# Difference between BLS and ALS



## Chimpie

Okay, I'm gonna sound like a real noob with this question.  But honestly, no one has really explained it to me and you guys seem cool so I'm gonna ask.  

What is the difference between BLS and ALS care?

Chimp


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## MMiz

> _Originally posted by Chimpie_@Jun 2 2004, 02:04 AM
> * Okay, I'm gonna sound like a real noob with this question.  But honestly, no one has really explained it to me and you guys seem cool so I'm gonna ask.
> 
> What is the difference between BLS and ALS care?
> 
> Chimp *


 Hey,

That's not a stupid question at all!  Here is some info:

*BLS = Basic Life Support*

Basic Life Support Units that are designed for inter-facility transportation and pre-hospital response to ill or injured patients.  Each unit is staffed with 2 licensed emergency medical technicians. 

EMT's in Michigan have 300 hours of training.  They can use AEDs, perform basic and intermediate airway procedures, and in general have all the tools to work many traumas.

*ALS = Advanced Life Support*

The ALS units have a minimum of one paramedic and one EMT, can administer certain medications, and have advanced airway equipment, cardiac monitors, advanced cardiac life support equipment and blood glucose testing equipment.

Paramedics usually have 1000 hours of education and training.  Then can start IVs, push medications, and perform more advanced procedures.

The EMT-Basic level is like getting an undergraduate degree, everyone has to start with it.  Then one can go on and get their "Masters", an EMT-Intermediate/Specialist.  The highest level is the EMT-Paramedic.

I know that may be a bit confusing, but I wanted to respond tot his one before I went out to dinner.  I hope that helps a bit.  Hopefully someone can add some more information.

If you have any more specific questions, feel free to ask


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## SafetyPro2

You'll find that every state's a little different. In California, this is how ours works:

EMT-1 (called Basic everywhere else) - 114 hours total with 104 hours of classroom/skills and 10 hours of either field ride-along or hospital clinical. Many programs go above these minimums. EMT-1s are all trained in AED use, oxygen administration, and the other basics (trauma, medical, assessment, etc.). Since California regulates EMS at both the state and county level (counties are the primary certifying agencies), each county can have its own "expanded scope of practice". In Los Angeles County, for example, we can also assist with an epi pen, nitro and asthma inhalers. Some providers in the county (like my department) also have approval for advanced airway.

EMT-2 (Intermediate) - This level is limited to primarily the rural counties in the state and is more an ALS than BLS level here.  306 hours total with 210 hours of classroom/skills and 96 hours of combined field ride-along and hospital clinical. EMT-2s can do some IV work, advanced airway, manually defibrillate/cardiovert, and give some ALS drugs.

Paramedic - 1,032 hours total with 320 hours of classroom/skills, 480 hours of field ride-along and 160 hours of hospital clinical.


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## Alpha752

It is the same way in Ohio as SafetyPro said, only we use the terms Basic, Int., Paramedic instead of 1, 2, 3.  The only diffrence that I noticed is that in Ohio Basics can perform Advanced Airway.  We can tube adults (no peds), and it is per your med control.  Your Dr. can say yea or nea on basics tubing.

In Ohio:
BLS- General transport, AED, Trauma, Basic and advanced Airway, Basic meds (O2, Glucose, EpiPen, charcol, perscribed inhalors, NTG)

ALS- Cardiac monitoring, a whole bunch of meds, all the fun stuff we Basics cant do.

Russ


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## Chimpie

Thanks for the explanation everyone.  That's pretty much what i deciphered myself.

I was under the impression though that EMT-B could start IVs.  Is this not the case?

Chimp


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## Alpha752

Not in Ohio.  We arnt allowed to poke people with needles.   

I dont know of anywhere where BLS can start IV's.  I know EMT-I's can but I dont know if they are considered BLS or ALS.


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## Chimpie

Okay, well there doesn't seem to be much difference between First Responders and EMT-B then.  I'm going to visit the school where I'll be taking the EMT class either tomorrow or Friday and will find out more.
Chimp


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## SafetyPro2

Just found out tonight that our department's losing advanced airway as of the first of next year (was going to be this month). Apparently, the state's no longer going to allow it for EMT-1. And, they're not going to allow the Combitube either, and are considering yanking it from Paramedics too. 

Chimp, you're right in that a lot of the scope for FR and EMT-B is similar. The big difference is that EMT-B goes into more detail in a lot of the areas and does allow for expanded scopes. Some EMT-Bs can start IV lines, or intubate, or manually defibrillate. Depends on your local EMS agency. Also, some states (like my own) don't regulate FR, so it's not technically part of the formal EMS but rather a glorified first aid class. 

The main difference between FR and EMT-B, which I posted recently in another forum, is that FRs are intended to provide just the initial treatment, while EMT-Bs (and higher levels) are intended to provide both initial treatment and treatment/monitoring during transport. May not always work out that way, but that's the intention.


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## Chimpie

See, in Indiana as a FR we were taught that they only difference between us and an EMT-B was that the EMTs have to know a little bit more about the human body and are able to use a combitube and start IVs.  Other than that we were the same.  I'm now learning that that is different throught the US.

As an Indiana-FR we could help administer nitro (actually just put it in their hand and tell them to put it in their mouth), c-collared and backboarded, supplied O2, oral and nasal airways, and I think that's it.

Chimp


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## MMiz

While theren't arent many differences to the actual skills an EMT-Basic an Medical First Responder (MFR) perform, EMT-Basics are taught much more of the "This is why that happens" kind of stuff.  Additionally, there aren't many job opportunities for MFRs, and I wonder why someone wouldn't just complete the additional training to get their EMT-B license.

Michigan recognizes EMT-Basics (EMT-B), EMT-Intermediate (EMT-I), and EMT-Paramedics (EMT-P).  My county only recognizes EMT-B and EMT-Paramedics, and an ALS unit is required to have two EMT-Paramedics on board for the administration of drugs.  

Starting IVs by itself isn't that hard of a task, but there really isn't any reason to teach a basic to start an IV if they can't push anything through it.  It's useful when working traumas with blood loss, and hospitals love when you bring in a patient with an IV, but it is a skill at the Intermediate level here in Michigan.

For us, the education went as follows:
EMT-Basic - 1 Semester
EMT-Intermediate - EMT-Basic + 1 Additional Semester
EMT-Paramedic - EMT-Intermediate + 1 Additional Semester + Summer-long clinicals.

The EMT-P program is usually a 12 month course including clinicals.

Hopefully I didn't confuse you too much


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## Chimpie

The only reason why I was a MFR vs. EMT-B was that the MFR class was sponsered by our department.  They wanted a good class that was going to be over quick.  

Chimp


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## ffemt8978

> _Originally posted by Chimpie_@Jun 2 2004, 07:12 PM
> * Okay, well there doesn't seem to be much difference between First Responders and EMT-B then.  I'm going to visit the school where I'll be taking the EMT class either tomorrow or Friday and will find out more.
> Chimp *


 In most areas, First Responders are NOT allowed to give drugs (Oral glucose, activated charcol, etc...) and are NOT allowed to transport a patient unless they are with an EMT.  Also, some states don't allow First Responders to use a multi-lumen airway like the Combitube.

In Washington, to run a legal ambulance, you must meet the following criteria:

1.  For a medical call, there must be at least one EMT and one person (may be the driver) Advanced First Aid certified.

2.  For a trauma, there must be at least one EMT and one First Responder (may be the driver).


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## MMiz

In my county MFRs can not work in ambulances.  This is how our system works:
EMT-Basic + EMT-Basic = BLS Unit, Performing all the skills of the EMT Basic
EMT-Basic + EMT-Paramedic or EMT-Intermeiate - BLS Unit + Full intubations
EMT-Paramedic + EMT-Paramedic - ALS Unit working at Paramedic Level
In my county EMT-Intermediate does not exist, you're seen as an EMT-Basic.

Most conties in Michigan will allow ALS as a "Basic / Medic" setup.  Meaning an EMT-B and EMT-P can run as a paramedic unit.

In my county 75% of Fire Fighters are EMT-Paramedics.  Only one city will allow Basics to join.  The MFR course is also part of both the police and fire academies here.

They can not transport patients, they are *First Responders*.  They have no means of intubation, just use a BVM with OPA or NPA.  

Okay, I have to work tomorrow, but I hope this helps make it a bit clearer.


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