rather than hijack it, I decided to start up a thread for it all it's own.

From the fingers of Miss VentMedic

The mentality for IFT is one that if it doesn't bleed or is a "trauma" there is little need to assess any further than the patient information sheet for billing info and a diagnosis.

I disagree. Some may take a rather blasé approach to patients, but I feel that IFT provides exposure to diseases, disorders and conditions that one might not run on frequently on a 911 truck. I believe some people actually take the job seriously and asses the patient to a greater extent than browsing the chart and copying a face sheet.

So I'm wondering, how many of those who do both 911 and IFT are lax with their assesment for an IFT patient??

 

[EMTinNEPA]

Every patient that I am ever in the back of an ambulance with gets a full set of vitals and the most thorough assessment that I, as an EMT, can perform (providing for patient modesty when it doesn't interfere with patient care). Altogether, I check blood pressure, pulse, respiratory rate, SpO2, mental status and orientation, skin temp, skin color, skin moisture, pupils, checks for JVD, tracheal deviation, and equal chest rise and fall, auscultation of lung sounds, palpation of the abdomen, assessment of PMS, cap refill, and check for pedal edema. Anything of note, right down to lacerations less than a centimeter in length, is documented. Altogether, I do this at least three times in your typical call: once upon first patient contact, again upon our departure from wherever we picked the patient up, and then every fifteen minutes (for stable patients) until a final assessment just before arrival at the facility. The only difference between my treatment during a BLS 911 and my treatment during a BLS IFT is that on a 911 I call the hospital and give a report.

 

[downunderwunda]

If people choose to ignore their patient on an inter-facility transport, then they should find another job.

Regardless of what is wrong with the patient, they are in your care, so when it all goes belly up, who is the retard then?

How do you handover to the receiving facility if you have not observed your patient? do you give them a handover verbatim of the original facility?

Most transfers go OK, but i have had a few go real bad real quick.

Laziness & lack of professionalism is what causes people to not want to observe their patient.

 

[VentMedic]

We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.

I'll start another thread about the show.

 

[Shishkabob]

Really long post

Pretty much what I do.

 

[emtfarva]

I do a mix of 911 and BLS / ALS IFTs. I work with a medic partner. On a BLS d/c back home or to a SNF or Rehab Hosp I review the Pt's paperwork. I will do a more focused assessment. Even on ALS IFTs, I do an assessment even though I am not in the back of the ambulance with the Pt. I will report my findings to my partner.

 

[Sasha]

We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.

I'll start another thread about the show.

It's sad, but that mentality is rampant. Not necessarily as punishment, but that those who work IFT are there because they wouldn't hack it on a 911 truck, they are lesser EMTs/Medics.

While there are those poster children for IFT who are sloppy, lazy, bad EMTs/Paramedics and treat it is a sit and stare, there are also those who take it seriously and as an opprotunity to learn and improve.

 

[Ridryder911]

Amazing is that many of our IFT are really the "worst" patients. I grew up a long time ago, believing that those of the "street" is going to challenge most of my medical education. In reality, it is those of the IFT that we see have a known PMHX and presentations are challenging hence: the reason for transfer.

Once one has began to understand medicine, you will see the need for the understanding of lab and x-ray interpretation. The importance of receiving a full history and review of the chart. Again, what one may perceive as boring if done properly will require more in-depth education and clinical practice than most of the simple MVC, falls, chest pains routine medical calls.

It is the mentality of those that have to have emergencies that will not last long in this business. After a while even good crashes and simple AMI's become typical and boring.

 

[Hockey]

I chose: I assess the patient, just not as well as I do 911 calls.


But, every situation and every patient is different. I use the whole common sense approach

 

[EMTinNEPA]

We also now have another fine Paramedic show, The Listener, that has made the statement about IFTs are for those who fail their cert evaluations and must become just taxi drivers.

I'll start another thread about the show.

Sadly, this is the case for some people. I work with a certain EMT who is the most confident thing in the world on an IFT, but completely falls apart even on 911s for your typical little old lady fall down go boom. Would be somewhat understandable if she were on the BLS truck, but "I've been here for eight years, I should be with the medic!"

<_<

 

[exodus]

I do a full assessment on every single patient. It's good practice if anything when you get onto 911 calls (which we do backup, so we get those). I also refuse to leave a facility until a nurse gives me a full report, and I do a verbal assessment through the nurse as well. Asking and veryfying Hx, Allergies, and Meds. Checking DNR status. Their normal mental status, I also require the last baseline vitals before leaving the facility so I know if what I get on thet rig is normal. And we also can't Tx systolic under 90. That goes to CCT.

Edit: And I've had several nurses that complain about me wanting all that. And I tell them, if something happens on the transport, I need to know all this. You can take 2 minutes out of your schedule to let me know what's going on with this patient. There's also the nurses I love who give full reports without even asking. They're the best ones :]

 

[VentMedic]

even on 911s for your typical little old lady fall down go boom.

It is the mentality of those that have to have emergencies that will not last long in this business. After a while even good crashes and simple AMI's become typical and boring.

What some don't realize is that the AMI patient can be out of the hospital in 2 - 4 days. The elderly lady who falls may require 2 - 4 weeks in the hospital and placement in a NH which forever changes or ends her life. There is a lot more to medicine than just the obvious and the adrenaline rush.

 

[Sasha]

I also refuse to leave a facility until a nurse gives me a full report, and I do a verbal assessment through the nurse as well. Asking and veryfying Hx, Allergies, and Meds. Checking DNR status. Their normal mental status, I also require the last baseline vitals before leaving the facility so I know if what I get on thet rig is normal. And we also can't Tx systolic under 90. That goes to CCT.

Why don't you do that through the patient???

 

[EMTinNEPA]

I'm not talking about the impact on the patient's life. I'm referencing how the certain EMT I was talking about handles and performs on 911 calls, and as far as 911 calls go, elderly people who fall down are pretty straight forward, for the most part.

 

[exodus]

Why don't you do that through the patient???

I do that through the patient during transport. I get the SAMPLE from the nurse at the facility because they are a more reliable source of information most of the time for getting everything quickly where it's understandable. And usually if we're tx'ing out of a facility it's to the ER, so the PT is sick and wants to just rest.

 

[VentMedic]

and as far as 911 calls go, elderly people who fall down are pretty straight forward, for the most part.

Which is why some end up on life support before you get your truck out of the ED driveway.

There is rarely anything simple about an elderly person's fall. Of course for prehospital probably the best thing you can do is get them to the ED where they can receive the care needed. They are complex as well as what is obviously broken often distracts from other breaks and bleeds. As well, cardiac conditions are often overlooked which may also be the reason the person fell in the first place. The elderly, diabetic and female may be in the process of having an MI but due to their sensory perception of pain, it is not immediately noticed. Thus, you have the reason these patients who fall get an EKG on arrival to the ED.

 

[Sasha]

Which is why some end up on life support before you get your truck out of the ED driveway.

I think that's slightly exaggerated.

But that being said, I understand the seriousness of a fall and how many do not recover from it. However, there's little one can do prehospital wise for a fall besides monitor, splinting and pain control.

 

[EMTinNEPA]

There is rarely anything simple about an elderly person's fall.

Really? So nobody trips over anything or slips on anything? Nobody on the planet misses their chair when they go to sit down or just loses their balance because they have an abnormal gait?

 

[Sasha]

Really? So nobody trips over anything or slips on anything? Nobody on the planet misses their chair when they go to sit down or just loses their balance because they have an abnormal gait?

I don't think she's referring to the reason the patient fell but the ramifications of the fall.

 

[EMTinNEPA]

I don't think she's referring to the reason the patient fell but the ramifications of the fall.

Really? Because the second half of her post...

As well, cardiac conditions are often overlooked which may also be the reason the person fell in the first place. The elderly, diabetic and female may be in the process of having an MI but due to their sensory perception of pain, it is not immediately noticed. Thus, you have the reason these patients who fall get an EKG on arrival to the ED.

Sounds like she's talking about the reason for the fall.