# What is considered a BLS call in your area



## Jayxbird521 (Mar 14, 2008)

In my area chester county pa a accadent/entrapment, fall, stabing, or chest pains and maternity are bls i think some of them need to be als becase half the time we end up requesting the medics.


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## JPINFV (Mar 14, 2008)

Chest pains are handled as a basic first response? I think I'd need to know a little more about your area before I know how to respond to this situation.


In the area that I worked (Southern California), all 911 calls were paramedic first response.


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## KEVD18 (Mar 14, 2008)

well, i dont know about your area but in some places every call has a bls first in with medics to follow if need be. some places only have a few medic rigs to cover several counties so youd better be damned sure you need em before they get toned.

i have what some would call the benefit of working in a densly populated urban setting. most of the fire depts are als and there are a hundred privates that run als with it seems a new one starting up every week. i very rarely find myself in the situation of not having a -p truck when i need one. quite the opposite, i end up cancelling medics on calls that "sounded bad" and thus were dual dispatched.


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## JPINFV (Mar 14, 2008)

KEVD18 said:


> i have what some would call the benefit of working in a densly populated urban setting. most of the fire depts are als and there are a hundred privates that run als with it seems a new one starting up every week. i very rarely find myself in the situation of not having a -p truck when i need one. quite the opposite, i end up cancelling medics on calls that "sounded bad" and thus were dual dispatched.



I worked between the two extremes. 911 first response via "EMS based fire suppression," but there weren't any paramedics with the private companies in the county. Thus, SNF->ER calls were either 911 or BLS. Yea, lets just say that the SNFs defaulted to BLS if there were any doubts on the patient's condition.


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## KEVD18 (Mar 14, 2008)

JPINFV said:


> Yea, lets just say that the SNFs defaulted to BLS if there were any doubts on the patient's condition.



well yeah, i mean its cheaper right? 

in my area, every nursing home is required to have a transport contact with a private service. its supposed to be just for routine txp but, well, some people are stupid. some nurses think that they are supposed to call their contract provider for EVERYTHING. ive seen my dispatcher have to call the local fd for arrests they called us for. us being a company whos base is 40 minutes away. ive also been present for the phone call for the pt complaining of diff breathing. so my dispatcher asks all the assesment questions to ascertain the level of difficulty. when he figures out the pt is really in trouble and says ok well we cant help you but ill call the local rescue, the story suddenly changes and the pt gets better. they dont want a box assignment showing up and causing a ruckus. they just want an ambulance. 

oh stupid people....


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## fma08 (Mar 14, 2008)

pretty much anything where and IV isnt place, the monitor isn't put on, or a med, other than O2, isn't given... so that leaves pretty much psychs, domestics, and b.s. calls


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## mikie (Mar 14, 2008)

Jayxbird521 said:


> In my area chester county pa a accadent/entrapment, fall, stabing, or chest pains and maternity are *bls *i



I know an EMTB can handle all of those emergencies, but I would feel more comfortable if, in addition to the basic, someone else was on the rig, such as an I or P.  Like I said, BLS providers can indeed treat those patients, but often I think ALS should be needed (ESPECIALLY depending on the longer response time.  Few minute transport? not as much). Not saying this about your particular area, there is *only* so much a BLS crew can do with a cardiac arrest, for example, before ACLS is needed.  

***I am NOT at all saying Basics can't do anything; I completely disagree with that, but we can argue this in a different thread (I think there is one already out there) if need be***


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## KEVD18 (Mar 14, 2008)

mikie333 said:


> I know an EMTB can handle all of those emergencies,



**please dont intrepret the following as bls bashing. im a bls provider so it really wouldnt be logical to bash myself**

define handle? are we able to reduce preload and afterload, reduce myocardial oxygen demand, treat hypotension, complete the thrombolytic checklist, examine the electrical conduction of the heart so as to accuratley prepare the er, draw labs so as to reduce the door to drug time etc et al.

sure, we can control bleeding, asa and nitro(either prescribed or unit supplied), stabalize c-spine. we can even deliver a baby(assuming nothing goes wrong right). but real treatment isnt in our scope. medics can really treat the problems, maybe not definatively but certaintly better than we can. remember, high flow diesel really isnt treatment, its what you do when you cant treat or treatment fails.

as a side note, i know some places have basics that can start lines and what not. this was written as a generalization


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## Ops Paramedic (Mar 15, 2008)

It appears from reading all the posts, that there are different call out criterias for the different areas with regards to the level of care which is dispatched.  I would think these call out criterias are used to manage the resources available for a certain area.  

I work for a private service, yet have very good relationships (Personal) with the ALS from the the other private and government services, and we help each other out a lot, should the the one be busy.  What I am trying to say is that at the end of the day we all have one common goal: The patient, no matter the level of care.  

To answers your original post, although we have call out criteria, i don't follow them (My bad) strictly.  Our BLS are dispatched to any call, and then back up will follow as soon as it is available (if not already dispatched).  I don't think that ALS is only there for patient management, there are many other things for them to do, such as, quality control, training, scene safety and extra hands even for a green code.  It would however also largly depend on the resources available, prior to dispatching on every call.   

It is sad to see that: "you better be sure you need them before you tone them" it is an attitude that is not only witnessed on this side.  It should not the end of the world if an ALS gets cancelled, but rather a case of would the ALS have been needed, he/she would have been there halfway already!!

Just to shed some light...


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## mikie (Mar 15, 2008)

KEVD18 said:


> define handle?



I guess not loosely enough you: we can treat them as we are trained to do in the situation until higher care (ie hospital) is available.


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## MedicPrincess (Mar 15, 2008)

All of the rigs for my service are staffed P/B, so all of our calls start out ALS.  After the Medics assessment, the patient can be determined BLS.  So long as the patient as stable vitals, does not require cardiac monitoring, IV access, or medications the patient can be BLS'd.


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## emtwacker710 (Mar 15, 2008)

hmm..in my lovely area (Warren County, NY) anytime there is chest pain, diff. breathing, serious trauma, sometimes head injuries if there is another problem..those all go out as ALS, I'm probably forgetting some but that all I can think of off the top of my head after a sleepless night of calls..also rectal bleeds go out as ALS here...I believe because 99.9% of the time an IV is started to replenish lost fluids so they just tone it as ALS


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## Ridryder911 (Mar 15, 2008)

There is no BLS or ALS, rather emergency or not. If they are emergency, then they should be considered to need a Paramedic. Period. 

If it is regarded as an emergency then why would you want to send a so called BLS unit only? Sounds like a litigation in the making... 

R/r 911


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## skyemt (Mar 15, 2008)

we have no BLS or ALS...

all calls are answered by the highest available provider... if ALS care is not needed, transfer of care to BLS crew will happen.

if ALS is not available (rural area), then BLS will do the best they can, and request ALS mutual aid...

but... there is no such thing a "BLS or ALS" call...

the way atypcial presentations work for a variety of ailments, as well as pain management considerations, i just don't see how you could qualify most of those calls as "BLS" before seeing the patient anyway.


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## Ridryder911 (Mar 15, 2008)

Exactly, one cannot really determine a call before responding. The routine "fall" many times turns out to be that they "fell" dead. The back pain can turn out to be a AAA. Even without advanced assessment skills, someone can misdiagnose or wrongfully make a determination. 


R/r911


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## skyemt (Mar 15, 2008)

Ridryder911 said:


> Exactly, one cannot really determine a call before responding. The routine "fall" many times turns out to be that they "fell" dead. The back pain can turn out to be a AAA. Even without advanced assessment skills, someone can misdiagnose or wrongfully make a determination.
> 
> 
> R/r911



to add, what is very common here, is a call for an elderly person "fall"... sounds innocent enough...until you get there and find out he fell due to syncopizing, secondary to a cardiac event unfolding...

so much for the BLS  "fall" call...


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## BossyCow (Mar 15, 2008)

ALS is not always available to us. It is provided as a mutual aid on an 'as needed basis'. Our protocols state clearly which incidents require us to call for ALS support. But those calls do not always get a medic and sometimes we just have to go like heck and hope we make it. 

We must call for ALS support if... unconscious pt, respiratory distress, multi-system trauma, diabetic emerg, cardiac,.  We transport the tourist fell down go boom calls, the faintings, the puking stomach flu, MVAs (unless multi system trauma) 

I have transported several of each of the 'must call ALS' examples in my BLS rig just because I didn't have a medic available.


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## skyemt (Mar 15, 2008)

BossyCow said:


> ALS is not always available to us. It is provided as a mutual aid on an 'as needed basis'. Our protocols state clearly which incidents require us to call for ALS support. But those calls do not always get a medic and sometimes we just have to go like heck and hope we make it.
> 
> We must call for ALS support if... unconscious pt, respiratory distress, multi-system trauma, diabetic emerg, cardiac,.  We transport the tourist fell down go boom calls, the faintings, the puking stomach flu, MVAs (unless multi system trauma)
> 
> I have transported several of each of the 'must call ALS' examples in my BLS rig just because I didn't have a medic available.



i have transported these cases as well, when ALS was not available...
HOWEVER, regarding this thread, that did not make them "BLS" calls.
i wouldn't want your comments to be misunderstood.


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## MikeRi24 (Mar 15, 2008)

we have 4 types of rigs we roll: BLS rig (2 basics), ILS rig (1 basic, 1 intermediate), ALS rig (either 1 basic or 1 intermediate and 1 medic), and Medic fly-cars (Tahoe with ALS supplies and a medic). we mostly use the BLS rigs for privates and, well, "Basic" calls. the majority of the 911 calls we get we will send ALS to. Our Basic rigs do handle a lot of 911 calls, and in a sense, if we get a call for someone thats coding and all we have available at the time is a BLS rig, then guess what the BLS rig is going, happens all the time. it pretty much depends on who is in the area at the time and so on.

I just now got transfered out to a more rural area, but when I worked in the city, theres enough hospitals in Buffalo that you can pretty much get to one within 5-10 min taking your time. If a basic rig goes on a call that should really be ALS, 9 times out of 10, the amount of time it would take to get an ALS rig there is more than if we just loaded and went to the hospital, which is what we do. why stay on scene for 10 minutes waiting for an ALS car to come screaming across town then have the medic do thier thing and then have transport time on top of all that when we would have the pt in the ED in 8 minutes? thats really how we make a lot of our decisions like this, if by the time ALS gets here we can have the pt in the ED's care then why bother waiting?

EDIT: skyemt, i agree with a lot of stuff you say, and I see you're in NY, where abouts?


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## Outbac1 (Mar 15, 2008)

Here it is the closest available unit to a 911 call that is sent regardless of how the truck is staffed. If two rigs are parked at a base then the ACP truck will get the call. Most urban areas have almost enough ACPs (Advanced Care Paramedic = EMT-P), to have one per truck for every shift. The balance are ICPs and occasionally PCP. Many rural trucks have only PCPs. Unless the call really sounds bad the ACP won't roll unless called for. Transfers are generally dropped on crews the other way around. 

 As an aside most Canadian PCPs have a much wider scope of practice than US Basics.


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## JPINFV (Mar 16, 2008)

Outbac1 said:


> As an aside most Canadian PCPs have a much wider scope of practice than US Basics.


For the sake of people who haven't heard about Canadian EMS levels (I have on another board), how much class time do your PCPs have? B) EMT-Bs are more like your guy's EMRs.


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## ResTech (Mar 16, 2008)

The initial post in this thread is incorrect. Being a Pennsylvania EMS provider myself, I know what the state-wide protocols say and stabbings and chest pain are ALS in PA! 

In most counties of PA and most EMS systems nation-wide, our dispatch center uses a tried and trusted system called Priority Medical Dispatch or EMD. Essentially its a system that interrogates callers and triages over the phone and assigns a response class of Class 1 (ALS/BLS emergency), Class 2 (BLS emergency only), and Class 3 response which is BLS non-emergency. This system is designed to add efficiency to an EMS system by greater resource allocation and to add an additional mechanism of safety for EMS responses. There is no need for a lights and sirens response or ALS unit for a finger fx, minor lac, etc. 

This tried and trusted, national standard system of Priority Dispatch is what protects against litigation when not sending an ALS unit on every call. It is also an element of risk management by reducing the number of lights and siren responses. 

So basicly, ALS IS NOT needed on every call. The Priority Dispatch system errs on the side of caution and I end up canceling ALS probably more times then not. In a perfect world every ambulance would be staffed by two paramedics... but thats not feasible in the majority of systems nor is it absolutely necessary. 

Show me some data that says patients treated in an all ALS system have better clinical outcomes then two-tiered systems of primary BLS and ALS from a hospital. Show me data that says BLS cannot safely and effectively assess a patient and make a determination if ALS is indicated or not. 

There are a 1,001 "what if's" we can play and if we want to play that game then why not have PA's and physicians staff an ambulance... then paramedics and nurses can just drive. We proceed pre-hospital with the information we get from the time the call comes in. If granny calls and says she has been having back pain for a week, should we all get excited and put the surgeon on stand-by cause it might be a AAA? That's crazy. You don't do that. 

If BLS get's there and presentation dictates something more severe, call for ALS, expedite transport, and thats it. Besides whats ALS gonna do for a AAA anyway? Make them bleed out faster by over zealous fluid administration?

This post got a little long I know but some of this "para-God complex" stuff really annoys me at times. It's EMS! our job is to stabilize and deliver patients alive to definitive care in the hospital... not play doctors out in the field!


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## reaper (Mar 16, 2008)

According to you, we should just drive yellow taxis!! I will stick to medicine.


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## ResTech (Mar 16, 2008)

Reaper, if ur referring to my post I really don't see how you can derive that from anything I posted.


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## reaper (Mar 16, 2008)

ResTech said:


> This post got a little long I know but some of this "para-God complex" stuff really annoys me at times. It's EMS! our job is to stabilize and deliver patients alive to definitive care in the hospital... not play doctors out in the field!



This is why!

 I do not play doctor, I treat my pt. Treatment in the field is Medicine. Stabilizing and transporting to the hospital is BLS care. ALS care is there to treat the pt's, then transport for evaluation. 

Most hospitals today have a wait time, till the DR. can evaluate the pt. Does this mean that the pt should be in pain or distress the entire time? No. If I can treat the problem in the field, the pt is already getting the care they need.

Sorry, but a BLS unit cannot evaluate a cardiac pt or for that matter, a trauma pt and determine that ALS is not needed. Basics are just not taught how to do it. Yes, it would be nice if they were, but for right now they are not.

We don't have Paragod complexes, we have Paramedic complexes. The pt's best welfare is paramount in our decisions, not whether we hurts the basics feelings.

This thread was not a ALS vs BLS bashing post, but if you want to bring out the Paragod phrase, then it will turn into that.:unsure:


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## Ridryder911 (Mar 16, 2008)

ResTech said:


> If BLS get's there and presentation dictates something more severe, call for ALS, expedite transport, and thats it. Besides whats ALS gonna do for a AAA anyway? Make them bleed out faster by over zealous fluid administration?



Wow! Thank you for proving my point of ignorance. If you cannot determine the difference of a AAA and general back pain after assessing, something is wrong. As well, dispatch is not the "end all" of medical clearance. 

I guess regulating blood pressure to prevent AAA from rupturing, is something you would not understand? Who in the h*ell, pushes fluids on a AAA? Go back to school!

As well, there are many documented problems with the "old and tried" priority dispatch system. Would you like to review the litigation's of that system? Yes, there has to be a system in place, but it is NOT without flaws. Sure there are non emergency calls, alike there are non emergency injuries and illness that arrive to ED, but guess what each one has to be evaluated by a person that can provide advanced care and be assessed to determine that there is not a life threatening event. 

Sorry, a person with 150 hour course is not qualified to make the determination and definitely not reading Clawson's dispatch program eleminates these errors. 

I don't play doctor, but I suggest you awake to 2008 and look around and look at over crowded ER's, and no hospital rooms. If you do not think that our role is not about to change, then continue to keep your head in the sand. 

Field termination of codes, treating and releasing, etc. is now becoming an everyday event. The Paramedic Practitioner is not a "dream" rather a needed reality not just because the system needs it rather it but also an economical  outlet that insurance corporations sees as feasible too. 

If you think this is B.S., then I refer you to the CEO of NREMT, Bill Brown and his statements at the Eagles Conference and articles in JEMS, EMS, etc. 

R/r 911


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## ResTech (Mar 16, 2008)

Certainly I am not against ALS... I wish all systems could be ALS but like I previously stated, that's not always feasible. I do believe my post was taken slightly out of context. ALS is medicine... but too many times ALS stay's and ****s around way to long to try and be impressive when if they would just transport the patient to the hospital the patient would be getting exactly what they need and want. Medic's are so afraid of walking into the ED and catching sh*t for not being able to get an IV so they will take 20mins and try 5 times when they could just transport and have the pt there in under 10mins. 

May I point out the study done in Los Angeles some years ago that showed patients who arrived at the hospital POV had a clinically significant better outcome then those patients that arrived by a paramedic unit. This better outcome was attributed to patients transported POV were taken direct to the hospital and didn't experience the delay of 911, dispatch, response, scene assessment & tx, and then transport. 

That's not all to negate the benefits of ALS... for example treating CHF, COPD, DM, MI, etc. that ALS can make a huge difference in during the tertiary phase of their care. ALS IS NEEDED MAKE NO MISTAKE. However, you guy's must have no clue what good BLS providers are. You state BLS cannot make a determination if ALS is needed or not.. thats just bullsh*it... I do it and my peers do it all the time.... under a state-wide protocol! The medics here are totally cool with it.. they know we are more then able to assess. You guys must have never had the privilege of working with great BLS people. EMS is an art... you guys think EMT's stop learning after a 150hr initial training course?  The amount of hours spent in a classroom outside the initial course combined with many, many years of clinical experience adds up to a hell of a lot more then 150hrs!



> Sorry, but a BLS unit cannot evaluate a cardiac pt or for that matter, a trauma pt and determine that ALS is not needed


Why is this so hard? You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion? An EMT can't assess a trauma patient and know if they will need ALS? This to me is elementary. Its not all that difficult to know if a trauma patient is effed up enough or suffered an event that warrants ALS. Your statement is quite the insult to every BLS provider on this forum.



> I guess regulating blood pressure to prevent AAA from rupturing, is something you would not understand? Who in the h*ell, pushes fluids on a AAA? Go back to school!


No, I understand about regulating B/P... but when the patient has none to regulate that becomes kinda hard don't ya think? and medics are hard pressed to push fluids for hypotension when they aren't 100% sure of the cause. 

I respect (however strongly disagree) your opinions and views from your own experience but from my experience (both ALS and BLS) hopefully you can learn from something that is done on an everyday basis in an EMS system outside of your own.   

I'm all for the progressing of EMS... especially research based EMS where modalities are not done under the premise of "well, it appears to work" with no scientific data to support why we are doing it. I'm also in strong favor of the National EMS Scope of Practice and the EMS Education Agenda For The Future that advocates the need for an "Advanced EMT" that pushes meds such as NTG, albuterol, Narcan, D50, Epi, and ASA. 

By the way, I have a subscription to JEMS and EMS Magazine and read the articles every month. Playboy is the only one where I only look at the pictures 

And for the original topic of what constitutes ALS... here is the link to the Pennsylvania State-Wide BLS Protocols in PDF format... Protocol 210

http://www.dsf.health.state.pa.us/health/lib/health/ems/bls_protocols_2004.pdf


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## Jon (Mar 16, 2008)

ResTech said:


> Quote:
> Sorry, but a BLS unit cannot evaluate a cardiac pt or for that matter, a trauma pt and determine that ALS is not needed
> Why is this so hard? You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion? An EMT can't assess a trauma patient and know if they will need ALS? This to me is elementary. Its not all that difficult to know if a trauma patient is effed up enough or suffered an event that warrants ALS. Your statement is quite the insult to every BLS provider on this forum.




I've got to side with Rid on the cardiac side... to rule out cardiac chest pain, you really need a 12 lead... and that isn't even always accurate. ANY chest pain patient is ALS until proven otherwise.

As for trauma... I often do make a decision to recall the medic. If the patient is CAOx4 with no loss of consciousness, dizziness or near-syncope, has a "decent" systolic blood pressure and pulse, along with clear lung sounds, equal chest expansion with no pain on inspiration, no resp. difficulty, no chest pain, no abdominal pain, and no severe bleeding or long-bone fractures... they are a candidate for BLS transport. If a patient has problems with any of these things... they are probably ALS.

 By the way, the above, as well as nausea/vomiting and headache are my list of pertinent negatives I document for most calls.

Rid... how many patients would pass those assessment criteria and still need urgent ALS intervention?




> By the way, I have a subscription to JEMS and EMS Magazine and read the articles every month. Playboy is the only one where I only look at the pictures


Nice. I'm even better... I've managed to get FREE subscriptions to both magazines... Unfortunately, I don't think Hugh Hefner gives out free copies to students/educators


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## skyemt (Mar 16, 2008)

ResTech,

what to do? as Jon pointed out, it is fairly common knowledge (should be anyway) that a 12 lead is needed in suspected cardiac cases... BLS? can't do it, right? 

i don't want to be accused of "bashing basics", because i am not.. in fact i am a basic... but these posts make me cringe, because they show a real lack of scope of knowledge, while at the same time belittling ALS treatments, and we all know where the post will go from there.

as someone who is trying to make more posts about A/P, so that basics may actually learn something,  posts like these come along and start the whole ridiculous argument of BLS vs ALS...

costs, time, and other factors aside... from the view point of patient care, if every Basic was asked if they could have the ALS skills, would they want them... it would be 100% yes... so what's the debate?

yes, yes, i know it's not feasible in all areas... Bossy is rural, i am rural, i am well aware of these factors...

but the bottom line then, is that patients are not getting a "high" level of patient care with a BLS crew... if patients sometimes knew the level of care they were really getting BLS, they might be more afraid!  We are providing a limited scope of care... do i think it is "first aid", personally no. Do i think it is anywhere near the stratosphere of ALS? also, no.  Just pick up a Paramedic text and read for yourself...

as for just "scooping and running", which pops up all the time... many of us have long transport times, not 5 min to the hospital... i sure hope to he** emt's can do more than that...

again, i can't stress enough... i am not bashing basics... but the level is inadequate to properly assess and treat many, many ailments out there...
just because most of the patients won't code on the way to the hospital doesn't mean the Basic level is adequate.


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## skyemt (Mar 16, 2008)

i guess, you can also look at it like this:

if you go down the list of Meds and skills that medics can administer and perform, you will clearly see the power to save lives... 

however, nothing comes for free... with that power comes the risk of killing someone if skills and meds are not used correctly.

now, basics are not given the ability to take those risks... logical reason would say that it then becomes a stretch to say that they have the ability to "save" lives...

sorry, but it's pretty cut and dried for me...

ironically, the biggest risk to the patient from a basic, in my humble opinion, is indecision, inadequate knowledge, and poor assessment skills.

however, these are the skills that i see least improved by basics, citing things like "it doesn't really matter", "we just stabilize and transport", etc.

something is not equating for me here...


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## ResTech (Mar 16, 2008)

Who is saying cancel ALS on cardiac patients? Who said a 12-lead isn't needed for a suspected cardiac pt?  I am saying that EMT's are able to make a patient determination of ALS or BLS. I've been doing it for the past 12yrs. And I am saying that EMT's are more then drivers and equipment gophers which is to the contrary of what Rid and Reaper like to think. That is all I am saying. 

I have a perfect realization of scope for BLS and ALS. It is a large part of this as to why I am able to make an accurate patient determination of BLS or ALS. And no, I am not belittling ALS modalities. I am defending the BLS level of care from both a BLS and ALS perspective and am trying to give it the credit it is due. We all know the jokes of BLS and some of the loser EMT's in every organization. But that should not detract from the majority of well rounded BLS providers and what they are able to do. That is all I am saying. Its not about BLS vs ALS at all. Its about integration and realizing the potential of both and not dismissing one or the other. Some things I stated are simply to try and make a point and aren't literally what I believe.     

I know I can assess a patient and know if they need ALS or not... a skill every BLS provider should possess.


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## ResTech (Mar 16, 2008)

> however, nothing comes for free... with that power comes the risk of killing someone if skills and meds are not used correctly.



Kinda like what Peter Parker said, "With great power comes great responsibility." This is my gift, my curse. Who am I? I'm Spider-man (aka a Paramedic).


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## MEDIC213 (Mar 16, 2008)

In my service, everything is ALS until proven otherwise.


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## skyemt (Mar 16, 2008)

ResTech said:


> I know I can assess a patient and know if they need ALS or not... a skill every BLS provider should possess.



so, in the world of atypical presentations, if you have a female patient who doesn't "feel well"... would that be ALS?

if it is, then aren't most of your calls ALS?

how do you rule out potential cardiac for ALS, when there are so many different presentations?

if you don't rule them out, you should be calling for ALS on most medical calls, no?

there is quite a bit of arrogance in your statement, but not much medicine. sorry.

if you have a list of 911 medical conditions that wouldn't prompt you to call ALS, it must be a very short list.


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## 3-Adam-28 (Mar 16, 2008)

We are a smaller area so we have a county wide based ambulance service that has both BLS and ALS.  We utilize volunteers in the cities for our BLS service and then we have ALS paramedics staffed in the middle of the county at our local hospital.  If dispatch determines that it is an emergency call, we run a dual response.  The nearest BLS service will get toned along with ALS.  BLS is generally closer to the call so they can get there faster and get a patient report out before ALS arrives.  If BLS determines that ALS isn't needed they call into medical control give the patient report and medical control decides if ALS is needed or not.  If they get the ok then ALS reports back to base and BLS does the transfer.  What's really nice about this is that we can get a BLS unit to the patient, have then packaged and loaded and then ALS jumps in the rig and away we go.  For a smaller county, it works great and really cuts down on wasted time.


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## Outbac1 (Mar 16, 2008)

JPINFV In answer to your post. 

 When I took my PCP in 2001 the National Occupational Competincy Profile (NOCP), had just come out, so my course was one of the first. I did about 850 hours of class and lab time followed by about 100 hrs of in hospital clinical time. This was followed by 260 hrs of preceptored time on an ambulance. I believe total time was 1200 hours. I know the field time has gone up to 504 hours(42 x 12hrs). The program takes about ten months to complete. 

 Many  community colleges and dedicated schools across the country offer it. Of course every place has its own take on how to instruct it and there are variations in content and time. However all programs have to adhere to the "National Occupational Competency Profile"  As put out by the Paramedic association of Canada. If a school wants Canadian Medical Association (CMA) approval they also have to meent stringent standards as to how they deliver the program.  The NOCPs can be found at 
http://www.paramedic.ca/Content.aspx?ContentID=4&ContentTypeID=2
At this site it lists the competencies for the different levels in Nova Scotia
http://www.gov.ns.ca/ehs/paramedics.htm
 Each province and medical director can allow variations in the NOCP. Eg: PCPs in NS routinely do 12 lead ECGs but not Iv's. PCPs in BC do Iv's. ACPs in AB do RSI's but we don't do them here. There is always discussion as to what we want to do and in some cases are already trained to do, but the Drs won't let us. In that aspect it is no different than any where else. 
 The PCP level is a good first level, not perfect and there is room for improvment. But it is a good place to start. 

  In an ideal world I suppose we could have Dr's and Rn's on every unit able to do emergency surgery on the spot. But I don't think it would be very practical seeing as we don't have enough for the hospitals as it is. Until then we will have to make do with something else. We all need the best trained and educated people we can get for our prehospital care. We should not accept having our sights set too low. For that is all we will achieve. Your basic is not enough. If we can do better you certainly can. And for the record I don't think PCP is enough. I believe it needs more education and skills to properly handle the cases we get. That will mean better assessments and less duplication. The more correct Dx we do potentialy the less work for the Dr. and faster Tx for the Pt. the faster the Pt is out of there. There will be more Dx and Tx out of hospital.

  I see the changes coming and I want to be part of it. We currently have nurse practioners that Dx and write prescriptions. There is a shortage of Drs for rural hospitals so they hire a paramedic to cover for emergencies. The day is not far away when they will have both a Rn praticioner and a Paramedic to run the small ERs. It will be business as usual with no Dr. The major emergencies will be shipped off to a larger Hosp. as they are now and the other stuff will be dealt with. The times as they say, are a changing. You can change and move with it or watch it go by. 

  Your basic level got your foot in the door of EMS. You've seen what it can be. If you want that for yourself you need to do it full time and make it your profession. If you educate the public to what they have and could have. They won't settle for basic service, they will demand better. With that you will have more pay, benefits, working conditions and respect. You will be a professional in a profession.

 I've been watching the fireworks between the "Medics" and "Basics" and both sides have points to their arguments. I'm not knocking volunteers either. There is a place for them. I just don't think it should be the primary response unit for anyone. 

 My service is not perfect, we have our problems. However we moved on from where we were 10 - 12 years ago and we are still moving and improving. 

 There, I had to get my two cents in.


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## JPINFV (Mar 16, 2008)

Outbac1 said:


> JPINFV In answer to your post.
> 
> When I took my PCP in 2001 the National Occupational Competincy Profile (NOCP), had just come out, so my course was one of the first. I did about 850 hours of class and lab time followed by about 100 hrs of in hospital clinical time. This was followed by 260 hrs of preceptored time on an ambulance. I believe total time was 1200 hours. I know the field time has gone up to 504 hours(42 x 12hrs). The program takes about ten months to complete.



I just wanted to make sure that you understand that you're comparing 1310 hours (class+lab+hospital+ambulance) to 110 hours (total) is kinda of bias. I'd like to hope that PCPs can do a fair amount more than a US EMT-B.


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## 3-Adam-28 (Mar 16, 2008)

Yea......thats definitely a huge difference.....


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## Outbac1 (Mar 16, 2008)

JPINFV
 Yes I know. I didn't when I first started coming to this forum. I was quite surprised at some of the questions I was seeing until I figured out what a "Basic" was.  It kinda puts me in the middle somewhere. At least until next year when I finish my ACP course. I was really quite surprised at the whole EMS setup the USA has.  I thought it was much more advanced than it is and that we were the ones trying to catch up. 

 Having said that I know not all areas are the same. It is just a general impression that I get.


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## Ridryder911 (Mar 17, 2008)

Outbac1 said:


> JPINFV
> I was really quite surprised at the whole EMS setup the USA has.  I thought it was much more advanced than it is and that we were the ones trying to catch up.
> 
> Having said that I know not all areas are the same. It is just a general impression that I get.




Yes, we started a good start but dropped the ball back in the 70's & 80's and have not went any further. Unfortunately, we will not observe and attempt to even come up to standards of other countries. 

Our system is so fragmented and poorly represented. As well, unfortunately many systems are represented by those that attended the first part of the EMS education portion (200 clock hours or less) then acclaim to be an "expert". Again in comparison a nurse aide or certified medication aide and acclaim to represent nursing, it would be considered ludicrous. Unfortunately our citizens are gullible and misinformed think that there is little difference or unaware there is so much difference between Basic EMT and a Paramedic, in reality there is very little in common if any at all. 

I agree we need to proceed with more education and increase each of our levels. I agree as well, the Basic level should be a minumum of one year in length. 

R/r 911


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## Outbac1 (Mar 17, 2008)

Rid
 I believe in another post you said you were working with some "lawmakers??", that is good as its the only way to make changes. Unfortunatly it will take many more than just you to make a change. 50 states and 300,000,000 + people is a lot to change. Even if you could get one state to come up with a new minimum standard it would be huge. The politicians tend to move slow without some motivation, (votes). If you could educate the people as to the difference between what they have vs could have. They may scream loud enough to provide some motavation. 

 Whether health care is paid for by Government or privately, (through insurance or the hip pocket), it isn't cheap. If people want good accessible health care, they are going to have to pay. One way or the other. 

  I know its been in the news about US politicians looking at the Canadian health care model. Don't copy what we have. Try to do better. Our system is good in many ways, but definately not perfect. Go ahead and copy the good stuff, you've got my permission , just change the bad to something better.

 PS   Try to have it done before I semi retire to a warm place with a great beach.


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## Ridryder911 (Mar 17, 2008)

Part of the problem is that each state is allowed to develop their standards  under the minimal guidelines of NHTSA. Most states barely will exceed any further. I do work on State as well on the National level but ironically; it appears that we agree on more national level than on state individual levels. 
More emotional and territorial boundaries are made, as even witnessed on this small forum site. 

I agree and realize Canada has their problems, they did have the foresight to change things a few years ago we did not. You were able to replace training with educational standards, something we are still attempting at. Slowly but surely. As well, although you have volunteer systems the resistance of increasing in education does not appear to be challenged as much. This even goes up the chain of levels as well. 

Hopefully, before either another medical division begins to start to perform EMS role, we can develop a better working plan. 

R/r 911


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## firecoins (Mar 17, 2008)

All calls are BLS.  All calls are ALS.  Hopefully both show up.


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## paramedix (Mar 18, 2008)

I dont really know what setup you guys have over there. Here we have an ILS and BLS on one vehicle and our ALS respond on the PRV. We seldom have the ALS on the ambulance.

So basically any call attended will have an BLS and ILS on scene, depends on the service responding to the scene. 

As previously mentioned in the thread, any call is a BLS call and any call is an ALS call. It all depends on the situation at hand. You can get a serious MVA or a minor MVA. You can get a chest pain that requires BLS treatment and you can get a chest pain that requires ILS or ALS intervention.

It all start with the basic treatment rendered as soon as possible. If you have to end up calling for ALS backup or intervention, it doesn't mean you dont know what to do for your patient, it merely means that you have exhausted your trained expertise. (Unless you omit your protocol)


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## skyemt (Mar 18, 2008)

I still can't get my hands around this "BLS or ALS" call...

there is NO SUCH THING!!!
it is either ALS available, or ALS not available...

If available, and not needed, care is transfered to a BLS crew...

it is a top down approach, best for the patient... the highest trained (read ALS) makes the call...

you guys talk about it totally backwards... assuming BLS unless BLS determines that it is an ALS call...

Bascially, you would have the most important decisions made by the least qualified... 

sorry, but that is just totally the wrong way to look at it.


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## firecoins (Mar 18, 2008)

I, as a BLS provider, cancel medics all the time.  The patient is always stable, never had loc or sob and usually is just needing transport to the hospital.  More often than not ALS triages the same types of patients down to me if they are on scene first.  I am a medic student. So I want calls to go ALS both for the patient and my personal learning so I am inclined not to cancel medics.


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## triemal04 (Mar 18, 2008)

All posted by ResTech:


> Who is saying cancel ALS on cardiac patients?


Apparently you are given the next quote:


> You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion?


That is correct sir, you can't.  Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.


> You state BLS cannot make a determination if ALS is needed or not.. thats just bullsh*it... I do it and my peers do it all the time.... under a state-wide protocol!


Ahh, good old cookbook medicine.  Great stuff.  Except for when it kills people.  Then it's prett sh!tty.

Just some highlights.


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## skyemt (Mar 18, 2008)

firecoins said:


> I, as a BLS provider, cancel medics all the time.  The patient is always stable, never had loc or sob and usually is just needing transport to the hospital.  More often than not ALS triages the same types of patients down to me if they are on scene first.  I am a medic student. So I want calls to go ALS both for the patient and my personal learning so I am inclined not to cancel medics.



yes, well we don't do "transports", we are 911 only...
and, for the percentage of patients, even with ankle sprains and fractures that are very painful, would we cancel ALS? if you ask the medic's out here, they would say foolish... most of the medical calls usually need something ruled out... 

of course, there will be some calls where ALS is not needed... i know that...

but a "top down approach" makes much more sense for the patient than a "bottom up" approach...

also, as you are a medic student, perhaps you should take a broader  look at who will be canceling most of the ALS... not medic students, but basics with the 100 hour class that everyone talks about...


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## JPINFV (Mar 18, 2008)

skyemt said:


> yes, well we don't do "transports", we are 911 only...


I think you're reading a little too much into his post. Even 911 units transport patients, how else do they get to the ER?


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## skyemt (Mar 18, 2008)

JPINFV said:


> I think you're reading a little too much into his post. Even 911 units transport patients, how else do they get to the ER?



ok, mr smart aleck...

however, there are many on this site who differentiate 911 from "transports", apparently of the inter-facility type..

all i did was say what we do...

too much time on your hands, i guess?


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## Jayxbird521 (Mar 18, 2008)

Ha Ridryder u define what a paramedic is ha do you know how many medics it takes to screw in a lightbulb??


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## JPINFV (Mar 18, 2008)

skyemt said:


> ok, mr smart aleck...
> 
> however, there are many on this site who differentiate 911 from "transports", apparently of the inter-facility type..
> 
> ...



Meh, it is spring break right now.

What I was getting at was that I didn't take his post to mean that he was working IFT, but simply that the patient on that call didn't require any treatment outside of a ride to the hospital. I'd also argue that a lot of interfacility EMT-Bs would put a lot of 911 EMT-Bs to shame when it comes to medical patients.


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## MMiz (Mar 18, 2008)

Lets remember to keep this thread on topic and to follow the community guidelines.  Lastly, if you don't have anything nice or constructive to say, don't say it!


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## firecoins (Mar 18, 2008)

skyemt said:


> yes, well we don't do "transports", we are 911 only...


How do you get people from the scene of a 911 call to the hospital? You transport them.  They don't magically appear in the ER unless YOU transport. 

i only take 911 calls. If a patient has a minor problem, they don't need ALS and I transport them to the hospital


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## Keith (Mar 21, 2008)

I skimmed through quick, but figured I would throw in my 2 cents. I work in and around Worcester MA, and since I know MA is technically seperated in specific regions for protocols, I can only vouch for what happens here. First and foremost, I work for a "private" company, and if there is any way they can get away with "making" a call ALS, they will, its all about the money. Unless otherwise requested, most emergency calls will be sent ALS, but we get a lot of MD offices that ask for BLS and such. If ALS isn't there, BLS will obviously go, so I guess it depends on the circumstances. I realise this didn't explain anything, haha... ok... chest pain, labor, SOB, significant MOI -> ALS, trauma, cva, weakness, general calls -> BLS. This makes sence in my head, sorry if its retarded, its been a long day for respiratory diseases, and we're cutting up pig hearts tomorrow, hooray! haha.


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## skyemt (Mar 21, 2008)

firecoins said:


> How do you get people from the scene of a 911 call to the hospital? You transport them.  They don't magically appear in the ER unless YOU transport.
> 
> i only take 911 calls. If a patient has a minor problem, they don't need ALS and I transport them to the hospital



well, you only took one sentence from my post and took it out of context...
no, they don't "magically appear" in the ER...

however, in my next post, which you failed to quote, i explained exactly what i meant by that.
feel free to go back and read it.


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## skyemt (Mar 21, 2008)

Keith said:


> I skimmed through quick, but figured I would throw in my 2 cents. I work in and around Worcester MA, and since I know MA is technically seperated in specific regions for protocols, I can only vouch for what happens here. First and foremost, I work for a "private" company, and if there is any way they can get away with "making" a call ALS, they will, its all about the money. Unless otherwise requested, most emergency calls will be sent ALS, but we get a lot of MD offices that ask for BLS and such. If ALS isn't there, BLS will obviously go, so I guess it depends on the circumstances. I realise this didn't explain anything, haha... ok... chest pain, labor, SOB, significant MOI -> ALS, trauma, cva, weakness, general calls -> BLS. This makes sence in my head, sorry if its retarded, its been a long day for respiratory diseases, and we're cutting up pig hearts tomorrow, hooray! haha.



among the elderly, weakness may be the only symptom of an MI...
yet you list that and strokes as BLS calls??

sorry, makes no sense.


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## Ridryder911 (Mar 21, 2008)

Now, I hope many will see the problems and the need of ALS on all emergency EMS units. 

OB calls and no assessment of fundal height, treatment of complications of high risk type patients. 

BLS on CVA's? A differentiation and advanced assessment should be made to tell the difference between a subarachnoid bleed and an occlusion HAS to be made ASAP! The difference is between fibro therapy and not. Time is the essence (< 3 hrs. of onset of s/s). 

Can a basic perform such differential diagnosis? Even Paramedics should attend and be certified in Advanced Stoke Life Support (ASLS). There is prescribed treatment and detailed neurological examinations that can be made to determine the location, degree of the stroke. Very important information to be notified to the ER and Stroke Team. 

Wow! More & more, I learn about how poorly our EMS Systems across the nations are, no wonder our mortality and death rate is high in comparison to other countries with aggressive EMS systems. Really it is embarrassing!..

R/r 911


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## ResTech (Mar 21, 2008)

ALS get's alerted on all CVA calls but 9 out of 10 times they get cancelled unless the patient is having respiratory issues or some other immediately life threatening problem. ALS isn't gonna do anything for a stable CVA pt. except a lock and throw the monitor on. 

You oxygenate the pt. and transport. And the two hospitals we transport to don't have Stoke Teams. This is standard and ALS kinda expects to get cancelled.


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## Ridryder911 (Mar 21, 2008)

ResTech said:


> ALS get's alerted on all CVA calls but 9 out of 10 times they get cancelled unless the patient is having respiratory issues or some other immediately life threatening problem. ALS isn't gonna do anything for a stable CVA pt. except a lock and throw the monitor on.
> 
> You oxygenate the pt. and transport. And the two hospitals we transport to don't have Stoke Teams. This is standard and ALS kinda expects to get cancelled.




Wow! How discouraging and dangerous it is to patients. Glad my family is not located in those areas. Oh, by the way, what is a "stable CVA" patient? If an assessment is not performed. One cannot determined if the penumbra has been affected or an active subarachnoid bleed has occurred, this can NOT be determined using triage on a phone. Ignorance amazes me. Maybe that is why stroke is the third leading cause of death and the leading disability.

How much oxygen you place on the patient? NRBM @ 15 lpm? Congrat's you may have just cause increased more cerebral ischemia! Of course, what does neurologists and strokelogists know? 

Your hospitals do not perform fibrolytics on CVA's? Geez.. wished I was an malpractice attorney. Litigation's on NOT performing fibro's on new onset of CVA (non-hemorrhage) is more likely than if you DID perform it and they had complications. Don't believe me do a lit search or better yet talk to any TKAse drug rep. they are proud to give you the statistics.

*Hint.. it is the national standard of care, per ECC/AHA. 

http://www.asls.net/introduction.html

Again, a shame many EMS Systems are stuck in the 70's

R/r 911


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## skyemt (Mar 21, 2008)

well, 

this issue does really speak towards education... again...

when i got out of EMT class, i thought i knew a fairly good amount...

since then, increasing my education, more A/P, etc...

i have come to the conclusion that the more you learn, the more you realize how much you don't know about medicine and patient care... especially about atypical presentations of common illnesses and the like...

i can only assume that the basics who think BLS can "handle" many of these emergencies are just not there knowledge wise... because if they were, we would NOT be reading many of these posts.

p.s.   before you start writing, i am a basic.


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## skyemt (Mar 21, 2008)

also, if there is a definitive time constraint to getting a CVA pt to fibrinolytic therapy (three hours from onset of symptoms), how in the world can they be considered STABLE? or if an ICH, surgery required??

there life may well come down to a race against the clock... can you get more opposite from STABLE than that?


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## skyemt (Mar 21, 2008)

firecoins said:


> All calls are BLS.  All calls are ALS.  Hopefully both show up.





firecoins said:


> I, as a BLS provider, cancel medics all the time.  The patient is always stable, never had loc or sob and usually is just needing transport to the hospital.  More often than not ALS triages the same types of patients down to me if they are on scene first.  I am a medic student. So I want calls to go ALS both for the patient and my personal learning so I am inclined not to cancel medics.



i am a bit confused, i must admit... in one post, you state that ALS should show up at EVERY call, and in the next, you say they can be cancelled by BLS no problem.  that doesn't make any sense to me.

also, there are issues in our county with BLS canceling ALS.  if you are not 100% sure ALS is not needed, you are opening up exposure to patient care violations and negligence, if it turns out that ALS could have helped.

keep that it mind when considering pain management for "basic trauma", whatever that is. so, a pt has a fx ankle... no big deal, we don't need ALS for that... pt suffers excruciating pain enroute to the hospital, only to find out that an ALS provider could have eased the pain... really, how do you feel about that?

and medical cases? can you be entirely sure ALS is not needed? how?? atypical presentations? differential diagnoses? by BLS instead of ALS?? REALLY??

i'm sure you and others will disagree, because you "cancel ALS all the time"... perhaps as a paramedic student you take more liberties...

i would hope you would acknowledge that your approach, if really as stated, is fraught with issues and exposures that most basics could not defend against.


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## Outbac1 (Mar 21, 2008)

Rid

 I obviously either missed something or it wasn't there in my training. How do you tell prehospitally if a pt is having a thrombolytic or intracranial bleed? I thought one had to get them to a CT machine to make that determination. Please enlighten.


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## firecoins (Mar 21, 2008)

skyemt said:


> i am a bit confused, i must admit... in one post, you state that ALS should show up at EVERY call, and in the next, you say they can be cancelled by BLS no problem.  that doesn't make any sense to me.


I do believe in general ALS should show up to every call.  But I do end up responding to calls of people requiring mearley transport to the hospital.  They are sick, have minor trauma or have some reason for needing to get to the hospital but lack transportation.  When we are nothing but taxi, I find it hard to justify letting ALS respond.  



> also, there are issues in our county with BLS canceling ALS.  if you are not 100% sure ALS is not needed, you are opening up exposure to patient care violations and negligence, if it turns out that ALS could have helped.


I prefer to have medics. If I am not sure, I am not cancelling.  I only cancel when I am 100% positive the problem can be handled by minor interventions and transport.  



> keep that it mind when considering pain management for "basic trauma", whatever that is. so, a pt has a fx ankle... no big deal, we don't need ALS for that... pt suffers excruciating pain enroute to the hospital, only to find out that an ALS provider could have eased the pain... really, how do you feel about that?


 For the 5 to 15 minute transport, pain control is not my biggest concern.  



> and medical cases? can you be entirely sure ALS is not needed? how?? atypical presentations? differential diagnoses? by BLS instead of ALS?? REALLY??


Chief complaint, relevant past medical hx and vital signs lead me to believe that they will not need ALS.  A person with the flu nd no relevant hx doesn't need medics. A person with the flu and a cardic hx may need medics and hence I don't cancel them.  



> i'm sure you and others will disagree, because you "cancel ALS all the time"... perhaps as a paramedic student you take more liberties...


 I cancel the medics on obvious BLS jobs. That is a far cry from "all the time"



> i would hope you would acknowledge that your approach, if really as stated, is fraught with issues and exposures that most basics could not defend against.


I don't think you have a good understanding of my approach.


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## skyemt (Mar 21, 2008)

Firecoins,

"for the 5-15 minute transport, pain control is not my biggest concern"

oh, but what about the patient? isn't it about the patient, not what your biggest concern is..it may be their biggest concern? too many EMT's downplay pain management, but it is SUPPOSED to be one of the most important things we do... sorry if the patient inconveniences you too much...

"I, as a BLS provider, cancel medics ALL THE TIME"...

these are your words... direct quote. then you say that you cancel them sometimes, "a far cry from ALL THE TIME"...

perhaps i don't understand your approach, because either you change you position, or you don't say what you really mean... ALL THE TIME MEANS ALL THE TIME.  If you didn't mean it, you can understand why anyone took it that way, because it's exactly what you said.

either way, your posts contradict themselves all over the place, and if i don't follow your approach, that is why.


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## ResTech (Mar 21, 2008)

Firecoins makes several good points. I cant believe Basics on here are so insecure about their ability that they dont know when a patient is ALS or not! 

I understand the significance of CVA's and time to tx... we have a relatively short transport time (<15mins) and if the pt. is "stable", the pt is ok to BLS to the hospital non-emergency. What is ALS gonna do that BLS isn't? Seriously. A lock and EKG isn't gonna fix the problem. The pt. needs O2 therapy, transport, and a CT in-hospital. If the pt. is having a subdural bleed, chances are your definitely gonna be able to tell the difference pretty easily.

If this was such a problem, how come the ED physicians are ok with it? How come the ALS providers are ok with it? This is common practice in not one but two EMS systems I've worked in. 

I'm all for doing whats best and having ALS on every unit... I always advocate that for Pennsylvania. Hopefully with the new EMS Act and the addition of the Advanced EMT provider level for PA, we can start having ALS on every unit as a start and then have agencies advance to paramedic level. Hopefully that will be a stepping stone.


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## ResTech (Mar 21, 2008)

ALS around here aren't to big on pain management. If you keep them for an isolated ankle fx because you want pain management... you will get some evil stares. I understand Firecoins position. He isn't saying pain management isn't a good idea. But when you have such a short transport time, by the time the medic starts a line, gets med command, pushes the med, were at the hospital where the pt. would be getting pain medication pretty early anyway.


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## skyemt (Mar 21, 2008)

ResTech said:


> Firecoins makes several good points. I cant believe Basics on here are so insecure about their ability that they dont know when a patient is ALS or not!
> 
> I understand the significance of CVA's and time to tx... we have a relatively short transport time (<15mins) and if the pt. is "stable", the pt is ok to BLS to the hospital non-emergency. What is ALS gonna do that BLS isn't? Seriously. A lock and EKG isn't gonna fix the problem. The pt. needs O2 therapy, transport, and a CT in-hospital. If the pt. is having a subdural bleed, chances are your definitely gonna be able to tell the difference pretty easily.
> 
> ...



arrogance is a dangerous thing... every provider is just one bad decision away from the end of a career, not to mention what happens to the patient.


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## ffemt8978 (Mar 21, 2008)

skyemt said:


> arrogance is a dangerous thing... every provider is just one bad decision away from the end of a career, not to mention what happens to the patient.



I don't always agree with you sky, but that is my vote for the post of the year!


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## ResTech (Mar 21, 2008)

Arrogance plays no part...


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## skyemt (Mar 21, 2008)

ResTech said:


> Arrogance plays no part...



i am curious... what is your level of certification?


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## ResTech (Mar 21, 2008)

I am currently an EMT-Basic... I was a Paramedic student in a 2-year degree program that I 3/4 completed before dropping for personal, non-academic reasons. I was 2nd in my class with an "A" average and completed most of the core ALS classes including A&P and clinicals I and II. I performed all the ALS modalities... IV's, meds, intubation (field, OR, and ED) in the field and IO's, surgical airways, and chest decompressions, and more intubation practice on cadavers at the University of MD. 

So you see I speak from both perspectives..


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## reaper (Mar 21, 2008)

But, you never worked as a medic? That is where you put what you learned to the test.
Have you never seen a STABLE CVA pt suddenly crash en route?

Pain management is a big deal. The pt with the ankle FX is in pain. You will spend 10-15 minutes to transport them. Then they will sit in ED for 15-60 minutes, before they get any pain meds. It would take a medic less then 5 minutes to get a lock and push a pain med. If your service has to call med control for pain management, then you may need to push your Med director for changes in protocol.

Are all pt's ALS, NO! Can some be evaluated by a EMT and deemed BLS, YES!

CVA's are never BLS calls. Flu's can be very dangerous. Simple N&V can lead to death. You as a basic, need to be truly confident in your evaluation of the pt, or you will get burned in the end. If a pt suffers damage or death because you canceled ALS response, it is all on your head.

Just something to keep in mind!


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## firecoins (Mar 21, 2008)

when I a  medic, you can let me triage ot down to you.


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## firecoins (Mar 21, 2008)

If your not confident in your ability to know or when not to cancel the medics, don't cancel the medics.  Very simple. My ability to do so comes from doing this for on a daily basis for a long time.  The EMT class in and of itself is not enough training but experience really moves you in the right direction.


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## BossyCow (Mar 21, 2008)

skyemt said:


> also, if there is a definitive time constraint to getting a CVA pt to fibrinolytic therapy (three hours from onset of symptoms), how in the world can they be considered STABLE? or if an ICH, surgery required??
> 
> there life may well come down to a race against the clock... can you get more opposite from STABLE than that?



Yep, and all hospitals should have a neurologist on board too! And who's paying that salary??

We had a CVA pt, who needed fibrinolytic therapy. She was picked up by EMS within 45 minutes of first onset and by a system close to the hospital. Unfortunately, the airlift that was to take her to the closest center for the procedure was grounded due to fog and ground ambulance transport put her arrival outside the 3 hour time limit. 

Now, you can say that if our hospital had the ability to perform this procedure (as all should according to Rid) the outcome for this patient may have been quite different. But, at what cost? The cost of the facility, staff and infrastructure needed to perform this one procedure would have had to be at the expense of other services our hospital offers. 

We run into the same situation with Peds calls. Our ability to diagnose and treat Peds pts is limited. Most are airlifted to Seattle, but our location makes it a crapshoot as to whether airlift is going to be able to land or even see where we are under the fog. 

Yes technological advances are wonderful and increase positive outcomes. But the sad old reality is, that a public district hospital cannot afford the latest and greatest technology in all areas. So, they pick those that get the biggest bang for their buck. Those what will provide the greatest benefit to the greatest number of patients. 

So, is it technology that is 'stuck in the 70's' which is the problem, or is it a financial issue? None of this technology comes for free. Who pays for it?


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## skyemt (Mar 21, 2008)

firecoins said:


> If your not confident in your ability to know or when not to cancel the medics, don't cancel the medics.  Very simple. My ability to do so comes from doing this for on a daily basis for a long time.  The EMT class in and of itself is not enough training but experience really moves you in the right direction.



ok... now you are coming around...

so, it is dependent on education and experience, both of which you have a lot of to feel like you can "cancel ALS".

i agree.. and after much experience and learning, you start to develop this..

but, you must admit, the key is to know when you can not know...

do you endorse canceling ALS for a CVA patient? it doesn't seem like your approach...

if you would not, then you are disagreeing with the basics who are posting otherwise... 

you have to admit, from the posts, canceling ALS seems to be an issue for some... canceling when you should not!  a more serious decision than, oh well, what can ALS do anyway...

that is all i am saying... i do not call for ALS every time... but if there is substantial pain, or even the chance they could become unstable, i will absolutely want ALS...

am i unconfident? absolutlely not... 
do i fully realize the limitations of the basic level, i certainly do.


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## skyemt (Mar 21, 2008)

BossyCow said:


> Yep, and all hospitals should have a neurologist on board too! And who's paying that salary??
> 
> We had a CVA pt, who needed fibrinolytic therapy. She was picked up by EMS within 45 minutes of first onset and by a system close to the hospital. Unfortunately, the airlift that was to take her to the closest center for the procedure was grounded due to fog and ground ambulance transport put her arrival outside the 3 hour time limit.
> 
> ...



not sure how that relates to the post of mine which you quoted...
don't know how to respond to that, other than, "ok, your hospital doesn't have it"....

does that mean it should be BLS not ALS?


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## reaper (Mar 21, 2008)

One thing with CVA's. Don't get stuck on the "3 hour" time window. 

Most stroke centers have multiple treatments available. They can go up to 16 hours out. You need to find out from your local stroke center, what they have available.


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## skyemt (Mar 21, 2008)

reaper said:


> One thing with CVA's. Don't get stuck on the "3 hour" time window.
> 
> Most stroke centers have multiple treatments available. They can go up to 16 hours out. You need to find out from your local stroke center, what they have available.



the reason i say "3 hours" is that it is our protocol. after working with our stroke centers, the state made our goal to get the patient there in under 3 hours.

not disagreeing with you... just explaining that that window is what our protocol says.


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## firecoins (Mar 21, 2008)

skyemt said:


> do you endorse canceling ALS for a CVA patient? it doesn't seem like your approach...
> 
> if you would not, then you are disagreeing with the basics who are posting otherwise...


cva is an als call.  They need more transport than minor interventions and transport.  

75% of the time medics beat me to a scene. Alot of times they triage it down to me. Many times they come in my rig and take it down to ER.  This is where I get the experience from. It isn't from being a medic student as I did this before I was a student.    Being a medic student helps though.  

25% of the time I beat the medics to the scene. I can see if the patinet is just in need of transport or need greater interventions. If i can handle it, cancel the mefics.  If I am unsure for any reason, I don't cancel. At least I get their opinion and take it from there.


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## reaper (Mar 21, 2008)

I understand. Everyone has to follow their protocols.

This may be some thing that you could work on, to get the state to change their protocol.

Ours is at 6 hours now, but the stroke centers vary on what they will still do in different treatments.


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## Ridryder911 (Mar 21, 2008)

What I have learned from this thread. 

Many of the EMT"s & even Paramedics are not currently informed and even understand current medical care involving emergency cardiovascular care and stroke management. Frightening is that many systems allow lower care to be delivered to patients without proper assessment from a qualified healthcare provider.

This is not just scary, and frightening but very discouraging. Only knowing your local protocols is not enough. Look outside the box, make recommendations to your medical director or committee to keep upon current care! 

This is not just essential in patient care but legally as well. Ignorance is NOT blessed. 

Read periodicals, journals, methodology of treatment outside just EMS. Keep informed.. it is your job! (be it paid or not). 




ResTech said:


> I am currently an EMT-Basic... I was a Paramedic student in a 2-year degree program that I 3/4 completed before dropping for personal, non-academic reasons. I was 2nd in my class with an "A" average and completed most of the core ALS classes including A&P and clinicals I and II. I performed all the ALS modalities... IV's, meds, intubation (field, OR, and ED) in the field and IO's, surgical airways, and chest decompressions, and more intubation practice on cadavers at the University of MD.
> 
> So you see I speak from both perspectives..



This bothers me. We have a person that acclaims to be a Paramedic drop out student but acclaims to practice as one? Maybe I misunderstood. Yet, how can one even critique EMS or medical care if one is not at equal or higher level?




ResTech said:


> ALS around here aren't to big on pain management. If you keep them for an isolated ankle fx because you want pain management... you will get some evil stares. I understand Firecoins position. He isn't saying pain management isn't a good idea. But when you have such a short transport time, by the time the medic starts a line, gets med command, pushes the med, were at the hospital where the pt. would be getting pain medication pretty early anyway.



Again, how long does it take to administer analgesics? Really, what is the hurry to run back to the hospital? Would it not be better to provide analgesics, splint appropriately calm, non hurried, smoothly? Med control for analgesics? What decade is this? Provide better education, maybe med control will have standing orders? 

Really, I would want someone to provide me pain control for my ankle fxr (which is considered, one of the most painful fxrs.) before transporting me. That is undue pain, and really not being in the best interest of the patient. 
Again, this has been debated to death *ten years ago* Get on with the current treatment plans. Again, show medical control the current trends and treatment. Prevent litigation and mainly prevent undue pain & suffering to your patients. 

In regards to door to drug time, *Three hours from time of onset to treatment, is the National Recommend Time allowable*. Geez folks, that is even a AHA test question! We are supposed to be supporting and encouraging the common laymen to seek treatment as soon as possible and here we are presenting the common man may know more than EMS personnel ? 

Yes, some centers may have increased time allotment as the may perform the Merci technique but be forewarned it does not have the same results or outcomes. Let's promote the national standard and leave the increased time for those that want to perform on their own protocols.

In regards to only certain  ER's can perform fibro on CVA. That is B.S.! After performing a CT and verifying there is not a hemorrhage as usually confirmed by a radiologist (some ER physicians will make the determination) can administer fibro. If they can administer "clot buster" to the heart, then they have the ability to fibro CVA's. Again, successful litigation has been made against the archaic thinking. 

Again, these posts reveal many of those in EMS have no clue to even what an emergency is or is not. Obstetrics is such an emergency and have potential complications, just ask what the procedure of an O.B. patient is > 20 weeks gestation is at your local ER?  Some of the medical liability insurance will not even cover ER physicians for emergency deliveries. 

I propose that we should really look and evaluate current care. Maybe discussion with citations and references should be made as much as possible. Yes, every one follows protocols, so do I but this does not mean I do not know or aware of current medical regime. This is how protocols are revised and brought up to date. 

I just wonder if most here ever attend increased education such Advanced Stroke Life Support, PALS, NRP or APLS courses? From what I have read many may not go past their initial first course. Remember, the EMT & Paramedic curriculum has not been updated over 12 years. 
R/r 911


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## reaper (Mar 21, 2008)

Rid,

 I did not post about the CVA times, to have people push them back. I see way to often EMS show up at a stroke call. They determine that the pt's S&S are more then 3 hours old and treat it as BLS, since it's outside the window.

Everyone needs to find out what their local stroke centers use for treatment. There are treatments that can be used after the 3 hour window, with excellent results. I have seen venom do wonders after 12 hours.

I just want everyone to know that there are a lot of options out there and not to treat a 5 hour old CVA likes it's to far gone!


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## Ridryder911 (Mar 21, 2008)

I totally agree, not my point actually. Mainly that EMS systems should pay attention to the new national data and DEFINITELY not a BLS issue. My point as well as you described was not to treat a CVA as an old one if it is greater than 3 hours. (We all know the perception of time of family members). As you described it may be treated even if longer than 3 hrs. in length. 

I believe we are on the same page, maybe lacking of communications on my part, and I apologize if so. 

I am frustrated though an EMS forum in the U.S. would have systems still operate that it was in the 70's as well as people attempting to defend it. I admit my systems has some major flaws, some I can attempt to change and things I will never change. This does not mean I cannot or will not continue to be up to date on patient care and current emergency medical trends. 

R/r 911


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## reaper (Mar 21, 2008)

I agree 100%!


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## Keith (Mar 22, 2008)

skyemt said:


> among the elderly, weakness may be the only symptom of an MI...
> yet you list that and strokes as BLS calls??
> 
> sorry, makes no sense.




I agree, it may not seem to make sence, but I do the best I can with the calls I am sent too. I don't get to make those choices, I go where dispatch sends me. One of the ups to being in this area is ample ALS if I need an intercept from the city service that operates out of a level 1 trauma center in downtown, as well as numerous private companies. I never stated that I belived those all SHOULD be BLS calls, I just stated thats how they are dished out, So I would like to clarify that. In this city, from any point within the limits, there are 2 level 2 trauma centers and 1 level 1 trauma center within 5 minutes. I believe a well trained basic is going to spot a CVAin just as much time as a medic, and then its all about transport time and a good CMED patch to alert the stroke team. I'm not trying to jump into an argument (thats obviously going on), I'm just going by how it is here.


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## skyemt (Mar 22, 2008)

Keith said:


> I agree, it may not seem to make sence, but I do the best I can with the calls I am sent too. I don't get to make those choices, I go where dispatch sends me. One of the ups to being in this area is ample ALS if I need an intercept from the city service that operates out of a level 1 trauma center in downtown, as well as numerous private companies. I never stated that I belived those all SHOULD be BLS calls, I just stated thats how they are dished out, So I would like to clarify that. In this city, from any point within the limits, there are 2 level 2 trauma centers and 1 level 1 trauma center within 5 minutes. I believe a well trained basic is going to spot a CVAin just as much time as a medic, and then its all about transport time and a good CMED patch to alert the stroke team. I'm not trying to jump into an argument (thats obviously going on), I'm just going by how it is here.



so, there is ample ALS available, including intercepts, but dispatch decides that CVA's are BLS calls? No, i don't think so.

then, you decide to run a CVA BLS, even though you state that you have ample ALS available to you?

have you been reading the posts on this thread?


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## BossyCow (Mar 24, 2008)

Ridryder911 said:


> Again, these posts reveal many of those in EMS have no clue to even what an emergency is or is not.
> R/r 911



Hmmm so should we have a paramedic in every livingroom so the pt can decide if they need to dial 911 or not? How far do we take this? After all, none of this care comes for free. Should I call ALS for everthing that might turn into a life threatening situation, at $800 per trip? If the people of my district live within the boundaries of a BLS district, what is my responsibility? We are a strictly BLS agency and to say that my agency doesn't count because of our rural exception is a cop out. 

The majority of the calls we run do not need ALS intervention. Sure it would be nice to have a paramedic evaluate everyone for that one odd call that isn't as initially presented. But, I don't know many paramedics who are going to work for free. Someone has to pay the cost. You can say that you can't put a price on a person's life, but that really isn't accurate either. Otherwise we'd all be lined up outside of the most expensive state of the art Cancer Clinic, Stroke Rehab Unit, Cardiac Care Facility.... etc....  Money matters!


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## Ridryder911 (Mar 24, 2008)

BossyCow said:


> The majority of the calls we run do not need ALS intervention. Sure it would be nice to have a paramedic evaluate everyone for that one odd call that isn't as initially presented.



Is a CVA or chest pain, Shob an odd call? Really, what is an odd call that require someone would need EMS services that did not need some form of evaluation & intervention? If that was the case, then they don't need an ambulance they need a transfer taxi service. Reality, what are you offering your patients more than that? Oxygen, some splinting and availability to lie down for transport. Are you offering pain control, anti-emetics, really what are you doing that the family could not do? 




BossyCow said:


> But, I don't know many paramedics who are going to work for free. Someone has to pay the cost. You can say that you can't put a price on a person's life, but that really isn't accurate either. Otherwise we'd all be lined up outside of the most expensive state of the art Cancer Clinic, Stroke Rehab Unit, Cardiac Care Facility.... etc....  Money matters!



Actually, how about consolidating and having a regional EMS service. Does your community have water regions, CoOp services, Public Health Department, Law Enforcement? See, there is services, again I guess it depends upon the priority. 

Just because someone chooses to live or so happen to drive in rural area, should not mean that they have less or poor care. Again, I have worked in very rural areas, most of the problems was it was easy to give excuses and not work on the problem. Amazing, they could find answers and funding on other of interest. When it is you or your family member & knowing that there is  something could had been done, but was not may present a different feeling than the "feel good" I was able to help. 

In regards to being "lined up outside the state of the art medical facility", I would agree it happens. I drove over 600 miles a week for over a year and will be in debt for ever for my wife's cancer treatment, all because it was better and more progressive. Again, I guess my priority was different..money did not matter, when involves my loved ones health. 

R/r 911


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## Arkymedic (Mar 24, 2008)

Ridryder911 said:


> Wow! Thank you for proving my point of ignorance. If you cannot determine the difference of a AAA and general back pain after assessing, something is wrong. As well, dispatch is not the "end all" of medical clearance.
> 
> I guess regulating blood pressure to prevent AAA from rupturing, is something you would not understand? Who in the h*ell, pushes fluids on a AAA? Go back to school!
> 
> ...


 
See Rid, this is exactly why I was for the extended scope of practice for Paramedics that was put forth...


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## Arkymedic (Mar 24, 2008)

BossyCow said:


> Yep, and all hospitals should have a neurologist on board too! And who's paying that salary??
> 
> We had a CVA pt, who needed fibrinolytic therapy. She was picked up by EMS within 45 minutes of first onset and by a system close to the hospital. Unfortunately, the airlift that was to take her to the closest center for the procedure was grounded due to fog and ground ambulance transport put her arrival outside the 3 hour time limit.
> 
> ...


 
Do not forget how common CVAs are. That one procedure is absolutely worth it if it saves a single life. The same is true of trauma centers. Many states are doing away with trauma centers because they are money pits; however, what about the individuals they save? If it saves a single 12 year old and allows them to grow up then hell yes it is absolutely worth it.


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## BossyCow (Mar 24, 2008)

Again, who pays, and how does a paramedic keep up skills running less than 200 calls a year? Certainly there are some services offered to rural areas, but in most cases, water is private well, sewer is on site personal septic and garbage is haul it yourself to the dump.  

Your perfect scenario for everyone to have ALS can go right up there with everyone should have a roof over their head and 3 meals a day. How about good preventive healthcare, or maybe, since we're waving a magic wand, college education for all those who qualify academically instead of just financially. 

Its nice to toss about all those 'shoulds' but bottom line, someone's gotta pay for it.


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## el Murpharino (Mar 24, 2008)

BossyCow said:


> Again, who pays, and how does a paramedic keep up skills running less than 200 calls a year? Certainly there are some services offered to rural areas, but in most cases, water is private well, sewer is on site personal septic and garbage is haul it yourself to the dump.
> 
> Your perfect scenario for everyone to have ALS can go right up there with everyone should have a roof over their head and 3 meals a day. How about good preventive healthcare, or maybe, since we're waving a magic wand, college education for all those who qualify academically instead of just financially.
> 
> Its nice to toss about all those 'shoulds' but bottom line, someone's gotta pay for it.



I think what's being said is that if 4 or 5 agencies combine their efforts and resources, you will find that the one conglomerate agency not only runs more calls per year, but will allow your medics to run more calls, thus helping them "keep up their skills".  Also, you will probably end up with only 2 or maybe 3 total stations, down from an original 5, which could provide you with more medic help.  Does your agency not bill patients or receive any tax revenue from the community?  I know of alot of rural, volunteer agencies that still practice this way...but they're slowly wasting away.


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## ffemt8978 (Mar 24, 2008)

el Murpharino said:


> I think what's being said is that if 4 or 5 agencies combine their efforts and resources, you will find that the one conglomerate agency not only runs more calls per year, but will allow your medics to run more calls, thus helping them "keep up their skills".  Also, you will probably end up with only 2 or maybe 3 total stations, down from an original 5, which could provide you with more medic help.  Does your agency not bill patients or receive any tax revenue from the community?  I know of alot of rural, volunteer agencies that still practice this way...but they're slowly wasting away.



How do you propose to cover a larger area with 2 or 3 stations, while at the same time maintaining minimum response time requirements?


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## Outbac1 (Mar 24, 2008)

Bossy it can be done, and yes it costs some money. Where I'm at we had the old way and our provincial gov't wanted better. They made changes which didn't happen overnight. The result is an EMS system that covers the whole province including a helicopter for an avg. cost of $83.00 each per year. Personally I don't consider $332.00 per year of my taxes for my family of 4 to be a lot of money for 24/7 coverage. The majority of which is ALS. With about 6,000,000 people in Washinton state at $83.00  thats $498,000,000.00 You could have a very nice EMS system for that much money. 

 Just my thoughts.


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## skyemt (Mar 24, 2008)

BossyCow said:


> Again, who pays, and how does a paramedic keep up skills running less than 200 calls a year? Certainly there are some services offered to rural areas, but in most cases, water is private well, sewer is on site personal septic and garbage is haul it yourself to the dump.
> 
> Your perfect scenario for everyone to have ALS can go right up there with everyone should have a roof over their head and 3 meals a day. How about good preventive healthcare, or maybe, since we're waving a magic wand, college education for all those who qualify academically instead of just financially.
> 
> Its nice to toss about all those 'shoulds' but bottom line, someone's gotta pay for it.



there is a big difference between acknowledging that ALS is necessary but not possible in certain areas, and saying that ALS is not necessary on most but the odd few calls...

you keep jumping between these two different lines of thought, and frankly your posts are confusing for this reason.

if you deem ALS necessary, but it is a fiscal issue, have you tried to increase public awareness? does your public know they are getting substandard care? if they did know, and were given the chance, would they pay for it?  the answer might very well be yes. 

the agencies in my area, rural as well, that were having trouble providing ALS all day, went to the public... would they want to pay for this service?
the answer, a resounding yes, and they did pay.

have you dont this? have your ems leaders pursued such an idea? i highly doubt it from your responses.

recently, from a leadership conference given by our county EMS...

our two most dangerous ideas:

"we are rural, we do the best we can"
"we are volly, we do the best we can"

sound familiar? well, it just isn't good enough. the public doesn't deserve "we do the best we can", they deserve the highest standard of care possible. if you are not providing it, do something proactive about it.


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## reaper (Mar 24, 2008)

In your RURAL area, do you law enforcement? Are they volley's? Do they shoot 30 suspects a month?

 I think the answer to all 3 is YES,NO,NO!

How do the LEO in your area keep up their range skills?  They practice.
If your county wanted ALS service it would be there. If it was and you had good medics, they would find a way to keep up on their skills and education.

I used to live in a rural county, pop. 3200 people. We had 24/7 ALS coverage. They combined with surrounding counties to make one service.

Someone mentioned longer response times with fewer stations. I for one, would rather wait 10 minutes longer for a service that can treat me, then get picked up and driven 30-40 minutes with no treatment! Maybe thats just me!!


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## ffemt8978 (Mar 24, 2008)

reaper said:


> In your RURAL area, do you law enforcement? Are they volley's? Do they shoot 30 suspects a month?
> 
> I think the answer to all 3 is YES,NO,NO!
> 
> ...



Waiting 10 minutes when brain damage can occur in 4-6 minutes?

Yes, we have law enforcement in our area.  Average response time for deputy is 30-35 minutes for a critical call, 45-60 for a routine call.  Using your analogy, that's a helluva long time to go without any treatment whatsoever.


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## Ridryder911 (Mar 24, 2008)

Okay before this subject gets out of hand, I and many others understand there are areas that will never be able to nor will have the chance to offer the care they wished they could deliver. Yes, in many rural, frontier, remote areas this will probably be the norm as long as I am alive. Again, I honor those that volunteer and dedicate their time in these areas.

Now, before we assume that this has to be the norm, let's look at areas that have made some changes and made it work. I am sure AK can chime in and can attest that Alaska has some of the most remote areas. Yet, they have attempted and made some major changes in their area. As well, we just placed a unit that will respond < 200 calls a year in a very small rural remote area; staffed by two Paramedics. So yes, it can be done, and I can assure them qualified well experienced and current Paramedics 24/7. 

You have to remember, I have arrived as the ALS provider on MVA's in a fixed wing. I have worked reservations and very rural remote areas. I do not buy into the philosophy of "it can't be done" attitude. Not until, all resources has been explored. Two things, I do not like being assumed. That a provider from the rural is more stupid than those from metro areas, as well we cannot deliver the same level of care, required to stabilize patients until we arrive at a tertiary hospital. 

Bossy, I am assured you do the best you can, if that is the fact, I am glad you are able to be there for your community. In fact, I give up attempting to persuade you of the difference. If one can tolerate their patients having excruciating pain with severe burns or during their course of an AMI, seizures that will not stop, or the patients that aspirate upon their own vomitus. Not that it could not been treated but rather that it was not available to them. I don't think I would still have that warm fuzzy feeling inside, knowing that. But hey that's me. Again, I do not know your exact location and its uniqueness, it maybe totally impossible. I just hope you and others attempt to explore the possibilities before giving up. 

I wish you and other rural areas the best of success. 

R/r 911


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## reaper (Mar 24, 2008)

Sounds like you have 2 problems for the county to fix!


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## AJemt (Apr 10, 2008)

&quot;
Quote:
You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion?  **
That is correct sir, you can't. Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.&quot;


so just out of curiousity, is that to say that I as an emt basic, responding to someone who called for a sick person class 2 (bls lights and sirens response),  cannot evaluate the 23 y/o/f who has been coughing for two days, with a sore throat and pain upon swallowing, a low-grade (100.1) fever, and is now having chest pain across the top of her chest (less than one hand wide down from the shoulders) that is present only when taking a deep breath and worsens with coughing but is not sharp, stabbing, radiating, or presenting with any cardiac symptoms, and whose lungs are clear with all vitals WNL?  are you telling me that that pt needs to have a paramedic show up and place an IV and put her on the monitor, and give her ASA and nitro (she has pain)?  btw, the pt didn't call her friend did bc the friend is tired of hearing her cough, but the pt does agree to go to the hospital.
i'm not trying to get cocky and don't take this post as coming across as arrogant bc i'll reach through the computer and smack you for being stupid  .  i am trying to further my education as an emt.   Or what about the calls that come out as bls but really should be als but you don't find it out till you get there?  do you sit on scene and wait for als to get there or do you start transport to the hospital (esp if the hospital is <10 minutes away and the medic is just as far if not farther)?  what then?
and if you're going to bring in a paramedic for every pt that just feels kinda sick to their stomach JUST BECAUSE they MIGHT be having a cardiac issue or they MIGHT need phenergan if they have to throw up (throwing up is the body's natural way of getting rid of something offensive - do you go find a paramedic every time you throw up) you are going to A) make every medic in the system dislike you B) get the reputation of not knowing your stuff as an emt and C) get sent back to training until you can perform as an EMT.
and if you are worried about the pt not getting a medic why don't you go get your medic?

yes i understand calling in a paramedic when a paramedic is needed.  if i'm not comfortable with a pt or i, by reason of my assessment training and protocols, feel the need for a medic, i'm the first to call and ask.  at the same time i'm not afraid to take a pt to the hospital bls if they don't need a medic.

i'm not bashing anyone nor am i trying to come across as arrogant cocky or any of those other things that i am not.  just trying to further educate myself as best i can.


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## Ridryder911 (Apr 11, 2008)

AJemt said:


> &quot;
> Quote:
> You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion?  **
> That is correct sir, you can't. Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.&quot;
> ...




Did you ever think that patient you just described had a P.E.? Is it not really about patient care and transporting or that "throwing up" (by the way is NOT the bodies way of removing toxins...*another myth). Then why shouldn't the patient get anti-emetics? It is better for the patient to get nauseated? Think... which is better for the patient, not the EMT... 

I do understand your thinking, but there is enough Paramedics and yes, enough money, if the system was fixed and we quit saying.."we can't". Shouldn't we promote ALS evaluation and better care for all responses, instead of making excuses? Again, the worst enemy of EMS is its own personnel. 

R/r 911


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## skyemt (Apr 11, 2008)

AJemt said:


> &quot;
> Quote:
> You mean a EMT can't assess if a chest pain is of a cardiac, pulmonary, or misc etiology based on exam and index of suspicion?  **
> That is correct sir, you can't. Chest pain should be considered cardiac in origin until someone with the knowledge to make that determination is available.&quot;
> ...



see, to me, this post seems to be about what you feel you can and can not do...

however, EMS is all about the patient... it is their emergency, not yours... and they don't really know or care about what basics think they can handle...

the only issue:  is the patient getting the best available care?

often, very often, the answer is no, if they get a BLS crew...

of course, sometimes that is the best care available, in certain situations...

but, at the end of the day, it really isn't about the EMT... it's about the patient.


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## Flight-LP (Apr 11, 2008)

skyemt said:


> see, to me, this post seems to be about what you feel you can and can not do...
> 
> however, EMS is all about the patient... it is their emergency, not yours... and they don't really know or care about what basics think they can handle...
> 
> ...



*Clap*Clap*Clap*

The best post I have seen in recent weeks!

More need to think along these lines and stop worrying about what they cannot do. No BLS is not optimal in most situations. Yes, every pt. deserves an assessment from a Paramedic provider. Will it always happen? NO! But if available, they should be utilized as the pt. deserves the best there is at the time.

AJemt -How do you know the lungs are clear? Did you auscultate in more than 4 locations? I was actually thinking the possibility of a pneumonia. Can you address the fever at your location as a basic? Do you think that the ER would appreciate the effort of IV access for a pneumonia pt.? If I was a patient and elected to call 911 for vomiting, then it would be safe to assume that I did so in an effort to find relief from puking my guts out. Which do you think I would rather have, an EMT who can hold my hair back while a puke (despite the fact that I am bald!) or a Paramedic that can offer an anti-emetic and IV fluids to prevent hypernatremic dehydration? Doesn't seem like rocket science to me.............................


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## el Murpharino (Apr 11, 2008)

AJemt said:


> &quot;
> 
> 
> and if you're going to bring in a paramedic for every pt that just feels kinda sick to their stomach JUST BECAUSE they MIGHT be having a cardiac issue or they MIGHT need phenergan if they have to throw up (throwing up is the body's natural way of getting rid of something offensive - do you go find a paramedic every time you throw up) you are going to A) make every medic in the system dislike you B) get the reputation of not knowing your stuff as an emt and C) get sent back to training until you can perform as an EMT.
> ...



You emphasize the word MIGHT a few times  - how many times MIGHT the patient be having a true emergency (silent MI, for example), and you overlook it because you don't want a medic mad at you or because you'll have to call for help instead of being the hero of the day and taking it in yourself?  Just because your patient isn't tripoding or having symptomatic bradycardia doesn't mean they shouldn't be ALS'd to the hospital.  It's not about being afraid to call or not call, in fact, it's not about you at all.  It's about the patient.  Put your ego to the side and recognize that we treat patients for the 'MIGHT' scenario.


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## BossyCow (Apr 11, 2008)

Ridryder911 said:


> Bossy, I am assured you do the best you can, if that is the fact, I am glad you are able to be there for your community. In fact, I give up attempting to persuade you of the difference. If one can tolerate their patients having excruciating pain with severe burns or during their course of an AMI, seizures that will not stop, or the patients that aspirate upon their own vomitus. Not that it could not been treated but rather that it was not available to them. I don't think I would still have that warm fuzzy feeling inside, knowing that. But hey that's me. Again, I do not know your exact location and its uniqueness, it maybe totally impossible. I just hope you and others attempt to explore the possibilities before giving up.
> 
> I wish you and other rural areas the best of success.
> 
> R/r 911



First of all, I do not get a 'Warm fuzzy feeling inside' when when I am transporting someone who needs more care than I can give. But I appreciate your assuming that was my reaction. I have transported the actively seizing pt. the record is 6 seizures during a 20 minute code transport with no ALS available. I've also transported a child with facial burns from an exploded propane tank with ALS 15 minutes away and me 35 minutes from the hospital. To assume that I would regard those experiences with anything even close to 'warm and fuzzy feelings inside' is to grossly overrate my naiveté or to grossly underate my humanity. But I'm sure you didn't mean that in any way as a personal attack.:glare:

I haven't 'given up' either. Our ALS service has been impacted by a neighboring district who was forced to downgrade from ALS to BLS due to a levy failure. That was a few years ago and attempts to replace it have not gone well. 

My point has never been that its not better to have more rather than less resources available, but the arrogant assumption that anything less is negligent. My area is unique. We are a rural logging community with the nearest hospital in a mill town that recently lost another mill (its second in 6 years) so we are an economically depressed area. Our residents are proud, poor, and primarily blue collar. Trying to explain to them that they need to pay taxes so someone else can be hired at more money than they have ever seen is a tough sell.

The only reason I continue to post on the topic is to remind you and the others who rant on and on about how every call should have an ALS response that there are always exceptions to the rules and your particular situation doesn't reflect everywhere. Blanket statments with 'shoulds' and 'musts' are always going to be wrong somewhere.


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## AJemt (Apr 11, 2008)

Flight-LP said:


> AJemt -How do you know the lungs are clear? Did you auscultate in more than 4 locations......



yes as a matter of fact i did.  just because i'm an emt basic doesn't mean i'm clueless.  8 pt posterior and 6 pt anterior.  is that more than 4 enough for you?


&quot;because you'll have to call for help instead of being the hero of the day and taking it in yourself? &quot;

bulls*** buddy!!  hero i am anything but!  or did you miss the part where i said if the pt needs als by protocol or assessment they get als?  and why is it all about the emt not calling the medic, what about the medic that downgrades a pt to bls b/c the vitals are WNL and pts only complaint is an upset stomach?  why is it the EMT's fault?

if you are going to make everything ALS you might as well not even bother with EMTs since apparently they can't do any more than drive....or do i have to get a medic to hold my hand so i can do that too?


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## firecoins (Apr 11, 2008)

Ideally, when someone has a medical emergency, an MD will show up.  Fortunately for us, we exist to do this job for the MDs.  

The next best thing to an MD is a paramedic.  Nurses and PAs usually don't make house calls either.  

Unfortunatly medics aren't always available.  Some place don't have them.  Or they have medics but the medic are not available for some reason.  

This means your left with EMT-Bs.  Some EMT-Bs are very capable.  Some aren't.  The greatest tool ALL EMS has is to transport to an appropriate facility.  If an EMT-B can do this,  the patient will get ALS care.


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## skyemt (Apr 11, 2008)

AJemt said:


> yes as a matter of fact i did.  just because i'm an emt basic doesn't mean i'm clueless.  8 pt posterior and 6 pt anterior.  is that more than 4 enough for you?
> 
> 
> &quot;because you'll have to call for help instead of being the hero of the day and taking it in yourself? &quot;
> ...



another angry basic...

it's all about the patient people....

"if you are going to make everything ALS..."  what does that mean?
"we" don't make the pt anything... the pt's acute illness does that, and we provide the highest standard of care possible...

and regarding the "upset stomach" remark, i don't see your point.. could be anything from a bad meal to an MI...

just ask yourself AJ... if you were the patient, what level of care would you want?


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## EMTMandy (Apr 12, 2008)

skyemt said:


> if you were the patient, what level of care would you want?


 

Just wanted to add--this is one of the most important questions EMS providers could possibly ask themselves.


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## AJemt (Apr 12, 2008)

screw it, i'm not wasting my breath arguing with people.  i have too much to deal with as is right now, and the last thing i need is someone i don't know telling me i'm an egotistical idiot who doesn't know anything and has no consideration for the pts.  for me it's all about the pts, always has been, and always will be.  say what you like, you can't change the truth.


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## Flight-LP (Apr 12, 2008)

AJemt said:


> screw it, i'm not wasting my breath arguing with people.  i have too much to deal with as is right now, and the last thing i need is someone i don't know telling me i'm an egotistical idiot who doesn't know anything and has no consideration for the pts.  for me it's all about the pts, always has been, and always will be.  say what you like, you can't change the truth.



Well you just did "waste your breath". If you have too much to deal with, then perhaps you need some time away for awhile so you can adequately take care of your business. Maybe when you come back, you won't be so hostile...........................


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## ffemt8978 (Apr 12, 2008)

Ahem....(cough cough)


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## fma08 (Apr 13, 2008)

just a quick question Rid, i had a call a while back for a 20something college student at a party, obviously had too much to drink, nauseated, and... well at this point dry heaving mostly cuz he'd already puked everything up. so we get him in the truck and start transporting, ABC's are fine, sats are good, vitals are good, sugar was WNL. we start an IV and start giving some fluids, (just mentioning this is a ride along for school so i'm a student), my preceptor asks me what else i want to do for the pt. i said i wanted to give some compazine to help the pt be less nauseated and hopefully lessen the dry heaving/puking. and my preceptor said no we're not going to do that because it wont do anything, he's puking cuz his body is trying to get rid of the alcohol... so my question is, would the compazine have worked at all or not?


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## Ridryder911 (Apr 13, 2008)

fma08 said:


> just a quick question Rid, i had a call a while back for a 20something college student at a party, obviously had too much to drink, nauseated, and... well at this point dry heaving mostly cuz he'd already puked everything up. so we get him in the truck and start transporting, ABC's are fine, sats are good, vitals are good, sugar was WNL. we start an IV and start giving some fluids, (just mentioning this is a ride along for school so i'm a student), my preceptor asks me what else i want to do for the pt. i said i wanted to give some compazine to help the pt be less nauseated and hopefully lessen the dry heaving/puking. and my preceptor said no we're not going to do that because it wont do anything, he's puking cuz his body is trying to get rid of the alcohol... so my question is, would the compazine have worked at all or not?



Here is a link that describes a detailed but excellent explanation. You will learn if you read through it. You can see if your preceptor was correct or full of it.

http://www.mywhatever.com/cifwriter/library/70/4936.html

R/r 911


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## fma08 (Apr 13, 2008)

thanks for the article. great info!


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## el Murpharino (Apr 14, 2008)

AJemt said:


> what about the medic that downgrades a pt to bls b/c the vitals are WNL and pts only complaint is an upset stomach?  why is it the EMT's fault



I'm willing to bet most medics downgrades those types of patients after a full ALS assessment and consideration for the scenario.  Believe me though, there are medics out there who won't properly assess their patients - those are the providers that end up getting burned.


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## evantheEMT (Oct 27, 2014)

I work for a private company with 5 911 towns.ALS is always dispatched through 911.BLS will cover towns or do emergencies if theres no ALS available.Also the dispatchers send BLS to the nursing home/assisted living emergencies and to back up boston ems they will send BLS.


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## MonkeyArrow (Oct 27, 2014)

evantheEMT said:


> I work for a private company with 5 911 towns.ALS is always dispatched through 911.BLS will cover towns or do emergencies if theres no ALS available.Also the dispatchers send BLS to the nursing home/assisted living emergencies and to back up boston ems they will send BLS.


Bro. Stop necro-posting and bringing back threads that are 5 years old. This is your second one that I've seen today.


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## evantheEMT (Oct 27, 2014)

Just replying to them it does say im a new member just scrolling through.


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## Jim37F (Oct 27, 2014)

MonkeyArrow said:


> Bro. Stop necro-posting and bringing back threads that are 5 years old. This is your second one that I've seen today.


And what exactly is wrong with that? It's not like he's "bumping" an old thread for the sake of bumping it, but actually replying to the topic being talked about. Ain't nothing wrong with that IMHO.

As for the topic at hand, for us, we respond at least two paramedics to every 911 call. While there's a policy that lists specific complaints and signs/symptoms will be ALS, but otherwise it's the medics discretion to release to BLS or not. Usually however, if the patient only requires BLS care (splinting and bandaging, or more often vitals, history, and transport) they'll release to us


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## MonkeyArrow (Oct 27, 2014)

Jim37F said:


> And what exactly is wrong with that? It's not like he's "bumping" an old thread for the sake of bumping it, but actually replying to the topic being talked about. Ain't nothing wrong with that IMHO.



Scroll up to the first post by DEmedic. I'm just saying...it's a thing here. And for those who are counting, I think evantheEMT has now necro-posted 4 or 5 threads from 2008 over the span of a hour.
http://emtlife.com/threads/suggsted-addition-to-community-rules.38463/#post-535986


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## evantheEMT (Oct 27, 2014)

Thank you jim37f and also if u dont want anyone commenting on posts after so long delete them.


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## DrankTheKoolaid (Oct 27, 2014)

Nothing.... Paramedics care for all 911 patients

In the last system I worked it was abused, often.


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## MonkeyArrow (Oct 27, 2014)

I'm not replying anymore after this post. I'm not trying to pick a fight or start a flame war. But did you even read the link that I posted authored by a former moderator?


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## TimRaven (Nov 9, 2014)

None, in Bay Area any 911 call is ALS.
BLS only serves IFT and CCT.


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## Tigger (Nov 9, 2014)

So we are all clear, replying to old threads is fine so long as the content is relevant to the topic. 

If you feel a post is in violation of the rules, report the post to the CL staff. That's the extent of what we would like you to do.


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## gotbeerz001 (Nov 10, 2014)

TimRaven said:


> None, in Bay Area any 911 call is ALS.
> BLS only serves IFT and CCT.


This statement is neither true nor does it answer the original question:

First, I believe that the original question has to do with scope of practice for EMTs and given areas.

Second, just because a rig is equipped to perform ALS, doesn't mean that every call requires such interventions.

Lastly, it would seem that the mere fact that a person requires CCT makes it a non-BLS transport.


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## DesertMedic66 (Nov 10, 2014)

gotshirtz001 said:


> This statement is neither true nor does it answer the original question:
> 
> First, I believe that the original question has to do with scope of practice for EMTs and given areas.
> 
> ...


While not every patient needs ALS in CA calling 911 means you get an ALS ambulance and not a BLS one (in most areas). 

Depending on the posters location BLS may do CCT calls. Take my area for example. My company is the only company allowed to do ALS calls because we are the only 911 provider. We also do BLS and CCT. The local BLS companies do BLS and CCT calls only (just have a nurse hop on a unit with 2 EMTs and you have a CCT unit, aside from the gear).


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## gotbeerz001 (Nov 10, 2014)

DesertEMT66 said:


> The local BLS companies do BLS and CCT calls only (just have a nurse hop on a unit with 2 EMTs and you have a CCT unit, aside from the gear).


The point being, you have to "just add" a nurse and gear... This makes it no longer a BLS transport.


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## DesertMedic66 (Nov 10, 2014)

gotshirtz001 said:


> The point being, you have to "just add" a nurse and gear... This makes it no longer a BLS transport.


Point being that many BLS companies also handle CCT calls


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## gotbeerz001 (Nov 10, 2014)

Copy... Whatevs.

I am talking about scope of practice. You are talking about response plans. If I am mistaken, I'll STFU...


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## DesertMedic66 (Nov 10, 2014)

gotshirtz001 said:


> Copy... Whatevs.
> 
> I am talking about scope of practice. You are talking about response plans. If I am mistaken, I'll STFU...


The thread is very broad and just states what is a BLS or ALS call. It doesn't really ask about scope of practice. It just asks what type of calls will get an ALS vs BLS response.


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## drl (Nov 10, 2014)

DesertEMT66 said:


> While not every patient needs ALS in CA calling 911 means you get an ALS ambulance and not a BLS one (in most areas).
> 
> Depending on the posters location BLS may do CCT calls. Take my area for example. My company is the only company allowed to do ALS calls because we are the only 911 provider. We also do BLS and CCT. The local BLS companies do BLS and CCT calls only (just have a nurse hop on a unit with 2 EMTs and you have a CCT unit, aside from the gear).



Yep, most places in the Bay Area have ALS response for a 911 call, but the call may be downgraded to BLS once on scene (ie the medic drives, EMT techs). In LA County though, most places have BLS ambulances respond to 911 calls, with a fire engine that has a medic on board. If ALS transport is needed, the FF hops in the back with his gear.

For my company's CCT calls, we pick up the nurse and one of the special CCT rigs that has a vent, monitor, etc and we're good to go.


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## PFDEMT (Nov 22, 2014)

mikie said:


> I know an EMTB can handle all of those emergencies, but I would feel more comfortable if, in addition to the basic, someone else was on the rig, such as an I or P.  Like I said, BLS providers can indeed treat those patients, but often I think ALS should be needed (ESPECIALLY depending on the longer response time.  Few minute transport? not as much). Not saying this about your particular area, there is *only* so much a BLS crew can do with a cardiac arrest, for example, before ACLS is needed.
> 
> ***I am NOT at all saying Basics can't do anything; I completely disagree with that, but we can argue this in a different thread (I think there is one already out there) if need be***





honestly tell me what more can you do as a medic during a cardiac arrest than a emt can other than push epi-vaso-intubate.

with out *BLS *skills and knowledge a cardiac arrest aint worth nothing. only thing that keeps pt alive is compression's. I never have ALS available in my service, I run arrest,stemi,overdose, gun shots, trauma.... I do it all. *BVM YOUR PATIENT ALL THE WAY!!!!!!* 
bvm=cpap(manual)


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## Akulahawk (Nov 22, 2014)

PFDEMT said:


> honestly tell me what more can you do as a medic during a cardiac arrest than a emt can other than push epi-vaso-intubate.
> 
> with out *BLS *skills and knowledge a cardiac arrest aint worth nothing. only thing that keeps pt alive is compression's. I never have ALS available in my service, I run arrest,stemi,overdose, gun shots, trauma.... I do it all. *BVM YOUR PATIENT ALL THE WAY!!!!!!*
> bvm=cpap(manual)


You should dig out your area's ALS protocol manual because contained within that will be many pages of what you won't be able to do as an EMT provider. The BVM is an extremely poor substitute for a CPAP, even assuming that you could maintain an adequate seal. From what I can tell so far, you're a good example for not knowing what you don't know. There's quite a bit that a well-educated medic could do for the cardiac arrest patient beyond epi-vaso-intubate. There's this class, known as ACLS that is just the _start_ of an education for what to do in those situations. For many of us here, ACLS is but a merit-badge course as it's fairly basic to a lot of us here, but it's evidently well beyond what you've learned to date.


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## STXmedic (Nov 22, 2014)

PFDEMT said:


> with out BLS skills and *knowledge* a cardiac arrest aint worth nothing.


This. What is this?


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## triemal04 (Nov 22, 2014)

PFDEMT said:


> honestly tell me what more can you do as a medic during a cardiac arrest than a emt can other than push epi-vaso-intubate.
> 
> with out *BLS *skills and knowledge a cardiac arrest aint worth nothing. only thing that keeps pt alive is compression's. I never have ALS available in my service, I run arrest,stemi,overdose, gun shots, trauma.... I do it all. *BVM YOUR PATIENT ALL THE WAY!!!!!!*
> bvm=cpap(manual)


Are you being serious right now?


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## TransportJockey (Nov 22, 2014)

PFDEMT said:


> honestly tell me what more can you do as a medic during a cardiac arrest than a emt can other than push epi-vaso-intubate.
> 
> with out *BLS *skills and knowledge a cardiac arrest aint worth nothing. only thing that keeps pt alive is compression's. I never have ALS available in my service, I run arrest,stemi,overdose, gun shots, trauma.... I do it all. *BVM YOUR PATIENT ALL THE WAY!!!!!!*
> bvm=cpap(manual)


I can run a full arrest on scene. That right there gives them a better chance at ROSC than loading a working code into an ambulance and running code back to the ED. All you're doing at that point us risking yourself, your partner, and innocent bystanders over a dead body


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## DesertMedic66 (Nov 22, 2014)

PFDEMT said:


> honestly tell me what more can you do as a medic during a cardiac arrest than a emt can other than push epi-vaso-intubate.
> 
> with out *BLS *skills and knowledge a cardiac arrest aint worth nothing. only thing that keeps pt alive is compression's. I never have ALS available in my service, I run arrest,stemi,overdose, gun shots, trauma.... I do it all. *BVM YOUR PATIENT ALL THE WAY!!!!!!*
> bvm=cpap(manual)


Ill bite with a very quick answer to what more a medic can do, tension pneumothorax...


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## SeeNoMore (Nov 22, 2014)

I would imagine post ROSC outcomes might differ BLS vs ALS with a long enough transport time. But I don't know if there is any good data on this.


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## Ewok Jerky (Nov 22, 2014)

PFDEMT said:


> honestly tell me what more can you do as a medic during a cardiac arrest than a emt can other than push epi-vaso-intubate.



Assess for a correctable cause of cardiac arrest...and correct it.


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## johnrsemt (Dec 1, 2014)

EVERY CALL IS BLS;  depending on time to ED.
I always hated (when I worked in a multi tier department) BLS crews that would wait on scene for ALS to arrive when they could see the ED across the street.


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## chaz90 (Dec 1, 2014)

johnrsemt said:


> EVERY CALL IS BLS;  depending on time to ED.
> I always hated (when I worked in a multi tier department) BLS crews that would wait on scene for ALS to arrive when they could see the ED across the street.


Sorta depends on the situation doesn't it? There's times where it's appropriate to pick up and go to the ED, and there are times appropriate to wait a couple minutes for ALS. Pain management and chest pain patients if nearest hospital is not PCI capable come to mind. Also, cardiac arrests if ALS is reasonably close.


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## nrfdfreal (Dec 15, 2014)

Living in a very rural area, our ambulance is just part of our volunteer fire dept. We provide care at the BLS level only. There is a county Paramedic fly car on 6a-6p everyday but during the night we go BLS. If I feel comfortable going basic I will but if I need ALS for whatever reason (chest pain, pain management, etc..) there are several neighboring ambulance services that staff Paramedics.


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## NomeProvider (Jan 5, 2015)

Being probably one of the most rural EMTs in this thread, there's no such thing as an ALS call where I'm at.  All volunteer department in Nome, Alaska, and we respond to everything with whomever is on-call that day/night.  GSW? Back Pain? Broken Arm? Doesn't matter, we're going with the same crew.  We'll do what we can, load, and go.  The plus side is that we have very short transport times once we're loaded.  The bad side is that our local hospital doesn't even have a real ED and barely qualifies as a "level 4 trauma center".  If anything serious happens, once you're stabilized at the hospital, you've got a 2 hour flight to a real medical facility.


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## Calico (Jan 5, 2015)

The weird thing is our station is fully capable of being ALS, but we have no medics to staff it so we have to defer to city/metro ALS. ;_; Anything chest pain or shortness of breath is automatically ALS.  Everything else including car in the ditch and car vs. deer (low speed impact) is typically BLS.  The only problem is that unless it's "quarter after one, I'm all alone and my knee hurts now" we're automatically simul-toned out with ALS.  Nice in real emergencies, pain in the butt with small stuff since they have greater authority to transport.


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## Joey DeMartino (Jan 22, 2015)

Never have seen a BLS run over here. It usually takes an IC, two engines, one medic unit, two BLS buggies, the county EMS coordinator , a mutual full aid response, water tender, and the standard contingency of LEO assistance to respond to a high school kid with potential separation anxiety.  But the bird will remain on stand-by. Ya' just never know....


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## DesertMedic66 (Jan 22, 2015)

Joey DeMartino said:


> Never have seen a BLS run over here. It usually takes an IC, two engines, one medic unit, two BLS buggies, the county EMS coordinator , a mutual full aid response, water tender, and the standard contingency of LEO assistance to respond to a high school kid with potential separation anxiety.  But the bird will remain on stand-by. Ya' just never know....


You must live in a very slow area. That tends to happen in our slower areas. It gives everyone something to do. 

And also I think it's about time you guys upgrade from those buggies


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## Joey DeMartino (Jan 22, 2015)

Naw... the horses are pretty bored too....  After all- we gotta' spread the happiness to all of our participating agencies. An' besides... it's good revenue for the alfalfa farmers.....  Sure miss Cali.....


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## Joey DeMartino (Jan 22, 2015)

DesertEMT66 said:


> You must live in a very slow area. That tends to happen in our slower areas. It gives everyone something to do.
> 
> And also I think it's about time you guys upgrade from those buggies





DesertEMT66 said:


> You must live in a very slow area. That tends to happen in our slower areas. It gives everyone something to do.
> 
> And also I think it's about time you guys upgrade from those buggies


I see you got a pic of our star medic doin' his morning whiskey update. Damn horses were still hung over.


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## redundantbassist (Jan 22, 2015)

Holy crap, I was in 6th grade when this thread was started...


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## TransportJockey (Jan 23, 2015)

redundantbassist said:


> Holy crap, I was in 6th grade when this thread was started...


I was two years out of high school... thanks for making me feel old lol


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## epipusher (Jan 23, 2015)

beano said:


> Assess for a correctable cause of cardiac arrest...and correct it.


End thread.


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