What % of Calls Require ALS?

[JROD]

Do you believe that every single patient is in dire need of ALS intervention after calling 911?? I was always taught that what might not seem like an emergency for me may be any emergency for the patient. If the patient is complaining of a tummy ache or an abnormal pain in there ankle and they want to be transported to the hospital, then I take them...I Don't necessarily do a complete ALS workup on the pt, and often will kick it to my EMT if it seems harmless...

 

[medic417]

Do you believe that every single patient is in dire need of ALS intervention after calling 911?? I was always taught that what might not seem like an emergency for me may be any emergency for the patient. If the patient is complaining of a tummy ache or an abnormal pain in there ankle and they want to be transported to the hospital, then I take them...I Don't necessarily do a complete ALS workup on the pt, and often will kick it to my EMT if it seems harmless...

Not to pick on your education but you should have learned that all patients need a complete ALS assessment to rule out or in for a proper diagnosis. I also question why any school would teach the "you call we haul idea". It is not the law that we have to transport all callers. After an ALS examination you can explain to the caller that while this may be an emergency to them it is not an emergency that requires an ambulance.
To kick to bls you need to know its harmless not just think it seems harmless.

 

[Sasha]

Do you believe that every single patient is in dire need of ALS intervention after calling 911??

Who said ALS intervention? Assesment and intervention are two different things.

 

[Veneficus]

Do you believe that every single patient is in dire need of ALS intervention after calling 911?? I was always taught that what might not seem like an emergency for me may be any emergency for the patient. If the patient is complaining of a tummy ache or an abnormal pain in there ankle and they want to be transported to the hospital, then I take them...I Don't necessarily do a complete ALS workup on the pt, and often will kick it to my EMT if it seems harmless...

Could I ask what an "ALS workup" is exactly? I am confused by your statement that you do an assessment but not a workup.

 

[emtdude]

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?

Yeah, that's EXACTLY what was asked and inferred.

It's a simple question... or should be.

 

[emtdude]

I also question why any school would teach the "you call we haul idea". It is not the law that we have to transport all callers.

Doesn't that depend on the ambulance company/FD you work for, or perhaps local EMS protocols?

What if the patient specifically requests transport? Can you say "No", or only advise?

 

[VentMedic]

Originally Posted by JROD

Do you believe that every single patient is in dire need of ALS intervention after calling 911?? I was always taught that what might not seem like an emergency for me may be any emergency for the patient. If the patient is complaining of a tummy ache or an abnormal pain in there ankle and they want to be transported to the hospital, then I take them...I Don't necessarily do a complete ALS workup on the pt, and often will kick it to my EMT if it seems harmless...

Not to pick on your education but you should have learned that all patients need a complete ALS assessment to rule out or in for a proper diagnosis. I also question why any school would teach the "you call we haul idea". It is not the law that we have to transport all callers. After an ALS examination you can explain to the caller that while this may be an emergency to them it is not an emergency that requires an ambulance.
To kick to bls you need to know its harmless not just think it seems harmless.

I just realized JROD has Paramedic on his profile. His posts have been reading very basic especially on the "experience" thread. Could it be all the time he spent as an EMT-B, he is having a difficult time understanding things now in terms of the need for an ALS assessment? This is perhaps another illustration where Paramedic programs lack or do the provider an injustice in their training. Some also misuse the term Critical Thinking to mean an opinion not necessarily based on science or knowledge acquired from an assessment. To some choosing BLS or ALS is more like, do you prefer this movie or that one. Often more thought is probably put into choosing a movie than determining the medical needs of a patient. But, is it because they don't know or understand? Or, are there other factors at work here?

 

[medic417]

Doesn't that depend on the ambulance company/FD you work for, or perhaps local EMS protocols?

What if the patient specifically requests transport? Can you say "No", or only advise?

We can say no at my service. And there is no state law that says you can not. But most services understand that most in EMS are not educated enough to say no so they write policys that say you must haul everyone. But that should be taught by your service not the school.

 

[emtdude]

We can say no at my service. And there is no state law that says you can not. But most services understand that most in EMS are not educated enough to say no so they write policys that say you must haul everyone. But that should be taught by your service not the school.

Oh, I think it's a lot more about services covering their butts. If you deny transport, even for good reason, and that person has any kind of subsequent problems... well, you know what would happen.

 

[medic417]

Oh, I think it's a lot more about services covering their butts. If you deny transport, even for good reason, and that person has any kind of subsequent problems... well, you know what would happen.

It is the fact that so many make decisions based on fear rather than on what is best for the patient that annoys me. It would be better to help the caller learn what a real emergency is. Help them locate the type of services they actually need rather than adding to abuse of ambulance and ER. But that would take time and effort and most would prefer to take the easy lazy way and just transport.

 

[EMTinNEPA]

It would be better to help the caller learn what a real emergency is.

What, and make them realize that we're not just a taxi service staffed by "ambulance drivers"? NEVER!

 

[medic417]

What, and make them realize that we're not just a taxi service staffed by "ambulance drivers"? NEVER!

Actually you as a basic would not be able to deny as it requires an ALS assessment.

 

[Veneficus]

I propose that henceforth we stop using the phrases ALS or BLS assessment.

I have decided there is no such thing as a BLS assessment. A proper assessment requires knowledge of physiology and pathophysiology at the least. There is no such thing taught in basic class and what is taught is too basic to qualify.

Even an ALS assessment is a flawed idea. I can check for a surgical abdomen by palpation, a heart monitor or a CT is not required.

Since checking ABC is not good enough to deny transport, then it is certainly not good enough to come up with a Dx working or otherwise.

I am not picking on Basics, just calling out the education requirements.

 

[fma08]

I propose that henceforth we stop using the phrases ALS or BLS assessment.

I have decided there is no such thing as a BLS assessment. A proper assessment requires knowledge of physiology and pathophysiology at the least. There is no such thing taught in basic class and what is taught is too basic to qualify.

Even an ALS assessment is a flawed idea. I can check for a surgical abdomen by palpation, a heart monitor or a CT is not required.

Since checking ABC is not good enough to deny transport, then it is certainly not good enough to come up with a Dx working or otherwise.

I am not picking on Basics, just calling out the education requirements.

Thank you.

 

[EMTinNEPA]

Since checking ABC is not good enough to deny transport, then it is certainly not good enough to come up with a Dx working or otherwise.

Yes, because there are NO EMT-Bs on the planet who can form a provider impression based on history, patient's complaints/symptoms, baseline vital signs, mechanism of injury, etc. because all we're taught is a pathetic pnemonic. Hell, I guess I should just forfeit my spot as a full-time EMT-B on a medic unit that I worked my hindquarters off for over a year to get simply because I am incapable of making any clinical decision simply because I don't have those nine magic letters on my shoulder. I'll give it to a paramedic, since we have an overabundance of them. There's no reason I should even exist in healthcare.

 

[medic417]

Yes, because there are NO EMT-Bs on the planet who can form a provider impression based on history, patient's complaints/symptoms, baseline vital signs, mechanism of injury, etc. because all we're taught is a pathetic pnemonic. Hell, I guess I should just forfeit my spot as a full-time EMT-B on a medic unit that I worked my hindquarters off for over a year to get simply because I am incapable of making any clinical decision simply because I don't have those nine magic letters on my shoulder. I'll give it to a paramedic, since we have an overabundance of them. There's no reason I should even exist in healthcare.

OK. Thanks for that.

 

[EMTinNEPA]

OK. Thanks for that.

Anytime. Now, if you'll excuse me, I have a resignation letter or five to write and I have to pick up an application for a job that includes repeating "Would you like fries with that?" ad nauseum.

 

[Shishkabob]

I wish some of you medics would quit making the assumption that basics are not properly educated in the medical part of the job. You don't know what I was or was not taught in addition to the mandated requirements.


Is it medic level? No, but it sure as hell wasn't "Blood? Ok, bandaid time" either.


Hell, for all you know, I could have already taken A&P 1/2, microbiology, pathology, phlebotomy, etc etc.

 

[JPINFV]

I wish some of you medics would quit making the assumption that basics are not properly educated in the medical part of the job. You don't know what I was or was not taught in addition to the mandated requirements.


Is it medic level? No, but it sure as hell wasn't "Blood? Ok, bandaid time" either.


Hell, for all you know, I could have already taken A&P 1/2, microbiology, pathology, phlebotomy, etc etc.

Yes, because there are NO EMT-Bs on the planet who can form a provider impression based on history, patient's complaints/symptoms, baseline vital signs, mechanism of injury, etc. because all we're taught is a pathetic pnemonic.

1. It's mnemonic.

2. There's not enough basics out there that know anatomy, physiology, and pathology enough to make a counter argument. It's EMT-Basic, not EMT-EMTinNEPA or EMT-Linus or EMT-JPINFV. We all have to play by the same basic rule book.

 

[Ridryder911]

I wish some of you medics would quit making the assumption that basics are not properly educated in the medical part of the job. You don't know what I was or was not taught in addition to the mandated requirements.


Is it medic level? No, but it sure as hell wasn't "Blood? Ok, bandaid time" either.


Hell, for all you know, I could have already taken A&P 1/2, microbiology, pathology, phlebotomy, etc etc.

That excuse would be fine, if and only if that was required for all basics entry. It's not though.

Yes the EMT is NOT an in-depth enough curriculum to be considered for medical profession alike the nurses aide in comparison to an RN. Yes, it is just a little bit over the First Aid course. What would you say to a nurse aide that proclaims that they have taken micro or A & P, etc?.. Their still just a nurse aide with some general education.. no more ... no less. Just alike someone studying to be an accountant.... (yeah they have to have science courses too) shameful that they have more science than what is required for the EMT level.

R/r 911