# Bringing in an AEDs on BLS Calls



## EpiEMS (May 8, 2013)

Do you bring an AED into the house, assisted living facility, etc. on every BLS call?
I usually only bring it in for respiratory distress, unknowns, and "unconscious" calls.


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## Uclabruin103 (May 8, 2013)

EpiEMS said:


> Do you bring an AED into the house, assisted living facility, etc. on every BLS call?
> I usually only bring it in for respiratory distress, unknowns, and "unconscious" calls.



Check your county or department policy for that. I know the department I work for reuqires us to bring our Zoll (my unit is BLS so we use AED function) to every call.


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## Tigger (May 8, 2013)

Every "emergency" call got the 02/trauma bag and AED when I worked BLS in Boston. It became company policy after a while but I did it anyway since it's not that big and easily fit on the net at the head when we took someone. 

Here med bag, airway bag, and monitor on every call as well, unless the paramedic is insistent on not bringing it. Already I have left the airway bag in truck after being told to, needed to give O2. Left the narcs and suction in truck after being told to, needed both.


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## chaz90 (May 8, 2013)

That's one of the interesting components about my system. We bring in two large Stat Packs and the LP15 in on every call. This is because we're only technically dispatched to "ALS" calls though, and not having an ambulance of our own means every piece of ALS equipment must come in on our own backs. Anticipate needing more than 1.5 liters of NS? Better bring the saline tub too. Maybe a cardiac arrest or trending that way? Better grab the Lucas plus Ventilator plus maybe cooler for induced hypothermia if you're feeling optimistic. How about RSI? Grab the other ventilator. I could go on...


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## SpecialK (May 9, 2013)

The monitor/defibrillator is taken on almost every job; every ambulance is equipped with either an LP12 or a Phillips Heartstart MRx which are replacing the LP12s.

There are a number of vehicles that do a very low volume of responses and they are having a manual defibrillator removed and replaced with an AED and a small Capnocheck SpO2/ETCO2 monitor.  Examples of this are the DOM/ROM and Clinical Support.  

Road crash is an example where the monitor/defibrillator would not be taken; at least initially.


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## Brandon O (May 9, 2013)

No. Not any more than we bring the suction.


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## Chris07 (May 9, 2013)

IFTs..no way. If we are first on scene of a 911 we bring a jump bag (Airway/O2/Basic Trauma) and the AED. If fire's already on scene we don't bother with that stuff and bring just the gurney since they have all of that stuff anyway.

Why?
Can't tell you how many times those "Sick Person" calls turned out to be something completely different. Dispatch C/Cs are just plain wrong too many times to ignore. I'd rather bring it and not need it than need it and not have it. Doesn't weight that much anyway.


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## Bullets (May 10, 2013)

No, AED only comes in on calls that are suspected cardiac, or unresponsive where we beat the cops

In a moment of brilliance, the township administers the AED program, so all ambulances have a commonality with every patrol car. The cops usually get on scene first and they bring in their AED and O2 bag.


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## Bosco836 (May 12, 2013)

EpiEMS said:


> Do you bring an AED into the house, assisted living facility, etc. on every BLS call?
> I usually only bring it in for respiratory distress, unknowns, and "unconscious" calls.




As per our SOPs - defib comes in on every call here.


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## Akulahawk (May 12, 2013)

(Queue Grandpa Simpson voice...) Way back in my day... 

When I was a BLS provider, we always took _something_ in with us on every call, IFT or not. That something was our O2 bag and a BP cuff, unless we knew we'd be needing something specific for that call. On _all_ emergency runs (we did tons of them), we'd take in our jump kit as well - every time. 

When I worked as a ALS provider, I always took the jump kit/O2 & airway bag, and monitor with us on every call. Even the BLS ones. Why? Simple. I never knew if I'd need to change IV tubing or solutions, insert a (rarely worked right) dial-a-flow into the line, or do whatever else was necessary... like put the patient on my monitor, because sometimes we'd be dispatched to an IFT as a BLS transfer only to have it become an ALS one because the fluid ordered wasn't in the BLS scope and that needed to stay infusing. 

My feeling is that BLS should always bring in at least O2 and an AED on every call and add equipment from there as needed.


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## DrParasite (May 13, 2013)

Company policy is oxygen, jump kit and carrying device (typically stairchair) are brought on on all calls.  

AED is at crews discretion.  typically only brought in on ALS calls (in which case the carrying device is switched to a Reeves).


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## NomadicMedic (May 13, 2013)

In most cases, the BLS people here don't even bring the stretcher to the house. Getting them to carry an AED in on every call would be impossible.


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## chaz90 (May 13, 2013)

DEmedic said:


> In most cases, the BLS people here don't even bring the stretcher to the house. Getting them to carry an AED in on every call would be impossible.



I have noticed one crew bringing in their LUCAS on routine CP calls, without the stretcher of course.


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## Rialaigh (May 13, 2013)

9-1-1 calls get the jumpbag and thats it, If its a not breathing the monitor and airway bag, if its unresponsive but breathing the airway bag goes but not the monitor on most

Our jump bag has BVM, IV start kit, Mini drug bag with first 4 rounds of cardiac drugs, narcan, D-50, etc...everything you need to work a code for the first 10-15 minutes, fix a diabetic emergency, correct a narcotic overdose, etc...


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## NPO (May 14, 2013)

BLS units here don't carry AEDs....


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## Chris07 (May 14, 2013)

NPO said:


> BLS units here don't carry AEDs....


What County? Not uncommon considering the state makes provider agencies jump through all sorts of hoops to become "AED Service Providers".


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## NPO (May 14, 2013)

Chris07 said:


> What County? Not uncommon considering the state makes provider agencies jump through all sorts of hoops to become "AED Service Providers".



Correct. Most counties in CA. I just like the shock factor that people react to when I tell them we don't carry AEDs 

It's also fun watching nurses freak out when I tell them we can't use pulse oximetry either. 

I'm speaking of LA County of course. My unit has an AED however. 

Also, non first-in 911 medics can't pace. Our monitors can do it, but county protocols don't allow it.


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## Chris07 (May 14, 2013)

NPO said:


> Correct. Most counties in CA. I just like the shock factor that people react to when I tell them we don't carry AEDs
> 
> It's also fun watching nurses freak out when I tell them we can't use pulse oximetry either.
> 
> ...


In LA, I believe the only private companies that carry AEDs are the ones that have 911 contracts. Other than that, no one else does.


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## NPO (May 14, 2013)

As far as BLS levels, that's correct.


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## DesertMedic66 (May 14, 2013)

We just started carrying AEDs on our BLS units around a year ago (it was optional for my county until recently). 

Our BLS units do not respond to 911 calls (there are rare cases). If we are picking someone up from home or a SNF we bring in our response bag, gurney with O2 attached. If its a call from the hospital or an urgent care we don't bring in the response bag. 

SpO2 is a BLS skill here however it is an optional piece of equipment for us (meaning we don't carry them).


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## Brandon O (May 14, 2013)

Southern California scares the kittens out of me. What happens in a major disaster?


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## NPO (May 14, 2013)

Brandon Oto said:


> Southern California scares the kittens out of me. What happens in a major disaster?



During a disaster it's mostly triage and BLS to hospitals. Up to 2 BLS or one 1 ALS patient per ambulances. 

Obviously the ALS patients would have a medic but in a disaster very few ALS interventions would be done with a hospital on every corner. Sometimes 3 per corner. (Sunset.. Lol)

My company, a non 911 provider, responded with LA City/County to a disaster a few years ago and it was just that. Triage package and go.


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## Brandon O (May 14, 2013)

Well, I get that. I mean that hopefully nobody codes en route because it's gonna be the precordial thump for them. (I guess they can call for an ambulance!)


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## NPO (May 14, 2013)

But don't think I don't see your point. It's just one of those stupid things. Like in LA City. Someone can be laying in the street 1/2 mile from a hospital bleeding out or in cardiac arrest. It is illegal for a non LAFD ambulance to transport. And there are a lot of other ambulances around. Even if I just happen to roll up on it. That sucks. Call 911


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## DesertMedic66 (May 14, 2013)

NPO said:


> During a disaster it's mostly triage and BLS to hospitals. Up to 2 BLS or one 1 ALS patient per ambulances.
> 
> Obviously the ALS patients would have a medic but in a disaster very few ALS interventions would be done with a hospital on every corner. Sometimes 3 per corner. (Sunset.. Lol)
> 
> My company, a non 911 provider, responded with LA City/County to a disaster a few years ago and it was just that. Triage package and go.



This doesn't quite fit for all of SoCal. We can transport as many patients as we feel comfortable. So that number could easily be well over 2. Heck during hurricane sandy we had ambulances transporting up to 6 patients each.


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## DrParasite (May 14, 2013)

DEmedic said:


> In most cases, the BLS people here don't even bring the stretcher to the house. Getting them to carry an AED in on every call would be impossible.


honestly, I don't bring the stretcher in either.  

If it gets left outside, it might disappear (either by rolling away or someone borrowing it), and most of our homes have steps to get into the house, and I don't like carrying the cot up several steps (its a transportation device, not a carrying device).

As I said, the light stairchair gets taken in on most calls, and the reeves for any unconcoius.


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## NomadicMedic (May 14, 2013)

Realize that we're not in an urban/city environment, most of the homes here are one story ranchers and 98% of the patients here go on the stretcher. It makes sense to bring it, along with a stair chair or reeves if you're so inclined, close to the place where the patient is.


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## Tigger (May 14, 2013)

I cannot stand not bringing at least the med bag in on calls, even if Fire is on scene already. I always get told not to and then always need something. It's less rare with the monitor, but I'd rather not send someone to get it. We never bring the stretcher with us either, someone always has to go get it from the truck which just adds unnecessary time. Many of our patients we can walk to the door, so weather permitting I'd prefer to leave it outside. It's a rural area, no one is going to take it.


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## Brandon O (May 15, 2013)

I consider it somewhat bad form not to bring some means of extrication to the patient side in nearly every case. Likewise for at least your basic tools. But not the AED, or suction, or your damned splints.

Obviously this is somewhat arbitrary. You draw the line where you want.


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## Chris07 (May 15, 2013)

Brandon Oto said:


> I consider it somewhat bad form not to bring some means of extrication to the patient side in nearly every case. Likewise for at least your basic tools. But not the AED, or suction, or your damned splints.
> 
> Obviously this is somewhat arbitrary. You draw the line where you want.


It strikes me as odd that some people don't bring the gurney out of the truck on every call. It's an automatic thing for me.


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## DesertMedic66 (May 15, 2013)

Brandon Oto said:


> I consider it somewhat bad form not to bring some means of extrication to the patient side in nearly every case. Likewise for at least your basic tools. But not the AED, or suction, or your damned splints.
> 
> Obviously this is somewhat arbitrary. You draw the line where you want.



A lot of this depends on your area. Where I'm at most of the houses are a single story so we will bring the gurney to the front door and then leave it there until it is needed. 

The only time we automatically bring in anything is for full arrests or falls.


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## Brandon O (May 15, 2013)

Chris07 said:


> It strikes me as odd that some people don't bring the gurney out of the truck on every call. It's an automatic thing for me.



Yes, well, when I worked in Cali I used the stairchair once. Out here it's most places. One or the other.


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## CentralCalEMT (May 15, 2013)

AED is required equipment in my county even though BLS units are not allowed to run 911. (Most times there are only 2 or 3 countywide anyway as compared to 15-20 ALS units.)

I still can't believe that some SoCal counties still do not allow AEDs on the BLS units. It's kinda sad when the customer service desk at Walmart has one and an ambulance doesn't.


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## chaz90 (May 15, 2013)

CentralCalEMT said:


> I still can't believe that some SoCal counties still do not allow AEDs on the BLS units. It's kinda sad when the customer service desk at Walmart has one and an ambulance doesn't.



Seriously??? What is the possible reasoning behind that? 911 or not, every ambulance should have an AED. I was already frustrated enough that a nursing home and rehab facility in my old city didn't have one. After working my second or third code there, I had to ask the nurse what justified that glaringly obvious lack of vital equipment.


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## DesertMedic66 (May 15, 2013)

chaz90 said:


> Seriously??? What is the possible reasoning behind that? 911 or not, every ambulance should have an AED. I was already frustrated enough that a nursing home and rehab facility in my old city didn't have one. After working my second or third code there, I had to ask the nurse what justified that glaringly obvious lack of vital equipment.



For many places an AED is an optional piece of equipment on BLS ambulances. In California ambulance companies are known for being extremely cheap so it saves them money.


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## chaz90 (May 15, 2013)

DesertEMT66 said:


> For many places an AED is an optional piece of equipment on BLS ambulances. In California ambulance companies are known for being extremely cheap so it saves them money.



Right, but not allowing BLS units to carry them is a whole different level of ignorance. IMO, they should be required anyway rather than optional, but completely outlawing qualified EMTs to carry them on an ambulance? This is after all meant to be a layperson skill.


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## brian328 (May 15, 2013)

I worked for a 911 BLS ambulance in southern California.. On BLS calls we bring our gurney (with 02) along with the AED and jump bag. If we arrive on scene before fire for an ALS call, we do the same.


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## DesertMedic66 (May 15, 2013)

chaz90 said:


> Right, but not allowing BLS units to carry them is a whole different level of ignorance. IMO, they should be required anyway rather than optional, but completely outlawing qualified EMTs to carry them on an ambulance? This is after all meant to be a layperson skill.



Welcome to California EMS. They are starting to become mandatory everywhere. 

As a general rule for Cali if it is optional we don't carry it or have it in our skills. SpO2 is in the EMT scope for my county, having a SpO2 monitor is optional so we don't carry them on BLS units.


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## Jim37F (May 15, 2013)

DesertEMT66 said:


> Welcome to California EMS. They are starting to become mandatory everywhere.
> 
> As a general rule for Cali if it is optional we don't carry it or have it in our skills. SpO2 is in the EMT scope for my county, having a SpO2 monitor is optional so we don't carry them on BLS units.



Yeah I never understood why we're allowed to get temp and SpO2 on the machines at the hospitals, but only carry manual BP cuffs in the ambulances. I just love it telling the nurse asking for vitals that I don't have any way to get those two.


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## DesertMedic66 (May 15, 2013)

Jim37F said:


> Yeah I never understood why we're allowed to get temp and SpO2 on the machines at the hospitals, but only carry manual BP cuffs in the ambulances. I just love it telling the nurse asking for vitals that I don't have any way to get those two.



Temp and SpO2 = $$$$
If they aren't required some ambulance companies aren't going to supply them because they want to make as much money as possible.


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## chaz90 (May 15, 2013)

DesertEMT66 said:


> Temp and SpO2 = $$$$
> If they aren't required some ambulance companies aren't going to supply them because they want to make as much money as possible.



This is why I have no desire to ever work for a private EMS company. I know some are better than others, but predatory profit from patients who have no choice but to call 911 from wherever they are when they need an ambulance leaves a bad taste in my mouth.


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## Jim37F (May 15, 2013)

chaz90 said:


> This is why I have no desire to ever work for a private EMS company. I know some are better than others, but predatory profit from patients who have no choice but to call 911 from wherever they are when they need an ambulance leaves a bad taste in my mouth.



I don't know if the 911 ambulance Co's do or don't carry them, but all 911 calls in the county automatically get FD ALS response. 

But yeah, I don't think any of the IFT onlys are AED authorized providers (which I think is BS, and agree it should be mandatory equipment on all ambulances)


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## NPO (May 15, 2013)

DesertEMT66 said:


> Welcome to California EMS. They are starting to become mandatory everywhere.
> 
> As a general rule for Cali if it is optional we don't carry it or have it in our skills. SpO2 is in the EMT scope for my county, having a SpO2 monitor is optional so we don't carry them on BLS units.



My favorite thing is this:
"Patient was complaining of SOB. She's on 10lpm just monitor her O2 level because it drops sometimes"

"Sorry we can't monitor SpO2. But I'd be happy to call an ALS unit that can."

"Really?! Umm well, actually the patients pulse ox has been stable. So it's okay."


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## NHEMTJai (May 17, 2013)

The company I work for doesn't have any bls units. Everything is als equipped. There are never 2 basics on a truck. Fire department and usually police respond to everything with us. If we are going into a nursing home or a place where we have to wait for an elevator, we are bringing everything in. Private residences, we will bring the in bag with O2 and the monitor. Fire department or police will run back and forth to the truck for anything else we find we need. Most of the time the fire department does our lifting too (911 only). They bring the stretcher or stair chair to us, help load patient, then carry stair chair or roll stretcher. We have a good relationship with the police and fire departments in the towns we do 911 coverage.


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