When IFT=lower level of care/abandonment

[Jim37F]

That's going to be system dependent. There are a number of systems where paramedics will hand over care to an AEMT or EMT. I believe Los Angeles does this (fire medics and private BLS company responds to all 911 calls, the medic assess the patient and then deems the patient needs ALS or BLS).

Pretty much. If they determine the patient is BLS the fire medics go available and the private EMTs transport the patient themselves. Perfectly legal, and written into our county protocols. It's also written into our protocols that if the BLS transport time is less than the ETA of the medic unit, the EMTs can load and go, so while due to the large number of ALS units (both fire and private ambulances) it'll never happen, but in the OPs scenario here if there were no ALS units available, the EMT BLS ambulance can legally transport an ALS patient to the higher level care, such as the example given of the trauma patient going from the "doc-in-a-box" community hospital to the trauma center (especially if the sending MD says the patient can't wait).

 

[FiremanMike]

How can the Dr tak care of that PT? If they dosed the patient with something and it wears off during transport how am I supposed to redose them? I'm only an EMT-B.

Just like off-line protocols, the doc will not be directly involved but will be absolutely responsible for everything that occurs until your patient until they reach the receiving facility.

 

[exodus]

It just doesn't make sense. In order for that "higher level of care" to happen those folks need to be present. Sending a PT in my BLS bus is definitely a lower level of care and definitely abandonment. If the PT were to code and die I bet a lawyer would have a field day. I've already been sued three times. I don't need a fourth!!!!

Holy ****, if you have been sued 3 times you are not a good provider and need to find a new job. If one person finds you an *******, chances are it's them. If EVERYONE find you an *******. It's you.

If you have issues with the IFT protocols in your area bring it up to your EMS authority. But I digress, sued 3 times a basic... Do something else.

 

[FiremanMike]

I hit 17 years this year, 15 years with a high volume system. I've also worked part time jobs at rural departments, in critical care, and in HEMS. I've been sued 0 times.. Either you are exaggerating or you're doing something very, very wrong.

On a final note, it is definitely not abandonment, as has been explained ad nauseam. You are functioning as an extended arm of the sending physician who has the ultimate responsibility for your patient until you reach the receiving facility. By your logic, it is abandonment when the physician leaves the patient's room in the care of the RN while he goes to see another patient or to eat lunch.

 

[Akulahawk]

As I was taught, you can't go down, you can only go up. Otherwise it's abandonment.

EMT can accept patient from EMR or EMT
Paramedic can accept from EMR, EMT, or Paramedic
Doctor can accept anyone because they're the "highest"

There are several flaws in this (does nobody ever get discharged? Do all transfers need MDs?) but this is the very simple way things are explained in an EMR or EMT class.

When I'm on scene with a patient, if my assessment tells me that the patient is OK for BLS care, then I can triage the patient to my EMT partner. If my EMT partner refuses the patient, then I cannot force the patient onto my partner. The fact that I'm also an RN doesn't mean that I cannot triage my patient "back down" to BLS as long as the patient meets criteria for BLS care. The only time I cannot triage a patient to a lower level of care is if that patient requires care that the lower level of care cannot provide for the duration expected.

In an IFT setting, the "rules" are different from the usual prehospital rules.

 

[ERDoc]

This only applies to NYS as far as I know but when I was a volley, the question of ALS handing a pt off to BLS came up and the question was actually sent to the state DOH. Their reply was that on a BLS call, everyone is a BLS provider so the pt can be handed off to someone else with a BLS cert even if the person doing the handoff is certified at the ALS level. The ALS provider becomes an ALS provider when the pt need ALS interventions at which point the pt cannot be handed off to a BLS provider.

 

[TransportJockey]

To the OP, in your opinion if I do a 12-lead to clear a patient to be taken by BLS, is that abandoment? Cause it seems no more out of the ordinary to me than your other scenarios

 

[ERDoc]

I'd still like to know more about the original scenario. Why was this person being transferred? What meds were given? Did the person have a previous seizure history?

 

[Ensihoitaja]

Really, the biggest issue is making sure the patients needs are met when transferring care. If the patient needs ALS care, then clearly handing them off to a BLS unit is inappropriate. If the patient needs CCT care then an ALS ambulance is inappropriate.

I've worked in systems when an ALS ambulance could transfer care to a BLS ambulance, it's really not that different from a medic/basic ambulance and having the basic attend.

 

[Gurby]

I'd still like to know more about the original scenario. Why was this person being transferred? What meds were given? Did the person have a previous seizure history?

I think I scared him by talking in chat about a call I had just done: IFT for a patient with glioblastoma, going from community hospital to big city hospital ED. Patient is very agitated, gets some Ativan just before transport. Patient starts seizing while we're waiting in triage, causing excitement and getting us to the front of the line. I joked that "the Ativan wore off just in time".

 

[GloriousGabe]

To the OP, in your opinion if I do a 12-lead to clear a patient to be taken by BLS, is that abandoment? Cause it seems no more out of the ordinary to me than your other scenarios

Way outside of my scope. What...I'm supposed to bring a 12 lead from home?!

 

[squirrel15]

Way outside of my scope. What...I'm supposed to bring a 12 lead from home?!

The twelve lead is done, you don't need to do one. But I have a new bridge for sale if the one your under is getting aged

 

[StCEMT]

Way outside of my scope. What...I'm supposed to bring a 12 lead from home?!

You weren't the one doing the 12 lead in that hypothetical, Transport Jockey was...

 

[Akulahawk]

Please keep things civil.

 

[Chimpie]

Way outside of my scope. What...I'm supposed to bring a 12 lead from home?!

What was your point with this statement?

 

[GloriousGabe]

What was your point with this statement?

That I only operate within my scope of practice. BLS doesn't have 12 leeds.

 

[StCEMT]

You ARENT doing a 12 lead based on what TransportJockey said, so you are within your scope. Where are you confused with that statement?

 

[GloriousGabe]

You ARENT doing a 12 lead based on what TransportJockey said, so you are within your scope. Where are you confused with that statement?

Maybe. Sorry. It's been a long day.

 

[Akulahawk]

That I only operate within my scope of practice. BLS doesn't have 12 leeds.

While this is true, a Paramedic has done the 12 lead and has triaged the patient down to BLS. Could you bring the 12 lead printout with you? Sure. That still doesn't mean that the patient still needs ALS level care during transport. The "downgrade" of patients from ALS to BLS happens all the time all over the country.

 

[Jim37F]

The "downgrade" of patients from ALS to BLS happens all the time all over the country.

As does the "downgrade" of patients from the care of a Doctor to BLS ambulances for inter-facility transports with out a problem.