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Inter-facility transports


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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.

Universal health care. That way, every transport, IFT or emergency, will be paid, EMS provider income will skyrocket (real EMS providers, especially, since emergency transports seem to have the lowest payment vs. non-payment ratio?) and there will be money to increase paramedic salary, luring more people in the field, which means EMS providers can be choosy. Then they will hire better (i.e. more educated) providers over the others, the profession advances, more money will be paid to more educated staff. Voila, you have a completely new profession. No more financial reasons for volunteer EMS.

Look at Iceland. I'm not saying we have the best EMS system in the world. Quite the opposite. But we have *very* rural areas. Yet, there is no place in Iceland where there is not professional EMS. The people who come get you may not be top-notch (that is material for a whole-new thread in itself), but at least they are not volunteers. Our country is roughly the size of Kentucky, but only 300,000 people. You do the math. Yet, full, paid EMS coverage, including outstanding medevac (large, well equipped coast guard helicopters that can carry 10+ patients, staffed with a MD (an ER doc) and an EMT-:D (Reykjavík), and fixed-wing well-equipped planes staffed with a paramedic and a MD (Akureyri and a few more places).

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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 agree that IFTs are important. But, instead of splitting it completely from EMS, I think the ideal service is one that has a combination of IFT units and 911 units. Allow the crews to switch between the two to prevent burnout. Possibly consider the IFT unit a "Psychological Light Duty" job.

Another idea, use the IFT units for new staff training and evaluation, then let them do some nursing home "emergencies", where the patient is coming from a stable environment before putting them on the 911 units.

When I worked for a private ambulance, almost 70% of the IFTs were paid, so this was a solid revenue stream for the company.

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ok how bout this take on this divisive topic

You have two or three divisions in your service. Now for the tiny services you can't but you can hire people for different roles.

Division 1 - 911 calls staff it sufficiently

Division 2 - non emergency patient transfers that require an ambulance or a wheelchair van. (these are staffed separately from 911 division)

Division 3 - Wheelchair vans that their whole reason for being is the transfer from home to doc office or anything of that nature.

Division 1 will always be a money losing entity

Division 2 might just break even

Division 3 this is the money maker - that division would not take insurance payments. It would require payment up front.

The EMS system has to follow some pretty strict guidelines that must be followed to make this work.

1. 911 ambulances are for 911 calls only. PERIOD NO TRANSFERS except for ALS transfers from Hospital to hospital

2. Division 2 - this division is strictly for the patient who either requires a ambulance cot or the services of a emt or paramedic. Like transfers with patients who are on a monitor or Iv with medications(for the ALS car) and patients who require to be on a cot due to inability to go any other way.

Division 2 would also have a set number of transfers that could be done in a given hour. Once they hit that number then the transfers need to be pushed back. For example, you have 5 ambulances for the division 2 purposes. You get 6 calls for transfers at 2pm. The 6th transfer needs to be moved to an hour in the day with available resources.

Division 3 - this would be the money maker of the service. You have patients who pay upfront and you can determine what a reasonable rate would be. Would it be a hourly fee plus mileage? Or would it be a set amount.

No division would be hogtied into covering for another division because that would be a flustercluck.

Finally each division would have it's own dispatcher and scheduler to make it easier to manage.

Just my thoughts. I have worked in a service that had a VA contract. if the VA Called and our service had only one ambulance available in the entire city of 120K then we sent that ambulance and prayed that there would be no calls that came in until another ambulance bacame available. How's that for protecting the citizens?

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That still leaves a lot of questions. Who staffs these different divisions? Do division 2 and 3 personnel still have to be EMTs? Why, or why not? Are those division 2 and 3 vehicles still ambulances, complete with red lights and sirens? Is there any cross-pollination of personnel, or are they completely separate? Is this an exclusive service, excluding all other companies from operating in the area, or is there competition? And what exactly is the purpose of running both services from one agency? Profit? The fire department doesn't make a profit. The street department doesn't make a profit. The parks and libraries don't make profits. Who says EMS has to make a profit?

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Is this a job for EMS? Pick up the little old lady at the hospital, take her to her doctors office, then back to the nursing home. Ect., ect,. ect.? What qualifications do you need for that type of job? Equipment? What about the long cross-state transfers?

That's a job for a Non-emergency Medical transport Company.

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  • 2 weeks later...
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.

I'm partial to this statement.....

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example of way an ambulance is needed.....I had a pt that needed transport from hosp to nursing home. I was driving my partner was in the back with her. The PA that was in charge said that she was fine and could go 'home'. The pt had a little anxiety, but was otherwise fine. Enroute to the 'home' her blood pressure went throughout the roof and would not calm down. Right there my partner and I had to make the choice of turning around or not. My partner said f... it and we turned around and was able to use our lights and sirens and make it back to the hosp without having any trouble. Now would a taxi be able to do that? I don't think so. Just because the pts seem like they can walk, you have to remember that any pt can be healthy one minute and crash the next. Our company has a few ambulances, they are used for many different reasons. We are all here to help people and that is what I will continue to do!

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