SD BLS = dialysis - 3 questions

[Novocaine]

I work for a bls medical transport in sd and I was wondering if +70% of bls calls as dialysis was typical for a bls agency. With the other 30% mostly filled in with discharges to sniffs, cct nurse stemi's, and an occassional legit call I aos code 2 that I -might- learn something on...

Also the agency I work for does "gurney" transports that I don't fill out a SD county ems report on. A call that im not expected to take vitals on reguardless of picc lines, wound vac's, pain pumps, contact precautions or O2 administration. (one of the few interventions that is in the emt-b scope locally) A call that effectivly removes my bls rig from ems for non ems purposes. Are "gurneys" a legitimate use of bls and where can I find more information on ems bls ambulance service expectations?

Additionally without having done much research on the subject, I was curious if many or any agencys have unions? Also I really don't want to discuss if a union serves an agencys intrest or its employees or if unions should or shouldn't exist in ems.

 

[VentMedic]

Do you know how many of your contracts with various facilities for dialysis patients are obtained?

Do you know why they are obtained?

If you company does 70% dialysis calls, I believe your company probaby would not stay in business very long without them.

Many companies go to battle in a competitive area to get those contracts. However, many EMT(P)s don't realize what is all involved. For ambulance services, if they lose even one of those contracts, they could be in finanacial difficulties.

It is also difficult to sell the services of just a BLS truck with the limited education and scope of practice of the EMT for anything other than BLS transports.

These are actually a better use of a BLS truck than for EMS which should have a Paramedic and be ALS. Although, the dialysiis patient is probably sicker than many EMS patients you have in the back of your truck.

Does your area have any ALS EMS?

A call that im not expected to take vitals on reguardless of picc lines, wound vac's, pain pumps, contact precautions or O2 administration.

Is there another licensed person on that transport? Are you contracted by a specialty team to provide transportation? If so, that patient is their responsibility. They do not know you or your abilities and do not have time to fill out a competency checkoff on you. Again, these transports are a source of income and security for your company without extending much liability except the driving.

As far as not taking contact or other exposure precautions, that is your responsibility. Failure to do so is an OSHA and/or local Public Health violation. You can also be liable if you are knowingly contaminating others (pts and staff) by blatantly ignoring certain safety and health issues. If you company is not supplying you with gloves, then you have more issues.

BTW, a union may be of little use to you in any of the situations you described. The unions are ran by non-medical people who are only concerned about collecting you dues and negotiating a generic contract. Have you not learned anything from the headlines making news articles with ambulance unions? If you want to make more money, get and education to move beyond "BLS".

 

[JPINFV]

I work for a bls medical transport in sd and I was wondering if +70% of bls calls as dialysis was typical for a bls agency. With the other 30% mostly filled in with discharges to sniffs, cct nurse stemi's, and an occassional legit call I aos code 2 that I -might- learn something on...

It depends on the contracts. At my old company in So Cal about 70% of the transports were non-emergent with about 30% being dialysis, 30% being discharges, and 10% being RN or RT CCTs. On the other hand, I currently work for a rather tiny company in Massachusetts that is pretty much only non-SNF dialysis patients right now.

Also don't sell yourself short on learning things on dialysis transports. Dialysis replaces probably the most important set of organs past the heart, lungs, and brain. Just focusing on the filtration aspect, the kidneys are responsible for controlling the blood volume as well as the mix of electrolytes and other components of the plasma. Bad things happen to people who miss or end treatments early or ignore diet/fluid restrictions. Also most patients coming from SNFs aren't exactly spring chickens so...

How good are your assessment skills? By good, I don't mean, 'can you describe the difference between rales, rhonchi, etc,' but have you actually heard them? How good are you at taking V/S in a moving ambulance? Non-emergent patients, for lack of a better term, are great patients to practice on. Similarly, on discharges, read everything in the packet. When you are on an emergency call at a SNF and the history isn't readily available (some SNFs put the history on the face sheet [past/current DX] while others require digging through the last H&P), it's easy to get them from a 5-6 page single space if you know where to look.

Also the agency I work for does "gurney" transports that I don't fill out a SD county ems report on. A call that im not expected to take vitals on reguardless of picc lines, wound vac's, pain pumps, contact precautions or O2 administration. (one of the few interventions that is in the emt-b scope locally) A call that effectivly removes my bls rig from ems for non ems purposes. Are "gurneys" a legitimate use of bls and where can I find more information on ems bls ambulance service expectations?

I'm kinda of surprised that at least the patients on O2 aren't a BLS transport since requiring O2 is considered a valid medical necessity for BLS transport. Are these patients that are actually wheel chair van patients and you're backing up overloaded wheel chair vans? Also, just because a patient isn't an ambulance patient doesn't mean you can't use contact precautions when transporting that patient.

Additionally without having done much research on the subject, I was curious if many or any agencys have unions? Also I really don't want to discuss if a union serves an agencys intrest or its employees or if unions should or shouldn't exist in ems.

I doubt most of the companies in So Cal have unions. I can't name one in OC that does. Talking to a few of the EMTs that work for a company with a union in Boston, the two EMTs utterly hatted the union.

 

[exodus]

I work for a bls medical transport in sd and I was wondering if +70% of bls calls as dialysis was typical for a bls agency. With the other 30% mostly filled in with discharges to sniffs, cct nurse stemi's, and an occassional legit call I aos code 2 that I -might- learn something on...

Also the agency I work for does "gurney" transports that I don't fill out a SD county ems report on. A call that im not expected to take vitals on reguardless of picc lines, wound vac's, pain pumps, contact precautions or O2 administration. (one of the few interventions that is in the emt-b scope locally) A call that effectivly removes my bls rig from ems for non ems purposes. Are "gurneys" a legitimate use of bls and where can I find more information on ems bls ambulance service expectations?

Additionally without having done much research on the subject, I was curious if many or any agencys have unions? Also I really don't want to discuss if a union serves an agencys intrest or its employees or if unions should or shouldn't exist in ems.

Do you happen to work for Alert? xD

If the pt has a pic line or an IV, it's automatically a BLS transfer, if they need o2, BLS! Which means county form.

Occasionaly our w/c vans get overloaded, and we get put onto those, I still do full vitals, an assessment and everything. Take the "easy" calls as a way to practice!t My last w/c pt ended up being hypoglycemic and I picked up on it during transport and when we got to the location, I had the nurses there check his BGL and the admin'd glucose. Otherwise the call would have upgraded to BLS instead of w/c and costed the pt hell of a lot more.

Before anyone *****es about that, we were within 5 minutes of the recieving facility and it wouldn't have been very beneficial to upgrade to BLS and charge him like a thousand bucks for this.

And you can *always* come up with a BS reason to use on the Physician sheet. And sometimes we really can't find anything, so o2 Via NC at 2LPM here we come!

 

[JPINFV]

And sometimes we really can't find anything, so o2 Via NC at 2LPM here we come!

I really wouldn't do this if I were you.

 

[VentMedic]

And you can *always* come up with a BS reason to use on the Physician sheet. And sometimes we really can't find anything, so o2 Via NC at 2LPM here we come!

Wow! Looks like we will soon have another ambulance service making headlines.

 

[exodus]

I really wouldn't do this if I were you.

Wow! Looks like we will soon have another ambulance service making headlines.

Joke... Sheesh! Even though, with what we're taught in school, we could get away with it because we're unable to test SpO2 and in the book it says to always give O2 xD

 

[VentMedic]

Joke... Sheesh! Even though, with what we're taught in school, we could get away with it because we're unable to test SpO2 and in the book it says to always give O2 xD

Your documentation would have to support it WHICH could lead the patient to undergo more expensive testing, which also has risks, including a CXR and ABGs as well as a hospital admission. The placement of O2 is definitely viewed as a chance in status.

 

[Sasha]

And you can *always* come up with a BS reason to use on the Physician sheet. And sometimes we really can't find anything, so o2 Via NC at 2LPM here we come!

That's called fraud.

 

[exodus]

There always is a reason, just half the time the RN's don't write it on the page. Obviously they need the ambulance because a w/c van is cheaper for the pt and easier for the hospital so they wouldn't go out of there way to do it.

And, what I said... Was a joke, if nobody got that...

 

[VentMedic]

There always is a reason, just half the time the RN's don't write it on the page. Obviously they need the ambulance because a w/c van is cheaper for the pt and easier for the hospital so they wouldn't go out of there way to do it.

And, what I said... Was a joke, if nobody got that...

What was their coverage for? If an ambulance is used, the EMTs on it will complain they could've gone w/c van. Either way the hospital just calls the services they have a contract with. It doesn't take much more dialing for one or the other and the case manager does the paperwork for billing, not the RN. There is no winning for those caught in the middle.

Somethings you don't joke about especially when there is another glaring headline in the news this week that puts poor light on private ambulance services. Some will think if they can not manage a little bookkeeping, they sure in heck have no business managing patients especially if they want to bid on an EMS contract.

 

[WolfmanHarris]

I'm glad stable IFT's are a separate industry around here. It keeps the yahoo wannabes from confusing their job with EMS rather than the horizontal taxi service. With the exception of a bariatric treat and return which the IFT companies can't handle, the only IFT's I've done are urgent if not emergent transfers from the local hospital ED to the regional hospital or for an ICU admit. Have learned a tonne from reading these charts or from the escorts on the times we have them.

 

[Novocaine]

I'm kinda of surprised that at least the patients on O2 aren't a BLS transport since requiring O2 is considered a valid medical necessity for BLS transport. Are these patients that are actually wheel chair van patients and you're backing up overloaded wheel chair vans? Also, just because a patient isn't an ambulance patient doesn't mean you can't use contact precautions when transporting that patient.

These patients basically are wheel chair van patients, the company I work for runs more gurney calls with bls ambulances than w/c calls on the w/c vans. I absolutly use the ppe contact precation garb.

 

[WolfmanHarris]

No. I come from a system where EMS is staffed with providers with a 2 years of education for BLS and 3 for ALS and where stable IFT exists in the private sector staffed by drivers with first aid or perhaps First Responder and where their vehicles are not considered Ambulances under the law. What I meant was that those without the inclination to professionally practice prehospital care are unlikely to go through two years of school. There are of course exceptions (as there is with anything), but education seems to keep the whacker and wannabes numbers low in EMS.

The criteria I referred to was directed largely to the concept of forging documents to pad bills and otherwise operating in a way that was no providing professional patient centered care.

 

[Shishkabob]

Not biting your head off. Just no need to repeat what's already been said well.

When you're here for a bit, you'll notice that I'm lazy and don't read an entire thread, instead latch on to one post, reply to it, and look like an idiot for bringing up something that's been said.


The cycle of life continues.

 

[mikeN]

Dialysis = money.
That is all.

The gourney transport thing you speak of, the only state I can think of that does something remotely close is NY.

 

[Jon]

I question what a "gurney" transport is, and who's paying for it... and what the rate difference really is.

I've worked a few places that had ambulette service - same idea. They actually had specially equipped vehicles... a wheelchair van and a minivan with strecher brackets. They were designed to be 1-person operations, like a wheelchair van - but the patient was unable to sit in a wheelchair.

I really can't go into more detail on what their patients were - it's been 5 years.


As for whether or not these runs are legitimate uses of BLS? Well... Do you have a job? Do you want to keep it? If these make your bosses money, and you aren't doing anything illiegal... why complain? If your company does both 911 and IFT, I'm sure they have adequate rigs in service to cover both sides... even if you don't get to run much 911.

As for all the other equipment. If the patient / staff are in control of the equipment - why would it matter to you?

Why does a PICC line automatically warrant a BLS transport? Folks are discharged to HOME with part-time care at home with PICC lines inserted.

 

[Novocaine]

Gurney

I question what a "gurney" transport is, and who's paying for it... and what the rate difference really is.

Gurney transports are payed for by hmo's or individuals. I often collect payment on the spot taking checks, credit card info or cash.

I understand a typical bls transport costs medicare around $550.(no O2) The "gruneys" I run, bill out at $100 plus milage.

 

[Buzz]

There always is a reason, just half the time the RN's don't write it on the page. Obviously they need the ambulance because a w/c van is cheaper for the pt and easier for the hospital so they wouldn't go out of there way to do it.

There isn't always a reason. We get called to take people home for all sorts of stupid reasons: no car and needs a ride home, or wheel chair vans don't run at night (though I've never once transported someone that actually was wheelchair bound), etc. The problem occurs is that incur a massive :censored::censored::censored::censored: storm if we were to refuse to take the patient for lack of a reason, yet if we take the patient and cannot justify transport by ambulance we catch it later on when the insurance doesn't pay out. There's one hospital around here that is pretty horrible for discharging patients via ambulance with no reason other than "He just needs a ride home." Isn't that what a cab is for?

 

[firecoins]

I do IFTs in NY and NJ and have no idea what a gurney transport is. Every call we are required to assess our patients.

My IFT company has many contracts with nursing homes for their emergencies. Patients are usually coveren by medicare so the company gets paid and they are legitimate emergencies and no so legit emergencies that come in.

We do many dialysis runs, psych transfers, ed and hospital discharges and CCTs.