# How do ALS feel doing BLS calls?



## MMiz (Mar 28, 2005)

In services with ALS/BLS units, how do you ALS people feel doing the BLS calls?

In general I find that ALS don't like doing the BLS calls, but when we're backed up, they have to step in. 

I understand the frustration, as many medics have earned their medic license.  

Some don't mind the BS, I mean BLS calls, and others can't stand 'em.  

Your thoughts?


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## AJemt (Mar 28, 2005)

well i'm not an als provider, but most of our medics are more than willing to step in and help out where needed.  one night i was working in the city, we had already had 3 bls calls (and i was done half of the first chart) and the 4th came in, emotional class something-BLS (can't remember if it was 2 or 3) and my partner (medic) goes i'm taking this one.  no arguments, it's mine.    i said fine (bc there wasnt' much else to say and besides if i had tried to discuss it with him....not that i was looking forward to a psych call anyways.
there was a situation where one of our medics picked up an open wheelchair van shift and went in, and when said medic arrived they were told that they could go on the city micu and make it a power truck and the emt would go to the wcv and the medics response was "absolutely not.  i picked up the wcv shift, i'm gonna do the wcv shift, it isn't fair to the emt and if you aren't gonna let me do the shift i picked up i'm going home." or something to that effect.


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## Jon (Mar 28, 2005)

I've often worked MICU's - the One co. had ALMOST NO ALS runs overnight, but lots of Wheel-chair psych overnight (Done by the on-duty ALS crew - only 24/7 crew). My partners and I always switched off, but if the medic was finishing a chart and they were up, I'd do it.

I did work with one guy who couldn't drive.. so when we got backed up, I'd do the wheel-chair paperwork and drive.

I also worked with one medic who, as a basic, worked with one of the childern's hospital transport teams' locally... She usually took the peds, because she knew all about peds.

I've also had the opportunity to work Wheel Chair (as an EMT) - honestly, for a few extra bucks, not a bad deal.. no lifting, most of your patients are nice and can talk with you, a good deal.

Jon


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## rescuecpt (Mar 28, 2005)

I like BLS calls.  If I had it my way, they'd all be BLS "I stubbed my toe" calls.  Not because I'm lazy or burned out, but because I'd rather not have people be seriously sick or injured.  I'm a sap like that.

Yesterday we had a "syncople episode" which was probably just a case of bad lox.  I put the monitor on, she was RSR, everything else seemed stable and normal, so I just sat back and let one of my brand-spankin-new E's do everything (I didn't run any ALS interventions - it would have been hole poking with no point).  It was quite relaxing.


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## ECC (May 17, 2005)

A call is a call. I would rather be doing the ALS stuff, but if I were doing nothing then I would be bored. 

However, I do believe that if there is an available BLS to come and do the transport, they should step up to the plate and do so, to free up the Medics.


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## Lootsie (Jun 9, 2005)

I am not on the ALS level but for one think I am sure is that paramedics don't have a problem to go out on BLS calls. Sometimes it is good to go back to the basics for all of us. I always envayed the ALS and will keep on envaying them for as long a I live. 

There are the one or two that have personal or attetude issues but you can work aound it. I believe that if you reached the ALS level you are a paramedic of heart and would not mind to do a call. Afterall, it is all about the pt. 

This does not mean that we can waist the valuable experience and resourses of ALS to send them on BLS calls if there is BLS available.


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## Flight-LP (Jul 2, 2005)

Personally, as a Paramedic working in an all MICU environment, I have no problems working the BLS calls. First off I do not have a choice, second off, it is a welcomed relief to have less work and documentation to complete. Getting backed up on run reports is my biggest pet peeve, I hate running all night and having multiple reports to finish at the end of shift!!!!


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## CanuckEMT (Aug 6, 2005)

ALS is standard level of care here. So it doesn't matter the call, they all get an ALS unit.
We decide between us who is going to attend depending on Pt presentation and findings.


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## asysin2leads (Aug 9, 2005)

BLS, ALS, so long as I get my paycheck on Thursday, I'll mop the floors. Any ALS provider that has some sort of indignation towards picking up a BLS job needs to get over themselves. Its a person who needs help. Do your job.


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## Phridae (Aug 9, 2005)

> _Originally posted by asysin2leads_@Aug 8 2005, 11:18 PM
> * BLS, ALS, so long as I get my paycheck on Thursday, I'll mop the floors. Any ALS provider that has some sort of indignation towards picking up a BLS job needs to get over themselves. Its a person who needs help. Do your job. *


   Thats so right.


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## mine-rescue-emt (Aug 31, 2005)

I'm new to this, so I'll try not to step on anyones' toes...

There's no such thing as an"ALS" call....  You have to do the ABC'S, assessment, and all the other alphabet letters before you can worry about doing anything else, and that goes for 1st responders, basics, I's, Medics, Nurses, and MD's!

The only difference between myself and a basic is that I get to poke people with needles and give them meds that will hopefully improve their status before I get them to the ER.

At one time or another, I think we all got into this to help people. (the money is what keeps me going...) If someone is complaining about running a "BLS" call, they need to have a little talk with themselves to see why they're still doing this...it may be time to move on.


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## ma2va92 (Sep 1, 2005)

> _Originally posted by mine-rescue-emt_@Aug 31 2005, 10:51 PM
> * I'm new to this, so I'll try not to step on anyones' toes...
> 
> There's no such thing as an"ALS" call....  You have to do the ABC'S, assessment, and all the other alphabet letters before you can worry about doing anything else, and that goes for 1st responders, basics, I's, Medics, Nurses, and MD's!
> ...


 very well said............


I'm ALS... but if it's BLS or BS ... I like the idea of being there if they need help or there are time when they thing they need help.. and it's a ride to the hospital with some chat time

thats why I like being a volly... 


if anything can change... dispatch could try to get more info...so we're not flying to a chest pain that is really chat time....but that will come in time as the EMD is put into action.......


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## trauma1534 (Oct 12, 2005)

What's fair is fair.  There is no need to burn out BLS, if ALS is not backed up.  I'll run a BS call.  I do however have a problem with ALS personel running wheelchair van calls.  I think they should be reserved for non-certified people.  But if anyone should have to run them between als and bls, it should be bls.  Let's face it.  If a cardiac call comes in and you have tied up your ALS taking granny back to the nursing home in the middle of the night, then you have in my opinion abused your als provider and ran them for no reason.  

Every bls call, ambulance, has a potential of becoming an als call.  Fred down the street who calls every friday night because he has gas, might be really haveing a heart attack.  Ya never can tell about them frequent flyers.


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## CaptainPanic (Oct 12, 2005)

Around here in this rural area we have only one service, and that one service is ALS only, so they end up doing BLS-ALS calls, including the WCV calls. It would be nice if the EMS Director saw that everytime his local unit was tied up taking granny back to the nursing home at 3 in the afternoon, there might be an MVA within the local area, that DOES need the ALS unit, so they end up having to call 2nd out and F&R has to send their truck, or grandpa may decide to present an MI.

We have a total of 7 trucks to cover 928 sq miles, and with 3 crews stationed in different areas to cut-down on response times.

He really needs to have 5 crews one of wich could be BLS that also does local WCV calls, with a secondary BLS crew to do the Little Rock transports that usually take anywhere from 6-8 hrs to complete, round trip. When YCEMS has a LR Tx, that ALS unit is tied up for the day and theres not much they can do about it at this point.  

-CP


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## mine-rescue-emt (Oct 19, 2005)

Who's to say that granny won't code on her transport?  With the exception of pushing drugs and intubation, is there anything a bls unit can't do for her? They can still put in an OPA/NPA, start CPR and shock.   Same goes for the MVA.  Does it take a paramedic to put on a c-collar?  How about doing a rapid assessment?  Last I checked, as an intermediate, I do pretty much the same scene sizeup and patient assessment as my basic counterparts do.
    With the exception of a few circumstances, a good EMT can provide the same quality of care a medic can.  The only thing that may change is the scope of practice and what your local protocols will allow.  
   The first thing a First Responder should do is establish the patient has an airway and that the rate and quality are adequate.
   Surprisingly enough, I've seen doc's in the ER do the same thing.  

     Don't get me wrong... some Medics can do pretty impressive work with all the little gadgets and gizmos available.  There are also some medics I've seen that I wouldn't trust to correctly fasten the velcro on my 3 y/o son's shoes.


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## Rangat (Oct 26, 2005)

In South Africa -in the areas with an infrastructure i might ad- ILS goes out to all calls standard, and the Paramedics goes out on request or provisionally in Response Vehicles. Thus ambulances work 3x more calls than PRV's.

If a Paramedic turns up on a BLS call, he will be highly bored. He will do the nessacary, and wait around for us to arrive. h34r: 

They don't really mind (most of them) except if it's walking around Moaning Myrtles. <_<


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## Medic38572 (Nov 7, 2005)

My feelings are this as a Paramedic I dont mind to make an a call. Thats why I schooled for two years. But I like many feel that bls calls should be made by the EMTs. The reason is this I feel that when you get out of EMT school you are just certified or licenced. And you have to agree just that. You have no experience except what you did on clinical rotation's. The place for you to get this experience is in the field in the back of the truck. Im not saying that all EMT's cant do there jobs, I have seen several new Paramedic's spaz on the first true emergency they have run. And they have been doing hundreds of hrs of clinicals. But when you are in control for the first time its differant and everyone here can relate to that. By putting EMT's in the back running granny back and forth you not only give then the extra clinical experience on a non - emergent patient but you also instill confidence in them. Giving them a chance in a controlled enviroment to properly assess there patient's with out all the stress of having to deal with a very sick patient.


Just my thought's..........................


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## rescuecpt (Nov 7, 2005)

My first call as a basic EMT after my card arrived was a very messy car accident.  Guess what, I handled it just fine, my patients (PLURAL) lived, and I did my job- I got them to the hospital in better or the same shape as when I found them.

When I became ALS, I was thrown into the field by myself - and I almost killed my first patient because medical control told me to give them the wrong drug, and I wasn't experienced enough as an ALS provider to know any better.  I "fixed" it, I guess you could say, and she ended up living.

Medic38572 - I think your generalization is unfair to the many level headed, smart, capable basic EMTs.  It's not rocket science.  I have met MANY moronic ALS providers.  I have also met many ALS providers who went straight to medic school out of basic school and have little to no experience on their own.  One's ability to react to a situation and have a positive outcome has less to do with their clinicals and their status as BLS or ALS and more to do with their personal character and strength.

My clinicals were a joke, most of my hospital time was spent in a corner not being allowed to do much of anything.  Luckily I was riding 6 days a week and made my own experiences on the ambulance.


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## Medic38572 (Nov 7, 2005)

> _Originally posted by rescuecpt_@Nov 7 2005, 05:31 PM
> *
> 
> Medic38572 - I think your generalization is unfair to the many level headed, smart, capable basic EMTs.  It's not rocket science.  I have met MANY moronic ALS providers.  I have also met many ALS providers who went straight to medic school out of basic school and have little to no experience on their own.  One's ability to react to a situation and have a positive outcome has less to do with their clinicals and their status as BLS or ALS and more to do with their personal character and strength.
> ...


 Rescuecpt,
                My generalization is not what it appears to be. What Im saying is this!
Without experience one tends to look over many things on a patient. Why because of the stress of the call. If you have an EMT on an ALS truck he does get some experience exspecially on MVA's with multible patients. HE or SHE has know one on one contact with a single severe respitory distress patient. no one on one contact with a severly hypovolemic pt with a GI Bleed. Im not saying that they cant come out doing there job. Thats not what Im saying. What Im saying is that most people learn better hands on, combined with the books. I work as a medic fulltime on a truck I have 16 yrs experience behind me 14 as a Paramedic. I also work in an Emergency room Part-time I enjoy my jobs I learn something every day I go into work. I see something new all the time. I enjoy working with new EMT's and Paramedic's. Because every year I learn something new when they get out of school. But I still believe that the best experience is in the back of a truck.
The best thing you can do is throw a new Paramedic out to the wolves. They in most case's have several years in ems. But throwing an EMT to the wolves just after getting out of school is wrong.


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## Jon (Nov 7, 2005)

> _Originally posted by rescuecpt_@Nov 7 2005, 05:31 PM
> * My clinicals were a joke, most of my hospital time was spent in a corner not being allowed to do much of anything.  Luckily I was riding 6 days a week and made my own experiences on the ambulance. *


 You too???

We were BELOW the ER techs... we did the 12-leads while they (usally an EMT w/hospital training) got an IV... :huh: 

We helped the nurses take rectal tempratures.  

Oh, and if we were REALLY lucky, we got to watch a resident get there 1000th tube...

Jon


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## Jon (Nov 7, 2005)

I think the point you are trying to make, Medic38572, is that a "newly minted" EMT needs to be "broken in some" before they get thrown the "oh crap" calls.  I really agree with you.

I recently helped out with the city Airport's "Holy Crap" drill.... transported 2 "red" patients to a trauma/burn center across town.

I'm driving... my partner has been an EMT for a year, but ONLY worked transport. I'm driving, trying to coach her in what she would need to do to treat a 3rd degree burn to the leg, and what she would need to do to treat a patient with a respiratory rate of 8, and burns to the face.....

We didn't actually "use" supplies, but documented as if we did...


My partner admitted afterwords that she was a little worried, because class was a long time ago, and she's not really used many of her skills since class... and was afraid she might have to actually deal with a "sick" patient someday.

Jon


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## hfdff422 (Nov 8, 2005)

> _Originally posted by Medic38572_@Nov 7 2005, 05:13 PM
> * My feelings are this as a Paramedic I dont mind to make an a call. Thats why I schooled for two years. But I like many feel that bls calls should be made by the EMTs. The reason is this I feel that when you get out of EMT school you are just certified or licenced. And you have to agree just that. You have no experience except what you did on clinical rotation's. The place for you to get this experience is in the field in the back of the truck. Im not saying that all EMT's cant do there jobs, I have seen several new Paramedic's spaz on the first true emergency they have run. And they have been doing hundreds of hrs of clinicals. But when you are in control for the first time its differant and everyone here can relate to that. By putting EMT's in the back running granny back and forth you not only give then the extra clinical experience on a non - emergent patient but you also instill confidence in them. Giving them a chance in a controlled enviroment to properly assess there patient's with out all the stress of having to deal with a very sick patient.
> 
> 
> Just my thought's..........................  *


 Do all EMS systems not require "precepts" before an EMT of any provider level is allowed to be the tech on a run. Our EMS system requires that you have 7 transporting runs before they clear you. Baqsically that blue card you get only allows you to practice under another EMT-B or higher until the precepting EMT(s), the department EMS officer, the hospital EMS director,  and the MD say you are really an EMT. 

The requirement is 7 transporting runs, no SOR's count, only 3 can be ALS assist, and 1 can be a DOA. This is only under an approved preceptor, so on our department you could theoretically make 15 transports to get 7 precepts since only 4 EMT's are allowed to precept. 

I assumed that all EMS systems were similar, but apparantly I am wrong.


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## rescuecpt (Nov 8, 2005)

Each place has their own requirements.  What it comes down to at my FD is this:  if there are no other EMTs on a call, and you are brand new, you run the call.  The closest department take 1/2 hr to get to our scenes, so even if you just get started in the direction of the hospital and have the other department meet you with more experience, it's better than standing there doing the stare of life.

At the Corps the official policy is three months of ALS ride alongs with a provider chosen by the Chiefs... or approval by the Chiefs.  I rode one call with the Chief and he blessed me and sent me on my way.

We do all of our precepting during our classes.


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## Jon (Nov 8, 2005)

My FD has a policy that, if there is no primary EMT availible, and there is a secondary (un-blessed) EMT availible, AND THEY FEEL COMFORTABLE TAKING THE CALL, they are allowed to take the call.

The FD requires each preceptee to complete at least 10 BLS and 10 ALS calls with a senior EMT before the officer staff discuss the canidate and decide whether or not to "bless" them, or throw them back for more training.

My ambulance Co. has a new program, and they require 5 ALS calls, 5 BLS medical, and 5 BLS trauma calls. Refusals count, so long as there was an assessment done. Our problem is that at least 50% of our calls are ALS, and the medics respond from the hospital across the street from our sqaud. On an ALS call, you often have little patient contact. You must precept with at least 3 preceptors (not sure of the number) A secondary is "blessed" after completing their 15 calls and a final "Check-ride" with a senior preceptor or supervisor. The final check ride is with someone you haven't precepted with before.

Jon


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## hfdff422 (Nov 8, 2005)

We have to do precepts during our class as well (8 patient contacts, minimum of 3 in an ambulance) just to pass the class so that gets us our blue card, but to transport without another EMT-B or higher you have to have permission from the affiliating MD. That is what requires the 7 precepts. There are no exceptions with our affiliating hospital, no amount of non-precepted, non-transporting runs mean anything. 

So rescuecpt, you were OK'd after one run? That would be a little scary for me, our driver does not have to be a tech or even a FR. AHA BCLS is all that is required to ride the bus. I wouldnt want to get out there without the experience and have a hairy call with no other EMS trained personnel to fill in those gaps that we all have (dumba$$ attacks).

Did that ever cause any problems?


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## rescuecpt (Nov 8, 2005)

Not to toot my own horn, but I'm pretty smart, very calm, and I don't freak out.  Never have in 5 years.  It's not like I'd NEVER been on an ambulance before - I had been in the department 10 months before I got my card and was going on calls with the rest of the crew throughout my training (I was in the department for 4 months before I started my EMT class).

To get your basic in NYS you need 10 hours of hospital clinical time or 10 hours of ambulance calls (from leaving the pad to arrival at the hospital).  The majority of people around here are riding as "probies" before they ever start class, and that truly helps a lot.

For my ALS time, I had been an EMT for 3 years by the time I finished my ALS training and had been riding with a preceptor for 9 months during my training.  If I pass the state exams, pass the practicals, pass the protocols exams, in theory, as an experienced BLS provider and graduate of ALS training you should be able to handle ALS calls on your own.  Granted some are more challenging than others, but don't we even encounter that after 5, 10, 20 years of experience?


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## Ridryder911 (Nov 10, 2005)

Wow I continously am surprised at vaiable levels of clinical hours and orientation level. In my state the basic has to do at least 40 hrs of EMS and 24 ER. This is still not considered enough. As the EMS educator in my service , I require the basic EMT level to have at least 3 months of field time before releasing as well as documented various calls. These calls have to include at least 3 cardiac arrest, 3 major trauma patients, and various other responses including O.B.  The Paramedic level is of-course higher, in experience and much more exposure. 

16 hrs is not even a full shift, and we expect these people to have a general knowledge ?

Be sfe,
Ridryder 911


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## Wingnut (Nov 10, 2005)

> _Originally posted by ridryder 911_@Nov 10 2005, 09:31 AM
> * Wow I continously am surprised at vaiable levels of clinical hours and orientation level. In my state the basic has to do at least 40 hrs of EMS and 24 ER. This is still not considered enough. As the EMS educator in my service , I require the basic EMT level to have at least 3 months of field time before releasing as well as documented various calls. These calls have to include at least 3 cardiac arrest, 3 major trauma patients, and various other responses including O.B.  The Paramedic level is of-course higher, in experience and much more exposure.
> 
> 16 hrs is not even a full shift, and we expect these people to have a general knowledge ?
> ...


 I am too...we had to do 30 hours in the ER, 72 on the rig, and I don't think it was enough.


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## hfdff422 (Nov 10, 2005)

> _Originally posted by ridryder 911_@Nov 10 2005, 08:31 AM
> * Wow I continously am surprised at vaiable levels of clinical hours and orientation level. In my state the basic has to do at least 40 hrs of EMS and 24 ER. This is still not considered enough. As the EMS educator in my service , I require the basic EMT level to have at least 3 months of field time before releasing as well as documented various calls. These calls have to include at least 3 cardiac arrest, 3 major trauma patients, and various other responses including O.B.  The Paramedic level is of-course higher, in experience and much more exposure.
> 
> 16 hrs is not even a full shift, and we expect these people to have a general knowledge ?
> ...


 The one thing that is true about EMS is that no amount of time will ever prepare you for dealing with every situation. Hopefully we all have enough brains to use our training and education to make the best choice possible. 

I know EMT's who want to treat every problem, try and diagnose the patient or just generally try to remember every detail in their text books and training manuals. That is not the approach I take. 

My approach is that depending on the call, I am either there to take baseline vitals and comfort the patient and get them to the hospital, or I ensure a patent airway and keep them from getting worse while I take them to the hospital. I constnatly re-read my text, take as much training as possible, and am not afraid to ask questions. But at the end of the day, I keep them alive, take them to the hospital, and give the nurse a report on my observations and findings.

We are not doctors (that includes EMT-P's), we are there to assess, comfort, and transport, and sometimes on the hairy calls we have to work our a$$es off to present the hospital with a viable patient. No amount of clinical time will prepare a person for those hairy calls when you are the only tech or medic- you revert to the basic desire to help people at this point. You know if a patient is pulseless and apneic that you are going to have to get in there, you know if there is a bleeding laceration that you are going to have to apply pressure. That preceptor is not going to be their to catch us when we get the one situation that never presented itself in training or clinicals (anal discomfort= MI)

Know your scope of practice, do what is best for that patient and throw deisel on it.


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## CaptainPanic (Nov 10, 2005)

I too was shocked to see that we had to do so little in ER and on the rigs. Our instructor req. 24 in ER (I did 36) and 12 calls on the ambulance, I barely met this req due to work schedule and and other things.

Our course was 5 mos long (about an avg. semester) but only met 2x/week.

Id like to see a full 5 mos course meeting 4 nights a week for 4 hrs at a time. And requiring weekends to be spent in the ER or on the ambulance (160 hrs in ER, 160 hrs on the ambulance). Have the students write an depth report paper due at the end of the course. Also have a skills night once a week where the students do nothing but skills, critique each others pt. assessments. And each student must throughly document all pt contacts in ER as well as ambulance. And as Rid does it require a minimum amt of certain types of calls, but if for some *legitimate* reason that they werent able to get those calls take into consideration class participation, grades, and skills assessment, time spent at clinicals, also maybe even require a letter of recommendation from the ER supervisor and preceptors before completing the course. Each call report should be reviewed 2 two weeks before finals, if the calls and student are satisfactory, the student may sit for class finals, if the student passes class final then student may test for NR/state certification.

But thats just coming from a students perspective. :unsure: 

-CP


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## Jon (Nov 10, 2005)

At least your school requries precept time.

In PA, it is OPTIONAL. I didn't ride an ambulance until a month into the program, when I was told I needed to be riding an ambulance, or I was going to look like an idiot later. This was a month into the course.

Jon


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## rescuecpt (Nov 10, 2005)

> _Originally posted by CaptainPanic_@Nov 10 2005, 12:20 PM
> * I too was shocked to see that we had to do so little in ER and on the rigs. Our instructor req. 24 in ER (I did 36) and 12 calls on the ambulance, I barely met this req due to work schedule and and other things.
> 
> Our course was 5 mos long (about an avg. semester) but only met 2x/week.
> ...


 Wow, then there would be no vollies.  When would people who have 40hr a week jobs (or even two jobs) find time?

I think if I spent 4 nights a week in class for 4 hours a) I would have time to read the entire Brady book 4 times and B) I wouldn't have done it.

Maybe I'm just burned out, jaded, or snotty - but it's not sooooo difficult to be BLS that we need to spend 320 hours in basic class plus 320 on rotations....  but then again I could be a crappy provider for all you all know.


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## hfdff422 (Nov 11, 2005)

> _Originally posted by rescuecpt_@Nov 10 2005, 03:06 PM
> *
> Maybe I'm just burned out, jaded, or snotty - but it's not sooooo difficult to be BLS that we need to spend 320 hours in basic class plus 320 on rotations....  but then again I could be a crappy provider for all you all know. *


 Lets see- Airway, airway, airway, breathing, circulation, stop the bleeding, immobilize the patient, drive to the hospital, write down what you did. 640 hours of training for that? You are right there would be no volunteers. And you would have to pay the B's alot more.


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## Ridryder911 (Nov 11, 2005)

Now just think the person that cuts and styles your hair went to school 4 X's longer than the average Basic EMT..... and about 200 hour longer in clinical setting.

Now which one do you think .. should have the most education & training ? .. & should we really care if it decreases the vollie number rate or improve & provide competent patient care ?


Be safe,
Ridryder 911


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## rescuecpt (Nov 11, 2005)

> _Originally posted by ridryder 911_@Nov 11 2005, 09:49 AM
> * Now just think the person that cuts and styles your hair went to school 4 X's longer than the average Basic EMT..... and about 200 hour longer in clinical setting.
> 
> Now which one do you think .. should have the most education & training ? .. & should we really care if it decreases the vollie number rate or improve & provide competent patient care ?
> ...


 Well, seeing as on long island we really only have vollies, and we're hurting for members as is, yeah, we should care if it decreases the vollie rate.

Under current basic protocols, there is only so much you are allowed to do.  If you can't learn that in the amount of time currently being taught, you shouldn't be an emt - volly or paid.

PS - it is much harder to feather someone's hair than to apply a pressure dressing.


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## hfdff422 (Nov 11, 2005)

> _Originally posted by ridryder 911_@Nov 11 2005, 09:49 AM
> * Now just think the person that cuts and styles your hair went to school 4 X's longer than the average Basic EMT..... and about 200 hour longer in clinical setting.
> 
> Now which one do you think .. should have the most education & training ? .. & should we really care if it decreases the vollie number rate or improve & provide competent patient care ?
> ...


 Rural and small town areas simply cannot afford to pay full time firefighter/EMT's (see my response to you in the "ranks of volunteers plummeting" portion in ems related news). So those areas that have coverage by volunteers get put out of business by unattainable standards (and yes it is hard to have time for even a B when you have a family, 50 hour a week job, other schooling, and are active on the FD). Then what happens? Private ambulance services wont cover our area because they can't commit a unit to our area due to such a small run load. Wait on the next closest entity?- which could be 20 minutes away depending on where the run is and that is if they are not already busy with other stuff. 

The amount of training that EMT-B's receive is adequate for what they need to do, If not there is this thing called a Paramedic that does have to do long clinical hours and have a minimum of 1 years training on top of the EMT-B certification.

If there is immediate transport required and/or defibrillation is required, then having an ambulance with an EMT-B 5 minutes away becomes critical. You seem to have this impression that throwing money at the problem will fix it. That is simply not the case. Volunteers have been and will continue to be a very effective response to emergencies. The people who are doing this have been held to ever increasing standards and that has cut into the ranks greatly, but most of the standards are necessary. But taking what is effectively 200 hours of training (in Indiana w/ 160 hour class, clinicals, precepts, a+r prior to being affiliated) and doubling that or more, you would make the time commitment beyond what the members could give.

Ridryder, I am guessing you have never served on a full volly dept. Or if you have, it must be a municipality that overfunds the equipment and training budget since they do not have to pay career FF's. There are a few dept.'s like that, they have don't have to wonder where they are going to get their next big purchase from, they are very visible, etc. but they are still having trouble getting new personnel due to increased time commitments.


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## smileyyemtb76 (Dec 11, 2005)

I can say that where I work, some (not all) of the ALS providers feel it is beneath them to do BLS transfers. And they let the dispatcher know it too.  But at the same time, some of the Basics feel it is beneath them to do wheelchair van transfers.  For some reason they all forget that we are one team, and a call is a call. No matter if its "below your licensure" or not.


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## coloradoemt (Dec 22, 2005)

Medic38572 said:
			
		

> My feelings are this as a Paramedic I dont mind to make an a call. Thats why I schooled for two years. But I like many feel that bls calls should be made by the EMTs.


 
As in EMT-P??

There are Basics in my co. whos medic will absolutely not run on a BLS call. The agreement I have with my partner is I take the first three and then she fills in every other one after. We do this as a mutual respect for each other. If we get a day of nothing but ALS calls, I will run a day of BLS. I will also on an ALS day jump in and take a borderline call just to give her a break. It is all about careing for each and every patient, as well as careing for your partner. If you are willing to let your partner get 3-4 sheets down simply because it is a BLS day, then not only do you not have my respect as a person, but I feel you should re-think why you are on a rig in the first place.


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## EMTK005 (Jan 23, 2006)

Always BLS before ALS!


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## MedicTroll (Jan 31, 2006)

*Have we forgotten our training*

One of the systems I work for is a 911 ALS service, the company run ALS and BLS buses.  Shucks are the norm and all jobs are in rotation/next available.  It is a norm with most paid service and a Medic accepts that going into the job, if they don't want to do the shucks and ED transport they find a service to meet their needs.  But as experience will prove, not every 911 call is an ALS call. But unless we all have forgotten our training, it was drilled into our heads "BLS before ALS".  It all starts with the ABC's, not IV ABC. Most of the Medics I know and have worked with had no problems working an BLS job, especially at re cert time. It is the best way to keep all your skills in check, and yea after working a code was refreshing shucking grandma back to the home.


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## i_drive_code3 (Feb 7, 2006)

we run als units here but my partner lets me pretty run most calls until i can't go any farther...he teaches me and quizzes me and i really appreciate it since i'm going to medic school in august.

its great when you work with a partner who trusts you so he can be freed up to talk with the patients family/caregiver etc while i hook up the ekg and get all the bls stuff out of the way.  

a patient is a patient is a patient...

kate


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## ksEMTbabe (Feb 8, 2006)

It's not a big deal to run BLS calls now and then...sometimes it's fun to be the one that gets to sit up front and play with the radio!


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