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Are you really part of EMS???


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NO EMERGENCY = NOT EMS
Well, I wouldn't put it that basically, because one of the common defenses is that transfer's job (in reality) is dealing with emergent patients. Most nursing home to ER transfers I've done are really borderline if not 100% emergencies and that's a routine part of the job.

So, I think one needs to specific that if your system isn't specifically and formally setup for dealing with official medical emergencies on a regular basis, then you're not EMS. (?)

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Unfortunately Emtb's are being replaced with Medics. Your standard run of the mill, "granny runs" are standard for emt's. So are transport runs still classified as "Emergency" medical services. Yes. The reason I say that is this. I was doing a "routine transport" from UPMC Presby to our local TCU in Oil CIty, PA. The older women maybe in 60's, was fine for most of our transport. Then about Zelienople on I-79 the pt started complaining of CHEST PAIN. Now normally this wouldn't bother me, but my partner and I were two EMT-B's (well seasoned). I called 911 and got Mercer Co. 911. I told them of my situation, turned on my lights and ran HOT to Grove City. The medic hopped in with us and we were good. The rest of the transport went without a hitch. We dropped the pt off at Grove City hospital and returned to quarters.

My point is this a routine transport can turn EMERGENCY quickly. I hope this helps. Thanks for the question.

With your logic every home would need a paramedic stationed in it because of the possibility of something happening.

IF YOU DO NOT RUN EMERGENCY YOU ARE NOT EMS.

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Just for the sake of throwing it out there. EMS stands for EMERGENCY Medical Services. I would say that the transport companies should be called TMS (Transport Medical Services) or NEMS (Non Emergency Medical Services) Yes they still are part of the Medical Services field, however not the Emergency Medical Services.

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I'll respond to this post from an Ontario perspective. Unfortunately, I don't think (I could be wrong) that there are any people here in this situation, but I digress.

While I still don't fully understand the semantics of 911 vs "emergency tranports" vs "80 F doing for dialysis goes bad" in certain contexts. I'll say this...

Ontario has a system where there are truely emergency (EMS) vs. non-emergency (transfer) ambulances (non-EMS).

EMS - keep in mind these are several of many legal obligations

- All are staffed with paramedics (PCP, ACP, CCP) who have provincial certifications under the Ontario Ambulance Act to practice. As well as been unde a service and hospital scope of practice.

- Are under employment with a municipal service

- Have to complete provincial ACR's on every call

- Respond to 911 calls, although all levels can and will do transfers as scope is needed.

- Can run L+S (prn)

These a several very basic aspects of the job...For comparison

Non-EMS (transfer services). I don't think are under any "real" legal obligation, beyond those listed below.

- Can be a random person who at least has a "G" License (keep in mind all paramedics, regadless of scope have "F" class).

- Can have "certs" from FA to foreign MD, to paramedic student to actual provincial cert. (those may not be yet hired as per competition).

- All of these services are private, FOR PROFIT. No municipal 911 service is for profit.

- No vitals of any kind are required, or really even need given what they are supposed to transfer.

- Have non-standard to irrelevant paper work. Meaning they will never be formally audited and "really" held for anything.

- Do not EVER respond to 911 calls EVER. They are not legally allowed to and besides, don't have access to any kind of 911 dispatch. If they have a patient that (goes south) or are picking up a patient that "doesn't look good", two of many examples, they must call 911. They don't go direct to the ER or OR, or any kind of emergency situation.

- It is illegal for them to go L+S.

I hope this makes it (somewhat) clear how this argument works here. Do some of these people still wear stethoscopes around their necks? Yup, and I hope they are paramedic students. Are there ambulances that still say "paramedic" on them? Yup, and that one kills me. It's rare, but it kills me.

There are probably about 60'ish (I'm guesstimating) EMS service in Ontario for 13 million'ish.

Transfer services are maybe half that'ish.

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I had a similar discussion a while back with a collegue. His opinion was that "transfer medics" from the city have no clue what to do in rural emergency situations. When you are 30 minutes from a hospital, you have to handle the situation the whole time. His opinion was that you need to be well seasoned as a rural medic to be able to handle the prolonged transport time. Most IFTs are either not critical or under doctor's orders. When you arrive on scene and have to decide for yourself what is going on, THEN you are practicing REAL medical skills. Many times we have to handle such situations at the BLS level for 20 to 30 minutes. I would guess that the IFT providers don't usually have to do that too often. Skills don't maintain if you don't use them.

Well said!

I think things are a bit different here however, because every service no matter the type has a medical director, as required by law. I love the longer transport times on the really good calls when there's no ALS. There's always the phone and medical direction around if need be of course, but we still have protocols regarding drugs/Tx and cannot go outside of them. When you're 20 minutes from hospital going hot with a critical/semi-critical pt and there's nobody around but you and your EMR/EMT partner, that's quite a feeling.

As for the transfer people, I think they'd have a hard time working rural. City, well whatever because they're 5 minutes from hospital, but there's still stuff to do. Less time to think and that would probably fluster a great deal of them. Rural? Well more time to monitor interventions like drugs, etc but you still have to perform the critical tasks STAT when it's a bad situation. They'd likely still get flustered.

EMS is not like riding a bike ...

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This topic makes me wonder if some people have forgotten what EMS stands for...or more so what the E in EMS stands for...

If theres no Emergency your not part of EMS.

Yes!

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NO EMERGENCY = NOT EMS

You can keep posting that over and over again, but I think this thread has moved well past the idea that there's a simple demarcation between 911 being pure emergent transport and interfacility being pure dialysis and discharge.

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Just for the sake of throwing it out there. EMS stands for EMERGENCY Medical Services. I would say that the transport companies should be called TMS (Transport Medical Services) or NEMS (Non Emergency Medical Services) Yes they still are part of the Medical Services field, however not the Emergency Medical Services.

Yea, ok. I guess when the fracking nursing home thinks that an altered diabetic with BGL of 30 is non-emergent, it really is non-emergent. Oh, that call isn't an anomaly either. I can think of more than 1 nursing home where I had more emergent transports coming out of than non-emergent.

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Yea, ok. I guess when the fracking nursing home thinks that an altered diabetic with BGL of 30 is non-emergent, it really is non-emergent. Oh, that call isn't an anomaly either. I can think of more than 1 nursing home where I had more emergent transports coming out of than non-emergent.

Well see where I come from, that would not be considered non-emergent, that would get full dispatch and ALS. I'm just going off of what I know.

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You're assuming that the nursing home is calling 911 when they should, that private ambulance companies can respond code 3 unless requested by the fire department, that private ambulance companies have paramedics here, or a combination of either of those.

Personally, I see major problems with 2 of those, and somewhat of a problem with the third [non-911 ambulances shouldn't respond code 3 unless requested for an emergency hospital to hospital transfer].

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