# 1 and 1 Rig?



## LeoLi4 (Sep 26, 2009)

Hi everyone, I recently got my emt-b license and have a question regard the 1 and 1 rig.  I would like to know what are the responsibility for the emt-b on the 1 and 1 rig?  And what is the purpose of having a 1 and 1 rig while the company can just put two paramedics and share the work load through out the day?


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## Flight-LP (Sep 26, 2009)

Depends. If your running 911, prepare to do a whole lot of driving. If interfacility, you may run all of the BLS runs, or your partner may swap BLS calls with you. Just depends on the company and the partner.

The reason why is simple. Its cheaper than paying two medics.


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## Mountain Res-Q (Sep 26, 2009)

Depends on the system...

I have seen 911 Medic/EMT units where the Medic runs almost every call and the EMT is a driver

I have seen 911 Medic/EMT units where 75% of all calls are determind to be BLS at scene and, while the EMT usually drives to the calls, the Medic drives to the hospital while the EMT takes pt. care.

I have seen 911 EMT/EMT rigs (even in CA) where the EMTs rotate driving/pt. care.

I have seen IFT BLS trucks where the EMTs simply rotate driving and pt. care...

But typically on 911... the EMT is the driver 95% of the time to calls and (depending on the system) drives 50% to 95% of the time on the return...  (usually closer to 95% of the time)


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## LeoLi4 (Sep 26, 2009)

So what will consider a BLS 911 call?


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## Dominion (Sep 26, 2009)

Maybe I'm being retarded tonight, but what's a 1 and 1 rig?  Medic Medic?  Basic Basic?


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## MMiz (Sep 26, 2009)

LeoLi4 said:


> So what will consider a BLS 911 call?


That's up to the city/county/area.

It is cheaper to run EMT/Paramedic, so many counties do it.  As an EMT-Basic on an ALS EMT/Paramedic truck it really is up to you and your partner as to what system you work out.  The idea is that the Paramedic will be the primary caregiver during ALS calls that require an expanded scope of practice and skills.


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## cfink911 (Sep 26, 2009)

Departments here will almost always run EMT/Medic on every call.
Whether we're meeting a BLS ambulance from the county or just going to a fall patient.

The medic will usually do the driving and the EMT monitors the patient - obviously that can change depending on patient status and type of call.

Most of our stations are staffed enough where we run 3 guys per medic - there will always be a medic but the other two will vary depending on the shift and who is there that day.

Fink


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## LeoLi4 (Sep 26, 2009)

Thanks for the replies.  At first I alway thought for an emt-b to be on a 1 and 1 rig, they need to have some kind of extra training or knowledge to be able to assist the medic.  But it seems like all they really doing is just being the driver, mainly.


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## cfink911 (Sep 26, 2009)

I always had that same inclination but as soon as I started working dispatch for the FD I got much more involved in their policies and protocols and it wasn't true.

On what we call "Priority 2" calls (everything minus cardiac arrest, unconscious, child labor, patient over 400lbs), the EMT will do most of the assessment and work as well as the driving.
When we get a "Priority 1" call we will add an extra apparatus to the dispatch, usually the closest engine or truck just for the extra manpower.
In those types of calls we have a minimum of two medics on the scene, in that situation the EMT's are mainly there for patient advocacy/PR to the family.

Fink


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## Mountain Res-Q (Sep 26, 2009)

LeoLi4 said:


> Thanks for the replies. * At first I alway thought for an emt-b to be on a 1 and 1 rig, they need to have some kind of extra training or knowledge to be able to assist the medic.  *But it seems like all they really doing is just being the driver, mainly.



Again, depends...  Where I worked ambo (right here in CA) all EMTs had to have 60-80 hours FTO time on BLS IFT units, followed by 6 months working BLS IFT.  After that, they had to be evaluated by another FTO and granted permission to get their "ALS Upgrade", which was another 60-80 hours FTO time with another FTO on ALS 911 Rigs, where we got the extra on the job training that you fingured there would be, such as IV setup, taking BGs, etc...  Just your basic assist type stuff...  But, yes... EMT's in a 911 ALS system are gonna be primarily drivers, then assistants in the field, and then the primary care providers on some BLS calls (system and company dependant).


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## Epi-do (Sep 26, 2009)

My current partner and I take turns driving.  One shift he will be the driver and the next shift I will be the driver.  Currently, he is a basic, but he just started medic school so this time next year we will be a dual medic truck, unless one of us gets moved between now and then. 

Regardless of who is the "driver" for the day, if we have an obviously BLS patient, then my partner takes the run.  If I have any doubts as to whether the patient could go BLS or ALS, I take it in. (And, since I am a relatively new medic, this happens _alot_!  I probably tend to be a bit overly cautious, but that is better for the patient than me blowing off every other run.)  Obviously, as the medic, I also take all of the ALS runs.

We have a good working relationship, and if we are getting slammed with BLS patients, we start rotating those runs so he doesn't get killed with paperwork.  Also, if we have a patient that he isn't sure about after I have decided to hand the patient over, he won't hesitate to speak up and have me take it in.  Most of those patients, I BLS to the hospital, but there have been a couple times where his gut has been right and they deteriorate enroute and I end up making them ALS.  Fortunately, that has only happened once or twice.  

Most of the time, my partner does the restocking of the truck.  Not because I won't do it, but because along with doing a paper report, once we get back to the firehouse there's computer based reports that we also have to do.  If I was the tech on the run, I am busy with that while he is restocking the truck.  The exception to that would be if it was some sort of big run, and then I will help to make sure we get everything back on the truck before doing the computer report.

Like everyone else has already mentioned, it totally depends upon the system you are working in and the partner you have as to what the duties of the basic would be on the truck.  Just thought I would share how my partner and myself have worked it out.


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## EMTinNEPA (Sep 27, 2009)

I don't particularly agree with ALS providers taking BLS calls for their EMT-B partner.  They can do BLS calls for me, but I can't do ALS calls for them...

I don't really have anything else to add.  Everything else I was gonna say has been covered.


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## LeoLi4 (Sep 27, 2009)

Thank you all for your experiences and info.  Now I am more clear on what 1 and 1 rig.  I am really looking forward to start working as a emt-b and really looking forward to be able to work on a 1 and 1 rig.  Thank you all.


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## Sapphyre (Sep 27, 2009)

Here (it's already been stated) 911 1 and 1 rigs are medic/basic.  The basic ALWAYS drives, the medic ALWAYS attends, even on an obvious BLS call.


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## LeoLi4 (Sep 27, 2009)

Anyone know how the system are like in San Francisco, ca?


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## Akulahawk (Sep 27, 2009)

San Francisco authorizes only 3 providers to do ALS. King-American, AMR/San Francisco Ambulance, and SFFD. IIRC, they all do 911, but the majority of it is by SFFD. Staffing can be medic/medic or EMT/medic. There are several BLS providers that might also do CCT as well, but generally speaking, they're not going to do many runs to the ED, in San Francisco itself.

Beyond that, I'm not all that certain, as I haven't worked in the Bay Area in several years, and am not entirely up to speed on how SF does things now.


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## JPINFV (Sep 27, 2009)

Akul, in SF are nursing home to ER transfers done by the IFT companies (thus, by default, attended to by basics) or the 911 companies (where paramedics are available regardless of if the SNF calls 911 or not)?


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## Akulahawk (Sep 27, 2009)

JPINFV said:


> Akul, in SF are nursing home to ER transfers done by the IFT companies (thus, by default, attended to by basics) or the 911 companies (where paramedics are available regardless of if the SNF calls 911 or not)?


In the past, I've seen both... When I worked in the Bay Area, what I saw in SF was most of the SNF to ED runs by BLS units were lower acuity patients, or those with DNR orders... and needed care above what the SNF could do, or needed a procedure done that the SNF couldn't provide. Basically, they were "routine BLS" calls where the destination happened to be an ED instead of a clinic or direct admit. AMR and King-American did a bunch of ALS IFTs because the SNFs didn't want to call 911 but needed an ALS response... It's been a few years since I've been there, so I don't know if things have changed over there.

I've seen that here in Sacramento. I used to do a lot of ALS IFTs from SNF's that didn't want to call 911... and those calls were often... not what they were advertised to be to begin with. Those calls were almost always a challenge as they would result in a blend of a scene call and an IFT. Sure, we had the chart, but also communication difficulties as the nurses we encountered often had a hard time speaking English...

The few SF calls I ran often had similar issues...but at the BLS level. They'd try to push the boundary of what's a BLS and what's an ALS patient...


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## JPINFV (Sep 27, 2009)

Language difficulties? In a SNF? Unheard of. Afterall, you don't speak Tagalog?


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## Sapphyre (Sep 27, 2009)

Or Chinese?  We seem to have a lot of Korean SNF nurses too....


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## LeoLi4 (Sep 27, 2009)

What is a SNF?  Sorry, I am still very new to all the acronym.


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## JPINFV (Sep 27, 2009)

SNF=Skilled nursing facility.


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## 46Young (Sep 27, 2009)

EMTinNEPA said:


> I don't particularly agree with ALS providers taking BLS calls for their EMT-B partner.  They can do BLS calls for me, but I can't do ALS calls for them...
> 
> I don't really have anything else to add. Everything else I was gonna say has been covered.



Some medics don't trust basics enough at their agency (I don't mean you, I'm speaking in the general sense) to trust them with unsupervised pt care and documentation. Consider also that many EMT's hired by the privates are brand new and not wise in the ways of proper PCR documentation.

I insist on teching all of the calls at the private agency that I work at per diem. If something were to happen to my P-card, it would have a significantly negative impact on my full time firemedic career. I can't have that. 

Most basics that I come across are more than happy to let me tech everything. It gives tham a break from writing reports with the high call volume and relatively unexciting calls (discharges and such).


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## 46Young (Sep 27, 2009)

LeoLi4 said:


> What is a SNF?  Sorry, I am still very new to all the acronym.



I like to tell my IFT pts that they're either going to a skilled nursing facility or rehab. When a pt asks where we're taking them, those two options sound way better than telling them that they're going to a nursing home, with the stigma that's attatched to the term.


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## JPINFV (Sep 27, 2009)

Well, a SNF is also a level of chronic care. A SNF isn't the same as an assisted living facility, which isn't the same as a board and care/halfway house.


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## 46Young (Sep 27, 2009)

JPINFV said:


> Well, a SNF is also a level of chronic care. A SNF isn't the same as an assisted living facility, which isn't the same as a board and care/halfway house.



If they're going to Sunrise or another legit assisted living facility, I tell them that I'm taking them home back to their apt, since they're free to come and go as they please, and they don't feel like it's the end of the road for them.

I'll typically refer to any NH as a SNF. It just sounds better.


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## JPINFV (Sep 27, 2009)

If a patient has all of their lights on upstairs, there's nothing stopping them from leaving a SNF either.


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