Who Should Handle Lift Assists?

[ustadoit 13]

As a sad side note: I am aware of people paying big bucks to live in an assisted living facility. Even though the second-worst-case scenario for one of their clients is to fall and need assistance to get up, they find out in their hour of need that this type of ASSISTANCE is not provided by the purported ASSISTED living facility.

[x129K 1,393]

For all of you guys pushing the "EMD Angle";

Falls; Public Assist (NO injuries and NO priority symptoms) 17A3 = EMS Only on my cardset....so to answer the question, where I work, lift assists are handled by EMS.

I will go on record as saying, again, that I am not a firm beleiver in the entire EMD concept. The pre-arrival instructions for CPR, choking, and hemmorage control are true lifesavers, but the majority of the other "fluff" is just that, and almost all callers in an urban area, are not receptive to it. "Just send the MFing ammolance!".

The check and advise system is set up for failure UNLESS the responding officers or firemen are at least EMT's AND carry gear...

I agree, well written post Joe. We didn't look at these calls as nuisance though.

We used to ride around the district and I'd spend a lot of time staring out the window at the neat row after row of little pink houses, block after block, ain't that America. Aided's, lift assists, water conditions, all the service calls gets all of that look behind the doors and locks of the little pink houses. The encounters would soften the hardest cigar chomping brutes of the job. They softened everybody.

There'd be the poor, frail elderly and oft neglected by remaining family or friends, victim; stuck in some torturous position for God knows how many hours, wedged behind a fixture, soiled, humiliate, scared, confused.

And the compassion that flew forth from otherwise stoic members of the services was always warming. Yet the whole scene always enveloped me. The old photos on the wall from when the husband was still alive, from their younger days of love, family, children, photos from later when those kids grew up, got married, moved on...

In the end, this poor compassion-needy person is stuck, helpless on the floor of her bathroom with acid burns from having been unable to relieve herself properly. Each and every single call, heartbreaking in a way. Makes the self-preservation instinct kick in for a lot. Trying to fit humor in some where when picking up.

In a way, Americans are all victims of our collective success, relatively luxurious compared with much of the rest of the world. Yet, here we are, all separated, elderly abandoned and left to their own means. Isolated. Alone. Half of everybody in this country has got some kind of head problem because of how we are all so alone so much even within the hustle and bustle of large populated areas.

Yeah, those lift assists. You've got to construct an iron ring around your heart for the time you do these jobs, because if you let all of that despairing into yours...it leaves scars.

THIS GUY right here F'ing gets it! Great post!

[dmc2007 17]

Sorry but I have to comment. In a VOLUNTEER district when a call comes in for a lift assist it should be first answered by police. They take the call and do the dispatch. There are many more police officers on duty in cars than there are vehicles for ems. When the call comes in IF the caller indicates that there is an injury or medical need then of course dispatch the ambulance. If the call is just to help the party back into a chair or bed then the call can and should be handled by police. Once again...should the called indicate a need for medical treatment fine then send the ambulance but DON'T send them and tie up the only EMS crew in the district for a LIFT unless the first responder requests one.

Volunteer or paid shouldn't make a difference. Guess what-the citizens in your district probably don't know and definitely don't care whether the crew responding to THEIR emergency is paid or volunteer-they expect and deserve the same level of service no matter where they are. Do all assists need to end with transport by ambulance to the hospital? Probably not, but until any medical concerns are ruled out, the call should be handled by a crew that's trained to identify possible the red flags that indicate something bigger is going on or that an injury has ocurred, as well as to stabilize and properly move an injured person.

If an EMS system doesn't feel like dealing with falls, which are the number one cause of injury death and trauma-related hospital admissions in the elderly (source: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html), then its time to revamp said system.

That being said, if a particular individual, or the family of an individual, keep calling for preventable falls that end up being non-medical, there is a bigger issue of finding a more suitable living environment for that individual that needs to be dealt with.

[Dinosaur 844]

I think it is disgraceful that people claiming to be emergency service professionals think that lift-assist calls are "nuisance" calls or the people who call 911 seeking assistance for a loved one shouldn't receive the best possible care possible.

99% of the time a lift-assist is a perfect public relations call. You get to be the hero and restore normalcy to someone who is in distress and needs your help. You're also helping taxpayers who are paying for your service? How can you collect tax money from someone and then decide not to help them when they call?

As for "taking a unit out of service" when another call drops, what kind of call volume do most volunteer agencies have? What's the turnaround time on a lift-assist? You can't pick grandma up off the floor and move on to the next job? What the heck are you doing?

[TimesUp 148]

Even though the call for a lift assist can come in at the worst time it never fails how the guys show how caring they can be. The person who fell off the toilet or out of bed is always embarrassed but very thankful. Some are as easy as two Guys lifting them up after checking for any injuries. Others will need 4 guys and a back board. Then Help get them dressed, find the remote or move whatever made them fall or arrange things around the apartment or house to prevent this from happening again.

At one lift assist we were met in the street by a healthy looking man who said his father had fallen. In the back yard was a elderly male wedged under a picnic table. He was in a wheel chair and was trying to plant tomato plants. Also in the back yard sitting there was his healthy 18yo grandson. One of the guys remarked with a straight face "you must be his Grand daughter" to which the kid who seemed un affected by seeing his grandfather wedged under the table said with a puzzled look "no I'm his grandson!" After getting him up and back in his chair we dug three holes and planted the tomato plants. All the while telling the son and grandson "don't worry we got it" BTW the man who fell out of the wheel chair was a amputee but other than that pretty solid for a 75yo. I think George said it best though!

Edited May 9, 2012 by ltrob

[peterose313 345]

FD and EMS. EMS to evaluate the clear/transport the patient. FD for the extra hands. PD too if they are having a slow day and they feel like it...

These can be generally simple with an extreme potential to go south quicker than anyone would like.

I would agree with that. It should be both FD and EMS imo.

[SRS131EMTFF 471]

I would agree with that. It should be both FD and EMS imo.

I couldn't disagree more. The only reason to call the FD is if you don't have the manpower, which is a system issue on your end, not a guideline or protocol issue like you seen to want to make it by forcing the inclusion of FD.

I run on a crew of 4 EMT-B's,I's and P's. Between the four of us, we can stabilize, lift and move almost any patient we come across. The only reason why we would consider calling the FD is if we need more hands or more tools, other than that, calling the FD will only bring more bodies to the scene, bodies I might add can cause further embarrassment and stress to an already distressed patient. People, especially if they are elderly or in a residential treatment facility, see ambulances on a daily basis, it is quite the commotion when our huge red truck comes screaming down the road to the facility. That commotion is stressful to the residents and the patients. Sometimes a lighter touch is what is required in these calls...

If I need the FD, they are a radio call away...

[SRS131EMTFF 471]

*can't edit, but remove the couldn't disagree more part*

I believe if you don't have adequate resources, then use the FD, otherwise, I am fine with just EMS...

[Atv300 69]

I couldn't disagree more. The only reason to call the FD is if you don't have the manpower, which is a system issue on your end, not a guideline or protocol issue like you seen to want to make it by forcing the inclusion of FD.

I run on a crew of 4 EMT-B's,I's and P's. Between the four of us, we can stabilize, lift and move almost any patient we come across. The only reason why we would consider calling the FD is if we need more hands or more tools, other than that, calling the FD will only bring more bodies to the scene, bodies I might add can cause further embarrassment and stress to an already distressed patient. People, especially if they are elderly or in a residential treatment facility, see ambulances on a daily basis, it is quite the commotion when our huge red truck comes screaming down the road to the facility. That commotion is stressful to the residents and the patients. Sometimes a lighter touch is what is required in these calls...

If I need the FD, they are a radio call away...

I Agree the EMS should be there first and the FD should be called if manpower or special equipment is needed. The lift assist is inherently an EMS call for the simple fact there is a reason or a consequence for the fall.

[peterose313 345]

I couldn't disagree more. The only reason to call the FD is if you don't have the manpower, which is a system issue on your end, not a guideline or protocol issue like you seen to want to make it by forcing the inclusion of FD.

I run on a crew of 4 EMT-B's,I's and P's. Between the four of us, we can stabilize, lift and move almost any patient we come across. The only reason why we would consider calling the FD is if we need more hands or more tools, other than that, calling the FD will only bring more bodies to the scene, bodies I might add can cause further embarrassment and stress to an already distressed patient. People, especially if they are elderly or in a residential treatment facility, see ambulances on a daily basis, it is quite the commotion when our huge red truck comes screaming down the road to the facility. That commotion is stressful to the residents and the patients. Sometimes a lighter touch is what is required in these calls...

If I need the FD, they are a radio call away...

You can disagree all you want, that's fine with me. I'm simply expressing my opinion that I think the FD should be there as an extra set of hands to work along side the EMS crews. If you want to do everything on your own and turn down the ability to have extra help to lighten the load, then that's on you.

Edited May 10, 2012 by peterose313

[ckroll 101]

Agreed. Well said PEMO3. Falls where a person can't get up happen for a reason. As a really lazy medic, I would much rather have that talk with a patient and family when the patient can still go in BLS than wait for it to be a true emergency. As ALS we 'assisted' someone today where it got bumped up to a transport. Please keep in mind our patient populations. There are those who see smail things as a crisis, and then there are those who 'don't want to be a burden' and struggle to keep going long past the point when help is needed. As EMS providers we have the opportunity to help families make good decisions for loved ones, and some days it is a lift assist, and some days it is getting the family member evaluated in the ED.

Look at lift assists as an opportunity to make a difference in people's lives. Send ALS to all of them and then redirect ALS if something moe urgent comes up. And I speak only fo rmyself, but I'd rather go out 50 times for nothing for the opportunity to catch one person with a treatable cardiac condition .

[firebuff860 54]

The first step in this decision should be, what is the level of training of PD, FD, and EMS in the municipality. Most if not all career depts have EMT FF's and EMS, not sure about PD. Volunteer Dept's depends on community, again not sure of PD or EMS. Off of a phone call you have no idea what the actual injury may or may not be. To have an untrained responder regardless of affiliation give inappropriate care could be harmful to that organization. Every organization (PD, FD, EMS) hates to be bothered with "non-essential" callls, but you cant make that determination until the lolfdgb has been evaluated. As Capt Glover stated earlier these are the calls you should take pride in, regardless of your affiliation.

[Ladder44 73]

for the more urban enviorments....with FD as a first responder to calls....can they pick up the pt and place them back in bed or chair or where ever they want and cancel EMS??

I say this because waterbury FD responds to all medical calls if available as the first responder except psychs and all 911s at skilled nursing (except codes). If its a "help me i cant get up" and put me in bed where as farmington FD they can cancel and obtain a refusal

[ems-buff 81]

I do believe it should be an FD response only, if the person isnt complaining of any injury, why should an ambulance be taken out of service to better sever the community its in. If the propper questions are asked, then thete is no need to tie up resourses. Noe if they is some sort of underline issue, like they got dizzy, or chest pain, for example then ofcourse dispatch an ambulance , but I feel it all comes to dispatch. I have read eveyones post, and this is my opinon..

[JJB531 652]

You're still tying up FD resources, so what's the difference if you're tying up FD or EMS?

[x4093k 654]

I heard over the scanner this morning, an ambulance got dispatched to a patient fallen unable to get up, with injuries. As the ambulance was responding, dispatch updated PD on scene, lift assist only. The ambulance asked "Any pending calls?" Dispatch replied "Negative" ambulance said "Ok, we will proceed in to help PD lift the patient" and then cleared less then 10 minutes later(including response time in the 10 minutes)

Thats what I would do, and if there happened to be a pending call, PD could have lifted the person by him/herself, or called for a 2nd ambulance to go(if needed)

[efdcapt115 1,511]

I heard over the scanner this morning, an ambulance got dispatched to a patient fallen unable to get up, with injuries. As the ambulance was responding, dispatch updated PD on scene, lift assist only. The ambulance asked "Any pending calls?" Dispatch replied "Negative" ambulance said "Ok, we will proceed in to help PD lift the patient" and then cleared less then 10 minutes later(including response time in the 10 minutes)

Thats what I would do, and if there happened to be a pending call, PD could have lifted the person by him/herself, or called for a 2nd ambulance to go(if needed)

Sounds like a good judgement call.

[EMT-7035 4]

What happens in my district is that if PD has an available car, they will go to almost any EMS call, as they carry life support supplies including AEDs and Oxygen. They will never clear the patient by themselves, but are there to help EMS with lifting and such when we arrive. And the medics (I live in Northern Westchester so our ALS is provided by WEMS) are not dispatched to things such as lift assists (assuming the nature of call can be established).

Also, I have never been on a scene where fire was called for anything other than a fire or major MVA.

[INIT915 1,119]

I heard over the scanner this morning, an ambulance got dispatched to a patient fallen unable to get up, with injuries. As the ambulance was responding, dispatch updated PD on scene, lift assist only. The ambulance asked "Any pending calls?" Dispatch replied "Negative" ambulance said "Ok, we will proceed in to help PD lift the patient" and then cleared less then 10 minutes later(including response time in the 10 minutes)

Thats what I would do, and if there happened to be a pending call, PD could have lifted the person by him/herself, or called for a 2nd ambulance to go(if needed)

Is it your position that "pending calls" negate the risks of associated liability?

[JM15 386]

What if the pending call was another lift assist? Which would you choose to go to?

[antiquefirelt 994]

I do believe it should be an FD response only, if the person isnt complaining of any injury, why should an ambulance be taken out of service to better sever the community its in. If the propper questions are asked, then thete is no need to tie up resourses. Noe if they is some sort of underline issue, like they got dizzy, or chest pain, for example then ofcourse dispatch an ambulance , but I feel it all comes to dispatch. I have read eveyones post, and this is my opinon..

Why the FD? Why not DPW? Whose resources are not important enough to be tied up? Why would the FD, if they have no other EMS responsibilities automatically be the "go to" for a human assistance call? Is EMS not really the agency most appropriate to deal with individual's bodily needs? And in the end once you've sent the engine and they find EMS is indicated, you are then calling EMS. So two agencies are involved when only one can cover the broadest spectrum of services that may be called for.

While I'm sure you have great dispatchers, there's a big difference between what they're told and what the case may really be. So if the dispatcher get's bad info from the elderly caller and care is delayed, I guess you call it "their fault"? Too bad the same people that seem to fall and need help also have a propensity toward weakening mental acuity. While I'm sure many of us might want to stay in bed or not have our meal interrupted, I'm betting far fewer Fire based EMS services would ditch these calls than any other service model.

If your system is overtaxed to the point these calls routinely delay true emergency responses, maybe you're system is broke? If you aren't doubling and tripling calls routinely, you have little excuse to try and pass these runs off.

[SOUSGT 357]

You're still tying up FD resources, so what's the difference if you're tying up FD or EMS?

In areas were EMS is provided by a commercial company or other fee for service group, is billing the patent for this type of call a consideration for a FD only response?

[JJB531 652]

In areas were EMS is provided by a commercial company or other fee for service group, is billing the patent for this type of call a consideration for a FD only response?

Is it? I don't know... I don't look at EMS like a businessman, I look at EMS as an emergency medical provider, so I have a hard time justifying or making decisions based on the finance side of the "business" of EMS. Could it be a consideration... I guess yes, it could, but now we're letting money determine what level of care a person receives when they all 911. Interesting question... I would say it shouldn't be a consideration, but I can definitely see the other side of the coin as well.

[antiquefirelt 994]

In areas were EMS is provided by a commercial company or other fee for service group, is billing the patent for this type of call a consideration for a FD only response?

I know we are not allowed to bill for services that do not result in a patient transport, I believe by Medicare rules. This means any call that doesn't get a transport is paid for wholly by the taxpayers.

[JJB531 652]

I know we are not allowed to bill for services that do not result in a patient transport, I believe by Medicare rules. This means any call that doesn't get a transport is paid for wholly by the taxpayers.

You may not be allowed to bill Medicare for non-transports, but that doesn't mean you can't bill the patient or other means of insurance. We don't bill for RMA's/Non-Transports where I work, but after speaking to a co-worker here who also works for another agency, there are companies that do bill for RMA's and DOA's.

I thought the same thing, that you can't bill for non-transports, but I just learned there are places that do.

[antiquefirelt 994]

You may not be allowed to bill Medicare for non-transports, but that doesn't mean you can't bill the patient or other means of insurance. We don't bill for RMA's/Non-Transports where I work, but after speaking to a co-worker here who also works for another agency, there are companies that do bill for RMA's and DOA's.

I thought the same thing, that you can't bill for non-transports, but I just learned there are places that do.

I believe there are specific allowances for specific areas, much like the Medicare bands that change the rules place to place. My understanding is that in our band/area we cannot balance bill or bill any one any differently than we bill MC. My understanding is that you must have one billing policy for all patients and it must conform to Medicare rules. I also know of places that violate this "unknowingly" and risk heavy penalties and loss of medicare reimbursement. As I recall the MC rules for may allow for the billing of consumables as long as your service buys them and they are not stocked by the hospital?

Noetheless,yet another case where some services, often commercial types, are first interested in the bottom line and second interested in patient care. I speak of this in broad terms and less about the providers, the issue lies with the "for profit" model.

[firemoose827 324]

It should definitely be EMS.. like the previous poster said more often than not there are underlying reasons for the person being incappacitated. Also, EMS can evaluate any potential injuries that the patient recieved while falling.

Even if it means taking a rig (and a medic if in Northern Westchester) to a lift assist when they could be responding to a more serious calls (e.g. cardiac arrest or a MVA)? Taking 1 of the 3 medics to respond to a lift assisnt is a waste, IMO, unless there is a need for pain management. I've never been to a lift assist, so maybe I shouldn't be talking, but I'm just looking for clarification and opinions.

I would agree, and add the fire department for the extra hands.

EMS will not only evaluate for injuries, they also have more specialised patient transport equipment on the rig such as a scoop stretcher, stair chair, REEVES stretchers and all of that, and have more training in moving patients with the least possibility of further injuring them or the rescuers. Up by me it is generally the EMS crews that call for the lift assist from the FD and PD because a lot of the EMS vollies around here are either older, or have bad backs, and cant lift without help, so they call FD, the PD usually respond with the EMS crews for scene safety and to help out anyway.

But again, its a simple fact of, after the patient is cleared medically by EMS and is given the ok to be moved, it all boils down to who has the strongest backs and who gets there the fastest, right?

[okcomputer 12]

If Police and EMS respond and the FD is needed, then the FD is needed. Sometimes it could be for additional manpower.

Edited May 10, 2012 by okcomputer

[x129K 1,393]

The only plus side of FD doing lift assists is that they get to see buildings without smoke in them. Someday they may be back...for a call involving smoke and that hot red orange stuff...

[PFDRes47cue 653]

I don't personally care who does the lift assist. I have done lift assists as both an EMS and FD provider. What I am curious about is why EMS agencies request FD's for lifting assistance without first retoning their own agency/department. Why? Is it possible that agencies do not have 1 or 2 extra hands not already on the call?

Edited May 10, 2012 by PFDRes47cue