Interfacility transports place new paramedics beside complex patients, advanced devices, and tight logistics. These calls demand precise preparation, disciplined communication, and smooth coordination across teams. The skillset builds on classroom learning yet relies on practiced, real-world routines. You can preview program context on the Paramedic classes at EMS Ricky page to understand how the curriculum frames these expectations.
Start Strong: Accepting the Patient and Confirming Orders
Receive the report with intent and verify every transport instruction
Every safe transfer begins with a focused report and a clear set of orders. You confirm the working diagnosis, current condition, and the clinical goals for transport. You identify which therapies must continue en route and which changes you must avoid. You review the order sheet for medication names, concentrations, and exact rates. You ask clarifying questions about limitations, hold parameters, and escalation triggers. You then repeat back critical points to cement shared understanding.
Match medications, devices, and monitoring to the written plan
Orders only help when equipment and medications match those directives precisely. You read each infusion label aloud and cross-check the pump settings against the written rate. You confirm monitoring requirements, including ECG lead selection, pulse oximetry, and capnography when appropriate. You verify oxygen delivery method, expected FiO₂, and backup availability. You assess patient positioning needs, pressure areas, and mobility restrictions. You document any variances and request corrections before moving the patient.
Ventilator Basics: Setup Checks and Alarm Responses
Confirm settings, circuit integrity, and power before leaving the room
Ventilated patients require deliberate checks before movement begins. You verify mode, target volumes or pressures, set rate, and PEEP against the orders. You check circuit connections, suction readiness, and tube security with a quick tactile tug. You confirm ETCO₂ or equivalent verification remains available during transport. You ensure battery life and power continuity for every ventilator component. You position the device so tubing remains visible and untangled during turns. You then brief your partner on anticipated alarms and response roles.
Respond to alarms quickly while protecting ventilation and oxygenation
Transport movement can trigger nuisance alarms that obscure urgent ones. You treat high-pressure alarms as potential obstruction, bronchospasm, or kinked tubing until proven otherwise. You treat low-pressure alarms as possible disconnections, cuff leaks, or circuit failures. You visualize the entire circuit first, then suction or reposition as signs dictate. You maintain oxygenation with BVM support if the ventilator falters. You re-establish the intended settings once stability returns. You document the alarm, the intervention, and the patient response promptly.
Infusion Reconciliation: Multiple Lines and Safe Titration
Cross-check every drip from bag to vein before you roll
Interfacility transfers often involve several concurrent infusions that require vigilance. You trace each line from the bag through the pump to the access site. You read the medication name, concentration, and programmed rate, then compare those values with the orders. You confirm patency at the catheter site and evaluate dressing integrity and line security. You label each line clearly so no tubing crosses unnoticed during movement. You confirm spare batteries, spare tubing, and replacement bags when travel distances run long. You stabilize pump mounts to prevent accidental occlusions.
Manage pump failures and convert safely to gravity if required
Pumps occasionally fail at the worst possible moment, so you prepare contingencies. You keep a backup pump ready when policy allows and distance justifies redundancy. You carry macrodrip or microdrip tubing and a quick chart for manual rates. You calculate a gravity rate using the ordered mL per hour and the tubing factor. You reassess vitals and clinical endpoints after any conversion, then notify medical control. You record the interruption, the workaround, and the patient’s response in your chart. You replace the pump as soon as conditions permit.
Transport Packaging: Securement, Access, and Monitor Strategy
Build a safe setup that survives corners, elevators, and bumps
Good packaging prevents accidents that rarely forgive in motion. You apply extra padding at pressure points and protect invasive lines with careful routing. You place pumps on the side that faces the aisle for easy access and visibility. You route tubing along predictable paths and anchor junctions with soft loops. You confirm that oxygen cylinders are full, secured, and reachable from the primary seat. You balance the stretcher so devices do not torque during turns. You reassess comfort and skin integrity after every transfer between surfaces.
Choose leads, alarms, and power sources with transport in mind
Transport monitoring must prioritize signal reliability and actionable alarms. You select lead II for arrhythmia surveillance unless orders suggest a different configuration. You enable alarm thresholds appropriate for that patient’s baseline and current therapy. You add ETCO₂ for airway patients and high-risk sedation cases when available. You stage extra power cables and confirm battery levels for each device. You avoid dangerous daisy chains that can fail with a single loose plug. You document baseline trends before departure to support later comparisons.
Documentation: Medical Necessity, Continuity, and Audit Readiness
Explain why ambulance transport and ALS monitoring were required
Strong documentation protects the patient, the crew, and the organization. You clearly state why the patient required continuous monitoring or advanced interventions. You describe ventilator dependence, invasive lines, or therapies that demand ALS oversight. You explain risks associated with lesser transport modes for this specific patient. You record orders received, parameters confirmed, and instructions repeated back to staff. You list devices attached, medications running, and any titration limits. You close the loop by documenting the receiving handoff and the accepting clinician’s role.
Capture events chronologically and tie actions to outcomes
Reviewers look for a coherent story that links assessments and actions. You time-stamp notable events, alarms, interventions, and reassessments. You record vital-sign trends that support or counter your working impression. You connect observed changes to plausible causes and corresponding interventions. You describe the patient’s response rather than leaving outcomes implied. You include partner roles when they add clarity to complex sequences. You audit your own chart once for completeness before closing it out.
Scope and Boundaries: Practice Within Protocol and Seek Direction Early
Know what your agency allows and what requires medical control
Scope varies by state and by agency, so you confirm boundaries before transports. You review which medications you may maintain, which you may titrate, and which require orders. You learn adjustment rules for ventilator settings under your local protocol. You identify devices that your agency prohibits outside hospital supervision. You clarify communication pathways for real-time consultation with medical control. You document any physician instructions that modify standing protocols during the trip.
Align onboarding, clearances, and competencies with transport roles
Readiness includes more than clinical skill, because paperwork drives access. You complete background screening, immunization verification, and fit testing per agency policy. You track certifications and hospital access requirements that enable bedside handoffs. You participate in device in-services and scenario drills before independent operations. You request proctored IFT charts during your first weeks to sharpen documentation. You can review logistics details on the Application Process page to understand typical onboarding milestones.
Build Confidence: Reps, Mentorship, and Targeted Micro-Drills
Use deliberate practice that mirrors real transport pressures
Confidence grows quickest when drills resemble actual transport stressors. You run alarm drills while moving stretchers through tight doorways and corners. You practice BVM takeovers while your partner simulates a ventilator failure. You rehearse line tracing in poorly lit hallways with realistic noise. You label tubing under time pressure to make accurate habits automatic. You practice quick debriefs that capture lessons before fatigue blurs details. You track improvements with a short checklist that highlights speed and safety.
Learn from experienced crews and review near-misses without blame
Mentorship compresses learning curves that otherwise stretch across months. You ask senior medics how they stage devices for clean access during bumps. You study anonymized near-miss reports to understand common traps and fixes. You invite feedback on packaging, narrative clarity, and alarm response timing. You share your own lessons with new teammates to strengthen collective awareness. You celebrate small gains, since steady progress builds durable confidence. You carry those habits into every transfer, no matter how routine it appears.
Frequently Asked Questions
What’s the difference between an IFT and a regular 911 call?
Interfacility transports move patients between facilities for continued or specialized care. These trips often involve ventilators, active infusions, or detailed physician orders. Emergency 911 responses emphasize rapid assessment and stabilization during unpredictable events. IFTs prioritize continuity, precise device management, and adherence to written plans. Both require vigilance, yet IFTs demand meticulous coordination and transport-specific workflows.
Can new paramedics transport ventilated patients on their own?
New paramedics usually complete ventilator orientation, supervised cases, and skills sign-offs first. Field training officers often ride along for early transports to ensure safe practices. Agencies define clearance thresholds based on local policy and equipment complexity. Crews escalate to medical control whenever alarm patterns or trends raise concern. These steps protect patients and help new medics gain confidence responsibly.
What should I do if a pump fails during transport?
You stabilize the patient and maintain the ordered therapy when possible. You switch to a backup pump if policy and availability support that option. You convert to gravity using the ordered rate and tubing factor when needed. You reassess hemodynamics and document the change, the math, and the response. You notify medical control and the receiving team at the earliest safe opportunity.
Do I need special certification for IFTs?
No national certification exists exclusively for interfacility transports at this time. Agencies typically provide device training, protocol refreshers, and supervised case minimums. Hospitals may require access steps before bedside handoffs or equipment use. Your service will outline these prerequisites during onboarding and orientation. You should track completions and refreshers to remain deployment ready.
Next Steps and Practical Tools
Turn this guidance into a ready checklist for your next transfer
You can build a pocket card that captures orders confirmation, device checks, and alarm plans. You can add quick drip calculations and a space for tubing factors. You can list contact numbers for medical control and receiving units. You can include reminder lines for narrative anchors and handoff details. You can review the card during unit checks so habits stay polished. You can then refine the card after each challenging transport to capture new lessons.