ALS Assist Skills for BLS Providers

[DrParasite]

this is actually a great topic, once that i think is under utilized (at least it was when i went to EMT class back in the day)

1) why would you need a patch to tell everyone that you know how to do stuff? it's even better if you can demonstrate it when asked on a call.
2) if AMR requires the certification, why not ask them how they prefer to get the certification?
3) it's much better to have the ALS providing agency run the ALS assist class, because they know their equipment, and they know what you will be using. while an EMT from a 3rd party can show you in general terms, it's much better to have a provider who uses that type of equipment demonstrate what they expect fo you.

 

[EpiEMS]

it's much better to have a provider who uses that type of equipment demonstrate what they expect fo you.

Especially the provider you're working with/under -- everybody has their own preferences for, say, how best to secure an IV.

 

[DesertMedic66]

Especially the provider you're working with/under -- everybody has their own preferences for, say, how best to secure an IV.

This a million times. I have my own ways that I prefer and that I find easier so I do not have my EMTs do a whole lot of prep for me. I tend to have everything set up prior to my shift starting.

I make IV rolls so all I have to do is grab it and everything I need is in it ready to go. I have my intubation bag set up how I prefer (Mac 3 on a handle or sometimes on the pediatric handle, 7.5mm tube, bougie, securing device, EtCO2, and suction all at the ready).

 

[EpiEMS]

I have my own ways that I prefer and that I find easier so I do not have my EMTs do a whole lot of prep for me.

Hey, as long as you don't yell at me about toilet bowl versus tegaderm versus ripped tape, it's all good! (I'm cautious with ALS assist more for the reasons of medic preferences than anything else.)

 

[DesertMedic66]

Hey, as long as you don't yell at me about toilet bowl versus tegaderm versus ripped tape, it's all good! (I'm cautious with ALS assist more for the reasons of medic preferences than anything else.)

We haven't carried toilet bowls in well over 6 years haha

 

[NomadicMedic]

Not a toilet bowl fan! Those are in our start kits, but I have a stack of Tegaderm that I snagged from the ED that stay with me.

 

[EpiEMS]

We haven't carried toilet bowls in well over 6 years haha

Not a toilet bowl fan! Those are in our start kits, but I have a stack of Tegaderm that I snagged from the ED that stay with me.

Thank gosh. I can't stand the toilet bowls! I like the torn tape method - cheap and easy.

 

[johnrsemt]

One of my old partners and I could run a critical ALS run without saying a word to each other. We knew exactly what the other was going to do and what they needed. I knew when he was ready for me to get up front and drive. We had BLS crews come assist a few times, and they usually backed off because we were, "scary brilliant" together, in the words of one of the EMTs.

Hopefully you are talking about me Kat; and glad to see you again here.

 

[johnrsemt]

What I always told my BLS partners was every ALS patient needs 4 things done:

O2 (if indicated), VS, Monitor, IV Setup.

Whatever I was doing pick one of the other 3.

Hard to go wrong with that

 

[NomadicMedic]

What I always told my BLS partners was every ALS patient needs 4 things done:

O2 (if indicated), VS, Monitor, IV Setup.

Whatever I was doing pick one of the other 3.

Hard to go wrong with that

VOMIT. Vitals, oxygen, monitor, IV, transport.

 

[DrParasite]

What I always told my BLS partners was every ALS patient needs 4 things done:

O2 (if indicated), VS, Monitor, IV Setup.

Whatever I was doing pick one of the other 3.

Hard to go wrong with that

so every one of your patients get an IV?

 

[NomadicMedic]

so every one of your patients get an IV?

When I first started, every patient got stuck. Practice was the best way to build my IV skill set. Now, not so much.

 

[DrParasite]

When I first started, every patient got stuck. Practice was the best way to build my IV skill set. Now, not so much.

when I started every ALS patient got an IV stick and a bag of IV fluid. Also when I started, only 20% of the EMS calls were handled by an ALS unit.

I wasn't sure if @johnrsemt meant that every one of his patients was ALS, and got the VOMIT treatment, or every one of the patients transported was considered an ALS patient and got the IV

 

[Handsome Robb]

when I started every ALS patient got an IV stick and a bag of IV fluid. Also when I started, only 20% of the EMS calls were handled by an ALS unit.

I wasn't sure if @johnrsemt meant that every one of his patients was ALS, and got the VOMIT treatment, or every one of the patients transported was considered an ALS patient and got the IV

I'm pretty sure most of his patients are ALS just due to the area he works. Literally the definition of BFE.


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[Tigger]

I can't remember the last time I transported someone and didn't start a line (or have my partner). Rural medicine...

 

[EpiEMS]

^ and ^^ and ^^^ More evidence that ALS assist needs are region and partner dependent

 

[NomadicMedic]

Honestly, when I get a new partner, I usually take some time to explain how I like things done. What gear I want in the house, what I want set up in the truck. How I like my intubation stuff set up. Whether I want a bag or a lock. All the little things that after you work with a partner for a while, they just learn through your practice.

I agree that some rudimentary skills for all basics should be taught during orientation. Including the big ones, like how to set up the CPAP! God, it frustrates me to no end when I've got a patient who needs CPAP and the EMT is looking at it like it's 4,273 IKEA parts and no instructions.

 

[EpiEMS]

@DEmedic, I wish more medics were like that - I get awfully peeved (containing myself, of course) when somebody expects me to know how they like something done when there are multiple valid approaches to it (e.g. securing an IV).

On the CPAP, that's the kind of thing that initial orientation ought to cover. That being said, we use a system that's all of, say, 3 pieces (mask, CPAP generator + tubing, nebulizer if needed) and pretty self explanatory.

 

[Tigger]

When they finally let me have an EMT for a partner, I will be happy to let them start all the lines they want, however they want. That's how I got to be decent.