BLS crews/ transport units

[Romania]

I want to appologize in advanced if I offend any BLS poroviders.

Do any of you have this problem? I have had repeated runs in with some BLS providers from the private transport units (most of our response area uses only private ambulances)onscene. Repeatedly, these EMTs come onscene and start repeating my assessment and questions of the patient. Typically, if time allows, I give a brief report to the transport crew before we load the patient, then either let them copy my paperwork or give them a photocopy so they can fill out their own. This happens to many of the other medics that I know in this area. I have tried talking with them, I have had their crewmembers talk with them, I have done everything I can thing of besides talking with their district managers.

I am getting fed-up, I have been told by some that we are fire and they are EMS so they have to also do an assessment. THe only problem with that is that the Fire Department's out here are EMS. We provide ALS emergency medical care and the private ambulances are only contracted for transportation.

It has gotten to the point that I have to have some crews stay out side. I have had patients tell the ambulance crews that they have already answered all these questions and don't feel like answering them again (their going to have to at the hsopital anyway, but I don't blam them!).

I must say that there are some awsome crews out there also, Mikey on A-73-C and Ken on A-73-A if your reading I'm talking about you.

Sorry, Had to vent.

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[FF McDonald]

Alan-

I am not a paramedic, but I do aspire to be one --soon. Anyway, the answer to your question....

I am an EMT. I am a member or my towns municipal ambulance corps. We are a seperate entity from the Fire Department. I just wanted to let you know where I was coming from in my responses.

In Northern NJ, we have hospital based ALS. The various hospitals in our area have Medic Units, and an organization called MICCCOM (Mobile Intensive Care COMmunications)dispatches them-- they [MICCOM] are notified by the Police Desk(aka 911).

The reason they may be 'repeating' part's of your initial assessment are: They recieved poor dispatch information, and possibly bad info en-route.

In regard to level of Conciousness- they may be "re-asking" a question to see if the persons reponse is the same as there last answer, or if it has changed-- as well as their level of conciousness.

I know where you are coming from. Everywhere you are there will be someone that you don't enjoy working with. Speaking broadly, there are some medic's that I can't stand, and when I hear them walk up on scene, I cringe. There are also medics out there who are willing to teach us BLS providers, and encourage them to keep up their studies, and become a Paramedic...

We all have to vent sometimes.

See you in the Forums.........

Marc

[Boothby]

Alan-
I am a Firefighter Paramedic and a union brother with IAFF local 1784. Before that, and long ago I worked as an EMT-B with a private ambulance company that transported BLS patients for several fire departments. I have run into the exact problem you described, except from the otherside of the fence.

When you call a private ambulance to transport your patients you are turning patient care over to the ambulance crew. At that point the BLS crew becomes legally responsible for that patient and anything that happens to that patient. Would you as a paramedic accept responsibility for a patient without performing some type of evaluation? I know I wouldn't and I don't know many medics that would just take someones word no matter who they are. Even today when I ride on the truck company and make a first responder call I expect that the Firefighter Paramedic who's turn it is to ride the ambulance will listen to my report and then perform an evaluation. When I transport patients to the hospital the nurse listens to my report and then performs an evaluation. This is done, not as a sign of disrespect, but of professionalism. The EMT's that you reference are doing their jobs. Just because they are EMT-Basic's and you are an EMT-Paramedic really doesn't make any difference. When they assume patient care from you then they are required to asses what is now their patient. If anything should happen to that patient it's their butts that will burn not yours. If all you want for your patients is a ride to the hospital then call them a taxi. It will certainly be cheaper that an ambulance. But if you want a continuation of medical care through to the emergency department then you must expect, and allow the EMT's to do their job. They are not taxi drivers, they are Emergency Medical Technicians and they have a certain standard of care that they are REQUIRED to follow. This includes performing a patient assesment on EVERY patient they see. Just like you.

Now I'm sure that you and I will agree that private ambulance services don't belong in ems. I make that statement after having worked for private services for several years. The management philosiphy to make money just dosn't mesh with ems. Unfortunatly you will have to deal with the private services. Try to remember that regardless of how you or I feel about the private sector, most of the EMT's are trying to do a PROFESSIONAL competant job. One last thing to remember. And I say this from personal experience. When you "talk" to an EMT or have them wait on the porch you are not going to earn their respect for your auhtority. You make yourself look like a fool, both to the EMT and to many of the patients. Remember most civilians don't have a bias agains private ambulance companies, and they don't know the difference between a basic and a medic. Most of the Paramedics that I respected (when I was young) made everyone part of the patient care TEAM regardless of what they rode to the scene on and what their certification level was.

[Romania]

Boothby,

I agree with you that the EMT should assess the patient and recieve the report when theyu are recieving repsonsiblity for the patient. However, all of our patinet are transported by a private ambulance. I have no problem with the BLS crew re-assessing the patient and asking questions when I am going to turn the patient over to them, infact I expect it.
My problem is when we have a patient who is an ALS patient, where I have to ride in (we utilize no ALS transports except when we run into the city of Phoenix). I have had EMTs from the ambulance start reasessing the patinet and question the family when I have been working an unstable patient. I see this as unexceptible. It increases onscene time and when they are repeated my job, who is doing theirs? I know they need all the same information on their paperwork as I do, that is why I make sure they have a copy of my report at the hospital and give them a rundown and any other information they need, once we have turned over patient care or the patient is stable enroute.

I to expect the members of the ambulance to be part of the patient care team. We all have to work together to accomplish the same goal. But every team member has a role. On an ALS patient the paramedic is the team leader, responsible for total patient outcome, onscene time, documentation, etc. The ambulance crew's role is to assit with patient care on scene as needed, assist with patient packaging and transportation. When everybody does their job, the overall goal is acomplished quickly, easilly (sometimes), and profesionally. Just like in firefighting, we have a captain, the engineer, nozzleman, plugman, etc. Each has tasks to do to complete the overall job. If the nozzleman is pumping the truck, who has pulled the line?

I don't look down on EMTs, They are the backbone of our EMS system. The EMTs that are on my engine know their job, and I know that working with a paramedic (especially me) makes their job so much harder.

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[Romania]

Marc,
Thanks for your reply. I know what you mean about cringing. When I hear certin units dispatched or arriving onscene I get the same feeling.

Actually, I am one of those who is more than happy to teach BLS personel. I ahve spent many an hour in the bay with all the ALS gear out answering questions, showing how to set up an IV, etc. I think any paramedic who dosen't is wasting a valuable resource (most of the EMTs I work with can setup an IV better than me).

On the poor dispatch/information thing. I don't think that this is a good reason to reassess (unless we are going to turn patient care over to them). Typically I (or another medic on our engine) ride in with the patient, so a quick rundown can be given and the rest of the pti can be given at the hospital.

Hey, don't think that I look down on EMTs. I don't. And I hope I haven't started a EMT vs. Medic bash session. My problem isn't with the average EMT, it is with the EMTs on our ambulances that Hate fire. I have been told that we (fire medics in general) over treat patients, force all patients to go in by ambulance... lets talk about that one.

It's 0340, you have a EMS call, it doesn't matter what kind of EMS call. Would you rather A. go back to the station and go to bed, or B. convince the patient to go in and be out for an extra hour. Of course A, we only do B if we have good reason.

Sorry, It was a bad shift...I get a little fired up about this.

Stay safe

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[Boothby]

Alan-
Sorry I ruffled your feathers. I missunderstood your original post. I thought you were talking about BLS patients who you turning over care. In the case of an ALS patient where you are riding in with the patient then I am in TOTAL agreement with you. The EMT basic needs to back off and let you do your job. In that type of situation if the EMT is not recognizing your responsibility for the patient then you are completely justified in your actions. From what it sounds like I would say have a talk with their supervisor.

[BURNSEMS]

YEP I agree, if they are BLS and you are ALS provider and rideing in the rig with them Then WHY do they not ask after your in route, Yes I agree its is there Unit and they have paperwork to do but no use in doing another exam and Hx if they are not takeing primary Care... Just my Opinion.. Keep your chin up you get there

[FF McDonald]

Alan,

I am glad that we are on a first name basis.. http://www.firehouse.com/interactive/boards/smile.gif

After having read your response to Boothby, I agree with you 100%.

And no, I don't think you were trying to start a EMT vs Medic bashing session. Please believe me when I tell you I know where you are coming from. I can somewhat relate to what you are saying in regards to the BLS crews that hate fire.

Personally, I enjoy both Firefighting, and Emergency medicine. I don't aspire to be an ER doctor or anything, but I know that I can contribute-- that's why I volunteer. Getting back to the BLS crews that hate firemedics-- I have to agree w/ you. There are a considerable amount of people that look down on me- both on the Fire Dept (Volunteer), adn the Ambulance Corps. The fire guys can't stand that I enjoy doing EMS, and the 'Band-Aids' can't stand that I like firefighting.

I hope I don't incite a riot by saying this--- but I believe that in the future we will have only Fire based EMS.

But that is a topic for another thread.

Marc

[benson911]

I have a problem with one of the opinions of this thread. Private EMS, in some areas is not only useful, but necessary. For example, in my jurisdiction the FD responds with an ALS ambulance to every EMS call along with a private provider for transport. Both units respond at the same level, emergency lights and sirens or non-emergency. Even though there are two different dispatche centers, the private provider calls us when they respond and we call them when we respond.

It is a mutually benificial system, they get the tranpsort and the right to bill the patient and we give our citizenry the necessary urgent and quick response. We average less than 4 minutes to the call, the private has 9 minutes to get to the call.

It doesn't seem right to bill a patient who is already paying a tax to receive the EMS response, but our city does not have an "EMS" levy. Actually, there are no levies for municipal services except the school system. We operate on a budget from the city's income tax that's not high enough to pay for more than 1 EMS unit. That single EMS unit is in combination with our Ladder truck and the crew responds to all calls, EMS or Fire, with the appropriate unit.

To transport all our patients and leave our fair city to take a patient to the hospital would remove a vital crew from service for over 1 hour. We currently turn around most EMS runs in less than 30 minutes by turning the transport over to the private.

As far as dealing with a private transport crew who reevaluates and retreats your patient...YOU, the ALS PARAMEDIC ARE IN CHARGE and must take control of the scene, the patient and especially the private transport crew. If they're sitting in the driveway reassessing, you need to poke your head in and tell them it's time to transport NOW. If they are running the whole patient history and assessment again on the way to the hospital with YOU in the back, it's time to SNAP THEM OFF and tell them in no uncertain terms that this is YOUR patient and YOU will tell them what they need to do. As long as you are with the patient, you are responsible for their treatment and transport. It will only take a few runs for you to get the reputation of someone not to mess with. Sometimes it's necessary to be the jerk, but most of the time killing them with kindness works best.

[Pamela Baber]

I'll refer back to the original post if I might. Does the private ambulance service you use for transport do any other transports other than response for ALS fire service? If so it could be that these folks may just be frustrated with the lack of patient care they experience and want to do what they were trained to do. Just a thought.

[Matt Fulton]

Hi,

I've worked in a variety of services, and I've seen both sides of this issue. One possible way to reduce this kind of confusion is to give incoming providers of any level a quick report and instructions. This should only take a few seconds - for instance: "Hi guys, this is Mr. Smith. He's 46 years old, and he's been having some chest pain today. I'll be riding in with you, and I'm all set for treatment, and I've got his info and history, so if we can get the cot and...." Then if they start playing 20 questions with the patient, at least you won't feel as bad when you tell them to back off!

-Matt

[Romania]

Thank you for your replies. To answer some of the questions. Most of the rides that I have problems with are dedicated to EMS.

Thansk all.


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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[pompanofd]

FIRST OFF! IT IS A KNOW FACT THAT A ONE TIER FIRE BASED EMS SYSTEM IS THE BEST!!!
I DON'T UNDERSTAND WHY I.A.F.F. LOCAL FIRE DEPTS. CONTINUE NOT TO GET INTO THE BLS TRANSPORT BUSINESS. I BACK UP MY OWN FIRE ENGINES FOR BLS CALLS, WE ARE ON THE SAME PAGE FOR SOP'S , LEVEL OF CARE , WE HAVE THE SAME RADIO FREQUENCIES , SAME UNIFORMS ETC. FIRE DEPTS. SHOULD ASLO HAVE DESIGNATED BLS TRUCKS! WHY SEND A 3 MAN ALS TRUCK TO TRANSPORT A CUT FINGER!!! THIS LEAVES YOUR ALS TRUCKS AVAIL FOR HIGHER PRIORITY CALLS!
YOU CAN USE THE BLS TRUCK AS AN APPRENTICESHIP FOR FUTURE PARAMEDICS. I'M SORRY BUT THE PRIVATES MUST GO!!!
IF THE PRIVATE AMBULANCE COMPANIES HAD N.F.P.
(NOT FOR PROFIT!) NEXT TO THIER NAME ,MAYBE I WOULD FEEL DIFFERENT. SUPPORT YOUR LOCAL UNION!!!!!!!!!!!!

[benson911]

pompanofd - can you come to my city council's next safety committee meeting? I'm sure they wouldn't mind spending a couple of million dollars to staff and purchase another squad for us. We need the manpower anyway.

Seriously, a Private/Public partnership does and can work. My city is unwilling to pay for another unit, or the personnel to staff it. Therefore, to make sure our citizenry receive the fastest repsonse by the highest trained personnel (and allow us to have some manning for fire calls,) we don't transport. The private ambulance company gives us the service we MUST have in order to provide our community with the best service possible.

[bgilmore07]

Interesting thread!

I am a hospital-based paramedic (the FD's around here are almost entirely volunteer), and we often work with the volunteer BLS ambulances as transports. We have the added difficulties of working as single-medic "aid-car" units and also having to soothe the egos of the BLS providers, since any conflicts that arise between us are usually blamed on us. My thoughts regarding your situation is based on having to walk on these eggshells for eight years: You encounter several good crews, and patient care goes well with them. You have to put up with a few knuckleheads, so let 'em be idiots and refuse to stoop to their level. In other words, do what you have to do to take care of the patient, and don't let the rest get to you. At the end of the day, you'll be able to sleep well, knowing that you've done what is right. Fighting with the BLS, whether on the scene or at the managerial level is not in the best interests of the EMS system. Yeah, I know it sounds like BOHICA, but some battles might just not be worth fighting. Besides, at least it sounds like you have the rest of your crew to help you if the patient is really getting bad. (I'm envious)

[FIREFIGHTERMEDIC]

IT ALL VERY HARD TO DEAL WITH WITH PRIVATE SERVICES ESPECIALLY THE ONE THAT IS THERE IN PHEONIX FEEL FOR YOU ROMAN IF YOUR REFERRING TO R/M I KNOW BECAUSE WE JUST TOOK OUR SERVICE BACK OVER FROM THE GENERIC SERVICE OF R/M WE RUN 15 ALS TRUCKS 24 HRS 365 DAYS A YEAR HERE SO THAT WE DO NOT HAVE THE BLS,ALS TRUCK PROBLEMS BUT I UNDERSTAND THE DIFFERENT SITUATIONS BUT AS FAR AS THE REQUESTIONING OF THE PT THE PT SHOULD NEVER HAVE TO ANSWER THE SAME BASIC QUESTIONS MORE THAN ONCE YOU ARE THE PARAMEDIC RELEASING THE BASIC CALL TO THE BLS TRUCK THEY ARE THERE FOR BASIC TRANSPORT ONLY!!!!!!! THE BLS TRUCK PERSONNEL GET ALL INFO FROM THE ALS TRUCK PERSONNEL AS FAR THE PERTINENT INFORMATION SO TRANSFER TRUCKS DO YOUR JOB AND TRANSFER THE PT TO THE HOSPITAL CAUSE REMEBER YOUR JUST THE BLS TRUCK!!!!!!!!!!!!

[NCRSQ751]

I'm not sure this is just an issue of public/private. Any time you have a system where one service starts care and another finishes you have the potential for this situation to occur.

I work on a volunteer EMT-D level first response service that turns patients over to a paid ALS service for transport. Depending on who is on the truck, they may either accept your assessment.. or throw it out and start over. The medics who know me and my abilities (that have a comfort level with my skills) are most likely to accept my assessment without repeating it.

If it's the same folks over and over again it may just be an attitude problem, but if you don't always see the same crews it may be a comfort level issue.

[Paramark14]

I was a EMT-I for many years. When I had a medic onboard I kept my mouth shut and assisted them when requested. Now that I'm a medic I expect the same. The EMT's on our service are the best and I have a lot of respect for them.

Mark
NREMTP
Indiana