Is your public EMS service providing interfacility transports?

DrParasite

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Tigger

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The two SNFs here call AMR for most everything (occasionally 911 for obviously sick folks), if AMR chooses to EMD the call they then immediately release it to us. If it’s a scheduled transfer request they keep it. The urgent cares call 911 and that gets EMDed as a transfer and we respond with an engine and an ambulance (sigh).

My part time job is the transfer provider for all IFTs from the local hospital, scheduled or not from 08-00. After that the hospital network’s CCT handles it if they’re available, otherwise it comes back to us. These are 45 to 75 minute trips each way and they suck. But they make the district a ton of money.

They used to... and it was huge money for them... but they didn't enjoy it so they quit, gave up the revenue, and want a huge mill levy increase to make up for the shortfall while a private rakes it in. Disgusting.
Well, can’t be a fire department and doing long distance transfers right?! /sarcasm
 

fm_emt

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My old county based EMS agency was the sole ambulance provider for the county. We did all of the 911 and IFTs as well. it was not uncommon to get hammered with 911 calls only to clear up and have a discharge or even worse a long distance transfer dumped on you. I ran the numbers from our CAD and our day shifts got held over due to long distance transfers (of more than 60 miles) about 23% of the time.

I miss a lot of things about my old place but I absolutely do not miss the long distance calls. I don't mind the local IFTs that much.
 

GMCmedic

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Anecdotal information but all the county based services that do IFT and 911 in my area, have nicer equipment and higher pay than the ones that do 911 only.
 

fm_emt

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yeah, we used to. Agency was a county based agency, not a private service. We had the "exclusive operating agreement" or something, so ALL of the transfers were ours. This meant discharges back to SNFs, etc. We didn't do doctors appointments and had no dialysis patients, though. We didn't have any that required a stretcher.

We also got a LOT of long distance transfers too, unfortunately. I did the numbers and nearly 30% of the time, day shift got held over 2+ hour because of long distance transfers. the agency would not turn them down and would not let them just sit around for the next shift. The hospital knew we were busy and would put in for the transfer and then just sit there until we could get around to it. We tried getting services from the destination city to come down and get the patients and they would always decline. It sucked. I do NOT miss doing those at all.
 

wcspa

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I know when I snoop LA on Pulse Point I see them list IFTs, which at first caught me by surprise, cuz LAFD doesn't really do that. Then I spotted one mapped at a SNF I been to a time or dozen back when I was working private ambulance, took another look, and it seems like whenever they get any EMS call out of a nursing home they automatically characterize it as an IFT.

Our third service County EMS does the occasional hospital to hospital Priority 1 transfer for things like trauma or Cath Lab upgrades, but usually only when AMR has some long ETA or whatever (they're the only private here, so EMS is their only backup when not available for emergent transfers).

Otherwise we get the same normal 911 calls out of SNFs as everyone else.

The LAFD does routinely (usually several times a day) do IFTs from ER to ER and characterizes them as IFTs in the dispatch code. The hospital systems in Los Angeles, especially Kaiser, will call 911 to facilitate time sensitive transfers such as STEMIs, walk-in traumas, and patients requiring neurointensive care. This is an agreed upon policy between the hospitals and LAFD that if there is a time sensitive diagnosis and the ETA of a CCT private resource is above a certain level (I am not sure what that is) they proceed to call 911. This sends the nearest ALS engine/light force, ALS ambulance, and EMS captain to facilitate the transfer. Also, calls from UCs, SNFs, outpatient clinics are not coded as IFTs.

Also, the Orange County Fire Authority does IFTs fairly often too and, from what I understand, it operates in a similar model to the LAFD (long ETA for a CCT rig? Call 911). However, OCFA will just send the nearest paramedic engine or truck and whatever private ambulance company is appropriate for the area (Care or Emergency).

Both the LAFD and OCFA have even occasionally does emergent IFTs out of one ICU to another when there is a lack of CCT resources.
 

EpiEMS

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This sends the nearest ALS engine/light force, ALS ambulance, and EMS captain to facilitate the transfer. Also, calls from UCs, SNFs, outpatient clinics are not coded as IFTs.

Why does a call from a hospital get an ALS engine + EMS captain? Ostensibly a hospital is equipped to provide all the services an ALS engine would do while awaiting the ALS transport unit? The UC and SNF, that I could almost understand.
 

Tigger

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Why does a call from a hospital get an ALS engine + EMS captain? Ostensibly a hospital is equipped to provide all the services an ALS engine would do while awaiting the ALS transport unit? The UC and SNF, that I could almost understand.
Transfer paperwork (PCS, EMTALA, etc) can be confusing if you don’t do it often, especially if the hospital is pushing on you to just take the patient NOW.
 

wcspa

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Why does a call from a hospital get an ALS engine + EMS captain? Ostensibly a hospital is equipped to provide all the services an ALS engine would do while awaiting the ALS transport unit? The UC and SNF, that I could almost understand.
Tigger got it right. EMS captain is for paperwork, compliance issues. The engine is for manpower and someone to drive the ALS rescue as the standard is for two paramedics to be in the back with a critical care patient.
 

Jim37F

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Tigger got it right. EMS captain is for paperwork, compliance issues. The engine is for manpower and someone to drive the ALS rescue as the standard is for two paramedics to be in the back with a critical care patient.
Interesting. Makes a certain internal sense. Though when our EMS gets one of those they just the one ambulance lol

In any case, that to me would make an argument for the EMS Captain to have a Staff Aid driver like the BCs who can then drive the RA when both medics are in the back, wouldn't need the Engine at all, whether on these IFTs or their other field calls they send EMS Captains to
 

wcspa

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Interesting. Makes a certain internal sense. Though when our EMS gets one of those they just the one ambulance lol

In any case, that to me would make an argument for the EMS Captain to have a Staff Aid driver like the BCs who can then drive the RA when both medics are in the back, wouldn't need the Engine at all, whether on these IFTs or their other field calls they send EMS Captains to

Yeah, well, I'm not necessarily making a case that their system is the most efficient. There is a lot I could say about the efficiencies and inefficiencies in that system and the positives and negatives of different staffing patterns, etc. That being said, I think having EMS captains is on the whole a good thing for their system.
 

EpiEMS

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Transfer paperwork (PCS, EMTALA, etc) can be confusing if you don’t do it often, especially if the hospital is pushing on you to just take the patient NOW.

Seems a little strange to me. A checklist or policy could solve this - do you really need to tie up an expensive resource for paperwork?
 

Jim37F

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Seems a little strange to me. A checklist or policy could solve this - do you really need to tie up an expensive resource for paperwork?
Well the EMS Captain is like the BC for the ambulances, when not on a multi-ambulance response MCI incident, managing paperwork kind of is their job....
(Otherwise agree fully if you're talking about the Engine for an IFT... doubly so if a Light Force was sent...)
 

Tigger

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Seems a little strange to me. A checklist or policy could solve this - do you really need to tie up an expensive resource for paperwork?
We've tried a checklist, it's an uphill battle and gets steeper the sicker the patient is. I have heard so many different iterations of who gets the original EMTALA, who needs a PCS, what can be sent electronically, I could go on. This is from both sides mind you. Many times we would go for a sick transfer and the staff would not listen to our needs regarding paperwork or would make up a new set of rules because "they must go now." Sorting this takes someone's entire attention, leaving your partner to actually get the patient ready and no one else.

The paperwork for our drip and ship tPA transfers became so arduous that we began sending a supervisor on these, or at the very least another paramedic.
 

BobBarker

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The LAFD does routinely (usually several times a day) do IFTs from ER to ER and characterizes them as IFTs in the dispatch code. The hospital systems in Los Angeles, especially Kaiser, will call 911 to facilitate time sensitive transfers such as STEMIs, walk-in traumas, and patients requiring neurointensive care. This is an agreed upon policy between the hospitals and LAFD that if there is a time sensitive diagnosis and the ETA of a CCT private resource is above a certain level (I am not sure what that is) they proceed to call 911. This sends the nearest ALS engine/light force, ALS ambulance, and EMS captain to facilitate the transfer. Also, calls from UCs, SNFs, outpatient clinics are not coded as IFTs.

Also, the Orange County Fire Authority does IFTs fairly often too and, from what I understand, it operates in a similar model to the LAFD (long ETA for a CCT rig? Call 911). However, OCFA will just send the nearest paramedic engine or truck and whatever private ambulance company is appropriate for the area (Care or Emergency).

Both the LAFD and OCFA have even occasionally does emergent IFTs out of one ICU to another when there is a lack of CCT resources.
100% true, although Kaiser abuses the 911 system often. Los Angeles County policy states that they are not to use 911 for IFT's for Stemi's unless an ALS/CCT resource ETA is above 10min, they are not to use 911 for IFT's involving strokes and they are not to use 911 for IFT's from the inpatient floor. Our CCT units have literally been posting in front of a Kaiser ER when LAFD comes in for a STEMI transfer. Higher level of care and closer eta, still called fire. Word on the street is the LAFD medics hate doing IFT's but the higher ups tell the hospital to continue using them for it because they can bill for it. I swear some Kaisers are just programmed to call 911 for every transfer and that can definitely put a burden on the fire department. Also, looking at PulsePoint now, IFT's from SNF's ARE categorized as IFT, they just don't have an EMS captain attached to it. Separate issue, but let's talk about how many times LAFD goes code 3 for no reason to get back to station quicker lol
 
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wcspa

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100% true, although Kaiser abuses the 911 system often. Los Angeles County policy states that they are not to use 911 for IFT's for Stemi's unless an ALS/CCT resource ETA is above 10min, they are not to use 911 for IFT's involving strokes and they are not to use 911 for IFT's from the inpatient floor. Our CCT units have literally been posting in front of a Kaiser ER when LAFD comes in for a STEMI transfer. Higher level of care and closer eta, still called fire. Word on the street is the LAFD medics hate doing IFT's but the higher ups tell the hospital to continue using them for it because they can bill for it. I swear some Kaisers are just programmed to call 911 for every transfer and that can definitely put a burden on the fire department. Also, looking at PulsePoint now, IFT's from SNF's ARE categorized as IFT, they just don't have an EMS captain attached to it. Separate issue, but let's talk about how many times LAFD goes code 3 for no reason to get back to station quicker lol

This is true. Kaiser will active 911 for a LAFD response more often than not. It is not clear to me ultimately why this is because, as you noted, they are supposed to try for a private CCT transport first. There were rumors about why this was the case -- but I am not privy to the real underlying factors. Also, while they may be coded similarly on PulsePoint, the internal LAFD TDS (tiered dispatch system) codes are different for ER IFT's (hospital to hospital) versus SNF/UC whatever to ED. The ones from SNFs are coded NP# (for iNPatient) versus IFT code for ED to ED. It's a trivial point but they are internally coded different which is what triggers the CAD to send a different set of responders.
 

BobBarker

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This is true. Kaiser will active 911 for a LAFD response more often than not. It is not clear to me ultimately why this is because, as you noted, they are supposed to try for a private CCT transport first. There were rumors about why this was the case -- but I am not privy to the real underlying factors. Also, while they may be coded similarly on PulsePoint, the internal LAFD TDS (tiered dispatch system) codes are different for ER IFT's (hospital to hospital) versus SNF/UC whatever to ED. The ones from SNFs are coded NP# (for iNPatient) versus IFT code for ED to ED. It's a trivial point but they are internally coded different which is what triggers the CAD to send a different set of responders.
Makes sense, gotya! We get code 3 IFT's daily for Kaiser ER's and UC's, so I know they use us, but I think it's more for the CCT level where they have a drip/vent and Kaiser just doesn't want to call 911 AND send a nurse with them lol. Should utilize us more so LAFD can stay in service to do what they do best but I guess not. We get call bonuses, so the more calls I run, the more $$$ I make lol
 

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