Code 3 IFT?

[NomadicMedic]

Many nursing homes would simply call the ambulance dispatch center directly, and say "we need a medic for this". I've done head bleeds, COPD/CHF, plenty of unresponsive's and lots of codes out of the nursing home as a private medic, while a 911 system truck sits across the street.

We called them "private emergencies", They were charted and billed just like a regular 911 call. Went through the same QI process. And, most of our medics were fire guys that were working per diem to make some extra cash on the ALS IFT truck

 

[Angel]

You guys are talking about "scene calls" and (at least where I work) with having an EOA any ALS call has to go through us. We are the only ALS agency in the area so nursing homes and Dr's offices don't have a choice.
The last company I worked with that had an EOA was the same way.
In an open county, where anyone can respond to "scene calls" is where other ambulance companies can respond to ALS emergencies but are not in the 911 dispatching system.
So I guess it depends on your area, though some companies are strictly ift (with the exception of cct) IMO have no business going lights and sirens because they aren't typically (ever) called for anything emergent.
Just the run of the mill discharge or transfer to a new hospital and unstable patients aren't transferred.

 

[cruiseforever]

That's highly variable and depends on the company. IFT companies run SNF->ER all the time. Often its abnormal labs and doesn't require a code 3 tx.

However, an AMS call that turns out to be positive on the Cincinnati sometimes get transported BLS because their ETA to definitive care is close enough to ALS's ETA to the patient.

Also, CCT interhospital transports can often be Code 3, such as an active brain bleed to a neurosurgical capable hospital. Rendezvous with air crews can also frequently be code 3. If you know that a company holds no hospital contracts, it can be pretty suspect.

That said, running a code 3 code 7 isn't unheard of.

Code 7?

 

[Ewok Jerky]

Code 7?

lunch

 

[hilliardxc]

Working both fire department and private ems doing IFT I see alot. Running code 3 on an IFT happens alot more often for us, being in a big city with a lot of small hospitals that are more of bandaid station than hospitals. We do a lot of critical care type transfers for like trauma, stemi, strokes. Where they need that more advanced care is need sooner rather than later. No one bats and eye for us doing, but are dispatch tracts that stuff and knows when we are using them so abuse does not really happen. But when we need them we need them for safety of are pts.

 

[Tigger]

I guess the follow-up to my question is: if its emergent enough to go Code 3, why would the sending facility not call 911? (It seems dumb to wait 30 minutes for Company XYZ to show up and then save 18 seconds by going Code 3 across town, when the fire ambulances are practically next door).

It generally does not take that long to get an IFT ambulance for that sort of urgent transfer and if it did that might be a reason for the facility to call 911. Also, even a little hospital is still a higher level of care (theoretically) than the ambulance.

 

[Ensihoitaja]

Code 7?

Out of service?

 

[Angel]

Out of service?

Lunch...or are you asking if they go out of service for lunch?

Wait I read the op and it doesn't make sense..."running code 3 code 7 isn't unheard of" ?? Code 3 to lunch? Lol

 

[Ensihoitaja]

Code 7 for us is out of service

 

[Aprz]

Wait I read the op and it doesn't make sense..."running code 3 code 7 isn't unheard of" ?? Code 3 to lunch? Lol

So you don't use up all of your time to pick up food or go to quarters.

 

[Ewok Jerky]

Code 3 code 7 is an emergent food bolus with rapid transport to a burrito recieving gastric facility. Code 7s are gnerally against private agency protocols but sometimes you just have to act in good faith and do what's right.

 

[Rin]

So I guess it depends on your area, though some companies are strictly ift (with the exception of cct) IMO have no business going lights and sirens because they aren't typically (ever) called for anything emergent.
Just the run of the mill discharge or transfer to a new hospital and unstable patients aren't transferred.

When your typical patients are 70+ years old with CHF, ESRD, and a host of other problems, "stable" isn't really saying much.

Then there's the difference between what you're called for and what you find when you arrive. You would think SNF nurses could tell the difference between an emergent patient and one that can safely wait when given an ETA that's over an hour from the contracted private, but alas. Strokes, MI's, AAA's...really.

It's not every shift, but it does happen.

 

[Akulahawk]

When your typical patients are 70+ years old with CHF, ESRD, and a host of other problems, "stable" isn't really saying much.

Then there's the difference between what you're called for and what you find when you arrive. You would think SNF nurses could tell the difference between an emergent patient and one that can safely wait when given an ETA that's over an hour from the contracted private, but alas. Strokes, MI's, AAA's...really.

It's not every shift, but it does happen.

Usually they can... but they may be under pressure from their admin to not call 911 for any reason. Then you have the burnt nurses... or the ones that don't want to get burned... those may use the "it's not my patient" defense. Take facility protocols, MD preferences, unwritten rules, social/peer pressures, and various stages of burnout and you get... SNF nurses. I used to work in an EMS system where only 911 entities (fire or contract ambulance) were the only places where Paramedics could actually function as Paramedics. All other EMS entities could do BLS and CCT (RN) only. Since a lot of the SNFs were within 1o minutes of an acute care hospital, they called the private EMS (aka non-911) for virtually everything. This was because they didn't get dinged as badly if they sent their emergent patients out by 911. Consequently, I ended up seeing a LOT of stuff that should have gone initially by 911.

Fortunately the county changed their protocols a bit and those SNFs that were more than about 2 miles from a hospital ended up effectively being forced to call 911 because the arriving BLS crews would do it for them as they were on a very tight clock - 10 minute from arrival at the SNF door to arrival at the ED doors. After a couple of years, the county began allowing private ALS... and the 10 minute clock didn't apply to any ALS unit (never did, but there weren't any for a long time), just BLS ones.

Now back to the topic at hand: I've seen lots of C3 IFT calls. Usually they were for CCT or for basically any time-critical transfer like meeting an incoming aircraft, transplant teams once organs have been harvested, or the like. Dispatchers can also be a cause of inappropriate C3 or C2 IFT runs. I've experienced the latter... One day we were dispatched C2 to meet up with a short ETA flight and our ETA there greatly exceeded theirs. A C3 run would have been appropriate and timely. Strong suggestion denied. The flight crew landed, didn't see us and ended up going via 911... I don't know whose head rolled after that, but it wasn't mine!

 

[johnrsemt]

and a lot of private services are ALS and BLS. So sometimes you see the Medics running Code 3.

Service I used to work for hated it when we transported Code 3; but we would get to a ECF for a patient having mild chest pain for 3 hours and they were having a major STEMI; or CVA patients (I was written up one day for NOT running code 3 to the ED on a pt having CVA symptoms; who had been having them for 6 days).
As others said small hospital to large hospitals; from a hospital 11 miles from a level I ED, we could get the patient there faster than the helicopters could if we were close to small hospital.
Also we did backup 911 for the county. Plus prison runs; either from prison itself to big county hospital; or small hospitals close to prison to middle of the state county hospital. And the state will never fly a prisoner so you get some good transports that way


I was in the ED using the facilities; and the doctor called for a bird to transport one of 2 critical patients wanted them back to back flights. I talked him into letting us take one of them so he didn't have to wait so long for transport. We took the CVA, while the helicopter was called for the MI. We got the patient to the ED, finished paperwork, and cleaned truck. and headed back to the small hospital. We got there in time to help the flight crew load their patient on the bird. Then they sat on the pad for 18 minutes. We could have taken both patients back to back faster.

 

[Handsome Robb]

I really hope that was a joke about code 3 code 7s.

Even working 911 it's rare for me to transport people code 3. We respond emergent all the time but 9/10 times if not more than that it's not needed.

 

[looker]

Every few weeks I'll see the IFT ambulances running with lights and sirens.

Does that happen only when something goes wrong, or are there ever "scheduled emergencies?"

It all depends on local protocol that is in place. In some place you can run code 3 to SNF without any issue. Without actually knowing your area and your protocol, it's hard to say why they are running code 3 . There are plenty of illegal reason of why someone might run code as been mentioned before like being late for pick up, accepting call that you should not have and instead of activating 911 and asking for ALS unit, you try to save *** by getting patient to ER quickly yourself.

 

[RocketMedic]

Working both fire department and private ems doing IFT I see alot. Running code 3 on an IFT happens alot more often for us, being in a big city with a lot of small hospitals that are more of bandaid station than hospitals. We do a lot of critical care type transfers for like trauma, stemi, strokes. Where they need that more advanced care is need sooner rather than later. No one bats and eye for us doing, but are dispatch tracts that stuff and knows when we are using them so abuse does not really happen. But when we need them we need them for safety of are pts.

Honestly, unless I'm in STXmedic's area here in San Antonio, I don't want SAFD or Acadian coming for me if I'm really sick. I'd actually prefer AMR or Metro, based on what I've seen.

 

[STXmedic]

Honestly, unless I'm in STXmedic's area here in San Antonio, I don't want SAFD or Acadian coming for me if I'm really sick. I'd actually prefer AMR or Metro, based on what I've seen.

Not that I'm saying either of the first two you mentioned are filled to the brim with stand-out medics, but AMR and Metro? Those would be at the absolute bottom of my list (not counting the small mom and pop organizations).

 

[RocketMedic]

Not that I'm saying either of the first two you mentioned are filled to the brim with stand-out medics, but AMR and Metro? Those would be at the absolute bottom of my list (not counting the small mom and pop organizations).

If I'm ever Really Sick, my goal is not necessarily to survive lol.

 

[COmedic17]

If I'm ever Really Sick, my goal is not necessarily to survive lol.

There's not a meme or emoticon for the face I made when I read this. But if there was, I would of posted it here.