stat transfers should they wait?

EMTIsee

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Is there anyone here whose company doesn't do transfers? Our company says it is wrong to allow another agency to take a transfer at anytime. Example all crews are on calls, transfer comes in, all crews are on another round of calls. Hospital calls wanting a eta, you to tell them 10 minuets despite it may be in reality hours. A stat ALS came in for trauma, the dispatcher told the hospital the truth and another agency was called.to take it immediately. When management heard this they called a meeting. The finial word was never let a transfer get away even if it may be hours even if it is a stat als. This is interesting because, it crosses the line between the best interest of the pt. or the payment.
 

RedAirplane

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There is a thread on here somewhere where I brought this issue up as a hypothetical and was very upset by how ambulances are allocated to IFT calls.
 

Akulahawk

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From the "other side" of that coin... if a company's dispatch center repeatedly gives an ETA that clearly is not truthful, the hospital will eventually call a provider that can give an ETA and stick to it. It is unbelievably frustrating to need to transfer a patient to another facility and be unable to because your contracted transport providers aren't capable of providing transport.

If I knew a company could provide transport in 2.5 hours (truthfully) instead of that same 20 minute ETA that's been quoted to me 6 times now, there are things I might be able to do in those 2.5 hours that I would have held off doing because I was expecting a unit 110 minutes ago that never showed up because I was repeatedly told "20 minutes" or whatever. That's time to start and finish a couple of antibiotics when you only have 1 line available. That's more labs or diagnostic studies that could be done, that's telemed consults that could be done, all things that might just speed things up on the receiving end... all because the hospital got truthful ETAs.

Doesn't matter if the transfer is STAT or not. A truthful ETA allows for better decision-making and contracts to be kept.
 

Gurby

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Your management is stupid and it's only a matter of time before your company loses all its contracts.
 

akflightmedic

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Agreed. Poor management. One thing I have practiced over the years and it has weighed to my benefit heavily is to communicate often and communicate the truth.

I have had issues, I have made mistakes. However I always owned them, presented them to the client, gave real time solutions and explained what led to the problem and how I have learned from it and how I have changed processes to fix it from reoccurring. Basically, I did what many of my previous employers would NEVER do.

I have found that most, if not all have enjoyed this tremendously. They give me more respect because of these actions and they know when I say I can or cannot do something, it is fact. This is how you gain respect in the business world. Holding to this standard has allowed me to grow, gain new contracts and then the financial just follows...

Too bad your company does not realize this.
 

johnrsemt

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When I worked in Dispatch and on the street for a private IFT service I hated that: sometimes you can't help it; if you have 2 ALS trucks transporting patients to the hospital that is requesting an ALS transfer out then you can tell them I have 2 trucks coming into you. But if one of those trucks was always slow getting runs done it was a pain.
We had a street supervisor that would take at least 90 minutes to do paperwork for EVERY ALS run. hated him for it, I would do 2-4 runs in the same time it took him to do one. Hated dispatching for him

As a dispatcher I would always try to be as honest as I could when people called in for transports (time wise) and even if they said they would call someone else I would have a crew go check with them when they marked in service to see if they could still help out.
 
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EMTIsee

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Your management is stupid and it's only a matter of time before your company loses all its contracts.

This same company has a kink in the dispatch system as dispatchers get no sleep time on a 24 hour shift.
 

CentralCalEMT

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It also sounds like there is a huge issue with your county EMS system in general if it allows companies to hold stat transfers. I am assuming stat transfers are higher level of care transfers where the patient is unstable or has a potential to deteriorate.. A genuine stat transport should never be held if it is dangerous to the patient. If it is because of money or contracts this is completely unacceptable. In my county, each of the 3 hospitals has their contracted company for transfers. However, if the transport is stat, it goes to the closest ALS ambulance regardless of company. If sounds like your company is putting profits over patient care.
 

RedAirplane

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It also sounds like there is a huge issue with your county EMS system in general if it allows companies to hold stat transfers. I am assuming stat transfers are higher level of care transfers where the patient is unstable or has a potential to deteriorate.. A genuine stat transport should never be held if it is dangerous to the patient. If it is because of money or contracts this is completely unacceptable. In my county, each of the 3 hospitals has their contracted company for transfers. However, if the transport is stat, it goes to the closest ALS ambulance regardless of company. If sounds like your company is putting profits over patient care.

How does your area hospital determine which ambulance is closest among different companies not on the same dispatch system?
 

chaz90

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How does your area hospital determine which ambulance is closest among different companies not on the same dispatch system?
Closest units generally don't matter in these situations. As mentioned in the other thread on this topic, most facilities have contracts in place on who they call first. One ambulance getting there 10 or 15 minutes earlier isn't a big deal as the patient is never immediately ready to go when the ambulance arrives. If you seek evaluation/treatment at one hospital and they eventually determine you need to be transferred out for whatever reason, it's not a quick process. Which ambulance company responds to the hospital and how far away they are is rarely the rate limiting step in this equation.
 

RedAirplane

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Closest units generally don't matter in these situations. As mentioned in the other thread on this topic, most facilities have contracts in place on who they call first. One ambulance getting there 10 or 15 minutes earlier isn't a big deal as the patient is never immediately ready to go when the ambulance arrives. If you seek evaluation/treatment at one hospital and they eventually determine you need to be transferred out for whatever reason, it's not a quick process. Which ambulance company responds to the hospital and how far away they are is rarely the rate limiting step in this equation.

I get that, was just curious based on the comment above.
 

Bullets

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I work for a municipal third service and a combination squad, so maybe thats why, but whats a "stat transfer"

In my area, IFT companies do IFT and 911 service does 911, there is very little overlap. Unless they have a 911 contract, then there is a dedicated truck for 911 calls for that contracted municipality.
 

Tigger

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Transfers, regardless of priority, are the lowest priority call for us. When you have three ambulances for 500 square miles, it's just not realistic to have an hour response time to a 911 call because the hospital called and wants a transfer done. The hospital is still a higher level of care than we are. Unless the patient is on our cot, we will leave to respond to 911 calls if no ambulances are available. Exceptions might be made for truly emergent transfers, but for the most part what the local ED sends out needs a higher level of care but several hours will not make any sort of clinical difference.

We are of course honest with our ETA to them, however. They know what there 5 ambulances for the 1000 square miles the hospital serves, and we will make sure an ambulance is dispatched to the hospital even if it's mutual aid or a crew that's close to an hour away down in the city where the big hospitals are.
 

CentralCalEMT

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How does your area hospital determine which ambulance is closest among different companies not on the same dispatch system?

In my county, there is a central dispatch for all the companies. Even IFTs are called into the county emergency medical dispatch center as the individual companies are not allowed to have the own dispatch. If the transfer is non stat, then the hospital's preferred company will get the call and the call will be held indefinitely. If the call is "STAT" then the closest unit goes as long as there is still another unit in the area that can handle 911 calls. If the area has low levels, move up units are immediately started from a different company so the stat transfer can be taken without delay. For example of Zone 2 is "ABC ambulance company" who only has one unit available and the hospital calls in a stat transfer, then a unit from "XYZ ambulance company" from Zone 1 will move up into your zone even though they are a different company. All 911 calls then are answered by that company until your units are back in the area. Typically we are allowed to post at the other company's station until they are back so we are not stuck posting roadside.

In our system, there is specific criteria for stat. They have to be higher level of care transfers that are unstable or are becoming unstable. STEMI, major trauma, etc. The fact the hospital just wants to get rid of the patient to turn beds is not stat. Transfers of patient's for insurance reasons are not stat. Stat transfers have to be transfers that have a high level of deteriorating within the next 30 minutes which is the allotted time for a non emergency transport.
 

RedAirplane

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In my county, there is a central dispatch for all the companies. Even IFTs are called into the county emergency medical dispatch center as the individual companies are not allowed to have the own dispatch. If the transfer is non stat, then the hospital's preferred company will get the call and the call will be held indefinitely. If the call is "STAT" then the closest unit goes as long as there is still another unit in the area that can handle 911 calls. If the area has low levels, move up units are immediately started from a different company so the stat transfer can be taken without delay. For example of Zone 2 is "ABC ambulance company" who only has one unit available and the hospital calls in a stat transfer, then a unit from "XYZ ambulance company" from Zone 1 will move up into your zone even though they are a different company. All 911 calls then are answered by that company until your units are back in the area. Typically we are allowed to post at the other company's station until they are back so we are not stuck posting roadside.

In our system, there is specific criteria for stat. They have to be higher level of care transfers that are unstable or are becoming unstable. STEMI, major trauma, etc. The fact the hospital just wants to get rid of the patient to turn beds is not stat. Transfers of patient's for insurance reasons are not stat. Stat transfers have to be transfers that have a high level of deteriorating within the next 30 minutes which is the allotted time for a non emergency transport.

In this system, does everybody do 911 and IFT, or are they separated based on a contract?
 

medicdan

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Transfers, regardless of priority, are the lowest priority call for us.

I'm not sure I understand this. Although the hospital may be a higher level of care than you are able to provide during transfer, it's likely they have patients who require a level of care that is only available at a tertiary care center. Depending on the capabilities of your local hospital, this could include neurosurgery (for evolving SAH/SDH), PCI, pediatric specialties, etc. These cases may be, in fact, the calls easiest to EMD - the patients already have diagnoses, and in partnership with the sending staff, you can triage (what can wait 10 minutes for a response, what can wait 30, etc.). Assuming all hospital transfers are low priority seems to significantly compromise care for those patients, even in a region with limited EMS resources.
 

Tigger

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There is no good solution. We don't have enough ambulances at times, and someone is going to have to wait. I'd rather the person wait in the hospital than in their home, where they are receiving no care.
 

chaz90

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There is no good solution. We don't have enough ambulances at times, and someone is going to have to wait. I'd rather the person wait in the hospital than in their home, where they are receiving no care.
I see where Medicdan is coming from here. A diagnosed STEMI in need of PCI at the critical access hospital is likely more deserving of a timely transfer than the Alpha level "sick person" or lift assist from home. I agree that there's no good solution, but many CCT transfers out of local community hospitals are far more time sensitive than the vast majority of 911 calls. It's hard to play the game of "probably" when EMDing a 911 call, but we all know the odds are in favor of the low triaged emergency response being extremely low acuity...This wouldn't be an easy concept to justify to residents of a district who are waiting for an ambulance though.
 

medicdan

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There is no good solution. We don't have enough ambulances at times, and someone is going to have to wait. I'd rather the person wait in the hospital than in their home, where they are receiving no care.
I agree, there isn't an easy answer. I'll stretch this a little further-- knowing nothing about your area or regional capabilities. For these STAT transfers, the most important resource for the hospital is the vehicle. In my area, if we aren't able to get an ALS transfer vehicle to a hospital for truly critical patients within a specific time, we have the ability to send a BLS truck and hospital staff accompany the patient (maintaining the ventilator, infusions, etc.) - noting the important intervention is the transportation, not the prehospital staff.

I worked for some time in a semi-rural area, with a critical access hospital. The ED was staffed, in part, by a tech (certified as an EMT), and all of the nurses are EMTs. If they needed to get a critical patient out, and an ALS/SCT vehicle was too far away, the tech and an RN would take an OOS ambulance; in turn, the 911 ambulances remained in service for the region. If/when the 911 trucks brought a patient into the ED while the transfer was in progress, the medics would help get the patient situated, or help in the ED to compensate for being down to staff (while the 911 ambulance remained in service). It was a win-win for everyone.
 

Tigger

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I agree, there isn't an easy answer. I'll stretch this a little further-- knowing nothing about your area or regional capabilities. For these STAT transfers, the most important resource for the hospital is the vehicle. In my area, if we aren't able to get an ALS transfer vehicle to a hospital for truly critical patients within a specific time, we have the ability to send a BLS truck and hospital staff accompany the patient (maintaining the ventilator, infusions, etc.) - noting the important intervention is the transportation, not the prehospital staff.

I worked for some time in a semi-rural area, with a critical access hospital. The ED was staffed, in part, by a tech (certified as an EMT), and all of the nurses are EMTs. If they needed to get a critical patient out, and an ALS/SCT vehicle was too far away, the tech and an RN would take an OOS ambulance; in turn, the 911 ambulances remained in service for the region. If/when the 911 trucks brought a patient into the ED while the transfer was in progress, the medics would help get the patient situated, or help in the ED to compensate for being down to staff (while the 911 ambulance remained in service). It was a win-win for everyone.
To be clear, we will not divert an ambulance that's headed to the hospital on an emergent (stat) transfer. But those are rather rare, and the local flight services will take them if there are no ambulances available even though its a whopping ten minute flight.

Our local ED has two nurses, a tech, and the doc (who is responsible for the floor as well after 5pm). While we have stolen the tech to drive in the past when two providers were needed in the past, they can't sacrifice one of two nurses for a transfer.
 
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