What is considered a BLS call in your area

[Ridryder911]

Okay before this subject gets out of hand, I and many others understand there are areas that will never be able to nor will have the chance to offer the care they wished they could deliver. Yes, in many rural, frontier, remote areas this will probably be the norm as long as I am alive. Again, I honor those that volunteer and dedicate their time in these areas.

Now, before we assume that this has to be the norm, let's look at areas that have made some changes and made it work. I am sure AK can chime in and can attest that Alaska has some of the most remote areas. Yet, they have attempted and made some major changes in their area. As well, we just placed a unit that will respond < 200 calls a year in a very small rural remote area; staffed by two Paramedics. So yes, it can be done, and I can assure them qualified well experienced and current Paramedics 24/7.

You have to remember, I have arrived as the ALS provider on MVA's in a fixed wing. I have worked reservations and very rural remote areas. I do not buy into the philosophy of "it can't be done" attitude. Not until, all resources has been explored. Two things, I do not like being assumed. That a provider from the rural is more stupid than those from metro areas, as well we cannot deliver the same level of care, required to stabilize patients until we arrive at a tertiary hospital.

Bossy, I am assured you do the best you can, if that is the fact, I am glad you are able to be there for your community. In fact, I give up attempting to persuade you of the difference. If one can tolerate their patients having excruciating pain with severe burns or during their course of an AMI, seizures that will not stop, or the patients that aspirate upon their own vomitus. Not that it could not been treated but rather that it was not available to them. I don't think I would still have that warm fuzzy feeling inside, knowing that. But hey that's me. Again, I do not know your exact location and its uniqueness, it maybe totally impossible. I just hope you and others attempt to explore the possibilities before giving up.

I wish you and other rural areas the best of success.

R/r 911

 

[reaper]

Sounds like you have 2 problems for the county to fix!

 

[AJemt]

&quot;
Quote:
You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion? **
That is correct sir, you can't. Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.&quot;


so just out of curiousity, is that to say that I as an emt basic, responding to someone who called for a sick person class 2 (bls lights and sirens response), cannot evaluate the 23 y/o/f who has been coughing for two days, with a sore throat and pain upon swallowing, a low-grade (100.1) fever, and is now having chest pain across the top of her chest (less than one hand wide down from the shoulders) that is present only when taking a deep breath and worsens with coughing but is not sharp, stabbing, radiating, or presenting with any cardiac symptoms, and whose lungs are clear with all vitals WNL? are you telling me that that pt needs to have a paramedic show up and place an IV and put her on the monitor, and give her ASA and nitro (she has pain)? btw, the pt didn't call her friend did bc the friend is tired of hearing her cough, but the pt does agree to go to the hospital.
i'm not trying to get cocky and don't take this post as coming across as arrogant bc i'll reach through the computer and smack you for being stupid . i am trying to further my education as an emt. Or what about the calls that come out as bls but really should be als but you don't find it out till you get there? do you sit on scene and wait for als to get there or do you start transport to the hospital (esp if the hospital is <10 minutes away and the medic is just as far if not farther)? what then?
and if you're going to bring in a paramedic for every pt that just feels kinda sick to their stomach JUST BECAUSE they MIGHT be having a cardiac issue or they MIGHT need phenergan if they have to throw up (throwing up is the body's natural way of getting rid of something offensive - do you go find a paramedic every time you throw up) you are going to A) make every medic in the system dislike you B) get the reputation of not knowing your stuff as an emt and C) get sent back to training until you can perform as an EMT.
and if you are worried about the pt not getting a medic why don't you go get your medic?

yes i understand calling in a paramedic when a paramedic is needed. if i'm not comfortable with a pt or i, by reason of my assessment training and protocols, feel the need for a medic, i'm the first to call and ask. at the same time i'm not afraid to take a pt to the hospital bls if they don't need a medic.

i'm not bashing anyone nor am i trying to come across as arrogant cocky or any of those other things that i am not. just trying to further educate myself as best i can.

 

[Ridryder911]

&quot;
Quote:
You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion? **
That is correct sir, you can't. Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.&quot;


so just out of curiousity, is that to say that I as an emt basic, responding to someone who called for a sick person class 2 (bls lights and sirens response), cannot evaluate the 23 y/o/f who has been coughing for two days, with a sore throat and pain upon swallowing, a low-grade (100.1) fever, and is now having chest pain across the top of her chest (less than one hand wide down from the shoulders) that is present only when taking a deep breath and worsens with coughing but is not sharp, stabbing, radiating, or presenting with any cardiac symptoms, and whose lungs are clear with all vitals WNL? are you telling me that that pt needs to have a paramedic show up and place an IV and put her on the monitor, and give her ASA and nitro (she has pain)? btw, the pt didn't call her friend did bc the friend is tired of hearing her cough, but the pt does agree to go to the hospital.
i'm not trying to get cocky and don't take this post as coming across as arrogant bc i'll reach through the computer and smack you for being stupid . i am trying to further my education as an emt. Or what about the calls that come out as bls but really should be als but you don't find it out till you get there? do you sit on scene and wait for als to get there or do you start transport to the hospital (esp if the hospital is <10 minutes away and the medic is just as far if not farther)? what then?
and if you're going to bring in a paramedic for every pt that just feels kinda sick to their stomach JUST BECAUSE they MIGHT be having a cardiac issue or they MIGHT need phenergan if they have to throw up (throwing up is the body's natural way of getting rid of something offensive - do you go find a paramedic every time you throw up) you are going to A) make every medic in the system dislike you B) get the reputation of not knowing your stuff as an emt and C) get sent back to training until you can perform as an EMT.
and if you are worried about the pt not getting a medic why don't you go get your medic?

yes i understand calling in a paramedic when a paramedic is needed. if i'm not comfortable with a pt or i, by reason of my assessment training and protocols, feel the need for a medic, i'm the first to call and ask. at the same time i'm not afraid to take a pt to the hospital bls if they don't need a medic.

i'm not bashing anyone nor am i trying to come across as arrogant cocky or any of those other things that i am not. just trying to further educate myself as best i can.

Did you ever think that patient you just described had a P.E.? Is it not really about patient care and transporting or that "throwing up" (by the way is NOT the bodies way of removing toxins...*another myth). Then why shouldn't the patient get anti-emetics? It is better for the patient to get nauseated? Think... which is better for the patient, not the EMT...

I do understand your thinking, but there is enough Paramedics and yes, enough money, if the system was fixed and we quit saying.."we can't". Shouldn't we promote ALS evaluation and better care for all responses, instead of making excuses? Again, the worst enemy of EMS is its own personnel.

R/r 911

 

[skyemt]

&quot;
Quote:
You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion? **
That is correct sir, you can't. Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.&quot;


so just out of curiousity, is that to say that I as an emt basic, responding to someone who called for a sick person class 2 (bls lights and sirens response), cannot evaluate the 23 y/o/f who has been coughing for two days, with a sore throat and pain upon swallowing, a low-grade (100.1) fever, and is now having chest pain across the top of her chest (less than one hand wide down from the shoulders) that is present only when taking a deep breath and worsens with coughing but is not sharp, stabbing, radiating, or presenting with any cardiac symptoms, and whose lungs are clear with all vitals WNL? are you telling me that that pt needs to have a paramedic show up and place an IV and put her on the monitor, and give her ASA and nitro (she has pain)? btw, the pt didn't call her friend did bc the friend is tired of hearing her cough, but the pt does agree to go to the hospital.
i'm not trying to get cocky and don't take this post as coming across as arrogant bc i'll reach through the computer and smack you for being stupid . i am trying to further my education as an emt. Or what about the calls that come out as bls but really should be als but you don't find it out till you get there? do you sit on scene and wait for als to get there or do you start transport to the hospital (esp if the hospital is <10 minutes away and the medic is just as far if not farther)? what then?
and if you're going to bring in a paramedic for every pt that just feels kinda sick to their stomach JUST BECAUSE they MIGHT be having a cardiac issue or they MIGHT need phenergan if they have to throw up (throwing up is the body's natural way of getting rid of something offensive - do you go find a paramedic every time you throw up) you are going to A) make every medic in the system dislike you B) get the reputation of not knowing your stuff as an emt and C) get sent back to training until you can perform as an EMT.
and if you are worried about the pt not getting a medic why don't you go get your medic?

yes i understand calling in a paramedic when a paramedic is needed. if i'm not comfortable with a pt or i, by reason of my assessment training and protocols, feel the need for a medic, i'm the first to call and ask. at the same time i'm not afraid to take a pt to the hospital bls if they don't need a medic.

i'm not bashing anyone nor am i trying to come across as arrogant cocky or any of those other things that i am not. just trying to further educate myself as best i can.

see, to me, this post seems to be about what you feel you can and can not do...

however, EMS is all about the patient... it is their emergency, not yours... and they don't really know or care about what basics think they can handle...

the only issue: is the patient getting the best available care?

often, very often, the answer is no, if they get a BLS crew...

of course, sometimes that is the best care available, in certain situations...

but, at the end of the day, it really isn't about the EMT... it's about the patient.

 

[Flight-LP]

see, to me, this post seems to be about what you feel you can and can not do...

however, EMS is all about the patient... it is their emergency, not yours... and they don't really know or care about what basics think they can handle...

the only issue: is the patient getting the best available care?

often, very often, the answer is no, if they get a BLS crew...

of course, sometimes that is the best care available, in certain situations...

but, at the end of the day, it really isn't about the EMT... it's about the patient.

*Clap*Clap*Clap*

The best post I have seen in recent weeks!

More need to think along these lines and stop worrying about what they cannot do. No BLS is not optimal in most situations. Yes, every pt. deserves an assessment from a Paramedic provider. Will it always happen? NO! But if available, they should be utilized as the pt. deserves the best there is at the time.

AJemt -How do you know the lungs are clear? Did you auscultate in more than 4 locations? I was actually thinking the possibility of a pneumonia. Can you address the fever at your location as a basic? Do you think that the ER would appreciate the effort of IV access for a pneumonia pt.? If I was a patient and elected to call 911 for vomiting, then it would be safe to assume that I did so in an effort to find relief from puking my guts out. Which do you think I would rather have, an EMT who can hold my hair back while a puke (despite the fact that I am bald!) or a Paramedic that can offer an anti-emetic and IV fluids to prevent hypernatremic dehydration? Doesn't seem like rocket science to me.............................

 

[el Murpharino]

&quot;


and if you're going to bring in a paramedic for every pt that just feels kinda sick to their stomach JUST BECAUSE they MIGHT be having a cardiac issue or they MIGHT need phenergan if they have to throw up (throwing up is the body's natural way of getting rid of something offensive - do you go find a paramedic every time you throw up) you are going to A) make every medic in the system dislike you B) get the reputation of not knowing your stuff as an emt and C) get sent back to training until you can perform as an EMT.
and if you are worried about the pt not getting a medic why don't you go get your medic?

yes i understand calling in a paramedic when a paramedic is needed. if i'm not comfortable with a pt or i, by reason of my assessment training and protocols, feel the need for a medic, i'm the first to call and ask. at the same time i'm not afraid to take a pt to the hospital bls if they don't need a medic.

i'm not bashing anyone nor am i trying to come across as arrogant cocky or any of those other things that i am not. just trying to further educate myself as best i can.

You emphasize the word MIGHT a few times - how many times MIGHT the patient be having a true emergency (silent MI, for example), and you overlook it because you don't want a medic mad at you or because you'll have to call for help instead of being the hero of the day and taking it in yourself? Just because your patient isn't tripoding or having symptomatic bradycardia doesn't mean they shouldn't be ALS'd to the hospital. It's not about being afraid to call or not call, in fact, it's not about you at all. It's about the patient. Put your ego to the side and recognize that we treat patients for the 'MIGHT' scenario.

 

[BossyCow]

Bossy, I am assured you do the best you can, if that is the fact, I am glad you are able to be there for your community. In fact, I give up attempting to persuade you of the difference. If one can tolerate their patients having excruciating pain with severe burns or during their course of an AMI, seizures that will not stop, or the patients that aspirate upon their own vomitus. Not that it could not been treated but rather that it was not available to them. I don't think I would still have that warm fuzzy feeling inside, knowing that. But hey that's me. Again, I do not know your exact location and its uniqueness, it maybe totally impossible. I just hope you and others attempt to explore the possibilities before giving up.

I wish you and other rural areas the best of success.

R/r 911

First of all, I do not get a 'Warm fuzzy feeling inside' when when I am transporting someone who needs more care than I can give. But I appreciate your assuming that was my reaction. I have transported the actively seizing pt. the record is 6 seizures during a 20 minute code transport with no ALS available. I've also transported a child with facial burns from an exploded propane tank with ALS 15 minutes away and me 35 minutes from the hospital. To assume that I would regard those experiences with anything even close to 'warm and fuzzy feelings inside' is to grossly overrate my naiveté or to grossly underate my humanity. But I'm sure you didn't mean that in any way as a personal attack.:glare:

I haven't 'given up' either. Our ALS service has been impacted by a neighboring district who was forced to downgrade from ALS to BLS due to a levy failure. That was a few years ago and attempts to replace it have not gone well.

My point has never been that its not better to have more rather than less resources available, but the arrogant assumption that anything less is negligent. My area is unique. We are a rural logging community with the nearest hospital in a mill town that recently lost another mill (its second in 6 years) so we are an economically depressed area. Our residents are proud, poor, and primarily blue collar. Trying to explain to them that they need to pay taxes so someone else can be hired at more money than they have ever seen is a tough sell.

The only reason I continue to post on the topic is to remind you and the others who rant on and on about how every call should have an ALS response that there are always exceptions to the rules and your particular situation doesn't reflect everywhere. Blanket statments with 'shoulds' and 'musts' are always going to be wrong somewhere.

 

[AJemt]

AJemt -How do you know the lungs are clear? Did you auscultate in more than 4 locations......

yes as a matter of fact i did. just because i'm an emt basic doesn't mean i'm clueless. 8 pt posterior and 6 pt anterior. is that more than 4 enough for you?


&quot;because you'll have to call for help instead of being the hero of the day and taking it in yourself? &quot;

bulls*** buddy!! hero i am anything but! or did you miss the part where i said if the pt needs als by protocol or assessment they get als? and why is it all about the emt not calling the medic, what about the medic that downgrades a pt to bls b/c the vitals are WNL and pts only complaint is an upset stomach? why is it the EMT's fault?

if you are going to make everything ALS you might as well not even bother with EMTs since apparently they can't do any more than drive....or do i have to get a medic to hold my hand so i can do that too?

 

[firecoins]

Ideally, when someone has a medical emergency, an MD will show up. Fortunately for us, we exist to do this job for the MDs.

The next best thing to an MD is a paramedic. Nurses and PAs usually don't make house calls either.

Unfortunatly medics aren't always available. Some place don't have them. Or they have medics but the medic are not available for some reason.

This means your left with EMT-Bs. Some EMT-Bs are very capable. Some aren't. The greatest tool ALL EMS has is to transport to an appropriate facility. If an EMT-B can do this, the patient will get ALS care.

 

[skyemt]

yes as a matter of fact i did. just because i'm an emt basic doesn't mean i'm clueless. 8 pt posterior and 6 pt anterior. is that more than 4 enough for you?


&quot;because you'll have to call for help instead of being the hero of the day and taking it in yourself? &quot;

bulls*** buddy!! hero i am anything but! or did you miss the part where i said if the pt needs als by protocol or assessment they get als? and why is it all about the emt not calling the medic, what about the medic that downgrades a pt to bls b/c the vitals are WNL and pts only complaint is an upset stomach? why is it the EMT's fault?

if you are going to make everything ALS you might as well not even bother with EMTs since apparently they can't do any more than drive....or do i have to get a medic to hold my hand so i can do that too?

another angry basic...

it's all about the patient people....

"if you are going to make everything ALS..." what does that mean?
"we" don't make the pt anything... the pt's acute illness does that, and we provide the highest standard of care possible...

and regarding the "upset stomach" remark, i don't see your point.. could be anything from a bad meal to an MI...

just ask yourself AJ... if you were the patient, what level of care would you want?

 

[EMTMandy]

if you were the patient, what level of care would you want?

Just wanted to add--this is one of the most important questions EMS providers could possibly ask themselves.

 

[AJemt]

screw it, i'm not wasting my breath arguing with people. i have too much to deal with as is right now, and the last thing i need is someone i don't know telling me i'm an egotistical idiot who doesn't know anything and has no consideration for the pts. for me it's all about the pts, always has been, and always will be. say what you like, you can't change the truth.

 

[Flight-LP]

screw it, i'm not wasting my breath arguing with people. i have too much to deal with as is right now, and the last thing i need is someone i don't know telling me i'm an egotistical idiot who doesn't know anything and has no consideration for the pts. for me it's all about the pts, always has been, and always will be. say what you like, you can't change the truth.

Well you just did "waste your breath". If you have too much to deal with, then perhaps you need some time away for awhile so you can adequately take care of your business. Maybe when you come back, you won't be so hostile...........................

 

[ffemt8978]

Ahem....(cough cough)

 

[fma08]

just a quick question Rid, i had a call a while back for a 20something college student at a party, obviously had too much to drink, nauseated, and... well at this point dry heaving mostly cuz he'd already puked everything up. so we get him in the truck and start transporting, ABC's are fine, sats are good, vitals are good, sugar was WNL. we start an IV and start giving some fluids, (just mentioning this is a ride along for school so i'm a student), my preceptor asks me what else i want to do for the pt. i said i wanted to give some compazine to help the pt be less nauseated and hopefully lessen the dry heaving/puking. and my preceptor said no we're not going to do that because it wont do anything, he's puking cuz his body is trying to get rid of the alcohol... so my question is, would the compazine have worked at all or not?

 

[Ridryder911]

just a quick question Rid, i had a call a while back for a 20something college student at a party, obviously had too much to drink, nauseated, and... well at this point dry heaving mostly cuz he'd already puked everything up. so we get him in the truck and start transporting, ABC's are fine, sats are good, vitals are good, sugar was WNL. we start an IV and start giving some fluids, (just mentioning this is a ride along for school so i'm a student), my preceptor asks me what else i want to do for the pt. i said i wanted to give some compazine to help the pt be less nauseated and hopefully lessen the dry heaving/puking. and my preceptor said no we're not going to do that because it wont do anything, he's puking cuz his body is trying to get rid of the alcohol... so my question is, would the compazine have worked at all or not?

Here is a link that describes a detailed but excellent explanation. You will learn if you read through it. You can see if your preceptor was correct or full of it.

http://www.mywhatever.com/cifwriter/library/70/4936.html

R/r 911

 

[fma08]

thanks for the article. great info!

 

[el Murpharino]

what about the medic that downgrades a pt to bls b/c the vitals are WNL and pts only complaint is an upset stomach? why is it the EMT's fault

I'm willing to bet most medics downgrades those types of patients after a full ALS assessment and consideration for the scenario. Believe me though, there are medics out there who won't properly assess their patients - those are the providers that end up getting burned.

 

[evantheEMT]

I work for a private company with 5 911 towns.ALS is always dispatched through 911.BLS will cover towns or do emergencies if theres no ALS available.Also the dispatchers send BLS to the nursing home/assisted living emergencies and to back up boston ems they will send BLS.