What to Expect During an Inter-Facility Ambulance Transport

The level of transport is matched to what the patient needs on the way. The terms come from two places: the clinicians on board and the care they can provide.

Basic life support (BLS)

The National EMS Scope of Practice Model, published by the National Highway Traffic Safety Administration, describes the EMT’s primary role as providing “basic patient care and medical transportation within the emergency care system.” Under Medicare’s rules, a BLS ambulance must be staffed by at least two people, at least one of whom is certified at a minimum as an EMT.

Advanced life support (ALS)

The same model describes the paramedic’s primary role as providing “advanced care in a variety of settings.” Paramedics administer medications, interpret and use diagnostic findings, provide complex patient care, and, according to the model, “may provide specialized interfacility care during transport.”

Critical care and specialty care transport

Some patients are critically ill or injured and need ongoing, specialized care during the trip. Medicare describes specialty care transport as inter-facility transport of a critically injured or ill patient at a level of service beyond the scope of the paramedic, furnished by health professionals in a specialty area or a paramedic with additional training.

Each state regulates EMS within its borders, so exact roles and skills can vary. In Texas, the Department of State Health Services (DSHS) administers EMS certification and licensure, from EMT certification to Paramedic licensure.

Established in early 2008, Republic EMS is a licensed Texas EMS provider offering BLS, ALS and critical care inter-facility transport. Every one of our units is staffed with a Paramedic and an EMT and carries a vent, pump and cardiac monitor, so each unit is MICU-ready. Our crews train in-house in American Heart Association BLS, ACLS and PALS and practice with mock codes. We serve Greater Houston, Dallas, San Antonio, Corpus Christi, Beaumont and surrounding areas, and we are dedicated to serving freestanding emergency centers.

1. 1At the sending facility, the patient’s nurse or physician gives the crew a report on the patient’s condition, treatments and medications, along with transfer paperwork.
2. 2Before moving, the crew checks on the patient, connects any monitoring or equipment that needs to continue, and secures the patient on the stretcher.
3. 3During the trip, the crew continues care and monitoring appropriate to the level of transport.
4. 4At the receiving facility, the crew gives a report to the receiving staff and hands over the paperwork before transferring the patient to their new bed.

Families can help by being ready to describe the symptoms and events that led up to the transfer. The National Institute on Aging notes that you may need to repeat this more than once to different staff members, which is normal.

The National Institute on Aging suggests keeping a list of important information for hospital trips, including all medicines, insurance cards, contact information for health care providers, and any advance directives. A medication list should include every prescription, over-the-counter drug, vitamin and supplement.

• A current medication list and allergy list
• Insurance and Medicare or Medicaid cards
• Copies of advance directives or a medical power of attorney, if the patient has them
• Names and phone numbers of the patient’s doctors and a family contact
• A small comfort item, such as a family photo, if the patient would like one

Ride-along policies vary depending on the patient’s condition, the equipment and crew needed, and safety considerations. Ask dispatch or the crew ahead of time, and plan your own way to the destination in case a seat isn’t available. If you do ride along, follow the crew’s instructions and wear your seat belt.

• What level of transport was requested (BLS, ALS or critical care), and why?
• What is the estimated pickup time, and who will call if it changes?
• Where exactly is the patient going: facility, unit and room?
• Will the patient’s records and medication list be sent with them?
• Who should we contact at the receiving facility after arrival?