IFT calling 911?

[ZombieEMT]

Has anyone here ever been called out on a 911 to find an IFT ambulance on location, that does not want to transport or refuses to transport the patient? This seems to be a regular occurance in my area. Many times, we have the IFT ambulance show up and call 911 when the patient experiences a real emergency. It is quite annoying and aggrivating. It takes away that ambulance to the rest of the community, when there is already an ambulance on scene. Its even worse when the patient was already going to the hospital.

In New Jersey, an ambulance is an ambulance. There is no difference between an IFT and 911 ambulance, the state licensure is the same. This includes the same staffing requirements. The last time I checked, EMTs that do IFT compared to 911 also have the same training, unless of course I am missing something.

Even in the event that an ALS intercept is needed, the IFT BLS can still perform the transport. In fact, I work for a company that does both IFT and 911, and have still heard stories of our EMTs doing the same.

The other thing that I see frequently by IFT, is running lights/sirens to nursing home calls. It amazes me. Way to rush and risk lives for abnormal lab work.

 

[exodus]

Has anyone here ever been called out on a 911 to find an IFT ambulance on location, that does not want to transport or refuses to transport the patient? This seems to be a regular occurance in my area. Many times, we have the IFT ambulance show up and call 911 when the patient experiences a real emergency. It is quite annoying and aggrivating. It takes away that ambulance to the rest of the community, when there is already an ambulance on scene. Its even worse when the patient was already going to the hospital.

In New Jersey, an ambulance is an ambulance. There is no difference between an IFT and 911 ambulance, the state licensure is the same. This includes the same staffing requirements. The last time I checked, EMTs that do IFT compared to 911 also have the same training, unless of course I am missing something.

Even in the event that an ALS intercept is needed, the IFT BLS can still perform the transport. In fact, I work for a company that does both IFT and 911, and have still heard stories of our EMTs doing the same.

The other thing that I see frequently by IFT, is running lights/sirens to nursing home calls. It amazes me. Way to rush and risk lives for abnormal lab work.

Maybe because they need als assessment or treatment?

 

[Handsome Robb]

Abnormal labs are usually the sickest patients we pick up out of nursing homes.

I don't know how many times I've got emergent to a respiratory distress call at a SNF that turns out to be unrelated yet when nana had a K of 8.5 and is altered and hypotensive we go non emergent because abnormal lab work could never possibly be an emergency.

We don't have an IFT service here, we do it all ourselves.

 

[DesertMedic66]

I've done a couple of intercepts with IFT units. In my area the majority of the IFT units are BLS where as 911 units are all ALS. If IFT arrives at a location with a sick patient they normally contact their dispatch who will normally tell them to call 911 or sometimes they will contact our dispatch directly. Very rarely will their dispatch ever tell them to transport.

In my county once ALS has made patient contact the patient has to remain in ALS care regardless of if the patient needs treatment or not.

 

[ZombieEMT]

Not in out case. Normally then call for abnormal lab is the patient that presents with no other complaint. If unresponsive it gets treated as such.

Exodus - I don't have any issue with receiving an ALS intercept for treatment and assessment but no need for an additional bls unit.

 

[ZombieEMT]

In Jersey ALS is a chase service. ALS provides treatment in BLS rig. BLS does transport.

 

[Handsome Robb]

Not in out case. Normally then call for abnormal lab is the patient that presents with no other complaint. If unresponsive it gets treated as such

This is the difference between EMTs and Paramedics. With that said plenty of Paramedics don't realize the gravity of the situation they're in on these calls a lot of the time.

Most of the sickest patients recently that I can remember from before I got hurt were abnormal lab calls. Hell I had an abnormal lab call that we went non emergent to and the dude coded a few minutes after I made contact. Worked him for over an hour and basically depleted my ambulance of meds.

 

[JPINFV]

In the county I worked with, all of the paramedics worked for the local fire departments. Some transported, some contracted transport out to EMT services. As such, when I was working IFT if I needed a paramedic, I did so through the 911 service. However, I always told the dispatcher that we were an IFT service and that we would be transporting with paramedics. However, often the 911 dispatcher would still dispatch the contracted ambulance service.

 

[JPINFV]

Way to rush and risk lives for abnormal lab work.

What labs were abnormal? Without knowing which labs, it's impossible to pass judgement on the decision to activate paramedics or not.

 

[UnkiEMT]

Couple of thoughts:

On the matter of IFT calling 911, I gather this doesn't really apply, since you're mostly talking about interfacility calls that turn out to be acute, but in New Mexico, IFT services like the one currently I work for are not allowed to take scene calls, in fact, unless a mass casualty is declared, not only can I not transport, despite that I'm a medic and on a rig that is in fact better equipped than some of the primary response trucks around here, I can't even perform ALS interventions, I'm purely BLS.

On the matter of IFT running lights, we have a couple of SNFs around here that straight up hate to call 911, and will only do it after they call us and we tell them we don't have a rig available, in addition to the aforementioned emergent abnormal labs calls, I've gone out to them for unresponsives, major traumas and a variety of other emergent patients. (The policy in my service is that if they are originating at a facility and going to another, it's an interfacility transfer, not a scene call, no matter the level of acuity.). Moreover, there are a couple of assisted living places that prefer us to 911. I straight up don't trust them. As far as I'm concerned, no matter what they say there are only two calls that originate from them, unknown medicals and multi-system traumas.

Personally, I almost never run code three to those calls, not because they aren't acute enough to justify it, but because the routes I take to them are such that the time I'd save is only 15-30 seconds, and that doesn't justify the risk as far as I'm concerned.

Now, where I do sometimes use my lights is when I'm doing PIFTs from the outlying hospitals. The majority of my calls in particular are moving patients from some small hospitals (A few of which I wouldn't trust to put a bandaid on correctly) to either my local midsized hospital or to the big hospitals down south. Frequently, these patients can be quite critical, even more often when the helicopters are grounded or otherwise unavailable. The most common one I do, takes an average of 50 minutes to drive code 1, it takes 32-36 minutes code 3. When you've got a patient who is going to crash sometime in the next couple of hours, those 15 minutes matter.

Bonus story: Right after I started working here, I was manning dispatch and had 911 call IFT. They had a patient with an acute exacerbation of an ultrarare chronic condition, who could only really receive appropriate care for at the big hospital 75 miles away, they couldn't go that far out of their service area and wanted us to come get the pt.

 

[Akulahawk]

It is entirely possible that the IFT's company policy requires that 911 be summoned instead of emergently transporting a patient. I never did mind taking those "abnormal labs" patients... I just want to know which lab values aren't right. When giving report to the MICN, I very much preferred to give report via telephone. It's much clearer and I can go into more detail and it's easier for the MICN to ask me questions.

 

[firecoins]

This is Jersey. I am sure it's not company policy. The company wants to get paid.

The medics are fly car based and can take calls to the er on IFT or 911 rigs. There is no reason a jersey bls IFT unit couldn't call for ALS and transport. Did it all the time when I worked a bls IFT rig.

 

[WuLabsWuTecH]

I concur that the "abnormal labs" patients were often the sickest. Back when I did IFT, I showed up to an "abnormal labs" patient to find a guy not breathing. Yeah, I'd say his labs weren't normal!

As 911, we don't care if it's an IFT company that calls us, an alarm company, or the patient himself (or another 911 agency for that matter!). Someone needing help is someone needing help regardless of who they are. We are down the road from a nursing home (less than 2 minutes, and only if I struggle to lace up my boots!) and our Chief had this discussion one night we were on scene with the head nurse who wasn't sure if we would come when she called 911 because they had a patient who was barely breathing and the IFT's ETA was 45 minutes. Yes, we understand they have a contract to call the IFT company first, but if they feel like a 2 minute ETA would benefit the patient over whatever the IFT's ETA is, then we have no qualms about them calling 911 to get us.

The nurse said she figured we might not come since we don't have a contract with them and we don't bill, to which our chief replied, "That's not what we're here for. We're here to take care of sick patients, not to make money off of them. You company pays taxes to the city and as such, you are afforded all the benefits of being in our city including the emergency medical services."

The reverse is also true--there have been plenty of times, especially out in rural areas where we're farther away from a hospital--where on the way there, or on the scene, we realize we need more help than what we've got, so we call up another fire department to come get us. Are we tying up another unit that could be used elsewhere in the county? Yes. But we need them now. Emergencies that are actively happening take precedence over emergencies that could possibly happen in the future.

 

[vc85]

When I was dispatching 911 we had the opposite situation.

The nursing homes called 911 for EVERYTHING not prescheduled because they figured out that IFT cost about $1000 per patient transported, where as 911 was "free" (taxpayer funded).

This resulted in several times 3 PIECES of fire apparatus being sent to a nursing home for a call that in most parts of the country is handled effectively by 1 IFT ambulance.

The way that happened was this, a lot of the ALS level calls are coded for ALS + an assist piece. So if a difficulty breathing or weakness with dizziness came out the CAD would pull the closest engine and ambulance, and if both of those were BLS it would pull the closest paramedic, which in some cases was a ladder truck. Resulting in an ambulance, engine, and 100' tiller ladder going to a nursing home that was literally 30 seconds away from the hospital. Luckily the fire officers usually caught on to this and cancelled the unnecessary engine

 

[rsd2nla]

I worked on a BLS rig for an IFT company in LA County. Whenever I've had to call 911 it was because we showed up on scene and found the patient actually required ALS, or a patient already in our care deteriorated and we had to call for an ALS intercept. If we were closer to an appropriate hospital than ALS we would just transport ourselves, otherwise per protocol we would have to call it in via 911 and not our own dispatchers.

 

[ZombieEMT]

This is Jersey. I am sure it's not company policy. The company wants to get paid.

The medics are fly car based and can take calls to the er on IFT or 911 rigs. There is no reason a jersey bls IFT unit couldn't call for ALS and transport. Did it all the time when I worked a bls IFT rig.

Actaully, some companies that I know, do have policies against. This could be for a number of reasons. One being, they known many of their EMTs do not have the experience with real emergencies and ALS interactions. Also, some also have additional runs scheduled and transporting a patient to an appropraite emergency room vs original destination. Third, up until recently, there was no specific requirements for medical directors in IFTs. Many IFTs had a medical director that was just a name on paper. Some only have private practice experience, with no emergency or critical care experience. Also many medical directors were no active in the organization. This limits appropraite QA processes.

 

[Mink0417]

In Taiwan, pre-hospital is belong to Fire Dept., and IFT is held by private funded companies, but the ambulance license and personnel training requirements are the same.
Our department get IFT calls occasionally, and mostly from nursing home. I don't know how they think, every time we receive calls from nursing home the patients is mostly cardiac arrest(90% i think) and even been a period of time, and sometimes patients are in severe dyspnea. Maybe they don't want patients to die in their facility(?) and ambulance of fire dept. is free i guess.
There are some situations that some clinic (eg. GYN clinics) call us to bring their patients to medical center.
We always transport these IFT calls, after all, policy of our high-ranked officers is to fulfill whatever callers want...... :glare:

 

[johnrsemt]

At my old area; I worked both IFT and 911 (2 services, 2 jobs).

Working IFT we would seldom call 911, but we had ALS and BLS trucks so we didn't need them often.
When we had a large patient we would sometimes call 911 for manpower, to the point that the city dept started refusing to help us.

The local nursing homes would seldom call 911 due to the extra paperwork they had to do to have us show up. But NO paperwork for IFT services to come.

911 Dispatch would call on some of the Private IFT services when they were overloaded or when they had a patient bigger than their ambulances could handle (Private services couldn't call them for help with Obese patients, but they could call us for help: LOL).