Low call volume 911 vs Transport work

[Akulahawk]

My EMS (BLS) career started at an IFT company (Hunter Ambulance-Ambulette Inc.) per diem for around 6 months prior to getting into a 911 hospital. I'll agree that it's a good learning opportunity to read charts, match meds with the pt's Hx, do assessments on truly sick pts. The learning curve flattens pretty quickly with that after a short time, though. I made sure to pick up shifts with medics only, so that I would see some good stuff occasionally.

NYC 911 has the benefit of having EMT-EMT BLS units, and medic-medic ALS units only, no EMT driving a medic, who dominates pt care. I've come to find out that much of the country runs EMT/medic ALS rigs. It cheats the EMT out of developing their critical thinking skills. Perhaps in the future an EMS degree will take one straight to medic, no more varying levels of education and scope.

A few months in an IFT company as a basic is beneficial IMO, but then it just becomes monotonous and mind numbingly boring. Complacency may also set in. A good BLS tech with solid 911 experience (or a 911 medic) is more likely, in general, to pick up a change in pt condition than an IFT tech only.

Doing IFT's (acute care facility to SNF) can be incredibly boring. It is, however, a good way to see how many disease processes present themselves. When I started, about 1/2 of the calls we ran were from home or from SNFs to an ED. If you don't do those types of calls... you'd be amazed at what they call BLS transport for... and what is actually going on with the patient when you get there... and find out that the facility should have called 911... The company I worked for was quite proficient at running 911 calls. Generally, better than the BLS component of the 911 contractor...

Complacency can be a problem, if you let it. I've seen many PCRs done by EMTs that have become complacent in doing care.... It's sad.

 

[46Young]

Doing IFT's (acute care facility to SNF) can be incredibly boring. It is, however, a good way to see how many disease processes present themselves. When I started, about 1/2 of the calls we ran were from home or from SNFs to an ED. If you don't do those types of calls... you'd be amazed at what they call BLS transport for... and what is actually going on with the patient when you get there... and find out that the facility should have called 911... The company I worked for was quite proficient at running 911 calls. Generally, better than the BLS component of the 911 contractor...

Complacency can be a problem, if you let it. I've seen many PCRs done by EMTs that have become complacent in doing care.... It's sad.

Recently, at the IFT company I work at per diem, I had an EMT-I ride along (this employer requires you to clear BLS precepting prior to ALS). His PCR was worse than some BLS techs out there. No physical assessment noted, he circled alert and oriented (to what? no mention), wrote that the pt was "lethargic" without mentioning that it was normal for that pt per the sending RN.

 

[Akulahawk]

Recently, at the IFT company I work at per diem, I had an EMT-I ride along (this employer requires you to clear BLS precepting prior to ALS). His PCR was worse than some BLS techs out there. No physical assessment noted, he circled alert and oriented (to what? no mention), wrote that the pt was "lethargic" without mentioning that it was normal for that pt per the sending RN.

I do NOT tolerate that kind of documentation. That's one of the few things I have a very low tolerance for. When one of the EMTs I was responsible for did that... a real quick lesson in as to why each report is done completely usually solves the issue. If I see it happen again, that person gets re-taught how to write the reports all over again... and a third time, they're heading for a suspension... We expected nothing less than good patient care and documentation from our crews. In general, we got it.

 

[46Young]

I do NOT tolerate that kind of documentation. That's one of the few things I have a very low tolerance for. When one of the EMTs I was responsible for did that... a real quick lesson in as to why each report is done completely usually solves the issue. If I see it happen again, that person gets re-taught how to write the reports all over again... and a third time, they're heading for a suspension... We expected nothing less than good patient care and documentation from our crews. In general, we got it.

Agreed. On the floor, I asked this individual and the basic to hook up my pt and get a set of vitals for me while I do ppw (after speaking with the pt). They moved him to the cot, attached a pulse ox only, then they both walked away from the pt! I was watching them, and immediately went to the pt, and told them that someone must be with the pt at all times. On another call, the pt had a sinus with 1st degree AV block. The EMT-I handed me the strip with a puzzled look and said "do what you want with this". WTF? The negative QRS deflection apparently puzzled him or something.

We had a "stat" call to the floor for an xfer for a pt w/CHF secondary to an aortic valve malfunction with tricuspid regurg. She was awaiting surgery at the receiving facility. I found the pt to be reasonably stable in fowler's on 4lpm O2. No drips or anything. Oh yeah, this was about 2000 hrs, the pt was admitted x 2 days, and surgery was scheduled for tomorrow afternoon. I found this out after calling the receiving RN. She agreed with me that running this pt hot was wholly unneccesary. The basic kept trying to convince me that we still should light it up because the sending MD requested it. I shared several accounts of co-workers and acquaintances that were killed or severely injured while txp lit up. I explained that it's unneccesary to put ourselves and the public in danger for no good reason. If we crash, it's really my fault for allowing code 3 txp.He still didn't get it, he seemed annoyed that I killed his chance to drive hot.

I was on duty this day and responded to this call...... http://www.postandcourier.com/news/2008/mar/26/fatal_collisioncar_ambulance_crash_kills34947/

http://cms.firehouse.com/web/online/In-The-Line-Of-Duty/Paramedic-and-a-Volunteer-Killed-in-Ambulance-Crash-on-Long-Island/39$41502 I used to work with Bill.
Good thing that I have experience at a top of the line 911/IFT hospital. Those that are new may learn things the hard way.

 

[WannaBeFlight]

I am currently doing my EMT-B in my medic program now. By January I would be able to work Routine Transport for a Level II hospital. I am intrigued by this type of work for these reasons: Experience with stretchers, patients, assessment and emergency vehicle driving. It would also serve me well in getting my foot in the door at that hospital, considering they have the Helo I want to work on in the future.

My main question is this: Can anyone tell me about working for a Hospital based RTS? Thanks.

 

[62_derick]

I work with a company that also does both IFT and 911 calls. I am a new emt (still wet behind the ears as some medics say) only 3 months into it. I have found out that I enjoy working the 911 calls more then the IFT calls but even just like someone else said that if you get something good it will most likly go to the medic but I still like being in the back assisting the medic.

I like doing both I dont really know what I like better, I enjoy the laid back days of IFT trips cuz it less crazy. We also run wheelchair calls and ambuletes there good but I really dont get to practice my skills.

I was once told by a friend when I was going through school that he recomends new emts getting into a BLS squad that way you can improve you skills and such.

Good luck hope everything works out.