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"Risky Business" The IFT Industry in Ontario


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I was recently admonished by another member of this forum for my description of the patient transfer industry in Ontario. Well exceptional companies and employees not withstanding, I'm happy to see some attention in the general public being drawn to this absolutely unregulated industry.

Attached is a link to a CBC Radio Documentary by Tina Pittaway:

http://tinapittaway.com/2009/12/listen-to-risky-business/'>http://tinapittaway.com/2009/12/listen-to-risky-business/

The transcript can also be found on the main page

http://tinapittaway.com/

It's well worth the listen for both Ontario and Canadian medics and providers elsewhere. About 25 minutes long.

I'll comment later when I'm at a less clunky computer.

- Matt

Edited by docharris
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I must say this is quite interesting.

The Patient Transfer Service (PTS) here in New Zealand is an 'addon' run by the the emergency ambulance providers so to that end it's semi-regulated through the contractural requirements between ambo and the DHB (although not by the Crown). There are one or two private companies that offer point-to-point medical transport but they must be privately booked, to my knowledge they do not hold PTS contracts with the DHBs (district health boards) although I could be wrong; as far as I know all DHB PTS contracts are held by the emergency ambulance providers.

All our PTOs (patient transport officers) have at least advanced first aid and can use an AED, BVM etc. Alot of PTOs are ex ambulance and used to be Paramedic or Intensive Care level so are fairly switched on and some are Technician level so can use LMAs, GTN etc.

Patients who use PTS mostly go in a fully equipped road ambulance (although some services use regular cars) and they have to be so stable it's not funny or they do not meet the criteria for a PTO. There is no Ambulance led CCT in New Zealand, we have no "critical care paramedics" and if the patient is really sick on pump meds etc then an RN/MD from the hospital CCT team will jump on board with a code box.

Again, a very interesting report.

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Well at least I can say in BC our trasfer cars have paramedics in the back

Same here in Newfoundland. In fact the services that provide routine transports (Patient Transfers) also provide emergency service so the same ambulances are used for both purposes and required to be fully stocked and staffed at all times. If the patient is truly critical then we get an RN or an MD on board from the sending hospital as well.

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Well at least I can say in BC our trasfer cars have paramedics in the back

Sorry Happiness but that's quickly changing here in BC. Firstly you actually only need to be an EMR to qualify for a transfer fleet position. Secondly, since the transfer of interfacility transfer budgets from BCAS to the health authorities, private transfer companies are springing up like weeds. Damaging unregulated weeds with no real standards beyond a first aid ticket and a pulse.

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Hello,

I have worked in three proviances (AB,BC,NS) and one territory (YT) and I have found transfer services in BC below standard. I do not mean this as an insult to BCAS staff but rather a symptom of poor management and funding.

For example, we frequently get patients transfer in with a BLS crew and a RN. Sometimes, things are well done. Sometimes, not so much. These are not short little transfers either. We have had a critically ill patient driven in for several hours away.

In addition, from a hospitals point of view they are paying for the RN to go with the BCAS crew (that cost money as well). In fact, a hospital-to-hospital transfer can cost a pile of overtime and short staff then sending hospital. Second, time delays waiting for a transfer ambulance. Therefore, it makes economic scene 'contract' it out.

In AB and NS this wasn't an issue. For example, a sepsis patient needs to get from the hospital A to hospital B. An ALS crew would show up, get report, load up the patient and be on their way.

Again.........no slight intended for BCAS paramedics....just a symptom.

Not to mention air ambulances services........ I would write more but work calls.

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Hello,

I have worked in three proviances (AB,BC,NS) and one territory (YT) and I have found transfer services in BC below standard. I do not mean this as an insult to BCAS staff but rather a symptom of poor management and funding.

For example, we frequently get patients transfer in with a BLS crew and a RN. Sometimes, things are well done. Sometimes, not so much. These are not short little transfers either. We have had a critically ill patient driven in for several hours away.

100% in agreement. These are all symptoms of a system that is underfunded and severely short of ALS providers. The situation is only made worse by the fact that the typical BC RN is not adequately qualified to work a true CCT. These are not normally CCRNs or even ICU nurses. They are rural nurses, frequently new grads, who often haven’t taken any training beyond their initial education.

In addition, from a hospitals point of view they are paying for the RN to go with the BCAS crew (that cost money as well). In fact, a hospital-to-hospital transfer can cost a pile of overtime and short staff then sending hospital. Second, time delays waiting for a transfer ambulance. Therefore, it makes economic scene 'contract' it out.

This is where I’m in total disagreement with you. Because of the existing structure of the service in BC and the fact that it’s a public not for profit entity, it is far less costly (to the hospitals and thus the tax payer) to properly fund the BCAS. Properly funded the BCAS could easily provide true dedicated transfer services. Private companies will only ever take on a service if they can make a profit in doing so. When it comes to public services it makes more sense for any profit to go directly back to the tax payer.

In AB and NS this wasn't an issue. For example, a sepsis patient needs to get from the hospital A to hospital B. An ALS crew would show up, get report, load up the patient and be on their way.

Again.........no slight intended for BCAS paramedics....just a symptom.

That’s exactly the way it should be. If the service was adequately funded and staffed that’s the way it would be.

Not to mention air ambulances services........ I would write more but work calls.

What air ambulance services? There are 3 dedicated day-time helicopters in the entire province and only one dedicated helicopter at night. The bird in Prince Rupert isn’t even staffed with ALS providers. It’s staffed with PCP-IV’s pulled off of a Prince Rupert BLS car for the flight. I could go on but I get the impression you’ve personally witnessed the sad state of affairs here in BC. BCAS has gone from being a provincial jewel to a pile of thorns. I’m still hoping we can get some roses out of this whole thing but it isn’t going to happen without some water and fertilizer. The soil’s getting might dry these days.

Cheers,

Ed

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Hello,

"This is where I’m in total disagreement with you. Because of the existing structure of the service in BC and the fact that it’s a public not for profit entity, it is far less costly (to the hospitals and thus the tax payer) to properly fund the BCAS. Properly funded the BCAS could easily provide true dedicated transfer services. Private companies will only ever take on a service if they can make a profit in doing so. When it comes to public services it makes more sense for any profit to go directly back to the tax payer."

If BCAS was properly funded and had enough ALS the hospital wouldn't have to send its staff. That is what I wanted to say. Now, a lack of ambulances and properly trained crews for ALS transfers costs hospitals money, time and staff. Not to mention effects patient outcomes.

For example, a small town sent in a patient with a green BLS crew and a new grad RN with no critical care background. It was a inferior/right-sided MI. The guy was hypotensive, gray, nauseated, and barfing for the whole long ride in. On arrival his BP was 70. No interventions were made. Who fault is that.......not the wide-eyed paramedics or nurse. No, it was a funding issue for BCAS.

"What air ambulance services? There are 3 dedicated day-time helicopters in the entire province and only one dedicated helicopter at night. The bird in Prince Rupert isn’t even staffed with ALS providers. It’s staffed with PCP-IV’s pulled off of a Prince Rupert BLS car for the flight. I could go on but I get the impression you’ve personally witnessed the sad state of affairs here in BC. BCAS has gone from being a provincial jewel to a pile of thorns. I’m still hoping we can get some roses out of this whole thing but it isn’t going to happen without some water and fertilizer. The soil’s getting might dry these days."

Holly....do not get me started on this one. Once it took 36 hours to get a sepsis/ARDS patient transfer to us. An other time a fairy young patient with failed TNK needed a rescue angio in Vancouver. After 12 hours of hurry up and wait BC bedline broke the bank (gave a P#....bill to an other service) and Alberta came in a took the patient to Edmonton. Also, in my area STARS and other Alberta services have been doing more and more transfers for us.

I do feel bad that BCAS has fallen behind from it glory days. When I think of good ambulance systems I think of Emergency Health Services Nova Scotia. Or new kids on the block with great potential like Ambulance New Brunswick and Island EMS (Prince Edward Island).

Gasp......

Rant done.

For now......

If BCAS funding dose not come around and transfer (ground and air) do not improve I can see each health region developing its own CCT program (the Trail boon-doggle notwithstanding).

Need to run.

David

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