“Routine”
Let me tell you about a word I hate.
Not “moist.” Not “synergy.” Not even “per my last email,” though that one’s climbing the list.
The word I hate is routine.
Specifically—and I need you to hear me on this—the phrase routine transfer.
Now somewhere right now, there’s a medic sitting in the back of an IFT truck, feet up, phone out, half-watching something on Netflix through a cracked screen, thinking to himself: This ain’t real EMS. This is just a paycheck. Side hustle. Beer money.
And his partner up front is thinking the same thing.
And the patient on the stretcher between them?
She’s a 78-year-old woman with a history longer than a CVS receipt—CHF, COPD, CKD, type 2 diabetes, on Coumadin, coming off a UTI admission, being transferred back to her skilled nursing facility at 11 o’clock at night.
Vitals were “stable” at discharge.
Were.
Go ahead and read that chart again.
I’ll wait.
Now. I want to ask you something, and I want you to think before you answer it.
When exactly did interfacility transport become the place where people go to not try?
Because I missed that memo. I must’ve been on a call or something. Getting IV access on a combative patient. Delivering a baby in a parking garage. Probably doing something stupid like taking the job seriously.
She Didn’t Get Better. She Got Discharged.
Here’s what the “it’s not 911” crowd forgets.
That woman on your stretcher? The one you haven’t assessed since you loaded her because she’s “just a transfer?”
She was already sick enough to be hospitalized.
Think about that. The bar for admission ain’t what it used to be. If the hospital kept her, something was wrong. And if the hospital is sending her somewhere else at this hour—something is still wrong, or close enough to wrong that it makes no difference.
I’ve worked IFT. Done my time. Plenty of it.
And I’ll tell you what I found out real quick, back when I still had the kind of energy that let me be surprised by things.
The sickest patient I ever had in the back of a truck wasn’t a GSW. Wasn’t a full arrest I pulled off the floor at 3 AM. Wasn’t a traumatic brain injury or a STEMI or a respiratory failure.
It was a “routine” transfer.
Dialysis patient. Going home. Stable.
He was septic before we even got in the unit.
Fever I missed because I didn’t take a temperature. Altered mental status I wrote off as baseline because the chart said “confused at times.” Blood pressure that looked fine until it very suddenly wasn’t.
He lived.
Not because I was brilliant. Because I got my head out of my fourth point of contact about fifteen minutes in and actually looked at him.
We got lucky.
I hate lucky.
Alone in a Box on a Dark Road
Here’s the thing about IFT patients that the “side hustle medic” crowd never seems to grasp...
These patients are complicated.
Comorbidities stacked like cord wood. Polypharmacy. Histories of the kind that take three pages to summarize and still leave something out. They’re the patients that attending physicians sometimes quietly dread because nothing about them is textbook.
And you’ve got them. Alone. In a box. On a dark road. At midnight.
No attending. No charge nurse. No rapid response team down the hall.
Just you, your partner, your monitor, and whatever assessment skills you either have or are currently faking.
You better know the difference.
Now don’t misunderstand me.
I’m not saying every IFT run is a time bomb. Most of them aren’t. Most of them are exactly what they look like—a person going from Point A to Point B, and your job is to make sure they arrive at Point B in at least the same condition they left Point A.
At least.
That’s the floor. Not the ceiling. The floor.
But here’s the rub—you don’t get to decide which run matters when you’re loading up. You don’t get a preview. Nobody sends you a text that says hey heads up, this one’s gonna go sideways around mile marker 12.
That’s not how any of this works.
And the medic who’s half-checked-out from the moment he confirms the pickup address?
He’s the one who misses it.
Every. Single. Time.
Your Résumé Doesn’t Ride in the Back
There’s a certain kind of provider—you’ve seen ’em, every service has ’em—who treats IFT like a necessary indignity. Like they’re above it. Like their 911 experience gives them the right to coast through anything that doesn’t involve lights and sirens and a crowd of bystanders watching them work.
Bless their hearts.
And before you get your feelings hurt and start typing—“Well I worked 911 in [major metropolitan city] for twenty-plus years, so I think I know a little something about—”
Stop.
Just... stop.
So did I.
And I’m going to tell you the same thing my old field training officer told me approximately thirty years ago in the front seat of an old F350 Box Unit that smelled like diesel and stale Krispy Creme:
Twenty years on a busy 911 system is real. I’m not taking that from you. You’ve seen things. Done things. Earned things. I believe you.
But that experience? That history?
It doesn’t give you permission to sleepwalk through someone else’s emergency just because you’ve decided it doesn’t qualify as one.
That’s not experience talking, Skippy.
That’s ego.
And ego has killed more patients than ignorance ever thought about.
At least ignorance is still paying attention.
Son, a patient in respiratory failure don’t care what kind of call you responded to last Tuesday. Sepsis don’t check your service record before it shows up. A PE don’t give one single damn whether your last shift was on a busy 911 truck or a quiet transfer unit.
Sick is sick.
The streets don’t negotiate. And neither does pathophysiology.
The Wrong Lesson
I’ve watched providers with genuinely good 911 instincts completely fall apart on a transfer run because they’d already decided the call didn’t matter before they left the building.
Didn’t chart worth a lick. Didn’t do a full assessment. Didn’t introduce themselves to the patient—which, by the way, is free and takes about four seconds and it tells the patient that somebody in that truck gives a damn whether they make it.
Just... coasted.
And sometimes they got away with it.
And that’s the part that bothers me most.
Because every time somebody coasts and nothing bad happens, they learn the wrong lesson.
They learn that coasting is fine.
Right up until it isn’t.
The Whole Test
You want to know who takes IFT seriously?
The good ones.
The medics who understand that this—this unglamorous, unwitnessed, non-heroic, no-crowd-watching transfer run—is exactly where your character shows up.
Nobody’s filming you. Nobody’s grading you. The patient can’t always tell you if something’s wrong.
It’s just you and what you actually know and whether you actually care.
That’s the whole test.
You took an oath.
Not a 911 oath. Not a “when I feel like it” oath.
An oath that covers every patient on every run, regardless of where they’re going, what time it is, or whether you’ve got something better to do on your phone.
That woman going back to her nursing home at 11 PM?
She’s got people who love her. A daughter somewhere who called the facility three times today to check on her. Grandkids who drew her pictures. A whole life that happened before she ended up on your stretcher.
She deserves somebody who’s paying attention.
Be that somebody.
Or find another line of work.
I hear Amazon’s hiring.