ALS units on BLS calls

[MAC4NH]

As well in regards to my posts abut headaches, my intent was most headaches are "blown off" when in fact, they could be life threatening. BLS providers are not adeuately trained to determine if it is life threatning or not. Rarely, I ever see a physician that does not perform a whole work up on a "worst H/A ever" complaint. It only takes once .. and they won't do that again.

So how can an ALS provider in the field determine if it's life threatening or not it if the physician needs to do a full workup? Sounds like ABC's and prompt transport are the solution. In an area where there are long transport times, I agree that ALS would be better in case the patient crashed. In an urban area, there's not that much more an ALS provider can do for the patient than a BLS provider. BTW, in my system, a headache not accompanied by AMS is a BLS dispatch. And no, we don't blow them off, even if we do think it's BS.

 

[daedalus]

Now this thread has got me going. Can we review medical emergencies where we as prehospital providers can make a proven difference?

Ones off the top of my head:

1. Cardiac Arrest. If patient is taken to hospital by POV, pt is a gonner. Pt needs EMS intervention to live. And fast.

2. FBAO. Without bystander clearance maneuvers, BCLS by EMT, or body removal with ALS technique, pt will die.

3. Near Drowning and Respiratory arrest. Pt needs resuscitation and medical transportation to hosp ED.

4. Trauma with entrapment. Medically supervised extrication and immediate transport, DX and TX shock PRN.

5. Syncope and Seizure. EMS needed as much for calming the public and providing transport as needed. This is a presence factor.

All others, including SOB, COPD exasperation, chest pain, broken arms, etc etc, can probably be transported to ER by POV, BLS and ALS care in the field will probably just delay definitive treatment.

This is a theory, can you prove it otherwise?

 

[JPINFV]

Also that one posted above by JPINFV.

Of course for 2 of the 3 pathologies of that study, there would most likely be zero difference between if the patient was transported by POV vs being transported by an ambulance.

 

[firecoins]

In my four years in public health and community medicine, I have seen PAs, NPs, and MDs work together like clockwork in simi valley, california. No turf wars except when the Kaiser residents would come in to volunteer, which one would get to remove the toenail.

Thats not the point. Team work is important. BLS first responder giving a seemless and competent report to the arriving paramedic ambulance, working as a team to load up, and things to that end.

what makes you think EMT and Medics don't work as a team? Because they argue on an internet forum?

Yes PAs, NP and MDs will work together and have turf battles. They aren't mutually exclusive. Not everything occurs in front of a patient.

 

[Flight-LP]

In an urban area, there's not that much more an ALS provider can do for the patient than a BLS provider.

AMI

BLS - O2, rapid transport to ER, possibly ASA and NTG administration

ALS - O2, ASA, NTG, Morphine, 12 Lead EKG for confirmation, Lopressor, Heparin, direct transport to Cath Lab

Seems like a pretty big difference to me......................

 

[daedalus]

Paramedic with heparin? Not in my county. They can't even transport someone with a drip of hep going. Lopressor...forget about it.

A CCT unit is needed for both those meds.

Even RNs make mistakes with these extremely dangerous drugs. At Cedars-Sinai.

 

[JPINFV]

Daedalus, just wondering, where are you currently working?

As to Flight-LP, where I worked you could cross off lopresor, heparin, and ASA from that list.

 

[MAC4NH]

AMI

BLS - O2, rapid transport to ER, possibly ASA and NTG administration

ALS - O2, ASA, NTG, Morphine, 12 Lead EKG for confirmation, Lopressor, Heparin, direct transport to Cath Lab

Seems like a pretty big difference to me......................
Flight-LP is offline Reply With Quote

I didn't say anything about AMI. I was referring to a headache.

 

[daedalus]

Just started with AMR in LA County. 911 transport provider for LACOFD.
I live in Ventura county.

I used to work for another private service, which shall remain nameless. I did CCT and ALS transport as the EMT/Driver. Interfacility only type of stuff.

 

[Ridryder911]

Okay, here we go again. Lower level and those without the medical expertise that assume they know what medications are dangerous, what is best for the patient. Not to be sarcastic, but that would be similar if I took a basic firefighting class and attempted to tell a Fire Chief on how to fight structure or handle a haz mat incident. Really, where and why do so many assume they have the insight to make assumptions.

Please cite where Heparin is such a "dangerous drug"? Yes, the incident in regards to neonate (as all medications) can be considered such. Heparin is a routine medication that is given thousands of times an hour in the U.S. without any major problems. Can it be dangerous... you bet, alike ASA, Tylenol, etc..

As well, what expertise do most have to determine what is needed metro, rural, suburban, and to describe ABC's are enough? Really, how many thousand calls and years of education, did you make that determination? How many respiratory arrest have you actually managed by yourself? How many aspirations did you care for? As well, in regards to fracture arms, strains, possible fxr ankles, denying pain management is horrible treatment and poor care! Sorry, break your arm and see if you would like to suffer with it. Where do we get off saying patients should be denied analgesics for fractures & potential fractures? That those are really a BLS call? Again, is there really such a thing? I could debate that statement on most or almost all calls.

So it goes back again, many that do NOT have the education and knowledge, attempting to "assume" they know what is best. Maybe, furthering ones education, gaining experience, should be considered first before making assumptions.

R/r 911

 

[Flight-LP]

I didn't say anything about AMI. I was referring to a headache.

I realize that, but the point has been made. Not just to you, but to the rest of the EMT-B's that have this belief that they are the best level of care and that ALS is pointless. Every single time this topic comes up, there a few statistically significant events that occur..............

1. An EMT-B initiates the point that ALS care isn't better than BLS care.

2. One or more additional EMT-B's jump on the bandwagon.

3. All parties then side step rebuttals from statistical research that is presented by ALS providers who know better as evidenced by the care they provide on a daily basis.

4. EMT-B's get mad and feel personally insulted.

5. Admin eventually steps in and locks thread.

So why do we continuously argure this point? YOU ARE WRONG, PERIOD!

Stop bi^#*ing about it. Want to make a difference, then promote your career and level of care by becoming a Paramedic. Then you won't have this continuous inferiority complex that constantly plagues the forum.

ALS care is and always will be more efficient for patient care. It allows for a higher knowledge base, a more thorough assessment, and more definitive care through the use of available ALS pharmaceuticals and diagnostic equipment. Regardless of the previous arguments about having ALS everywhere, the consistant belief presented is that ALS is still a higher level of care than BLS and therefore is better if available to that particular community.

Trauma studies to support your mythical belief offers zero validation. Neither BLS or ALS saves a trauma patient. A TRAUMA SURGEON saves the trauma patient. Time, distance, and extent of injuries determine the outcome.

Sorry to jump on you MAC4NH, but these topics get old after years of argument, its nothing personal, just something to think about. Just a strong belief from one who has witnessed it first hand for almost 2 decade's......................

Keep it safe friends!

 

[Flight-LP]

Okay, here we go again. Lower level and those without the medical expertise that assume they know what medications are dangerous, what is best for the patient. Not to be sarcastic, but that would be similar if I took a basic firefighting class and attempted to tell a Fire Chief on how to fight structure or handle a haz mat incident. Really, where and why do so many assume they have the insight to make assumptions.

Please cite where Heparin is such a "dangerous drug"? Yes, the incident in regards to neonate (as all medications) can be considered such. Heparin is a routine medication that is given thousands of times an hour in the U.S. without any major problems. Can it be dangerous... you bet, alike ASA, Tylenol, etc..

As well, what expertise do most have to determine what is needed metro, rural, suburban, and to describe ABC's are enough? Really, how many thousand calls and years of education, did you make that determination? How many respiratory arrest have you actually managed by yourself? How many aspirations did you care for? As well, in regards to fracture arms, strains, possible fxr ankles, denying pain management is horrible treatment and poor care! Sorry, break your arm and see if you would like to suffer with it. Where do we get off saying patients should be denied analgesics for fractures & potential fractures? That those are really a BLS call? Again, is there really such a thing? I could debate that statement on most or almost all calls.

So it goes back again, many that do NOT have the education and knowledge, attempting to "assume" they know what is best. Maybe, furthering ones education, gaining experience, should be considered first before making assumptions.

R/r 911

New rule, Rid, you can no longer type when I am!

Too much logic and truth at once can hurt................

 

[Arkymedic]

because they called! i dont know about where you work, but dispatchers in ma cant diagnose a call as bs over the phone. if you call, you get a truck. if, when that truck arrives, you want to go to the H, we take you. we cant refuse to transport because we think a call is bs.

all three of those calls are calls i have done. in your dream system, they all would have been handled by an als truck with two paramedics. does that seem like a good use of resources?

This is why ABNs exist.

 

[Arkymedic]

To clarify further,

since no one can decide on where EMS should be going, how can we decide how much education an EMT should have? Is what we have enough? or do we need more even though most transporting should be done by paramedic ambulance?
Perhaps we need a bit more. Im not saying EMT should be almost paramedic level in scope and education, but we need a more worldly view of medicine in general before we get to the field. And yes, anyone wanting to be in charge of a 911 call, become a medic, and save the whining on how BLS is just as good as ALS.

In a nutshell, yes a properly educated EMT should know what they doing.

I think we need to make it so EMT is at least a 2 yr associates program with A and P I and II, english, life span development, etc and Paramedic needs to become a four year bachelors degree. I think this would add to both sides education. Canada had this one right...

 

[mdkemt]

Our protocols state to call ALS no matter what. This may have been a load-and-go situation which they should have done but you still have to call ASL. You can never be to safe or careful. Sometimes situations can turn real bad real quick.

 

[skyemt]

I realize that, but the point has been made. Not just to you, but to the rest of the EMT-B's that have this belief that they are the best level of care and that ALS is pointless. Every single time this topic comes up, there a few statistically significant events that occur..............

1. An EMT-B initiates the point that ALS care isn't better than BLS care.

2. One or more additional EMT-B's jump on the bandwagon.

3. All parties then side step rebuttals from statistical research that is presented by ALS providers who know better as evidenced by the care they provide on a daily basis.

4. EMT-B's get mad and feel personally insulted.

5. Admin eventually steps in and locks thread.

So why do we continuously argure this point? YOU ARE WRONG, PERIOD!

Stop bi^#*ing about it. Want to make a difference, then promote your career and level of care by becoming a Paramedic. Then you won't have this continuous inferiority complex that constantly plagues the forum.

ALS care is and always will be more efficient for patient care. It allows for a higher knowledge base, a more thorough assessment, and more definitive care through the use of available ALS pharmaceuticals and diagnostic equipment. Regardless of the previous arguments about having ALS everywhere, the consistant belief presented is that ALS is still a higher level of care than BLS and therefore is better if available to that particular community.

Trauma studies to support your mythical belief offers zero validation. Neither BLS or ALS saves a trauma patient. A TRAUMA SURGEON saves the trauma patient. Time, distance, and extent of injuries determine the outcome.

Sorry to jump on you MAC4NH, but these topics get old after years of argument, its nothing personal, just something to think about. Just a strong belief from one who has witnessed it first hand for almost 2 decade's......................

Keep it safe friends!

try not to generalize, please... i am a basic, and have continually argued the same as you... just because there are basics that are misguided out here, there are also a great number that are not...

but you are correct, the same thing happens every time... lol

and frankly, the arguments against ALS care is just silly.

 

[Flight-LP]

try not to generalize, please... i am a basic, and have continually argued the same as you... just because there are basics that are misguided out here, there are also a great number that are not...

but you are correct, the same thing happens every time... lol

and frankly, the arguments against ALS care is just silly.

I actually thought about you when I posted, I figured a response was coming. Sorry for the generalization, but sometimes people just don't get it. I do appreciate your postings and your effort. It nice hearing the same thing coming from someone other a "Paragod" with a huge ego (as I have been called numerous times!).....................

 

[JPINFV]

try not to generalize, please... i am a basic, and have continually argued the same as you... just because there are basics that are misguided out here, there are also a great number that are not...

but you are correct, the same thing happens every time... lol

and frankly, the arguments against ALS care is just silly.

It helps to realize that sometimes you are the exception, not the rule.

 

[MAC4NH]

Originally posted by Flight-LP:

1. An EMT-B initiates the point that ALS care isn't better than BLS care.

I think you're misunderstanding my point. I don't believe that ALS and BLS are at the same level. I do believe in the importance and necessity of ALS and I may even become a paramedic myself someday (if I can inflate my ego enough )

However please understand that conditions and situations are different in different areas. What is good for rural Utah may not work as well in the middle of Boston or in DC.

In my system, medics are getting burned out from running around chasing calls that do not require ALS (this comes from the ALS providers, not from me). There are many people here who abuse the system and call 911 for everything from a hangnail to head lice. I hear all the arguments that we need to change the system and triage these calls or refuse to respond to some calls. I agree. Everyone involved in the medical field here agrees. However there are tens of thousands of lawyers in the northeast who are trying to prevent this with every fiber of their being. Oh, BTW, most of the politicians in my state are, guess what? Lawyers. Yes, change would be good. But until then, this is our reality. We have to answer every call that comes in and treat it like a real emergency. If we don't, we could get sued or, even worse, our employer could get bad press (No! Anything but that!).

In your view of the system, highly trained ALS providers would spend half their day picking up homeless drunks. The same drunks they picked up yesterday and the day before for the same reason they picked them up the yesterday and the day before, ie they were cold and/or hungry. They will also pick up the 25 year old with the head lice. They will pick up the 30 year old complaining of non-specific pain who, BTW, somehow always manages to call when his/her percocet runs out.

We have a statewide paramedic shortage as it is. If we add these calls to their workload, what will that do the burnout rate?

As an EMT who has been doing this for 20 years, I realize that the above patients are abusing the system. But I also realize that the system is a semi-willing party to this abuse. Many of these people do need help. Do they need ALS? No way! Do they need BLS? Probably not. They need an alternative to the ED. There are smarter people than me working on alternatives. Until then, this is what we have to live with here.

While I did not mean to Medic-bash, I hope you ALS providers realize that you are not doctors either and that whether ALS or BLS we all basically take patients to the hospital! And maybe in your particular system, you don't need or want BLS. In mine the medics would be pretty upset if they had to do my job.

 

[daedalus]

Okay, here we go again. Lower level and those without the medical expertise that assume they know what medications are dangerous, what is best for the patient. Not to be sarcastic, but that would be similar if I took a basic firefighting class and attempted to tell a Fire Chief on how to fight structure or handle a haz mat incident. Really, where and why do so many assume they have the insight to make assumptions.

Please cite where Heparin is such a "dangerous drug"? Yes, the incident in regards to neonate (as all medications) can be considered such. Heparin is a routine medication that is given thousands of times an hour in the U.S. without any major problems. Can it be dangerous... you bet, alike ASA, Tylenol, etc..

As well, what expertise do most have to determine what is needed metro, rural, suburban, and to describe ABC's are enough? Really, how many thousand calls and years of education, did you make that determination? How many respiratory arrest have you actually managed by yourself? How many aspirations did you care for? As well, in regards to fracture arms, strains, possible fxr ankles, denying pain management is horrible treatment and poor care! Sorry, break your arm and see if you would like to suffer with it. Where do we get off saying patients should be denied analgesics for fractures & potential fractures? That those are really a BLS call? Again, is there really such a thing? I could debate that statement on most or almost all calls.

So it goes back again, many that do NOT have the education and knowledge, attempting to "assume" they know what is best. Maybe, furthering ones education, gaining experience, should be considered first before making assumptions.

R/r 911

Sir, you have no right nor standing to make such a claim. And yes, Heparin is very dangerous if it is allowed to drip more than it should. Special care is required to ensure it is given safely in controlled circumstances. As a RN, you very well know that. My four years of partnering with the chief of staff (an MD) of a local hospital to learn about hospital and internal medicine give me the right to say that, not my silly "EMT" training. As a rule, definitive diagnosis and treatment are in the domain of doctors, and EMS should provide critical, simple interventions proven to influence positive outcome, and rapidly transport in an ALS ambulance. EMS should leave definitive treatment to the hospital.

While I know next to nothing about LMWH, I can tell you that a patient on UH needs to be hospitalized and watched closely by an experienced RN. Check the Journal of Family Practice, because that is their recommenced guidelines for using UH.