# "Echo" Units



## MMiz (Nov 25, 2007)

Detroit has implemented "Echo" units with mixed results.  My own service used "Echo Units"/Paramedic-in-SUV with mixed results.  Because the county requires two EMT-Paramedics for ALS, our "Echo" units are glorified first responders.  They carry LifePak 12s with all the options, along with an airway kit, but can only perm ALS skills when a full ALS unit arrives.  Working for a private service, the city wanted echo units to ensure that we always had three paramedics in the city at all times.  Their SUVs were provided by the city.

What do you think about echo units?  Can they work?  Do they work?

I can't see how you can justify taking ALS units off the streets to put together the echo units like Detroit did.  I'm sure there is a correct model somewhere, but I can't find it!


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## medic001918 (Nov 25, 2007)

I think they can and do work.  I work in an intercept service with good results.  Your policies regarding having to wait for an ALS unit to arrive prior to initiating ALS care is counter productive however.  The primary goal of an intercept service should be utilization of resources.  You don't tie up a paramedic on a BLS transport.

Dispatch plays a large role as well in the success of a tiered response system.  They have to EMD calls appropriately to ensure the proper response to the best of their ability.

The way the system that I work in works is as such:

For an ALS call, the paramedic intercept vehicle (echo unit) is dispatched with a BLS ambulance.  The paramedic does an assessment and if the call needs a paramedic, you go in the ambulance with the BLS crew.  If the call is not ALS, then the paramedic goes back in service and has to write a complete downgrade PCR.  If the BLS ambulance beats the paramedic there and they deem the call to be BLS, they can cancel the medic.

For a BLS call, a BLS ambulance is dispatched and they can always call for a paramedic if needed.

We don't have rules that you need two medics to make an ALS truck.  Any vehicle with a single paramedic is deemed ALS here.

Hope that clarifies things a little.

Shane
NREMT-P


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## MMiz (Nov 25, 2007)

Shane,

A singleparamedic is ALS?  You don't need an Intermediate or Basic also?


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## Flight-LP (Nov 25, 2007)

It really is counterproductive to require two medics to initiate ALS. It isn't required here, in fact our Paramedic 1st responders have their full scope of practice when responding off duty. It works very well..............


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## Ridryder911 (Nov 25, 2007)

How about doing it right the first time? Place more EMS units, w/Paramedics. 
The system is similar to the "band-aid" system, where ALS EMS unit is dispatched to all possible ALS calls, then a BLS unit responds behind them non-emergency. The ALS would only transport those that need ALS units, and the others be transported by BLS crew. Keeps paramedics from having to transport everyone, as well each patient does get evaluated by a Paramedic. 

I worked on a "echo" type of unit. We called them ERU (emergency response unit) and was manned by one Paramedic, until a transport unit was available. I was young and eager, and enjoyed it but it did have its moments of terror. The system now has a Paramedic on each transport unit. 

Like any other system, each community has its own uniqueness and needs. If it works, that is great.. 

R/r 911


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## Asclepius (Nov 25, 2007)

I think in a system where cost is a matter of concern an 'echo' type response would be one way to keep those costs down. Think about it. You can have more BLS units for less money than the ALS units and for those calls that do not require ALS interventions you could keep the paramedic free for the next emergency. It would cost less, because perhaps you need one or two less street vehicles during non-peak times. Make a paramedic respond to every single call and do an assessment, then have that medic sign off on whether ALS intervention is needed. It takes the liability off the BLS crew and makes the paramedic responsible. 

I personally would like to see this happen in our system. We cover 22 communities for 911, we run intercepts, and we do ALL of the scheduled transport calls. I'd like to see some BLS units just for the scheduled calls, but they could also respond to emergencies in between calls. In a system where we run about 30 ambulances, it could work. It would sure help to have an echo vehicle or two for times when the system becomes taxed. The echo medic could arrive on scene and begin treatment, allowing the taxed crews to get to the hospital, drop the patient, and get back in service. To me, that is much better than having no one respond to the emergency because all of our transport units are running calls. It would also help for the intercepts that we do. One medic on the intercept and the smaller department can drive the vehicle behind to the hospital as soon as the medic takes over patient care.

I absolutely can see the value of this and to me, it makes good business sense too.


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## firecoins (Nov 25, 2007)

Here we are covered by a BLS volunteer ambulance and an ALS fly car.  Both are dispatched to every call.  The ALS fly car is staffed by two medics.  When they respond to a call that requires a paramedic, he put his bags in the BLS truck and provides treatment while enroute to the ER.  The other medic goes back into service for any other emergencies.


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## triemal04 (Nov 25, 2007)

Still reading the article, but...wow...Detroit is having some serious issues if even half of what's there is accurate.

For the call mentioned:  pretty sad, unless something has been left out.  (really, really, really hope something has been left out).  But that's a topic for a whole 'nother thread.

The echo units, or chase cars, first responce cars, whatever you want to call them...not a bad idea.  If they are used correctly.  It would definetly be better to simply have more ALS units on the road 24/7.  Solves the problem right there, especially in a system that is ALS only.  For a tiered system...having them available during peak hours wouldn't be bad; if an ALS call came in and the only ambulance was BLS, it'd be fine.  And it'd work the same if they were staffed 24/7.  The time it'd be a problem (and is the problem in Detroit apparently) is when you start sacrificing ALS ambulances to get the chase cars on the road; it makes no sense to remove a ALS transport capable unit and replace them with a BLS unit that has to wait for ALS help.  Or an ALS unit that has to wait for it's BLS transport to arrive.

And that is the issue, and very likely would be for a lot of places when they're first implemented: to do it right (not remove any resources) means hiring a lot more people (paramedics really, which costs more than a Basic) which is going to be a hard sell.  The easier way to do it would be to remove medics from an ambulance, convert it to BLS, and staff the chase cars with those people.  Which won't solve anything, given that the number of transport cable units hasn't changed.  For this to work as a concept, the number of ambulances has to remain constant, or even increase, and the number of ALS personell needs to do the same.  Anything less is an extreme disservice and waste of resources.

Edit:  Finished the article...man oh man...Detroit is royally screwed up.


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## medic001918 (Nov 25, 2007)

MMiz said:


> Shane,
> 
> A singleparamedic is ALS?  You don't need an Intermediate or Basic also?



My error for not being more clear.  A single paramedic in a fly car is an ALS unit.  For an ambulance to be ALS, it has to be a single paramedic with an Intermediate or basic.

Shane
NREMT-P


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## eggshen (Dec 3, 2007)

Here we have ALS (double medic) and BLS (double basic) cars. This is fairly new within the last few years. ALS being the only thing we had. I think in theory it may not be a bad idea but here we are hobbled by the state which will not allow basics to to much in the way of anything and also the fact that a majority of our basics are more likley than not to bugger even the most mundane calls.

Egg


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## disassociative (Dec 4, 2007)

Here in TN; most stations require Paramedic/EMT-IV or Paramedic/Paramedic. Some stations have BLS trucks with EMT-IV/EMT-IV; however the majority are either Paramedic/Paramedic or Paramedic/EMT-IV. It works out quite well for us seeing as we have first responders, EMT-IV responders, and Paramedic responders out the wazzoo here at our fire depts and rescue squad. It is rare to come across a scene in this area in which there is no first responder.


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## jaron (Dec 7, 2007)

I've seen a similar system done in two different ambulance services that I have worked for.

Service 1 was a private ambulance. There was a team leader for each shift. This team leader tried to stay in the "office" and only responded to calls if the crew on scene requests it. The F-250 that they were issued had a ALS kit in it along with a couple of back boards. It the system was really busy and there wasn't anyone available or the team leader was closer then the team leader would take the call. For the most part the only reason the team leader would take the call would be to stop the clock (911 call to arrival by a ALS unit) there by keeping our average down for the county contract.

Service 2 was a hospital based ambulance. They had a team leader and a supervisor on every shift. The team leader would respond to all delta's unless called off first by the first unit on scene. On echo's both the team leader and the supervisor would respond. You might think that this would cause a "to many cooks in the kitchen" kind of situation but it never did. The team leaders and supervisor's were very good about just showing up, looking and the primary crew on scene and asking "what can I do to help". It worked out very well.

Anyway there's my two cents

Jaron F.


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## kiwimedic (Dec 23, 2007)

In New Zealand we have B/I/ALS ambulances and fly cars.  Some of the country has all ILS and ALS ambulances while the rest has a mix of BLS, ILS and ALS with fly cars.

Because a station might only have one ALS ambulance we also have fly cars.  They work well except that a fly car is often to every job which might require them which means a lot of running around and not a lot of time providing care.

My neighbor broke hig leg the other night - an ILS ambulance and a fly car Paramedic turned up.

We use the ProQA/AMPDS system which is good but not great at determining what level of care is required so we err on the side of caution and send either an ILS ambulance or fly car to jobs which *might* require them.

There is a push on to get every rig in the nation staffed with at least one EMT-I (ILS Paramedic) for just that reason - to get delays to ALS down and patient outcomes up.


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## Jolt (Dec 23, 2007)

..........


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## Jon (Dec 24, 2007)

At the volly squad, we are all BLS, with ALS being provided by 2 single-provider fly-cars out of the hospital next door to our base. If the 2 local ALS units are busy, we get the next due one, which is often 10+ minutes away. We have a supervisor and at least 2 full BLS crews on station 24x7, and have 5 BLS rigs ready to go. When we get busy, vollies come in from home and get the rigs out (we haven't missed a call in over 15 years).

Our SOP's call for a supervisor response on serious MVC's, MCI's, shootings/stabbings/assualts, and all other major incidents (fires with rehab, etc). The supervisors are usually good about standing back and helping... they are there to assist the EMS crews with WHATEVER needs to happen... they will grab a board and collar... request aeromedical, and just make my life easier... they don't try to take over patient care.

As for ALS coverage.... if the call sounds like something more than a standard chest pain/SOB call - "Subject Down / Cardiac Arrest / MVC with entrapment" BOTH ALS units will respond, if availible. Codes always work better with 2 medics 




As for the Chicago article -  WTF? EMT/Medic ambulances, and Medic/Medic fly cars? Someone needs to remove their head from their posterior. IF you really feel the fly car needs a second provider... make it an EMT - they can do compressions while the medic gets the tube. In fact, why not make every unit EMT/Medic? If you have a serious call... send 2 ambulances or an ambulance and an Echo unit... then you have 2 medics and an extra basic to help in the back if needed.


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## bonedog (Dec 27, 2007)

We have a targeted system here. We used to be dispatched by paramedics cross trained in dispatch, who would sus out the calls using their history taking skills, now they are using AMPDS.

It seems to be a crap shoot as to if the call will be as "dispatched as".

Way too many unwarranted emerg response's with this system. Being a targeted system, ALS units are probably at a 15 to 1 ratio to BLS units, unfortunately the current dispatch system doesn't fit with limited resources....the 6C1 comes to mind, or gut pain over 35.


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