# BLS Ambulance Staffing



## frdude1000

How do you staff your BLS ambulances?  Do you do 2 emt's, three emts's?  What is the training level of the driver?  Do you allow/have first responders on the ambulance?


----------



## Hastings

Never ever heard of a BLS ambulance around here. I think everyone knows better.


----------



## frdude1000

*Do you allow first responders on the ambulance*

Do you allow first responders to provide care on a BLS rig?

a. Yes
b. No
c. Only if their is an EMT with them in the back
d. As an advisor to watch and to not provide ANY care


----------



## ffemt8978

Duplicate threads merged.


----------



## medicdan

in MA, a BLS truck cannot role unless it has 2 EMTs, an ALS unless it has 2 medics (or a waiver for p/b) somewhere on the truck.


----------



## ffemt8978

In WA, the minimum requirements are different between medical and trauma calls.  For a medical call, the ambulance must be staffed with a minimum of an EMT and Advanced First Aid.  For trauma, the minimum staffing requirements are an EMT and a FR.


----------



## Foxbat

ffemt8978 said:


> In WA, the minimum requirements are different between medical and trauma calls.  For a medical call, the ambulance must be staffed with a minimum of an EMT and Advanced First Aid.  For trauma, the minimum staffing requirements are an EMT and a FR.


Isn't EMT the same as Advanced First Aid? 
On a serious note, what is the difference between AFA and FR?


----------



## PapaBear434

I don't know how to make this short and simple.  So, here is my convoluted system setup for handling BLS and ALS staffing simultaneously.  

Our system is set up around the idea that not every ambulance is going to have a medic, as there aren't enough to go around.  Trucks are all manned by a standard two people.  If you are a truck with two Basics, you log in your truck as a "Rescue" truck.  IE: "920R"  

If you log in with an Enhanced, you log in as "920S" for "Shock/Trauma."

Intermediate gets an "I," and Medics get a "P."  On the very rare occasion you don't have more than one EMT on board, you log in as a Driver Only vehicle, which is the same thing only with a "D" in front of your letter.  "920DR" or "920DP."

Now, there are only two of the eleven stations that will allow for a driver only vehicle.  All the rest of them are too busy, and if you are unable to man a second person EMS admin sends one of the paid medics to work on the truck with you, taking them off "zone duty."

In the cases of a rescue truck needing ALS, every area is covered by a zone car, which is basically a police interceptor with our logo on it.  They are dispatched simultaneously as the ambulance, and dispatched almost immediately if the Basics request one previous to arriving or once on scene.  One Basic will drive the truck, one will drive the zone car, and the medic treats the patient in the back on the way to the hospital.  

With those rare cases of a driver only truck, either the basic drives the truck with ALS in the back and a firefighter driving the zone, or the basic treats the patient (BLS patients only, of course) while a firefighter drives the ambulance.  Either way, the firefighter hates it because they can't just leave and go back to sleep, they have to follow the EMT and wait for the paperwork to get done before they are allowed to go back.


----------



## emtfarva

We work at the double basic, PI, PB, or double medic level. during certain types of calls we will take fire FR with us. usally they will drive or help with the emt in the back.


----------



## TransportJockey

When I worked IFT, EMT-B was the lowest allowed on an ambulance. I don't think MFRs have any place working on a truck, unless they are the third man and all they are allowed to do is drive.


----------



## PapaBear434

jtpaintball70 said:


> When I worked IFT, EMT-B was the lowest allowed on an ambulance. I don't think MFRs have any place working on a truck, unless they are the third man and all they are allowed to do is drive.



Virginia doesn't even have a "First Responder" status.  It's EMT-B as the lowest rate.


----------



## Ridryder911

My state will allow "individual" protocols but to be licensed as a Paramedic Life Support EMS Service, there has to be a Paramedic on each truck.  

In reality there is not much difference in expenditure for staffing ALS and BLS. Considering the amount of payment structure. 

R/r 911


----------



## ffemt8978

Foxbat said:


> Isn't EMT the same as Advanced First Aid?
> On a serious note, what is the difference between AFA and FR?



AFA is an 8 hour course similar to industrial first aid...FR is about 80 hours and they can do spinal immobilization, administer O2, assist patient with meds, etc...


----------



## Foxbat

ffemt8978 said:


> AFA is an 8 hour course similar to industrial first aid...FR is about 80 hours and they can do spinal immobilization, administer O2, assist patient with meds, etc...


Then what's the difference between FR and EMT-B?


----------



## PapaBear434

Foxbat said:


> Then what's the difference between FR and EMT-B?



About 40 hours?


----------



## Foxbat

PapaBear434 said:


> About 40 hours?



Yes, but what do they teach in EMT-B class that they don't teach to FR?


----------



## medicdan

limited pharmacology and med administration, more depth with medical and trauma. not much.


----------



## PapaBear434

Foxbat said:


> Yes, but what do they teach in EMT-B class that they don't teach to FR?



Oh, I was just making a joke.


----------



## Sapphyre

I work a 911 BLS rig.  We staff BB, and, on calls, can grab up to 2 fire personnel (PP or PB).  Normally, at most, we grab one P, so, in the back, we're B, BP, or BBP or BPP


----------



## AJ Hidell

Hastings said:


> Never ever heard of a BLS ambulance around here. I think everyone knows better.


Same here.  There hasn't been a BLS ambulance round these parts in over twenty years, thank God.  However, in Texas, non-emergency transfer trucks can staff with one MFR, so long as the other crew member is at least an EMT.  No such thing in Florida.


----------



## boingo

I don't know.  A medic on every truck is probably overkill.  I think a better educated BLS provider on most trucks, with fewer, better educated ALS providers fits well.  If you look around at systems that are all ALS, especially fairly busy ones you will generally find a lot of burnout and high turnover.  Medics are competing for skills, less experience with truly sick patients and skills degredation unless they have a robust con-ed system in place.  There is no evidence of all ALS resulting in better pt care overall.  I won't argue against an ALS assesment, but tying up your ALS assets transporting non acute pts is a waste. ALS should be reserved for pts who truly need ALS, at least in my opinion.


----------



## VentMedic

boingo said:


> ALS should be reserved for pts who truly need ALS, at least in my opinion.


 
And who determines that?  A BLS provider who has very limitied training and assessment abilities?


----------



## boingo

No, it would either be a much better educated EMT-B or a much better educated P that would assess the patient and refer the pt to BLS for transport after an appropriate assessment.  No medics on fire trucks, no medics in cop cars, no medics on every truck, fewer, better educated medics dedicated to taking care of patient that would benefit.  It wouldn't be perfect, but from where I sit it would be better than what most of us have now.


----------



## JPINFV

Ok, so how would a "BLS" call go down?

Medic arrives, assesses, downgrades to BLS, calls BLS ambulance, waits on scene for BLS ambulance, transfers care to BLS ambulance and clears? At this point you might as well have just transported the patient to the hospital.

Alternatively, BLS and ALS ambulances respond. ALS downgrades to BLS, ALS clears, and the EMS system has trouble justifying to the city council why every patient needs 2 ambulances to respond.


----------



## boingo

The second option, without any need to justify the dual response.  If the patient is acute, the patient get treated by both medics, the BLS crew will drive both trucks.


----------



## JPINFV

Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?


----------



## medic417

JPINFV said:


> Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?



Brilliant idea.  
Wish we could all convince people that instead of sending two ambulances and 20 fire trucks.  You get my point way to much overkill.


----------



## rmellish

JPINFV said:


> Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?



I like that. More so than my suggestion:

BLS on the ambulances

ALS in fly cars. 

All ambulances have ALS loadout, medic grabs a jump kit with the narcs, jumps on the BLS ambulance if it is an ALS run.


----------



## EMTinNEPA

Around here, BLS ambulance staffing is virtually nonexistent and their apathy winds up taking one of the FOUR ALS UNITS IN THE ENTIRE COUNTY out of service to handle because they're too lazy and/or don't have enough people and/or are only interested in the "good" calls.


----------



## FireResuce48

JPINFV said:


> Ok, so how would a "BLS" call go down?
> 
> Medic arrives, assesses, downgrades to BLS, calls BLS ambulance, waits on scene for BLS ambulance, transfers care to BLS ambulance and clears? At this point you might as well have just transported the patient to the hospital.
> 
> Alternatively, BLS and ALS ambulances respond. ALS downgrades to BLS, ALS clears, and the EMS system has trouble justifying to the city council why every patient needs 2 ambulances to respond.




That's nothing.
Let's say there is a diabetic emergency in my first due and the BLS ambulance from my station (48)is on another call. The station down the street (18)houses a BLS and a paramedic ambo (1 emt-b and a P). The station even further then that (30) houses a medic unit (2 medics)

This is how they would dispatch it.
Engine 48
Ambulance 18
Paramedic Ambulance 18
Medic 30

4 units for a diabetic emergency. Now the paramedic ambulance will usually cancel the medic unit. For some reason on all als type calls they dispatch a medic unit even though there is a paramedic ambulance on it. And all ALS calls get a basic ambulance on the call as well. 
It's dumb. Really dumb.


----------



## boingo

JPINFV said:


> Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?



Probably not.  You would still need close to the same number of ambulances for transports, yet you would be paying for 4x the number of medics.  Instead of 10 medics in 5 ALS truck you would have 40 medics in 20 ALS trucks.  You would be paying for less EMT-B's, however in the end it would cost more.  You would also decrease the paramedics interaction with acute patients by a factor of 4 as well.  Instead of one tube a week you would get one a month.  The evidence already suggests that if you don't use it you lose it.  The level and quality of care would be reduced (my opinion) unless you could provide time for OR/ED rotations (cost).  It is the medic on every truck mentality that the fire department uses to ovesaturate systems with medics.  If one is good, ten is better.  Sounds good on paper, but in practice it hasn't proven its worth.


----------



## medicdan

boingo, I am just going to say right out that the system you work in seems to be flawless in this way. You have EMT-B++ staffing BLS trucks, EMT-P+++ staffing ALS, but maintain fairly few ALS trucks, and fairly few ALS providers, so you all get an average of 1 tube/month (per your MD), and the BLS crews see acute patients. You train your basics well, your medics better, and everyone is happy.


----------



## medic417

emt.dan said:


> boingo, I am just going to say right out that the system you work in seems to be flawless in this way. You have EMT-B++ staffing BLS trucks, EMT-P+++ staffing ALS, but maintain fairly few ALS trucks, and fairly few ALS providers, so you all get an average of 1 tube/month (per your MD), and the BLS crews see acute patients. You train your basics well, your medics better, and everyone is happy.



How do you train the basics?  They are by themselves.  Bad habits are developed and no one is available to correct them.  At least on a basic/Paramedic ambulance the Paramedic can make sure the assessment is done correctly and teach the basic a thing or two and keep the basic from missing the problem or killing them.  

Having two Paramedics is better.  They can work together as equals.  Then not one person is stuck making all the calls.  As to the skills such as intubation all medics should be required to do them at least quarterly under supervision of professionals so they can be helped to improve and to not develope bad habits.  So any suggestion that there are to many paramedics is a bogus arguement.


----------



## medicdan

Boingo, feel free to correct me, but as I understand it, before setting foot on a truck, new hires (already basics) sit through a 3 month recruit academy-- which covers everything from a review of EMT-B, to advanced skills (nasal narcan, etc), additional assessment skills, etc. 
Only at that point do they go out on a truck, with an FTO, for an additional 3 months. Supervisors like to show up on scenes with recruits to review and critique, then at the end of the 3 months, they are re-evaluated, and cuts are made appropriately.


----------



## BossyCow

Okay, the thread is a BLS thread.. so lets keep the responses appropriate for BLS agencies.


----------



## AJ Hidell

BossyCow said:


> Okay, the thread is a BLS thread.. so lets keep the responses appropriate for BLS agencies.


BLS ambulances are not synonymous with BLS agencies.  There are a great many agencies that run a mix of ALS and BLS ambulances.


----------



## EMTinNEPA

JPINFV said:


> Ok, so how would a "BLS" call go down?
> 
> Medic arrives, assesses, downgrades to BLS, calls BLS ambulance, waits on scene for BLS ambulance, transfers care to BLS ambulance and clears? At this point you might as well have just transported the patient to the hospital.
> 
> Alternatively, BLS and ALS ambulances respond. ALS downgrades to BLS, ALS clears, and the EMS system has trouble justifying to the city council why every patient needs 2 ambulances to respond.



OR, here's how it's done around here...

The medic assesses the patient, says "This patient does not need ALS", gets the ok from medical command, and releases to his partner, an EMT-B.  The EMT rides in the back, takes vitals, reassesses, calls in the report, yadda yadda yadda, and the paramedic drives.  The EMT does a chart as the primary patient caregiver and the medic does a chart for the initial ALS dispatch but ends with being released by medical command.

OR... the same scenario, only medical command doesn't get involved and the medic doesn't do a chart.

OR... the medic rides in the back, but doesn't start and IV or do any real ALS interventions.

Not saying it's right, but that's how it's done around here and it's a lot more practical than either of the scenarios you put forth.


----------



## Foxbat

...or a medic comes in a fly-car, assesses the patient, releases him to BLS ambulance and goes back in service.


----------



## BossyCow

medic417 said:


> How do you train the basics?  They are by themselves.  Bad habits are developed and no one is available to correct them.



*MASSIVE BIG DISCLAIMER: I am not against ALS and would dearly love to have a Paramedic on every single call. However the reality of my current situation is BLS only with sporadic ALS support as available.*

A decently run program has a run review process established with the Medical Program Director. Every run is reviewed monthly with discussion regarding treatment, time spent on scene, etc. Our MPD will ding us on everything from our handwriting on reports to "if ALS wasn't available, document it". It is a discussion. It is used as a teaching moment, we get our share of tongue lashings and kudos. 

There is no excuse for shoddy treatment or the unchecked development of bad habits. Being BLS doesn't mean you have no obligation to maintain the highest level of skill and treatment within the BLS protocols.


----------



## zacdav89

We run 2 first responders one drives and one assists the EMTB IV or the intermediate we only have one emt pre bus


----------



## whizkid1

With our BLS service a fr would have to be with an EMT in the back,or he would have to drive.


----------



## tlkennedy5

In our system, each ambulance is staffed with 2 EMT-B's.  Then we have several paramedic fly cars (Explorers) that are dispatched with each call.  Both units usually arrive on scene around the same time.  If the medic is needed, he rides in the rig and one of the EMT-B's will take the Explorer back to the station.  If the medic is not needed, he radios dispatch that he is back in service and available.  

As for first responders, most of the fire fighters that run med calls as first responders in my area are EMT-B's, with several of them being medics.  Regardless though, if they are needed in the rig they jump in the back, but they aren't employed with county EMS and aren't regularly staffing the ambulance.  Kentucky is supposedly phasing out FR all together and is going to add in EMT-Advanced (Intermediate).  That will be interesting to see how that works out...


----------



## sarahharter

one of the companies i work for has first responders. they are only drivers. but there have been many times on bls and als calls where i need help. and they cant do anything. i now im only an emt and i wish there was always a medic. but i just dont get the point of there being first responders on the truck when they cant do anything really but drive. they are not allowed pt contact in the back of our truck. some of our drivers aren't even first responders they just have basic first aid and cpr.


----------



## BLSBoy

sarahharter said:


> some of our drivers aren't even first responders they just have basic first aid and cpr.



And we get mad why when EMTs are called ambulance driver?

We confuse the hell out of the citizens with non essential personnel too lazy to get a 110hr course.......


----------



## sarahharter

exactly. i hate having to explain why my partner is just standing there and doesnt help. some people asked my why they are even on the truck.  along with people saying oh u just drive an ambulance, its ridiculous.


----------



## BLSBoy

We will not advance our profession with observers who play with lights and sirens being allowed on ambulances. 

This is something that frustrates the hell out of me.


----------



## eynonqrs

In pennsylvania, depending on the region. Some require 2 EMT's to staff the rig. In my region, for A BLS crew, it can be an EMT and a driver who is not an EMT or FR. They must have CPR and First Aid.  For a paramedic unit, it must be an EMT and Paramedic.


----------



## BLSBoy

eynonqrs said:


> In pennsylvania, depending on the region. Some require 2 EMT's to staff the rig. In my region, for A BLS crew, it can be an EMT and a driver who is not an EMT or FR. They must have CPR and First Aid.  For a paramedic unit, it must be an EMT and Paramedic.



Jersey is similar, at least for the members of the first grade counsil. (I refuse to acknowledge them by capitalizing, or correctly spelling the name of their org. that is dedicated to keeping NJ EMS in the dark ages) They require an EMT, and a driver. 
We will not advance until we make it a minimum standard to be a crewman on an ambulance. 
Disgraceful. 
Simply disgraceful.


----------



## AJ Hidell

If they aren't even allowed to assist with patient care, I don't get the point of even requiring FR certification in the first place.  Seems pointless, doesn't it?  If I'm going to have someone who is there only to drive, I'd at least want him to have some training in that purpose.  Otherwise, FR, EMT, or whatever, he's of no more use to me than a McDonald's cashier.


----------



## BossyCow

EMS is not a spectator sport. I do not want anyone in the back of the ambulance with me and the patient that is not able to help with patient care. At the very minimum, as a new EMT I want them familiar with the shelves and inventory so they can fetch and carry stuff for me. I don't want to have to reach around you, step over you, or have to ask you to get out of my way. 

If you can't help, ride up front.


----------



## triemal04

BossyCow said:


> If you can't help, ride up front.


If you can't help then why in the hell are you there in the first place?


----------



## BossyCow

triemal04 said:


> If you can't help then why in the hell are you there in the first place?



triemal, I'm a rural volly district. I may be the only EMS responder to a call. If its a 360lb pt in dka, I'm not going to care what level of medical training the responder has if they are able to help me manuever the pt into the ambulance. Depending on the geographical location of the call, I may be driving the ambulance myself and have only three non-medical trained responders who show up at the scene POV. Or I may be on scene directly from home in my POV. 

While this may not be the optimum level of care in a perfect world, it is the reality of my location. We can debate endlessly the rightness or wrongness of it, but in the meantime, on the way to a perfect system with none of these issues, the rest of us still have to make these determinations and manage a scene that may have non EMS personnel responding.


----------



## triemal04

BossyCow said:


> triemal, I'm a rural volly district. I may be the only EMS responder to a call. If its a 360lb pt in dka, I'm not going to care what level of medical training the responder has if they are able to help me manuever the pt into the ambulance. Depending on the geographical location of the call, I may be driving the ambulance myself and have only three non-medical trained responders who show up at the scene POV. Or I may be on scene directly from home in my POV.
> 
> While this may not be the optimum level of care in a perfect world, it is the reality of my location. We can debate endlessly the rightness or wrongness of it, but in the meantime, on the way to a perfect system with none of these issues, the rest of us still have to make these determinations and manage a scene that may have non EMS personnel responding.


Won't argue with that, but it does bring up the next question:  if you have people in your service that aren't able to provide pt care, is it because they are still in the process of learning how, or is it because they really don't want to and only drive?


----------



## eynonqrs

In my organization, all members are required to go through each unit at our station.  We do not have very many members that are not emt's.  They don't have it because they want to help, but don't want to take the EMT class.  We never had any problems.  Also our service runs a rescue company. Any member that joins our squad must be in for 1 year and get either first aid/cpr, first responder or emt.  Therefore, they must ride in the back and get familliar with equipment.  It's all about SOP's my friends.  And besides, everyone is hurting for volunteers, if you can get any kind of good members it's a plus.


----------



## AJ Hidell

eynonqrs said:


> We do not have very many members that are not emt's.  They don't have it because they want to help, but don't want to take the EMT class.


I think I would have to question the motives and commitment of those members.  Have they ever thought of volunteering to "help" Meals On Wheels?  Have they ever volunteered to "help" drive senior citizens on errands and doctor visits?  Do they volunteer to drive a school bus?  Why are they so anxious to "help" the rescue squad instead of those other agencies?


----------



## BLSBoy

eynonqrs said:


> In my organization, all members are required to go through each unit at our station.  We do not have very many members that are not emt's.  They don't have it because they want to help, but don't want to take the EMT class.



Wackers. Useless wackers.


----------



## eynonqrs

Well, here is some more answers:

I guess before the comments were fired off, you didn't read the part about the SOP's.  They must get CPR/First Aid, EVOC, and must RIDE IN THE BACK and get familliar with all equipment.  Secondly, we do more than EMS, we have a rescue, we have an ATV unit with a trailer, we have a collapse trailer. Thirdly, we usually have at least 3 people on the rig for calls, and there are usually 2 EMT's in the back. Out of our active members, there are only 3 that don't have EMT.  These people are not useless wackers.


----------



## OnceAnEagle

Holy crap, a lot of heat around on the subject.

My area:

"Standard" ambulance throughout the region: BLS/ALS, or "ALS rig"
.. if the call is ALS, the P takes it and B drives, and vice versa. This has minimum staffing, but most flexibility. The system also prompts for fire first response, usually a squad or an engine, to all calls coded as emergent.

"BLS" ambulance, or "basic bus" (on top of many other fun names, when working commerical): Two EMT's, with protocols and EMD coding to specify what calls, at dispatch, warrant either the redirection of an ALS rig/flycar for added resources. 

Very rarely will you see a double ALS unit. In my company, a double ALS unit means that two EMTs called in sick.

As a BLS provider, we have recognition of ALS criteria from the initial assessment pounded into our heads, so if the dispatch doesn't code it correctly, then at least basic care is on scene to support the pt or begin transport to the closest facility with the possibility of an intercept.


----------



## aandjmayne

No such thing as BLS around here.. only ALS one medic and one basic with the occasional ride along student (basic or paramedic)


----------



## Sasha

> I may be the only EMS responder to a call. If its a 360lb pt in dka, I'm not going to care what level of medical training the responder has if they are able to help me manuever the pt into the ambulance. Depending on the geographical location of the call, I may be driving the ambulance myself and have only three non-medical trained responders who show up at the scene POV. Or I may be on scene directly from home in my POV.



Sounds like you need to get your staffing issues worked out. One EMT in the area is just a little bit on the pathetic side. EMT class isn't a hard thing to pass.


----------



## marineman

WI state law, the lowest level of provider allowed to staff an ambulance is EMT-B. Most local services run 2 paramedic crews. One service I work for is 1 emt, 1 medic. The other service is 1 emt, 1 intermediate. We use first responders as drivers if they're available on scene and we have a critical patient that requires both of us in the back or if we have multiple patients.


----------



## Sasha

After work yesterday I traveled with a friend down into the Tampa area and back and talking to an EMT in Tampa, I found out that they have a BLS 911 ambulance. The BLS 911 ambulance gets dispatched with an ALS engine to all calls (Still giving us an ALS response.) but the BLS engine can be staffed with two EMTs or an EMT and a First Responder.

( I didn't know Florida had FR! )


----------



## AJ Hidell

Sasha said:


> ( I didn't know Florida had FR! )


Isn't that just a fancy name for a fireman who let his EMT cert expire so he wouldn't get stuck on the ambulance?


----------



## Sasha

AJ Hidell said:


> Isn't that just a fancy name for a fireman who let his EMT cert expire so he wouldn't get stuck on the ambulance?



Negative. State law mandates that all Fire Fighters must be at least an EMT-Basic. So I've been told. I'm too lazy to look it up.


----------



## Hockey

Hmmm at my last job, they let MFR's work on the rig (only as drivers though)

Kinda sucked being partnered up with the few because they wouldn't help on the nasty calls or when they didn't "feel" like it.  They'd play the well my SOP only allows me to...


----------



## AJ Hidell

Sasha said:


> Negative. State law mandates that all Fire Fighters must be at least an EMT-Basic. So I've been told. I'm too lazy to look it up.


Some states require EMT for fire certification, but do not require you to maintain it after certification.  Not sure about Florida.


----------



## BossyCow

triemal04 said:


> Won't argue with that, but it does bring up the next question:  if you have people in your service that aren't able to provide pt care, is it because they are still in the process of learning how, or is it because they really don't want to and only drive?



Generally they are still in the process of obtaining certification. There are two volunteers who do not have EMT-B and who do not plan on obtaining it. They are both long term vollies and invaluable on scenes. 

Sasha in response to your comment: 





> Sounds like you need to get your staffing issues worked out. One EMT in the area is just a little bit on the pathetic side. EMT class isn't a hard thing to pass.



We are a volly agency and our 'staffing' depends on who is in the area and available to respond. It has nothing to do with the difficulty of the training, but availability of the personnel. There are no jobs here, other than clerk at the general store or working at the school. Everyone else works in town some 30 miles to the east. We have 14 EMTs but no guarantees as to how many will be available to respond to any given call. We can't do shifts without paying on-call pay and our board refuses to do that.


----------



## Sasha

Then you area seriously needs to get it together. That is unacceptable that you may be the only responding provider. What happens when you're not there and no one responds?

And if there is a will there is a way. There are some pretty piss poor areas in Florida, as well, but they still manage to find a way to provide decent, reliable EMS to their area and there are VERY few volunteer agencies.


----------



## BossyCow

Sasha said:


> Then you area seriously needs to get it together. That is unacceptable that you may be the only responding provider. What happens when you're not there and no one responds?
> 
> And if there is a will there is a way. There are some pretty piss poor areas in Florida, as well, but they still manage to find a way to provide decent, reliable EMS to their area and there are VERY few volunteer agencies.



It is acceptable to the citizens of the district. If we are not available, dispatch tones out the nearest adjoining district for response. They are about a half hour away. Some people opt to go to the ER POV. Some just wait, some die. The people who live here have the option of moving someplace with better service, more available resources, but chose to remain here.


----------



## Sasha

> They are about a half hour away. Some people opt to go to the ER POV. Some just wait, *some die.*



And that's acceptable?


----------



## BLSBoy

Sasha said:


> And that's acceptable?



Screw em. 
They dont wanna pay, thats what they get. 
Cold? Yes
Reality? Yes. 

To quote Ron White.....Ya can't fix stupid.


----------



## BossyCow

BLSBoy said:


> Screw em.
> They dont wanna pay, thats what they get.
> Cold? Yes
> Reality? Yes.
> 
> To quote Ron White.....Ya can't fix stupid.



Absolutely..... while it would be great to have it all wonderful, it would also be great if they all got indoor plumbing.. that ain't happening either any time soon!


----------



## Shishkabob

God, I could never live in an area like that.


Not because of no EMS, but I've always lived in the suburbs where everything I could ever want was within a 10 minute drive.


----------



## ffemt8978

Linuss said:


> God, I could never live in an area like that.
> 
> 
> Not because of no EMS, but I've always lived in the suburbs where everything I could ever want was within a 10 minute drive.



And I prefer not to have neighbors closer than 10 minutes away.


----------



## marineman

ffemt8978 said:


> And I prefer not to have neighbors closer than 10 minutes away.



x2

10 characters


----------



## Mountain Res-Q

In California the law does not allow First Responders (a 50-60 hour course) to drive ambulance, and since you must be at least an EMT-B to drive ambulance, then I know of no First Responders who work Ambulance.  We do however have BLS and ALS cars out here.  ALS cars are typically staffed with one Paramedic and one EMT.  The Paramedic takes ALS calls and the EMT takes BLS calls.  If we need a third or forth hand on a call, we grab one of the Firefighters (a FR or EMT) to ride to the hospital.  BLS cars are transfer ambulances only and are staffed with 2 EMT's who take every other call.  The other type of car we use are Critial Care Transport (CCT) which handled critical transfers an was staffed with one MICN and one Paramedic, or one MICN and two EMT's.  I worked BLS, ALS, and CCT cars when I was on ambulance.  This system seemed to work and was more cost effective then some of the setups I've seen here.  The advantage to a BLS transfer system is that the new guys got start out tehre and hone their assessment and driving skills before jumping on an ALS rig.


----------



## tydek07

There are a lot of Volunteer BLS services around here. First Responders are always in the back doing pt care with an EMT. So yes, they can/do ride, as there has to be an EMT (or higher) in back.


----------



## Joel Yarberry

In AR. FR is 40 hours.  To go from FR to EMT is a big difference 240 class hours rescue ops class practicals and then national.  I was reading some post & replies  I dont know how it is every where else


----------



## eynonqrs

Well, this topic to me has no bearing and I am letting some steam off here. Where I am at ALS gets sent for just about everything.  Acutally I feel like a glorified ambulance driver.  BLS shouldn't stand for Basic Life Support , it should stand for BAND AID Life Support.  99% of the time we get to the call and just take the strecher in.  Why have all that required equipment when you don't get to use it ? BLS is better off going back to cadiallac ambulances, why pay all this money for equipment ?


----------



## Kendall

Our levels of care are somewhat different; our "first responder," or Emergency Medical Responder, is equivalent to the American EMT-B. Our BLS units can be staffed by max 3 people, and must have at least one EMT-A onboard (EMT-A being equivalent of EMT-I)


----------



## TransportJockey

eynonqrs said:


> Well, this topic to me has no bearing and I am letting some steam off here. Where I am at ALS gets sent for just about everything.  Acutally I feel like a glorified ambulance driver.  BLS shouldn't stand for Basic Life Support , it should stand for BAND AID Life Support.  99% of the time we get to the call and just take the strecher in.  Why have all that required equipment when you don't get to use it ? BLS is better off going back to cadiallac ambulances, why pay all this money for equipment ?



ALS SHOULD be sent to everything. Every pt deserves an ALS assessment. If you feel so left out, continue your education and become an ALS provider


----------



## JustMarti

obviously a bit after the fact, but...
I'm from rural MN, a bedroom community with a 45 minute drive ONE WAY to the nearest hospital.  Here in Mn we can run with a minimum of  2 EMT-B's... 
we also have "driver's only" (minimum training is CPR, First AID and CEVO)... which can save our butts on a serious call.  When we need ALS we call for intercept or the heli.  Yes, it would be WONDERFUL if all our crew were EMT-B's, but we barely have enough to cover full time as it is.  
Please keep in mind that things may be different in rural areas, and ALL our members are needed and valued.


----------



## Joel Yarberry

I believe the last sentence in JustMarti's post reply is the smartest thing i have heard sence i joined EMTLIFE.   Im an EMT going to school to be a medic. I think some titles are not given enough credit.    It doesn't matter if you are Paramedic, EMT, First Responder, or just cpr cert. u make a difference.      EMS is a team!!!


----------



## CAOX3

Yes we are a team in theory however the relationship is fractured.  If we spent as much time working together as we do tearing each other apart we wouldnt have half the problems we do.


----------



## TransportJockey

CAOX3 said:


> Yes we are a team in theory however the relationship is fractured.  If we spent as much time working together as we do tearing each other apart we wouldnt have half the problems we do.



The whole US EMS style of doing things is fractured.


----------



## AaronMRT

We need at least 1 MRT & 1 EMT to roll and the MRT will drive while the EMT is in the back, but if we happen to have 2 MRTs & 1 EMT, the additional MRT will assist in the back of the rig.


----------



## eynonqrs

jtpaintball70 said:


> ALS SHOULD be sent to everything. Every pt deserves an ALS assessment. If you feel so left out, continue your education and become an ALS provider




I disagree for several reasons:

1) In my county BLS services are mainly ran by volunteer services, ALS is provided by paid services. The ALS units also run calls in the City of Scranton. They are dispatched by the county EOC, the ALS units have AVL units in them. The closest unit get's dispatched to the call.  Some sections of the county are rural areas.  There are days it gets so busy that there may be 1 or 2 ALS units in the county. So, if they get sent on bulls#@*! calls and someone is having cardiac issues or other critical issues and they are not available to give them lifesaving medications or other measures, what good is it ? 

2) Remember the computer GIGO ? It means garbage in = garbage out. In order to be a good paramedic, you need to be a good EMT first. EMT's now have no skill value, from the poor instruction to the everything ALS.  Therefore poor EMT's=poor paramedics. This is no joke, because I see unfolding right in front of my eyes. EMT's value is becoming less and less these days.


----------



## AJ Hidell

Always amusing how many Basics think they are qualified to comment upon Advanced Life Support.


----------



## eynonqrs

AJ Hidell said:


> Always amusing how many Basics think they are qualified to comment upon Advanced Life Support.



For your information, I have been doing this for 17+ years.  I am no rookie, and I do have the right to comment on this. I remember when ALS was only dispatched to a trauma or other serious condition. Not for someone with a fever, stubbed toe or nose bleed. My comments are based on observations and experience. So don't assume EMT-B's are all dumb. It makes me sick that we (EMT's) get treated like scum. I am no dumb a**. That is all.


----------



## AJ Hidell

Dumb, no.  Ignorant, yes.

Whether it is seventeen years or seventy years is irrelevant.  Being an EMT-Basic does not result in the knowledge or context necessary to make informed and intelligent comment on the theories of ALS practice.

And all EMT-Bs are rookies.


----------



## Shishkabob

AJ Hidell said:


> Dumb, no.  Ignorant, yes.
> 
> Whether it is seventeen years or seventy years is irrelevant.  Being an EMT-Basic does not result in the knowledge or context necessary to make informed and intelligent comment on the theories of ALS practice.
> 
> And all EMT-Bs are rookies.



This is where you and I always disagree, AJ.


Just because someone has a B after their EMT does not mean they are not educated.  They could have a BS in microbiology for all you know and just haven't started medic school yet.



Don't judge someone by their patch, but by their willingness to learn.


----------



## Sasha

eynonqrs said:


> I disagree for several reasons:
> 
> 1) In my county BLS services are mainly ran by volunteer services, ALS is provided by paid services. The ALS units also run calls in the City of Scranton. They are dispatched by the county EOC, the ALS units have AVL units in them. The closest unit get's dispatched to the call.  Some sections of the county are rural areas.  There are days it gets so busy that there may be 1 or 2 ALS units in the county. So, if they get sent on bulls#@*! calls and someone is having cardiac issues or other critical issues and they are not available to give them lifesaving medications or other measures, what good is it ?
> 
> 2) Remember the computer GIGO ? It means garbage in = garbage out. In order to be a good paramedic, you need to be a good EMT first. EMT's now have no skill value, from the poor instruction to the everything ALS.  Therefore poor EMT's=poor paramedics. This is no joke, because I see unfolding right in front of my eyes. EMT's value is becoming less and less these days.



and how are you to decide what is BS and what's not?

17 years and still an EMT? You don't have the eduation to make that decision. EMTs are becoming less and less valuable because people are realizing it's little more than a boy scout and you can better service your patient as an ALS provider then a BLS provider.


----------



## JPINFV

Oh, this should be good.

/me pulls up a seat
/me puts some popcorn into the microwave.


----------



## Shishkabob

JPINFV said:


> Oh, this should be good.
> 
> /me pulls up a seat
> /me puts some popcorn into the microwave.



/me takes popcorn out when done, and sits down.


----------



## Mountain Res-Q

Linuss said:


> /me takes popcorn out when done, and sits down.



Wanna a beer?


----------



## TransportJockey

Sasha said:


> and how are you to decide what is BS and what's not?
> 
> 17 years and still an EMT? You don't have the eduation to make that decision. EMTs are becoming less and less valuable because people are realizing it's little more than a boy scout and you can better service your patient as an ALS provider then a BLS provider.



I really have to agree with this point. BLS providers are glorified first aid providers. For FD that should work because you are a first responder, but dedicated EMS should always be there right after with ALS professionals


----------



## Sapphyre

Linuss said:


> /me takes popcorn out when done, and sits down.



/me pours caramel on the popcorn and pops open a Diet Sunkist Orange


----------



## VFFforpeople

My area, 1 EMT-1 Medic. EMRs are on the fire trucks (and those are very few, as about 87% of the FDs here are either medics,or EMT-Bs.) ((we also have 6 EMT-I)).


----------



## eynonqrs

Sasha said:


> and how are you to decide what is BS and what's not?
> 
> 17 years and still an EMT? You don't have the eduation to make that decision. EMTs are becoming less and less valuable because people are realizing it's little more than a boy scout and you can better service your patient as an ALS provider then a BLS provider.



This makes me sick. Don't call me stupid and I take offense to this response. Let me tell you folks something. I have been on ALS units for a long time. I have worked with medics that have been medics for 20+ years, and told me that some calls that they dispatch ALS to is BS. I ask the questions, I do look up and read up on things of this nature. What is ALS going to start IV's and put monitors on every pt ? Do you really need that ? I am done here. I am going to fu@$*& puke ! This thread needs a time out or lockout.


----------



## Melbourne MICA

*Two Tier*

In Melbourne we run a two tier system comprising "BLS" cars that are probably about the EMT-I level ie they use a number of ALS skills and have an expanded scope of practice. The second tier is MICA - Full ALS Paramedic level.

The "BLS" guys are taught when and under what circumstances to call for a MICA unit if the dispatch GRID sends them by themselves first up. Basically  all time critical pts.  Many dispatches get two cars first up. Whoever gets there first will decide if the pt warrants more or less care. 

There are no BLS volunteers, no first aiders, no mixed crewing trucks and the fire department has no involvement in EMS except for an EMR first responder role in arrests. (There are two or three CERT community based vollies in some very small remote communities as well who get sent backup with pro ambos anyway).

Our BLS guys do three years minimum education (now uni based ) with a degree qualification at the end of it. When I did it it was in-house three years full time, probably about 42 weeks (6 semesters)face to face in school education with on-road instructor training all through the course. 

MICA types are very worried about the number of very young and inexperienced staff making decisions under the new pre-emplyment model we have. 

We are also loath to the idea of MICA running predominantly on "fly cars"  - though we have a few currently. Single responder ALS in a sedan - the idea is thoroughly flawed as far as I am concerned and without any basis in evidence as to its superiority or equivalency with two man ALS crews. (I'm happy to argue that point by the way).

It's bad enough that our bosses seem to have turned their backs on hand picking the right people to become ambos.  We don't need to send a guy by himself hoping a BLS car will arrive on time in the first place and that the crew is capable of assisting him in the back. A dependent system - not a good idea.

The general principle here has always been to use ALS a bit like special forces deployment - when the case looks like a time critical emergency or when a "BLS" crew identifies one and calls for us. But the BLS guys still have an important role and lots of skills to use until the MICA crew arrives.

For the most part our experienced BLS guys (deliberate qualification) are very reliable and good operators. As for the toddlers joining the job (for some its their first job) I''l keep my mouth shut for now.

MM


----------



## JPINFV

Melbourne MICA said:


> Our BLS guys do three years minimum education (now uni based ) with a degree qualification at the end of it. When I did it it was in-house three years full time, probably about 42 weeks (6 semesters)face to face in school education with on-road instructor training all through the course.



Of course this makes any comparison a moot point. Your BLS level has more education than our ALS level.


----------



## JPINFV

eynonqrs said:


> I have worked with medics that have been medics for 20+ years, and told me that some calls that they dispatch ALS to is BS. I ask the questions, I do look up and read up on things of this nature. What is ALS going to start IV's and put monitors on every pt ? Do you really need that ? I am done here. I am going to fu@$*& puke ! This thread needs a time out or lockout.




Yet the patient still sees a physician or mid level at the end of the transport. Amazing that a patient that is not sick enough for a paramedic is still sick enough to see a physician.


----------



## VentMedic

> Originally Posted by *Melbourne MICA*
> 
> 
> _Our BLS guys do three years minimum education (now uni based ) with a degree qualification at the end of it. When I did it it was in-house three years full time, probably about 42 weeks (6 semesters)face to face in school education with on-road instructor training all through the course. _


 


JPINFV said:


> Of course this makes any comparison a moot point. Your BLS level has more education than our ALS level.


 

Yet some of the U.S.  EMT-Bs are still dumbfounded as to why their 110 hour cert is criticized.


----------



## Sasha

eynonqrs said:


> This makes me sick. Don't call me stupid and I take offense to this response. Let me tell you folks something. I have been on ALS units for a long time. I have worked with medics that have been medics for 20+ years, and told me that some calls that they dispatch ALS to is BS. I ask the questions, I do look up and read up on things of this nature. What is ALS going to start IV's and put monitors on every pt ? Do you really need that ? I am done here. I am going to fu@$*& puke ! This thread needs a time out or lockout.



Where did I call anyone stupid?

There's a difference between stupidity and being uneducated. 

And no, not every patient gets a monitor and an IV, but every patient deserves an ALS assesment.


----------



## Melbourne MICA

*Bls*



VentMedic said:


> Yet some of the U.S.  EMT-Bs are still dumbfounded as to why their 110 hour cert is criticized.



But surely JP and Venty there are services with a roughly equivalent level of training and education for their BLS ground troops if I can use the military analogy again?

When I first started back in 19...., we did a bit but not that much though it was still three years at school (from just 10 weeks or so back in the 70's/ early eighties). We have added a fair bit to the "BLS" plate since - drugs and procedures and of course upgraded the curriculum of the training programme.

Our BLS guys now do IV's, fluid resus, adrenaline IM (anaphylaxis) and IV (arrests), hypos with glucagon, resp stuff (no IV meds though just neb masks), Ceph for meningococal, LMA.s, Laryngo blades NP/OP, BVM for airways etc. A fair bit more. Having said that the authority to practice matrix in our guidleines (determines who is allowed to do what) has BLS 55 procedures, drugs etc and MICA 110 -that's everything in the book for us MICA types.

And like your situation our BLS recruits are now Uni based, many straight out of high school, first job - a few haven't even got their drivers license yet!!!!!

So the base of knowledge has improved but the on-road and maturity thing has gone out the window. Not to say some of the younger ones can't excel.

But it's hard to see how even a mature EMT-B with bugger all education can make the big calls. Once again not to say some don't have the wherwithall to keep themselves sharp and up to date. There must be some excellent basics out there as there are amongst our ALS (BLS) guys. 

(By the same token we have some shockers as well - so bad you wouldn't let them treat your pet hamster let alone a real live human. And on occasion they rock up to your MICA job where the pt is Ok just needs BLS+transport and you go....."oh s..t - on second thoughts kids we'll take the pt". 

However, if it's true what a lot of you guys are saying that the bottom line standard, even the majority staffing level in many counties is made up with B's that must scare the crap out of you. What do the ED docs and the general public think?

MM


----------



## CAOX3

Wasn't this thread about first responders be allowed on a ambulance?

Oh sorry I forgot every thread here reverts into a pissing match between ALS and BLS.


----------



## VentMedic

CAOX3 said:


> Wasn't this thread about first responders be allowed on a ambulance?
> 
> Oh sorry I forgot every thread here reverts into a pissing match between ALS and BLS.


 
If you read Melbourne MICA's post you will see what is considered a "First Responder" and who responds in the ambulances where he is.

To read what others in different countries think of the U.S. system should make some think about improving EMS in their area and not keep justifying the same very low standards.


----------



## CAOX3

I agree, this would be the perfect opportunity to conduct a study.

With the highly educated EMS systems around the world Australia, Canada...does their educational standards directly correlate to better patient outcomes?

I am for education in any field, just out of curiosity I would like to see how their patient outcomes stack up against the majority of trained US system providers.


----------



## VentMedic

For trauma, the OPALS studies did provide good results but, again, the BLS provider had almost a year of college education.

In a few other countries such as the U.K., EMS providers have already expanded their roles into community health. 

Some Canadian Paramedics also have enough education which includes specialized ICU experiences and can do specialty transports for adults, peds and neonates without being just the stretcher fetcher for the RNs and RRTs.


----------



## Melbourne MICA

*Bls*



CAOX3 said:


> I agree, this would be the perfect opportunity to conduct a study.
> 
> With the highly educated EMS systems around the world Australia, Canada...does their educational standards directly correlate to better patient outcomes?
> 
> I am for education in any field, just out of curiosity I would like to see how their patient outcomes stack up against the majority of trained US system providers.



Just regarding your original post - this was the original thread

"How do you staff your BLS ambulances? Do you do 2 emt's, three emts's? What is the training level of the driver? Do you allow/have first responders on the ambulance?"

And sorry  - you are right to an extent and that's my fault - I tend to waffle and go off in tangents a fair bit. 

Anyway your point is a fair one. Is the "better" training/education curriculum equating with better outcomes?

For MICA in Melbourne some yes's. RSI in head injured pts -Seattles trial back in about 93 flopped -ours hasn't - significantly improved outcomes and very high success rates on procedures. Cardiac arrest survival to hospital - ours is now above 30% if I remember correctly maybe better than that.
Some trauma wins in pts with bad ISS scores considered non survivable - big hospital trauma centre study last year - pts survived apparently because of MICA interventions particularly decompressions, RSI, etc.

The BLS guys must be considered a part in all of this as they often arrive before we do.  But what worries us is their key role may go downhill because of dilution of experience, no experience, too many young students and a lack of emphasis on on-road training and tutelage. Hands on stuff.

We have two crew on all BLS cars. Many many students - about 50% of our BLS staff now. They have some or all of their "ALS" training skills from uni  like the qualified guys but no time on road and for some apparently little interest in their own performance or an appreciation of the the pt - no sense of advocacy.

So once again I have gone off on a tangent, written way too much.  I hope at least the earlier paragraph answers your query.

Cheers
MM


----------



## CAOX3

Is your trial on RSI and decompression in trauma patients concluded?  If yours has positive findings I am sure everyone wiould be interested in that.

As far as save rates for out of hospital cardiac arrest.  What would be the criteria?  ROSC or to discharge?  I know some areas have different criteria.

I guess now I'm guilty of hijacking too.  My apologies.


----------



## Melbourne MICA

CAOX3 said:


> Is your trial on RSI and decompression in trauma patients concluded?  If yours has positive findings I am sure everyone wiould be interested in that.
> 
> As far as save rates for out of hospital cardiac arrest.  What would be the criteria?  ROSC or to discharge?  I know some areas have different criteria.
> 
> I guess now I'm guilty of hijacking too.  My apologies.



No apologies necessary. 

The decompression findings followed on from the study by the hospital itself. They were actually looking at what they could do to improve outcomes for such pts in ED.

But they couldn't account for the bad ISS score pts surviving so they re-examined the data. They discovered a correlation between these pts surviving and MICA interventions pre-hospital especially expeditious and even prophylactic decompressions. They are currently setting up a new study to have a second look. It was good win for EMS - we need these types of positive findings big time as I'm sure you are aware. 

The RSI trial finished about early 08. Only preliminary results have been released. They were excellent based on the outcomes markers specified as the endpoint of the trial.

The arrest survival rates were to the hospital door. So yes ROSC with good obs on arrival at ED. It still may have made no difference in the end but we were holding up our end. I'll try and get an accurate figure for you.

I guess the most important point about all of this is the skill, precision and consistency of the operators because of or despite education and training.
Everyone is trying to find out where the best balance is. Our service has gone heavily into education ( there are dollar issues in this which can't be overlooked ie they don't have to pay for it any more the students do).

But their rush to put bums on seats because their response times are crap by creating a whole heap of new ambo branches is a flawed approach. Uni trained kids with little longterm interest in ambulance, take lots of sickies on weekends so they can maintain their social calendar and generally look out of water dealing with tough community med emergency situations - they have no life experience. Besides the bar has been lowered to accommodate all the recruitment numbers the service (and the government) want. heaps have failed and incredibly the government says put them through anyway. They need the publicity. All sound familiar?

Cheers
MM


----------



## DavethetrainWreck

In new Jersey they are changing the law to a mandatory two EMTs per BLS rig. However First Responders will still be allowed to ride the Ambulance as a third person they will also be allowed to drive the rig while the two EMTS in are the back with a critical patient. I think upgrading the standard of care is a great idea. However the formula of having a CFR-D as a driver and an EMT for patient
care has worked just fine for most volunteer squads considering the shortage of certified personnel.


----------



## BLSBoy

DavethetrainWreck said:


> However the formula of having a CFR-D as a driver and an EMT for patient care has worked just fine for most volunteer squads considering the shortage of certified personnel.



Theres no shortage of certified personnel. Theres a shortage of those who want to do it for _free._


----------



## emtwacker710

In NYS you have to have a minimum of a EMT-Basic and a driver available for the rig to roll. CFRs can practice but not provide the only care en route to the hospital.


----------



## drdique

*First Responder's Life in Canada*

So up here we generally have 4 levels of care: EMR/FMR (First responder), Primary Care Paramedic (EMT-Ambulance), Advanced Care Paramedic, and Critical Care Paramedic. Due to the difference in Scope, EMR's are not allowed to work on-car with Advanced/Critical care medics. That being said, an EMR can work alongside a PCP/EMT. Our BLS cars usually consist of 1 EMR and 1 PCP, or 2 PCP's. It is then up to the PCP/EMT to determine if their skills are required, or if the pt is stable and without IV, the EMR can attend.

EMR = 90hrs classroom
PCP/EMT-A = 500hrs classrooom, 50 hrs hospital clinical, 400hrs ambulance practicum
Adv Care Medic = 500hrs classroom, 300 hrs hospital, 480 hrs ambulance
Critical care Medic =500 hrs classrom, 250hrs hospital, 500 hrs ambulance.

Hope this can provide some insight. 

First responders do ride on-car in various circumstances in Canada


----------



## ResTech

Pennsylvania requires one EMT and the driver must be a State First Responder or ARC Emergency Responder as a minimum staff level. PA accepts the Red Cross Emergency Responder course as an equivalent.

If the driver is only CPR certified, then two EMT's or an EMT and a First Responder must be onboard.


----------



## HotelCo

2 EMTs. 

Both drive.


----------



## VentMedic

Florida:  1 EMT-B and 1 driver who meets the driving requirements are all that is required for BLS.


----------



## DWemt28

where i live, you must be at least a basic to even work on a rig. the only time you can go in w/o basic is if you're in school training to be a basic and you're on a clinical, and the care you provide would still be very limited. You would also be accompanied by a basic.


----------



## VCEMT

What? There are people that are not EMTs working on a rig? That doesn't sound very safe.


----------



## EMT2SaveU

*Rig staffing*

We ride 4 in a rig, all have to be EMT-B minimum. All EMT's must pass dispatch training before becoming an attendant. Two of the EMT's can be attendants, one driver and a crew chief.

Isaac


----------



## BLSBoy

Where does the patient go?!


----------



## 62_derick

In Pa the citys run Duel Medics on the rigs and don't hire any Emt's (which I dont think is really right) on the rual areas they run medic/emt (BLS/ALS) or EMT/EMT (Bls) or sometimes Duel Medics too.

When I went to emt school I would right on the truck observing and sometimes helping out with an emt/medic.


----------



## RescueYou

Here, is depends on the circulstance.

Our station protocol says:
The minimum staffing on a BLS truck is a driver (not required to be EMT certified) and an EMT in the back who is over the age of 18. 
In the case that there is an EMT driver and an EMT in the back who is under the age of 18, they cannot take a call. There MUST always be an EMT over age 18 in the back, no matter what the cert. level of the driver is. Elsewhere, there aren't any restrictions.

Note that we normally take 2 EMTs, one being at least 18yrs old, and a driver. All but one of our drivers are EMT-B certified and the one that isn't, used to be and just needs to get his CE class in before the end of December.


----------



## RescueYou

EMT2SaveU said:


> We ride 4 in a rig, all have to be EMT-B minimum. All EMT's must pass dispatch training before becoming an attendant. Two of the EMT's can be attendants, one driver and a crew chief.
> 
> Isaac



Geez!!! does the patient have room to breathe!?!? yall must either have a huge crew to fill multiple trucks up like that or your district is out of luck if more than one call comes in at once!


----------



## whizkid1

We are a basic service,we would allow a FR to drive the ambulance.


----------



## 51 RESCUE EMT-B

Here being DOH a min of two EMT's and a driver is required.B)


----------



## Jon

is that 2 EMT's including the driver?

PA state law allows for 1 EMT and 1 driver with EVOC+Advanced First Aid to staff a BLS unit. Common practice in paid situations is to only have EMT's on the ambulance.

At the volunteer squad, we'll allow a total of 4 crewmembers... Driver, Primary EMT, and then a combination of Precepting EMT's, EMT Students, and Attendants. Sometimes they are useful... sometimes they are in the way. Some of them complete precepting and become useful members of the squad... and some seem to have no useful purpose. We haven't been able to find a real solution for that yet.

As for space - we run Type III's, and that usually gives us enough room for us, the patient, and an ALS provider if need be. If we have a medic onboard, someone off the crew will drive the medic's car to the ED as a courtesy, and I've been known to have multiple attendants ride in the medic's car, or have one ride in the front passenger seat if the back is too crowded.


----------



## Akulahawk

The last time I looked at (California) Title 22 and DMV requirements, a BLS truck can be staffed by an EMT and a Driver. The Driver must be First Responder certified, with CPR. Here's the catch: The Driver must become an EMT within one year of obtaining the Ambulance Driver Certificate. The DMV enforces that. I have not heard of any services using EMT/FR staffing. The realistic minimum is EMT/EMT for BLS.


----------



## 51 RESCUE EMT-B

That would be (2) two EMT's and (1) a driver to be DOH compliant.B)




Jon said:


> is that 2 EMT's including the driver?
> 
> PA state law allows for 1 EMT and 1 driver with EVOC+Advanced First Aid to staff a BLS unit. Common practice in paid situations is to only have EMT's on the ambulance.
> 
> At the volunteer squad, we'll allow a total of 4 crewmembers... Driver, Primary EMT, and then a combination of Precepting EMT's, EMT Students, and Attendants. Sometimes they are useful... sometimes they are in the way. Some of them complete precepting and become useful members of the squad... and some seem to have no useful purpose. We haven't been able to find a real solution for that yet.
> 
> As for space - we run Type III's, and that usually gives us enough room for us, the patient, and an ALS provider if need be. If we have a medic onboard, someone off the crew will drive the medic's car to the ED as a courtesy, and I've been known to have multiple attendants ride in the medic's car, or have one ride in the front passenger seat if the back is too crowded.


----------



## BLSBoy

51 RESCUE EMT-B said:


> That would be (2) two EMT's and (1) a driver to be DOH compliant.B)


Uhhhh. Yea. Lemme see that statute.


----------



## 51 RESCUE EMT-B

The state DOH statute requires (2) two EMT's on the vehicle. Local protocol requires (2) EMT's and (1) a driver.B) 


8:40-3.7 Minimum personnel requirements
(a) Each person who operates a motor vehicle licensed under this chapter shall possess and
have readily available for inspection a valid driver's license, as required by Title 39 of the Revised
Statutes of New Jersey.
(b) Each required staff person, as defined by this chapter, who staffs or operates a vehicle
licensed under this chapter:
23
1. Shall be at least 18 years old;
2. Shall dress in clothing, including any outerwear, of a similar uniform appearance
which presents a professional appearance;
3. Shall wear the following identification:
i. His or her first and/or last name; and
ii. The name of the licensee.
4. Shall not wear or display any identification which suggests or indicates affiliation with any
other organization or agency. However, identification may be displayed which indicates the person's
level of training or personal or licensee membership in a professional association or society.
5. Shall have readily available for inspection, either on his or her person or in the vehicle, valid
documentation, or other proof thereof, of his or her training as may be required in this chapter.
(c) Each person who provides patient care (as part of any service licensed under this chapter)
shall possess a license, registration, certification or training certificate valid in the State of New Jersey
for the type or level of patient care he or she is providing. No person shall be allowed to provide a
type or level of patient care beyond the level he or she is lawfully eligible
to provide in the State of New Jersey.
(d) Each person who staffs a vehicle licensed under this chapter may wear appropriate
patches, pins, or other items identifying training courses the person has completed. However, no
person shall be allowed to staff a vehicle licensed under this chapter while displaying any patch or
other symbol indicating a level of training he or she has not attained.
(e) No person shall be allowed to staff or operate a vehicle licensed under this chapter:
1. While under the influence of intoxicating liquor or narcotic or habit forming drugs; or
2. In a reckless manner; or
3. At excessive speed; or
4. While engaging in any illegal conduct.
(f) While in service, each Mobility Assistance Vehicle shall be staffed by at least one person
who shall meet the requirements of (a) and (b) above. A second Mobility Assistance staff member,
also meeting the same requirements, shall be required at the time the patient is loaded or unloaded, if
a patient in a wheelchair must be moved up or down five or more steps or if a patient in a wheelchair
weighs 200 or more pounds and must be moved up or down two or more steps. The second staff
member need not be present at other times.
24
1. If oxygen administration devices are not carried in the vehicle, the required staff person(s)
shall possess valid certification in:
i. Passenger Assistance Techniques issued by Transportation Management Associates, Fort
Worth, Texas, or a course which is similar in content and curriculum, developed by the licensee and
approved by the Department; and
ii. Adult CPR, issued by the American Heart Association, American National Red Cross or the
National Safety Council.
2. If oxygen administration devices are carried in the vehicle, the required staff person(s) shall
possess valid certification as an Emergency Medical Technician, issued or recognized by the
Department, in addition to the training required in (f)1i and ii above.
(g) When in-service, including any time the vehicle is used as a Mobility Assistance Vehicle,
each Transport Ambulance shall be staffed by at least two persons who shall meet the requirements of
(a) and (b) above. Staff persons of a hospital or of another agency who accompany a patient need not
meet the requirements of (a) and (b) above.
1. Each of the required staff persons shall possess current valid certification as an Emergency
Medical Technician, issued or recognized by the Department.
2. Each of the required Emergency Medical Technicians shall possess valid current
certification in cardiopulmonary resuscitation (CPR) for professional rescuers issued by the American
Heart Association, the National Safety Council or the American Red Cross.
(h) When in-service, each Emergency Ambulance vehicle shall be staffed by at least two
persons (including anytime the vehicle is used as a Mobility Assistance Vehicle) who shall meet the
requirements of (a) and (b) above. Staff persons of a hospital or of another agency who accompany a
patient need not meet the requirements of (a) and (b) above.
1. Each of the required staff persons shall possess current valid certification as an Emergency
Medical Technician, issued or recognized by the Department.
i. If the vehicle is utilized to provide Street EMS, at least one of the two required emergency
medical technicians shall be certified as an emergency medical technician-defibrillation in accordance
with N.J.A.C. 8:41A;
2. Each of the required Emergency Medical Technicians shall possess valid current
certification in cardiopulmonary resuscitation (CPR) for professional rescuers issued by the American
Heart Association, the National Safety Council or the American Red Cross.
Amended by R.1992 d.16, effective January 6, 1992.
See: 23 N.J.R. 2566(a), 24 N.J.R. 119(a).
Age, appearance and operating requirements amended.
Amended by R.1998 d.107, effective February 17, 1998.
See: 29 N.J.R. 4416(a), 30 N.J.R. 648(a).
In (a), substituted a reference to Title 39 of the Revised Statutes of New


----------



## thatSPIKYflip

In my town, we have a private volunteer EMS squad (of which I am a member) and the fire department. My squad staffs ambulances with four members at max and at least one EMT. If using a full crew, an ambulance is staffed with two EMTs and two assistants who are at least CPR/AED certified. If an ambulance is staffed with only one EMT, then we have to roll with a FD engine, then one of the FF/EMTs has to ride in the back with the assistants.


----------



## Seaglass

If we have a first responder, they're either the driver or a ridealong, and there need to be at least two EMT-Bs on the crew. We technically can have a BLS crew, but we almost always run ALS.


----------



## squrt29batt12

Here in FL, the minimum for BLS is one EMT and one First Responder. ALS on the other hand is obviously at least a PMD and an EMT, a First Responder can ride as a third though.


----------



## DrParasite

*bumping an old thread since it's slow at work on the overnight*

where I work (paid job), we run 2 paramedic medic trucks and 2 EMT BLS trucks.  I support 2 the person requirements 100% for all paid services, because otherwise, some :censored::censored::censored::censored:ty (private) or penny pinching boss would staff their ambulance with a medic/EMT and a taxi driver and pay the taxi driver peanuts to save on overall expenses.

For volunteer BLS, 1 EMT and one FA/CPR driver.  The logic behind this is that you have a harder time getting two volunteer EMTs, and you will still have an EMT treating and in the patient compartment at all times.  If you have a sick patient, you will have 2 paramedics coming as well, so you will still have an EMT treating and a paramedic treating while you go to the hospital.

want an even scarier thought?  in NJ, a volunteer EMS agency (as in one that doesn't bill for services, regardless of if the personnel are paid or not) that doesn't belong to the First Aid Council (arguably one of the most useless group of people in the state, and an optional one to belong to, but I digress) does not need a to have a single EMT on the ambulance to respond to 911 medical emergency calls.  No I don't like this, but it is definitely a scary thought.


----------



## MrBrown

"BLS" here means Technician or the old IV/Cardiac level (being phased out)
"ILS" means Paramedic
"ALS" means Intensive Care Paramedic

More and more, true "BLS" (being Technician level) is only found here in rural areas serviced by volunteers.


----------



## emt_irl

ideally we'll have atleast 2 emt's or higher  but in some cases its 1 emt/paramedic and 1 very trusted first responder who only assists really


----------



## Wax

Where I'm from its 2 medics and they handle 911 only.


----------



## fortsmithman

ffemt8978 said:


> AFA is an 8 hour course similar to industrial first aid...FR is about 80 hours and they can do spinal immobilization, administer O2, assist patient with meds, etc...



In Canada our advanced first aid course as taught by St John Ambulance is 80 hrs.
http://www.sja.ca/Alberta/Training/AdvancedFirstAid/Pages/default.aspx


----------

