What % of Calls Require ALS?

[emtdude]

Without getting into ALS vs. BLS controversies, what has been the real life observations regarding percentage of calls requiring ALS?

I know it's a bit broad, as no doubt there are days when it might be 100%, but taken on average, what is the estimate? Or has there ever been a national study done?

In light of LA County's experiment with eliminating field intubations, will that significantly impact the ALS percentage?

 

[Foxbat]

In light of LA County's experiment with eliminating field intubations, will that significantly impact the ALS percentage?

I think that if patient's condition is severe enough to even consider intubation, he will probably receive some ALS interventions (IV access, monitor) anyway.

 

[medic417]

100% of patients deserve an ALS patient assessment.

Intubations are a very small % of what Parmedics do. I would say it would eliminate less than 1% of ALS treatment. Those that need intubation will still require some form of advanced airway. So really no impact at all.

 

[JPINFV]

^
What he said.

The answer is also based off of what you consider a paramedic level call. For example, any trauma that leave the patient in pain is a paramedic level call by nature of the ability to control pain with pharmaceuticals.

 

[medicdan]

What I am really more interested in, and what I think the OP was asking-- was how many calls REQUIRE ALS. Lets start with what %age of calls took advantage of an ALS skills (IV, Rx, 12 lead, intubation, BS in some places, etc), as opposed to ALS assessment, BLS skills.

Then i'd be interested in how many of those skills were actually necessary and benefited the patient. Were the skills performed just for the heck of it? Merely to practice?

Then i'd be interested in the difference in these percentages between urban, suburban and rural.

 

[JPINFV]

We need to ask the reverse too. How many patients were downgraded to basics that shouldn't have benn (either because the patient WAS critical (hopefully few) or because the patient wasn't critical, but could use a paramedic level intervention (e.g. pain control).

 

[Ridryder911]

Even in a hospital setting one could ask.. " What % was there given ALS or even medications that were truly beneficial". I believe one would be shocked.

Remember, EMS and medicine is not about the procedure(s) or skill(s) rather the knowledge needed to know the whys, how and what if''s.

It has been determined that approximately 20% of EMS calls require some form of ALS. I am sure there is less as per intervention, yet again each call should be cleared by an ALS provider to determine if that level of care is needed or not. Therefore; ALS level of knowledge and (if the care) needed should be 100%.

R/r 911

 

[amberdt03]

We need to ask the reverse too. How many patients were downgraded to basics that shouldn't have benn (either because the patient WAS critical (hopefully few)

i can't tell you how many calls i've ran where, dispatch downgraded it to bls when it should have been als. the problem is most of our dispatchers don't have any "medical" experience and don't truely understand that when a nursing home calls in with a patient whose blood pressure is 70/30, they need to send an als ambulance. but hey thats amr for ya.

 

[emtdude]

What I am really more interested in, and what I think the OP was asking-- was how many calls REQUIRE ALS. Lets start with what %age of calls took advantage of an ALS skills (IV, Rx, 12 lead, intubation, BS in some places, etc), as opposed to ALS assessment, BLS skills.

Then i'd be interested in how many of those skills were actually necessary and benefited the patient. Were the skills performed just for the heck of it? Merely to practice?

Then i'd be interested in the difference in these percentages between urban, suburban and rural.

Yes, that is what I was asking. After all is said and done... was it a call that -required- ALS skills?

 

[emtdude]

It has been determined that approximately 20% of EMS calls require some form of ALS. I am sure there is less as per intervention, yet again each call should be cleared by an ALS provider to determine if that level of care is needed or not. Therefore; ALS level of knowledge and (if the care) needed should be 100%.

R/r 911

I had heard that too. 80% of all 911 calls requiring EMS are/were BLS.

From my very unscientific times listening to scanners, that -seems- about right. At least for this area. Lots of "I've fallen and I can't get back up" etc. type calls.

 

[medic417]

I had heard that too. 80% of all 911 calls requiring EMS are/were BLS.

From my very unscientific times listening to scanners, that -seems- about right. At least for this area. Lots of "I've fallen and I can't get back up" etc. type calls.

But that can not be determined w/o an ALS patient assesment.

 

[trevor1189]

In my area we are dual dispatched, unless it is clearly not ALS. Local ambulance responds (usually BLS) to get on scene quicker, shortly followed by a M.I.C.U. (ALS unit) from one of the stations spread throughout the county.

 

[trevor1189]

What I am really more interested in, and what I think the OP was asking-- was how many calls REQUIRE ALS. Lets start with what %age of calls took advantage of an ALS skills (IV, Rx, 12 lead, intubation, BS in some places, etc), as opposed to ALS assessment, BLS skills.

Then i'd be interested in how many of those skills were actually necessary and benefited the patient. Were the skills performed just for the heck of it? Merely to practice?

Then i'd be interested in the difference in these percentages between urban, suburban and rural.

This is just a question but do any BLS providers do 12 leads? I am pretty sure I have seen some lifepacks on BLS rigs, not just AEDs. Maybe it is just to print of a rhythm strip for the hospital to interpret.... not sure.

 

[amberdt03]

This is just a question but do any BLS providers do 12 leads? I am pretty sure I have seen some lifepacks on BLS rigs, not just AEDs. Maybe it is just to print of a rhythm strip for the hospital to interpret.... not sure.

my understanding is that bls rigs carry lifepacks so that a medic can just jump on and already have everything they need without doing a bunch of carrying equipment.

 

[emtdude]

It might depend on the area.

In my county, BLS does not include 12 lead. However, EMT-Techs in the ER routinely do the 12 lead. Of course, they don't discuss the interpretation with the patient.

 

[trevor1189]

my understanding is that bls rigs carry lifepacks so that a medic can just jump on and already have everything they need without doing a bunch of carrying equipment.

It might depend on the area.

In my county, BLS does not include 12 lead. However, EMT-Techs in the ER routinely do the 12 lead. Of course, they don't discuss the interpretation with the patient.

Thanks for the info, that might just be the case.

 

[Hockey]

I would say about 50%

 

[medicdan]

My question is less about individual systems, more about where there is any hard data that could be analyzed. Is NEMSIS data available for analysis. Has any already been done, relating to this?

 

[AJ Hidell]

I had heard that too. 80% of all 911 calls requiring EMS are/were BLS.

Then perhaps we should be no-riding 80 percent of all patients. After all, if they don't need ALS, what are they going to a hospital for? BLS?

 

[medic417]

Then perhaps we should be no-riding 80 percent of all patients. After all, if they don't need ALS, what are they going to a hospital for? BLS?

See topic on denying patients started by me a few weeks back for a protocol to get that started.

http://www.emtlife.com/showthread.php?t=11320&highlight=deny

And one by another poster:

http://www.emtlife.com/showthread.php?t=11686