Is your public EMS service providing interfacility transports?

[EpiEMS]

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.

Makes sense, I can imagine that you might rather have a dedicated administratively focused person. My historical experience has mainly been from the SNF setting so probably out of my scope to speak on the acute care hospital transfer!

If somebody needs an ALS transfer out of a acute care facility to another one, what paperwork is needed beyond an EMTALA verification from the transferring provider? Also, is there a point that your policy allows you to forego paperwork & just start transporting?

 

[Tigger]

Makes sense, I can imagine that you might rather have a dedicated administratively focused person. My historical experience has mainly been from the SNF setting so probably out of my scope to speak on the acute care hospital transfer!

If somebody needs an ALS transfer out of a acute care facility to another one, what paperwork is needed beyond an EMTALA verification from the transferring provider? Also, is there a point that your policy allows you to forego paperwork & just start transporting?

This is where you find trouble. It feels like the right thing to do but in the long run, you might not really be setting the patient up properly if the sending facility didn’t properly arrange a transfer.

A few times the sending told us to just leave and they’d figure it out, we’d arrive at the receiving and either wouldn’t have a bed or the ED would not be expecting us and be unhappy.

 

[BobBarker]

This is where you find trouble. It feels like the right thing to do but in the long run, you might not really be setting the patient up properly if the sending facility didn’t properly arrange a transfer.

A few times the sending told us to just leave and they’d figure it out, we’d arrive at the receiving and either wouldn’t have a bed or the ED would not be expecting us and be unhappy.

100% agree, especially if you show up with no chart/labs/imaging. "Oh, it will be clouded over, they will have access to it". And I say: "What if I have to divert to another hospital because the patient is detiorating, I can't just show up with an unstable patient with nothing, I need paperwork also." Because we are strictly IFT and we have had issues in the past regarding improper transfer arrangements like you say, if we have enough time enroute to the call, we will call the receiving facility to verify they are to receive the patient. 30 second call could save a ton of hassle.
For our CCT calls, we have to have a minimum of 7 signatures: CCT RN, EMT Tech, EMT Driver, RN for PCS, RN(can co-sign for MD) or MD for CCT orders, patient or patient rep if unable to sign and RN/MD at receiving facility. It can be easy to forget one when you have an intubated stemi on 5 drips.

 

[EpiEMS]

This is where you find trouble. It feels like the right thing to do but in the long run, you might not really be setting the patient up properly if the sending facility didn’t properly arrange a transfer.

A few times the sending told us to just leave and they’d figure it out, we’d arrive at the receiving and either wouldn’t have a bed or the ED would not be expecting us and be unhappy.

I can certainly imagine an irritated receiving physician in that case. Maybe I have just been lucky coming from SNFs!

 

[johnrsemt]

bob Barker: We used to have the worst time getting paperwork for transports.
I used the what if we have to divert a few times, and the response was usually "You can't, hospital A is expecting the patient"
I switched to, "no paperwork, no transport, Bye".
Worked better

 

[BobBarker]

bob Barker: We used to have the worst time getting paperwork for transports.
I used the what if we have to divert a few times, and the response was usually "You can't, hospital A is expecting the patient"
I switched to, "no paperwork, no transport, Bye".
Worked better

I say: “Hospital A is expecting patient with a STEMI not asystole, that’s when we divert” and then add what you say. Most of these people don’t do transport so we have to explain why we do things a particular way, including not removing iv’s when being transported to another hospital.