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Inter-facility transports


brentoli

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Hey here's a novel concept - - just go where you are told to go, when you are told to go there and do what needs to be done, even if sometimes it is just to hold a hand or to hold your mouth closed and stop whining. . .

if you want to be the manager, supervisor or medical director, go get the credentials (or Time on grade) to do the job, otherwise, , quityerbitchin

I work for a sevice that runs 911 calls and also non-emergent transports. We take the calls as they come in and dont complain. Could so pt go by other mean , yes.. But if a Doctor signs the paper that they need to go by squad. what can you do. We are here to help people so just take the trip. :?

These are basically the same post, thus the same answer will apply.

Most non-emergent patients do not need anything more then a bed to ride on. These patients, including hip precaution patients, do not need, nor really warrent an ambulance. There are services popping up that offer ambulette transports [think wheelchair van with a gurney]. Once society gets non-emergent/non-CCT patients out of ambulances [ex discharges, doctors appointment, dialysis, etc], then we can really start moving towards requiring more than an advanced first aid course to be considered a prehospital provider.

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For interfacility transfers, we check the non-emergency box on the PCR and have the nurse (though I think it should technically be the doctor) fill out and sign a form saying why the patient requires transport by ambulance instead of private vehicle or one of those medical transportation vans (which I guess insurance won't pay for).

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Every pt that goes by ambulance needs a certificate of medical necessity filled out by an MD (mostly for Medicare and caid). This form can be quite a pain in the ass because there are very strict guidelines that we have to meet. There have been a few pts that I have transferred to another facility that were borderline on these criteria. A problem we have in the ER at night is there is no one but ambulances to take people home, so we are stuck calling one (and trying to justify it). As someone else said there are ambulettes but they often do not run at night. I have even seen an ambulette with a strecher and a 2 man crew (great idea to take the burden off of the EMS crews). Again, these are not available at night. Renal roundup is such a waste of ambulance resources also. A better system needs to be developed, until then you guys are gonna get stuck with inappropriate transfers (sorry).

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Firedoc, you and Mr. Anderson have totally missed the point of this discussion. This isn't a matter of a crew whining about having to take a run they don't want to make. This is a broader operational discussion of system-wide significance. Just because you don't have the motivation or education necessary to supervise or manage a system does not prohibit the rest of us from discussing the broader issues in EMS, such as resource management. Sit back with your head in the sand of blissful ignorance if you like, but the intellectuals here will continue to talk EMS as a whole and our future, and not just the last cool run we made.

Reading comprehension goes a long way here, folks. Brent didn't ask if those people needed an ambulance. He asked if they really needed EMS. I know this may come as a shock to all you transfer monkeys out there, but you are not EMS. I don't care what EMT stands for, how shiny your badge is, or how red the lights on your ambulance are, you are not EMS. You are there to transport people who require assistance or a supine ride, but not EMS.

The question is, should EMS systems also be running non-emergency, invalid transports that do not require medical attention? Should they be separate industries? Should states even be requiring that such transfer ambulances be staffed with EMS certified personnel and equipment? Shouldn't customers have a choice? If I have absolutely no acute medical condition that requires any medical attention or assessment, but just need somebody to carry my decrepit old arse home, shouldn't I have a whole yellow pages full of options, instead of just the couple of "ambulance" companies approved of by the local FD, or worse yet, the "Public Utility Model" EMS system that runs my area with an exclusive hold on the transfer business, and charges three times as much as Joe's Transfer Service would charge me?

Pull you heads out and look past your little ambulance and look at the big picture here. This is a question that may very well determine the future of EMS in this country. Will EMS continue to identify itself with non-medical transfer services just for a few extra Medicare bucks, resulting in us forever being called horizontal taxi services? Or should we maybe decide to take our name literally and declare that EMS is exactly what it says: EMERGENCY MEDICAL SERVICE? Words mean something. To be strutting around with our patches under everybody's nose and declaring ourselves to be an essential, lifesaving emergency service, yet spending more than half of our time doing nothing more than giving people non-emergency, non-medical transportation is living a lie. It's time to get serious about our primary purpose and specialise in what we claim to do best.

No, Mr. Anderson, you are wrong. This isn't about "helping people." That's the biggest lie in EMS. There are a million ways to help people in this world that we have to choose from. Unfortunately, most of them don't involve badges and sirens. If our field didn't involve badges and sirens, three quarters of the current EMTs would quit tomorrow. Do you think they would go searching for some new way to "help people?" Hell no. They'd take the first union job they could find that didn't require a lot of book learnin’. They darn sure wouldn't go to work running a transfer car for a career, with no hope of ever driving with lights and siren or calling themselves "public safety." I guess that doesn't "help people" enough. The other twenty-five percent that would stay here are those who are here because emergency medicine is just the coolest, most interesting and intellectually satisfying thing we can imagine to apply our talents to. Those are the people that ought to comprise one hundred percent of the EMS ranks in order to call ourselves a true profession.

EMS runs non-emergency, non-medical transports for the exact same reason that they hire EMTs. Money. No other reason. And the retarded laws that regulate non-emergency ambulances currently allow us a bit of a monopoly. It doesn't have to stay that way. It shouldn't stay that way. It isn't that way in Canada or Mexico, and their people seem to get to the nursing home just fine. If we continue to do things the way we've always done them, we will continue to get the results we have always gotten. That means we will forever remain nothing more than "ambulance drivers," with all the [lack of] respect that comes with that. Good luck making a profession out of that.

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That means we will forever remain nothing more than "ambulance drivers," with all the [lack of] respect that comes with that. Good luck making a profession out of that.

Dust enjoyed your post. Very clear and to the point. The only thing I disagree with is "ambulance driver". When we keep taking all these non-emergency transports we do not even qualify for that. You should have called us what we really are TAXI DRIVERS. Yes our taxis have bright lights and make lots of noise but not really any different than the yellow cab in what we do. Both have people that that hollar "hey I need a ride".

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Dust, you're certainly right in that IFTs make money. They're guaranteed payment from what I've been told. For the past year at our company, we've been having to do IFTs mixed in with 911 calls as a supplemental income to the company. After they picked up the 911 contract in the area, their net gain plummeted...yet previously when they were just a transfer company (with a good reputation), they were (according to old employees) making bank.

How are EMS companies to survive when providing services to areas where no one has insurance? There are two cities we cover that I like working OT in where I have yet (in maybe 10 shifts) to have a patient with medical coverage, other than occasional infants with state coverage.

Our company was lucky enough to also get some of the more glamorous LA areas (though they're low call volume, yet require a number of ambulances because the area is so spread out with lots of curvy canyon roads. But without that, I think we'd be going under. And this is a company where they come down on you hard on paperwork (so insurances pay out).

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Dust, you're certainly right in that IFTs make money. They're guaranteed payment from what I've been told.

HA! No. If you get payment for 30% you're doing very well.

The company I used to work for picked up a dialysis patient from home three days a week round trip for 5 years. Completely bedridden, met all the criteria for medical necessity. Medicare paid every other transport. Didn't matter what was in the paperwork or not, they paid every other.

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The question is, should EMS systems also be running non-emergency, invalid transports that do not require medical attention? Should they be separate industries? Should states even be requiring that such transfer ambulances be staffed with EMS certified personnel and equipment? Shouldn't customers have a choice? If I have absolutely no acute medical condition that requires any medical attention or assessment, but just need somebody to carry my decrepit old arse home, shouldn't I have a whole yellow pages full of options.....

......look past your little ambulance and look at the big picture here. This is a question that may very well determine the future of EMS in this country. Will EMS continue to identify itself with non-medical transfer services just for a few extra Medicare bucks, resulting in us forever being called horizontal taxi services? Or should we maybe decide to take our name literally and declare that EMS is exactly what it says: EMERGENCY MEDICAL SERVICE? Words mean something. To be strutting around with our patches under everybody's nose and declaring ourselves to be an essential, lifesaving emergency service, yet spending more than half of our time doing nothing more than giving people non-emergency, non-medical transportation is living a lie. It's time to get serious about our primary purpose and specialise in what we claim to do best.

Having worked for a transport company and a 911 service, I couldn't agree more, or could I have actually stated this as well as Dust has.

Allow me to give you +5

The entire post is worth quoting so people read it more than once, and then think.

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I worked at a strictly IFT company here in so cali for 6months until i recently got hired at a 911 company(but do have areas for only IFT also). At the IFT company, i was really only there for the money and scheduling because of my school, but as far as an EMT i very very rarely got use my skills besides pt. assesment. I just got burned out doing only IFT's and thats the reason i switched. This way ill be able to do 911 and get the experience that i personally feel that i need before i head to medic school. Dont get me wrong, IFT's are just as important and it goes along with EMS. (this is just my personal views)

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Dont get me wrong, IFT's are just as important and it goes along with EMS. (this is just my personal views)

Important? Absolutely! It has to be done, and if you're the one that's stuck someplace you don't want to be, then it is absolutely important.

But it does NOT go along with EMS. It is not an EMERGENCY, and it is not MEDICAL, so how exactly does this have anything to do with Emergency Medical Service?

I definitely agree it's important though. In fact, it is so important that those who need it should have multiple choices, so that they can choose who they want to perform it instead of just being stuck with whoever they are assigned. They should be able to call one of twenty providers out of the Yellow Pages and get somebody who wants their business enough to get there WHEN they want them there, not just whenever the 911 system can free up an extra car to make the run.

EMS should not be providing private, non-emergency, non-medical transportation any more than the PD should be providing private, non-law enforcement security guard services. In fact, federal law should prohibit it.

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