# BLS vs. ALS



## Pudge40 (Aug 25, 2009)

Well since we now have this policy of post whatever you want so long as the discussion is civil and no one hijacks the thread here goes. Do you feel that every ambulance should be ALS staffed?

I feel that it is better to have ALS but if BLS is around it is better than nothing.


----------



## Ridryder911 (Aug 25, 2009)

Why do we prefer to settle for first aid? Especially since medical care/ALS has been around for more than 40+ years? 

R/r 911


----------



## Pudge40 (Aug 25, 2009)

Ridryder911 said:


> Why do we prefer to settle for first aid? Especially since medical care/ALS has been around for more than 40+ years?
> 
> R/r 911



I guess because some areas don't have the means to support an ALS service.


----------



## Ridryder911 (Aug 25, 2009)

Pudge40 said:


> I guess because some areas don't have the means to support an ALS service.



Yet, they still survive and able to offer other services. I guess then, communities should have to place signs and placards to visitors and those passing through to enter at your own risk. Community cannot reach modern medical practices but enjoy our park and lighted softball field. 

R/r 911


----------



## Pudge40 (Aug 25, 2009)

Ridryder911 said:


> Yet, they still survive and able to offer other services. I guess then, communities should have to place signs and placards to visitors and those passing through to enter at your own risk. Community cannot reach modern medical practices but enjoy our park and lighted softball field.
> 
> R/r 911



But still having BLS is still better than waiting 30-45 minutes for ALS. At least with BLS they can start basic care and then rendevouz with the ALS.


----------



## TransportJockey (Aug 25, 2009)

Pudge40 said:


> But still having BLS is still better than waiting 30-45 minutes for ALS. At least with BLS they can start basic care and then rendevouz with the ALS.



You get rid of the long wait if every ambulance was staffed by at least one ALS provider. I see nothing wrong with having at least one medic on every rig, and that's the way things should be run. 

And to help that along, there should be enough ambulances so services can stop having to send BLS engine companies on medical calls.


----------



## MrBrown (Aug 25, 2009)

This is a contensious issue from a number of standpoints.

Let me use an analogy; if you go to the emergency department do you expect to be seen by some sort of lesser nurse and have them call up for backup if you need it?  If you go down to the store do you deserve to be seen by some sort of tiered system of employee to get what you want?

If you call the cops for some guy boosting your car the cops that roll up will arrest the guy, take him back to the station, maybe smack him around a bit and take him to court; it doesn't matter if they are detectives, dog handlers, beat cops or whatever a cop is a cop is a cop.  Doesn't matter who you call they will show up and do the same thing (maybe not if you call the Ghostbusters).

The whole fragmentation in EMS of BLS vs ILS vs ALS vs EMT vs A-EMT vs Paramedic vs EMT-A,B,C,D,E,F, G etc etc is a problem.  When you look at the related health disclipines a doctor is a doctor is a doctor it doesn't matter if he's an ER doc, a general practitioner, a OBGYN or whatever.

So I think ALS should be the prime standard.  What really tears me apart is the vastly different scopes of practice and education.


----------



## Sasha (Aug 25, 2009)

Pudge40 said:


> I guess because some areas don't have the means to support an ALS service.



I'm calling BS. Florida has 100% ALS response. That means every ambulance that does 911 has at least one paraedic. There are some very rural and poor areas of Florida, yet we are still able to provide ALS AND we don't have state taxes to draw the funding for it from.

If the entire state, including rural and poor areas, can provide ALS response, it's proof that it CAN be done.


----------



## medic417 (Aug 25, 2009)

It is a myth that it costs tons more to staff at an ALS patient care level.  Other than initial costs it really does not add that much to the costs.  The biggest reason it is really fought is those at the basic level are not wanting to get the extra education so they claim the extra expense to keep communities from moving to it.  

The only way you would ever save money would be in a large service where the small savings per ambulance would add up.  Of course the savings vs the cost in lives, I don't want to live with that.


----------



## Flight-LP (Aug 25, 2009)

God, this is beyond beating the dead horse!

Why do people insist that 2 people who have completed a 120 hour first aid course can effectively deliver high quality pre-hospital emergency care? Especially when there is a known entity out there that can far exceed that level of care. 

It can be done in most communities, you just have to prioritize resources and get a little creative. As I have now said 3 times in the last month, if the two poorest counties in the State of Texas can do it, yours can too probably. As my favorite little Floridian pointed out, every primary 911 ambulance in Florida is ALS. The proof is there!

Here is a little personal story that I like to tell people when they feed this BS.............

Back in 2000, I was working in a very poor rural county in east Texas that had a small part-time ALS service (1 truck, ALS staffed about 60% of the time) that wanted (and desperately needed) to expand. The notion was rejected by the county citing a lack of financial resources. Ironically enough, 3 of the county fire departments had a budget of $100K+ and were replacing apparatus on an alost yearly basis. Now, yes some of these trucks needed to be replaced as they were 20+ years old. However, suitable used replacements were sourced at an economical cost. The departments however pissed and whined about why they needed a new truck for their less than 100 runs per year volume (EMS meanwhile was running 500+ per year with surrounding counties having to pick up an additional 200). So the county allowed each of them to buy a $150k fire truck (when they could have gotten a reliable used one for under $75k). When it was all said and done, the final sticker was over $600K! 

After organizing some data, providing recent statistics of mortality for various ailments, and basically justifying the need for better service, the idea was again considered. Then we effectively showed the excessive spending and under utilization of their new half million plus fire apparatus, plus the unneeded $20-40k spent by the departments for additional training never utilized nor needed.

That county received 24/7 ALS coverage with 3 units immediately after the next board meeting! The county was able to divert almost $200k per year from uneeded fire budgets over to a much needed EMS budget. Add to it effective billing, grants, and happy employees that ensure a low turnover, and they today have a well established ALS service.

Just one example, but one that can be commonly applied throughout the US. How much money does your fire service have? Does it truly need it? Maybe, maybe not...............


----------



## firecoins (Aug 25, 2009)

another ALS versus BLS thread?  I love the variety here!


----------



## TransportJockey (Aug 25, 2009)

Flight-LP said:


> Maybe, maybe not...............



Probably not.



firecoins said:


> another ALS versus BLS thread?  I love the variety here!


No kidding. We need a sticky with all the possible outcomes to this thread... which there is only 1.

All 911 units need to be staffed at the ALS level


----------



## Sasha (Aug 25, 2009)

> Just one example, but one that can be commonly applied throughout the US. How much money does your fire service have? Does it truly need it? Maybe, maybe not...............



Actually, a majority of central Florida EMS is through fire service, up north and down south they have various third service providers, county and private, but EMS based fire is spreading like wildfire.


----------



## firecoins (Aug 25, 2009)

Sasha said:


> Actually, a majority of central Florida EMS is through fire service, up north and down south they have various third service providers, county and private, but EMS based fire is spreading like wildfire.



but who will they call to put the wildfire?  5 FF/Medics are charging an IV to put dehydration.


----------



## Sasha (Aug 25, 2009)

firecoins said:


> but who will they call to put the wildfire?  5 FF/Medics are charging an IV to put dehydration.



That's not the way it works here. Especially smaller departments, fire fighters are not forced to be medics to my knowledge in my area with the exception of OCFD. And there is a designated crew for the rescue and for the engine/tower/what have you. If dispatched and not needed, the engine/tower returns to the station. 

There is a right way to do EMS based fire. And a wrong way.

I like this current wildfire, so hopefully no one, and it will spread to the rest of the country.


----------



## firecoins (Aug 25, 2009)

Sasha said:


> I like this current wildfire, so hopefully no one, and it will spread to the rest of the country.



Now we need another threads dedicated to Fire based EMS versus third service.


----------



## exodus (Aug 25, 2009)

I'm a believer of totally getting rid of EMT, and simply going to medic. Maybe EMT-B's can be wheelchair van drivers?


----------



## TransportJockey (Aug 25, 2009)

exodus said:


> I'm a believer of totally getting rid of EMT, and simply going to medic. Maybe EMT-B's can be wheelchair van drivers?



They do qualify to do that... barely


----------



## Flight-LP (Aug 25, 2009)

Sasha said:


> Actually, a majority of central Florida EMS is through fire service, up north and down south they have various third service providers, county and private, but EMS based fire is spreading like wildfire.



Yeah, not so much around here. We really do not want these volunteer fire departments having anything to do with EMS. Besides, none of them have any ALS providers.


----------



## subliminal1284 (Aug 25, 2009)

Rid your avavar fits you perfect, I could see you with the same personality as that character :lol:


----------



## Akulahawk (Aug 25, 2009)

*Yet another wrinkle*

There is but another wrinkle in this ALS/BLS thread... Skill utilization and dilution of those skills. What I'm referring to is that in a given area, there's going to be a certain number of ALS skills (not just placing a line or ECG monitoring) that need to be performed. When you have an a lot of ALS providers, the liklihood of any given provider having performed that skill drops. So, even while you might have kept the providers "proficient" through training, the providers don't generally have experience in that skill, whatever it may be.

This becomes an issue in larger EMS systems. 

Going to an all ALS system is not always the panacea that people make it out to be.


----------



## firecoins (Aug 25, 2009)

Akulahawk said:


> There is but another wrinkle in this ALS/BLS thread... Skill utilization and dilution of those skills. What I'm referring to is that in a given area, there's going to be a certain number of ALS skills (not just placing a line or ECG monitoring) that need to be performed. When you have an a lot of ALS providers, the liklihood of any given provider having performed that skill drops. So, even while you might have kept the providers "proficient" through training, the providers don't generally have experience in that skill, whatever it may be.



you mean 4 or 5 FF/Medics charing an IV line to put out dehydration?  Yep.


----------



## medic417 (Aug 25, 2009)

Akulahawk said:


> There is but another wrinkle in this ALS/BLS thread... Skill utilization and dilution of those skills. What I'm referring to is that in a given area, there's going to be a certain number of ALS skills (not just placing a line or ECG monitoring) that need to be performed. When you have an a lot of ALS providers, the liklihood of any given provider having performed that skill drops. So, even while you might have kept the providers "proficient" through training, the providers don't generally have experience in that skill, whatever it may be.
> 
> This becomes an issue in larger EMS systems.
> 
> Going to an all ALS system is not always the panacea that people make it out to be.



I would respectfully disagree.  A service goes all ALS.  Yes in the field you may get less times doing a skill.  But since you are with a quality service they will have worked with hospitals, etc to allow you to practice skills under the supervision of someone that can help you develope better skills.  So instead of doing it in the field developing poor techniques you actually will see your Paramedics be better educated and qualified to perform the skills.


----------



## Sasha (Aug 25, 2009)

Flight-LP said:


> Yeah, not so much around here. We really do not want these volunteer fire departments having anything to do with EMS. Besides, none of them have any ALS providers.



Ah, perhaps that is your problem. Our fire department is career and staffed by EMTs AND Paramedics. There are a few with volunteer and paid, but the volunteers are only there to up their chances of getting hired. In smaller departments they aren't forced to go to paramedic if they don't want to and the ones that DO go to paramedic school do it because they want to be a paramedic, and that makes for some fantastic providers.

It works for my area.


----------



## HotelCo (Aug 25, 2009)

Pudge40 said:


> Well since we now have this policy of post whatever you want so long as the discussion is civil and no one hijacks the thread here goes. Do you feel that every ambulance should be ALS staffed?
> 
> I feel that it is better to have ALS but if BLS is around it is better than nothing.



Yes, I think all 911 calls should have an ALS response.


----------



## Akulahawk (Aug 25, 2009)

medic417 said:


> I would respectfully disagree.  A service goes all ALS.  Yes in the field you may get less times doing a skill.  But since you are with a quality service they will have worked with hospitals, etc to allow you to practice skills under the supervision of someone that can help you develope better skills.  So instead of doing it in the field developing poor techniques you actually will see your Paramedics be better educated and qualified to perform the skills.


I would completely agree... as long as the service and the hospitals actually do work together to provide on-going clinical time/practice to actually improve skills, especially the underutilized skills. If you have a quality service and excellent hospitals, but the hospitals won't allow the prehospital providers get the time in OR, Peds, ICU, ER... because they're afraid of liability... (yes I've seen this first hand) it doesn't work well. I'm referring to the same hospitals that allow EMT-P students to get that time... 

I actually worked in such a county. When I worked as a medic here, I couldn't get time in-hospital to improve any of my skills. However, if I was a paramedic student... those same hospitals would have not had an issue with me doing that through the school.


----------



## Akulahawk (Aug 25, 2009)

Sasha said:


> Ah, perhaps that is your problem. Our fire department is career and staffed by EMTs AND Paramedics. There are a few with volunteer and paid, but the volunteers are only there to up their chances of getting hired. In smaller departments they aren't forced to go to paramedic if they don't want to and the ones that DO go to paramedic school do it because they want to be a paramedic, and that makes for some fantastic providers.
> 
> It works for my area.


I have no issue with FD EMS. I do have an issue with Firefighters becoming, or forced to become Paramedics so that they can be Firefighters. I've seen LOTS of that. I'm a Paramedic who'd do Fire so that I could be a Paramedic. However, once I'm on a few years, I'd get promoted off the ambulance, and onto another apparatus where the most patient care I get is just walking on-scene with the transport guys right there with me. That's not what I want to do.


HotelCo said:


> Yes, I think all 911 calls should have an ALS response.


I would agree for the simple reason that sometimes, a cut finger call really is a CVA or an MI call...


----------



## Shishkabob (Aug 25, 2009)

Not every call requires ALS. 

Having said that, and before Sasha gets on her "Every pt deserves an ALS assessment!" rampage: I agree.


So what was the point of the "Not every call requires ALS" then?  Simple:  Not every single provider needs to be a medic on a call.  There is nothing wrong with having a basic response to a call arrive first.  And who fulfills that first response?  Basics.  Therefor, getting rid of the EMT-B level is idiotic.  

Train FF's to EMT.  Train rural police to EMT.  Train lifeguards to EMT.  Train industrial security guards to EMT.  Etc etc.



Does the education lack?  Sure.  But no reason why it cannot be upped.    And no reason why the level as a whole should be abolished.


----------



## Sasha (Aug 25, 2009)

Linuss said:


> \There is nothing wrong with having a basic response to a call arrive first.  And who fulfills that first response?  Basics.  Therefor, getting rid of the EMT-B level is idiotic.



Why do you not just take a basic off a truck and put a medic in it's place so the patient doesn't have to wait around while the EMTs wait for ALS?


----------



## HotelCo (Aug 25, 2009)

I was just thinking of an idea, and haven't had a ton of time to think it through, tell me your thoughts..

BLS ambulances, ALS fly-cars. ALS car responds to call along with the BLS ambulance, if ALS clears them, they go BLS. If not, one (or both) of the medics ride with the BLS ambulance, and one of the BLS providers takes the fly car and follows to the hospital.

Like I said, I just thought of it, and haven't looked too deeply into it.

Thoughts?


----------



## Shishkabob (Aug 25, 2009)

Sasha said:


> Why do you not just take a basic off a truck and put a medic in it's place so the patient doesn't have to wait around while the EMTs wait for ALS?




No one said they couldn't, but that wasn't my point, was it?  My point was it'd be stupid to get rid of the EMT-B level completely.


----------



## Pudge40 (Aug 25, 2009)

Linuss said:


> Not every call requires ALS.
> 
> Having said that, and before Sasha gets on her "Every pt deserves an ALS assessment!" rampage: I agree.
> 
> ...



Here Here!


----------



## Shishkabob (Aug 25, 2009)

HotelCo said:


> I was just thinking of an idea, and haven't had a ton of time to think it through, tell me your thoughts..
> 
> BLS ambulances, ALS fly-cars. ALS car responds to call along with the BLS ambulance, if ALS clears them, they go BLS. If not, one (or both) of the medics ride with the BLS ambulance, and one of the BLS providers takes the fly car and follows to the hospital.
> 
> ...



This is the type of system I've always liked (I think Boston has it?) because again, NOT every call requires ALS treatment en route to the hospital.


The only downside I see to it is lazy medics who turf the pts who really need ALS, or if a pt drops in a BLS rig.  I guess that could be taken care of by instituting a "IF the basic request a medic on the truck, the medic has to stay" rule.


----------



## HotelCo (Aug 25, 2009)

Linuss said:


> This is the type of system I've always liked (I think Boston has it?) because again, NOT every call requires ALS treatment en route to the hospital.
> 
> 
> The only downside I see to it is lazy medics who turf the pts who really need ALS, or if a pt drops in a BLS rig.  I guess that could be taken care of by instituting a "IF the basic request a medic on the truck, the medic has to stay" rule.



That happens when you have an ALS ambulance response too. Medic doesn't want to do the work, and the patient isn't in a life or death situation, so they just transport, and perhaps start an IV.


----------



## Shishkabob (Aug 25, 2009)

Oh, that I know, just you have a medic more readily availble on a basic/medic truck.



Here in Ft Worth, the FD has a basic engine response, with some engines that carry medics.  Response time is short.

MedStar then gets dispatched, and they do a basic/medic truck.    


I haven't heard any bad about the system we have going on here.  Heck, the FD wants to stay out of EMS aside from a first response group.  They don't want to do fire based EMS.... weird.


----------



## subliminal1284 (Aug 25, 2009)

Here in Milwaukee all the ALS is run by the fire department and BLS calls are contracted out to private companies. The problem is the fire departments meics refuse to run BLS calls and have even been known to pawn off calls that should have been ALS to the BLS crew.


----------



## Akulahawk (Aug 25, 2009)

Linuss said:


> Oh, that I know, just you have a medic more readily availble on a basic/medic truck.
> 
> 
> 
> ...


Not wierd at all. FD recognizes that they often have a shorter response time... so they'll go out on those calls. They're up-front about the desires of their people. They don't want to do EMS. That results in a better overall level of care than forcing EMS on a FD that doesn't want it. One of the key things in getting good FD EMS going is buy-in by the line personnel. If they don't buy-in, it isn't going to be good. The same could be said for PD based EMS. 


subliminal1284 said:


> Here in Milwaukee all the ALS is run by the fire department and BLS calls are contracted out to private companies. The problem is the fire departments *medics refuse to run BLS calls* and have even been known to pawn off calls that should have been ALS to the BLS crew.


I've seen that happen in the Private Ambulance world too. I've seen ALS crews pawn off ALL of the BLS calls to BLS crews... when running a short distance/time BLS call or two can make a world of difference to the BLS guys and the overall transport schedule... and that can create openings to schedule more BLS runs... while generally remaining available for ALS (usually transfers) calls.


----------



## rescue99 (Aug 25, 2009)

subliminal1284 said:


> Here in Milwaukee all the ALS is run by the fire department and BLS calls are contracted out to private companies. The problem is the fire departments meics refuse to run BLS calls and have even been known to pawn off calls that should have been ALS to the BLS crew.



LOL...noooooo..do tell? It's an age old problem with ALS, be they fire based or private. Thus just one of the several good reasons to keep EMS, EMS and fire, fire and Basics right where they are!


----------



## medic_texas (Aug 25, 2009)

I can agree with that, EMS is a professional all by itself.  It shouldn't be the :censored::censored::censored::censored::censored::censored::censored: child of the FD or PD (I've worked for a PD/EMS before, horrible idea).


----------



## harkj (Aug 25, 2009)

in my area there are still BLS trucks but i think that it should all be ALS, the dispatchers never really know whats going on all they can go by is what the person on the phone tells them... So I get a call the patient on the phone says he has the flu i ask a few more questions and by what he tells me its a BLS call i send a BLS truck on it... they get there the patient is not breathing (its happened to me but all we have is ALS trucks) the chance should not be taken to send a BLS truck just send the ALS its better for everybody


----------



## FR Wrath (Aug 25, 2009)

That's how it is in Central Louisiana. We have basic units, but they only handle transfers. All other units have at least 1 ALS medic. Some have 2 ALS.


----------



## firecoins (Aug 25, 2009)

HotelCo said:


> BLS ambulances, ALS fly-cars. ALS car responds to call along with the BLS ambulance, if ALS clears them, they go BLS. If not, one (or both) of the medics ride with the BLS ambulance, and one of the BLS providers takes the fly car and follows to the hospital.



Gee that sounds like the system I work in.


----------



## HotelCo (Aug 25, 2009)

firecoins said:


> Gee that sounds like the system I work in.



Does it work well?


----------



## firecoins (Aug 25, 2009)

HotelCo said:


> Does it work well?



yes it does.  Its much better than what I see elsewhere.  Medics and BLS crews work on scene together and quite well...most of the time. Patients get taken care of very well.


----------



## MrBrown (Aug 25, 2009)

jtpaintball70 said:


> All 911 units need to be staffed at the ALS level



A good point.  What about if we went a step further and made ALS or at least some heavily upskilled ILS the minimum level like Australia, Canada and the UK does?  We're trying to do it here.

This new _Agenda for the Future_ where salbutamol is considered an "advanced" procedure and an Intermediate is not trusted to obtain an ECG or manually defibrllate just drives me mental!

Intermediates here (at most) can...
- insert an LMA,
- start IVs, 
- defibrillate and cardiovert, 
- morphine IM/IV,
- naloxone IM/IV,
- adrenaline IM for anaphylaxis, asthma, croup
- adrenaline IV for cardiac arrest, 
- amiodarone IV for cardiac arrest, 
- neb salbutamol, 
- SL GTN, 
- PO ASA, 
- IM glucagon,
- 10% glucose IV

Now that seems to be a pretty good scope to deal with almost anything.

I think we need to do away with this BLS vs ILS vs maybe a bit more ILS vs ALS vs fifty million scopes of practice and education programs that deliver inconsistent care and confuse the heck out of the public ... maybe we should, gasp, do away with our egos and call everybody a Paramedic?

You know I was initially very against the idea of just one or two levels and titles but the more I read up on it the more I am sold.


----------



## Sasha (Aug 25, 2009)

HotelCo said:


> I was just thinking of an idea, and haven't had a ton of time to think it through, tell me your thoughts..
> 
> BLS ambulances, ALS fly-cars. ALS car responds to call along with the BLS ambulance, if ALS clears them, they go BLS. If not, one (or both) of the medics ride with the BLS ambulance, and one of the BLS providers takes the fly car and follows to the hospital.
> 
> ...



My thought is...once again... why not just send an ALS ambulance to begin with? Why do you need a BLS ambulance and an ALS fly car? What is the point besides wasted resources? That way, when "BLS Stable" calls decide to bite you in the butt and go south, the medic is already there.

I don't get why an ALS ambulance is taboo.


----------



## HotelCo (Aug 25, 2009)

Sasha said:


> My thought is...once again... why not just send an ALS ambulance to begin with? Why do you need a BLS ambulance and an ALS fly car? What is the point besides wasted resources? That way, when "BLS Stable" calls decide to bite you in the butt and go south, the medic is already there.
> 
> I don't get why an ALS ambulance is taboo.



I don't see wasted resources. I see maximizing a single ALS unit's potential.

You have 1 (or 2) medics on a fly car that respond with a BLS ambulance, you assess, and if needed stay. If not, you're back out there able to respond to another call. In my mind, it would save money. You don't have to pay to have so many medics. It may not be a huge difference, but there will be some. I'm glad that Florida has the resources, structure and funds to provide all ALS ambulances that respond. That's awesome. However, it doesn't mean it can happen everywhere right away. Compromises will be made in some places for a while.


----------



## Sasha (Aug 25, 2009)

HotelCo said:


> I don't see wasted resources. I see maximizing a single ALS unit's potential.
> 
> You have 1 (or 2) medics on a fly car that respond with a BLS ambulance, you assess, and if needed stay. If not, you're back out there able to respond to another call. In my mind, it would save money. You don't have to pay to have so many medics. It may not be a huge difference, but there will be some. I'm glad that Florida has the resources, structure and funds to provide all ALS ambulances that respond. That's awesome. However, it doesn't mean it can happen everywhere right away. Compromises will be made in some places for a while.



Split up the fly car and instead of one medic unit, you have two.


----------



## HotelCo (Aug 25, 2009)

Sasha said:


> Split up the fly car and instead of one medic unit, you have two.



And you've just committed a medic to a call that may not need ALS treatment.


----------



## TransportJockey (Aug 25, 2009)

HotelCo said:


> And you've just committed a medic to a call that may not need ALS treatment.



Medics run non ALS calls all the time here, and I don't see it hurting response times or draining the medic pool


----------



## HotelCo (Aug 25, 2009)

jtpaintball70 said:


> Medics run non ALS calls all the time here, and I don't see it hurting response times or draining the medic pool



Yes they do, and you have to pay that medic to run a BLS call. When you could just pay a basic to do it.


----------



## Sasha (Aug 25, 2009)

HotelCo said:


> And you've just committed a medic to a call that may not need ALS treatment.



The medic can downgrade to BLS and let the EMT treat it. I don't see the issue. Take a dual medic flycar and put one medic on each ambulance. Instead of responding to one call at a time you have two capable ALS units.


----------



## TransportJockey (Aug 25, 2009)

HotelCo said:


> Yes they do, and you have to pay that medic to run a BLS call. When you could just pay a basic to do it.



The medic is still going to get paid, due to the fact that he's the Basics partner. And besides, one of the few things I like about the protocols here in ABQ is that to run a 911 call you must have a medic in the back. Basics are EVOs only.


And before you say that we sure can't have enough medics or that that's only FD... ABQ runs dual tier. First tier is FD, which runs dual medic rescues. Second tier is the private transport service which maintains at least 1 medic on every truck, 24/7


----------



## Micro_87 (Aug 25, 2009)

Sasha said:


> The medic can downgrade to BLS and let the EMT treat it. I don't see the issue. Take a dual medic flycar and put one medic on each ambulance. Instead of responding to one call at a time you have two capable ALS units.



best answer i have heard in this thread


----------



## 46Young (Aug 25, 2009)

I've heard it said before, that EMS as a whole would be better off if there was only one main certification level, which would be paramedic. This can be a two year degree, with maybe a few pre reqs, and a paid internship afterward not unlike a MD residency. That way, you can marry your newfound knowledge with real life "street" situations under the watchful eye of your FTO. All paid EMS positions would be paramedic level as a minimum requirement.

Increase the scope of a MFR/CFR to that of a current BLS provider. That way volly organizations will always have at least BLS, and medics will have providers onscene that are at least competent enough to support their efforts properly.

CCEMT-P would be a legit specialty, maybe an additional one or two years of schooling, and would be able to replace txp RN's.

Gaining (true) licensure would be great as well.


----------



## TransportJockey (Aug 25, 2009)

46Young said:


> I've heard it said before, that EMS as a whole would be better off if there was only one main certification level, which would be paramedic. This can be a two year degree, with maybe a few pre reqs, and a paid internship afterward not unlike a MD residency. That way, you can marry your newfound knowledge with real life "street" situations under the watchful eye of your FTO. All paid EMS positions would be paramedic level as a minimum requirement.
> 
> Increase the scope of a MFR/CFR to that of a current BLS provider. That way volly organizations will always have at least BLS, and medics will have providers onscene that are at least competent enough to support their efforts properly.
> 
> ...



I truly wish that in my career I see a system like this come to pass nationwide


----------

