ALS/BLS interaction

[hometownmedic5]

I suppose, I think more and more I try and just roll with it. There are peaks and valleys at our service like anywhere.

When the rest of the state dried up several years ago, we were still hiring paramedics. I worked dual paramedic for the better part of a year. It was ok, and I actually got along really well with a (then) very green paramedic now turned supervisor.

I honestly prefer/ preferred teching calls most nights; we rotated shifts, not calls. It was just my spin, everyone's got their own grooves and preferences. I will admit though, the nights I drove was some of the easiest money I've made.

P/P is fine, P/B is fine so long as either one yields a mellow partner.

I also prefer teching. In fact, if i never drove an ambulance again until i die, i would be ok with that. That works fro me, right up until I'm on my fifth straight call, three reports behind, my doc is screaming at me for my report from two patients ago, i have a headache and my blood sugar is 60. Then, i would really like to have another paramedic on the box with me.

My partner and i also rotate in an unconventional manner. We each take half(12hr) of each shift as driver, then we switch. While one of us may get our teeth kicked in one day, in the end it evens out. I hate switching call for call. Every call you have to adjust the mirrors, move beverages, sunglasses, which radio am i responsible for, whose grabbing what and so on.

Either way, I never work with a basic on my town truck. The chief would pop an aneurysm if he saw a basic hop out of a town ambulance; but I work OT on transfer/back up trucks and I'm usually p/b. It really does depend on the partnership to make it work.

 

[NomadicMedic]

I work with a basic every shift. It's a great system. He and I get along great, he knows what I need/want on calls, is a safe driver and can help me with the stuff that I need. And, like me, needs coffee and food frequently. He's also about my age, which is a huge help. Nothing against a 20 year old, but it's nice to work with someone you have more in common with.

Eventually I'll lose him to medic school and then I'll have to reevaluate if I want to go through the hassle of training a new partner.

We run dual medics in cases where we have a green medic that needs some mentoring or we don't have a enough Bs or As to go around.

 

[VentMonkey]

I work with a basic every shift. It's a great system. He and I get along great, he knows what I need/want on calls. Eventually I'll lose him to medic school and then I'll have to reevaluate if I want to go through the hassle of training a new partner.

I had one of those, he also went on to become a good paramedic. They're almost like having kids: you hate seeing them grow up in front of your eyes so fast, but you're still proud of them.

 

[DrParasite]

I was thinking in terms of maybe a dicey transport where there might be a borderline call to be made. With another medic as a partner, you at least have that option. With a basic, it's all me. I don't have the resource available to me.

Oddly enough, I worked with a medic who said that if we went from a P/B system to a P/P system (which was our director's intent) he was going to look to work for a new agency. His line of thinking (and I don't agree with it) was on the ambulance, someone needs to be in charge, and with two paramedics, that doesn't always happen, because they are both equal. if there is a disagreement about the treatment path, what do you do? If its only one medic, than it's his call, and it's very clear who has the overall responsibility for the patient. And that paramedic should be able to handle almost any all on his or her own, without needing to call another medic (but of course, could call the doc if he or she needed guidance).

Further, on a p/p truck, you do a call, I do a call. Rinse, repeat. On a pb truck, I do a call, then I do a call, then I do a call, then I do a call...(do here having the meaning of tech/write. I get they are there with stuff to do too). To not the basics fault, but it can wear on your good nature pretty quick if you have a busy day.

No offense, but I would hate that system. your EMT doesn't even do the BLS calls? if the patient doesn't need any ALS, just a ride to the hospital, it's still your chart? Your type of system gives you a driver, not an EMT... your EMTs probably make minimum wage too, and based on your description of what they have to do, it sounds like an appropriate wage.

Throughout my career, if I'm on a truck with a similarly credentialed person, we typically alternate calls, or occasionally switch halfway through the shift. If I'm on a PB truck, typically the EMT drives, but who writes the chart is dictated by if the patient is a BLS patient or ALS.

 

[VentMonkey]

No offense, but I would hate that system. your EMT doesn't even do the BLS calls? if the patient doesn't need any ALS, just a ride to the hospital, it's still your chart? Your type of system gives you a driver, not an EMT... your EMTs probably make minimum wage too, and based on your description of what they have to do, it sounds like an appropriate wage.

Idk about hometown's system, but in mine on an ALS rig, no they don't. There are times when it certainly would be nice for them to be allowed to. Now, if they work on a BLS rig then they're doing low-level 911 calls, sometimes (depending on system levels) higher acuity calls as well, if there's no ALS units available or closer; they also do all their own charting, assessments, and radio call-ins.

I have told many new EMT's (still do) how valuable it is to work BLS for preferably 6 months to a year. When I work with an EMT who is a seasoned BLS EMT, meaning they normally work BLS shifts, their skills often surpass most of the straight-to-an-ALS-shift EMT's because as you said, the ALS only EMT is essentially being paid to taxi the paramedics around; they have the option of doing BLS shifts, but far too many don't want to, and have a severely misguided notion that ALS is that much more exciting when in reality it almost parallels BLS low-level, low-acuity calls. I don't know how much learning they think they're doing on an ALS unit vs. what they actually are.

Again though, as a part-time field paramedic I just find it so much easier to treat it as such, play it by ear, and guide where I need them. Now, if they're asking insightful questions, then sure they get insightful answers, but more often than not the ALS EMT's are more than comfortable in their little routine. I will say now currently as it stands, and in their defense, we have so many EMT's that a lot do sit around, so I kind of understand how they get bored milling around at our main with little to do at times.

 

[NomadicMedic]

Oddly enough, I worked with a medic who said that if we went from a P/B system to a P/P system (which was our director's intent) he was going to look to work for a new agency. His line of thinking (and I don't agree with it) was on the ambulance, someone needs to be in charge, and with two paramedics, that doesn't always happen, because they are both equal. if there is a disagreement about the treatment path, what do you do? If its only one medic, than it's his call, and it's very clear who has the overall responsibility for the patient. And that paramedic should be able to handle almost any all on his or her own, without needing to call another medic (but of course, could call the doc if he or she needed guidance).

That doesn't happen. I came from a system with two medics on a squad. There was never a major disagreement about treatment or an argument over what to do. The medic that is leading the call writes the chart and will have to face the QI music if somthing untoward was done.

Of course, two medics make it a LOT easier when you're unsure of a 12 lead, stuck for what to do next or need an extra pair of hands. I agree that just about everything, with the exception of RSI, can be done by one competent medic with an EMT partner.

 

[StCEMT]

I like the days I get to run double medic. Usually don't need it for the reasons Vent Monkey already stated, but it is nice to be able to bounce ideas off another medic. That being said, I haven't ever felt overwhelmed having a basic partner. There is plenty that they can do that a medic would be while assessing.

 

[DrParasite]

Oddly enough, coming from a system where it was always double medic or double EMT, I thought that was a little odd myself. But it was the opinion of a senior paramedic / FTO at a former agency I used to work with (one that I think is in the minority among most providers).

Please don't judge the messenger based on the message of another.

 

[VentMonkey]

Please don't judge the messenger based on the message of another.

 

[hometownmedic5]

Oddly enough, I worked with a medic who said that if we went from a P/B system to a P/P system (which was our director's intent) he was going to look to work for a new agency. His line of thinking (and I don't agree with it) was on the ambulance, someone needs to be in charge, and with two paramedics, that doesn't always happen, because they are both equal. if there is a disagreement about the treatment path, what do you do? If its only one medic, than it's his call, and it's very clear who has the overall responsibility for the patient. And that paramedic should be able to handle almost any all on his or her own, without needing to call another medic (but of course, could call the doc if he or she needed guidance).
No offense, but I would hate that system. your EMT doesn't even do the BLS calls? if the patient doesn't need any ALS, just a ride to the hospital, it's still your chart? Your type of system gives you a driver, not an EMT... your EMTs probably make minimum wage too, and based on your description of what they have to do, it sounds like an appropriate wage.

Throughout my career, if I'm on a truck with a similarly credentialed person, we typically alternate calls, or occasionally switch halfway through the shift. If I'm on a PB truck, typically the EMT drives, but who writes the chart is dictated by if the patient is a BLS patient or ALS.

My town trucks are always without fail P/P; but my company also runs transfer trucks p/b. On those trucks, if the call is BLS, the basic techs it; however its not common for the pb transfer truck to be sent on a bls call. Those trucks exist to take als patients between facilities. And they work their butts off with call after call after call. While a bls call might sneak its way in there, its mostly als. Naturally, that means stacking calls on the medic while the basic makes the rack, drives, and puts the monitor back together.

There are places that require the highest card on the truck to attend. While I don't work there, if you're working a busy als IFT truck, that's pretty much your life.

 

[hometownmedic5]

In regards to treatment disagreements, it happens. There are all kinds of medics. Lazy, do nothing medics; high speed cowboys who do too much just because they can, and many shades of grey in between. Wel talk about this all the time here. Would you treat this complaint with these vitals and so on. Invariably, theres some disparity. Putting aside regional protocol differences, there is always opinions that will differ. Does this patient get pain meds? Are we slow belling this call with every line item in the protocol book or are we saddling up and going straight to line 13 because that's what will ultimatley keep the patient out of a pine box?

Some times, i like working pb for exactly the stated reason. I am the boss and you don't get a vote. Sometimes, when I'm hip deep in brown smelly stuff and I'm unsure of my next move. I like having another patched medic nearby to nudge us in a direction without having to debase myself before med control.

Back to the original point, all I'm saying is that if your a basic in a pb system where the medic routinely gets their teeth kicked in, don't be surprised or take it personally when someday the medic has a little meltdown.

 

[Handsome Robb]

That doesn't happen. I came from a system with two medics on a squad. There was never a major disagreement about treatment or an argument over what to do. The medic that is leading the call writes the chart and will have to face the QI music if somthing untoward was done.

Not here. If your partner does something dumb while you're both in the back before transporting or in the house you'll have to face the music as well for not stepping in.


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[NomadicMedic]

Not here. If your partner does something dumb while you're both in the back before transporting or in the house you'll have to face the music as well for not stepping in.


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Okay, fair enough. I think that's fair. However, 4 years at Sussex and that never happened to me, not did I ever hear about it. I think if you have a cadre of high speed, well educated, disciplined medics... it's less of an issue.

I could easily see that happening where I am now though.

 

[hometownmedic5]

Not here. If your partner does something dumb while you're both in the back before transporting or in the house you'll have to face the music as well for not stepping in.


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Same here. You might not be in as much trouble as the medic who did whatever wrong, but you're responsible for a piece of it because your name is on the chart right next to theirs. The only time your partner is completely absolved of responsibility on a call is when you're working pb. Obviously it would be unreasonable to expect the basic to be qualified to talk the medic out of doing something wrong.

 

[NomadicMedic]

I guess I should mention, where I came from it was 2 medics on a squad but 9 out of 10 times only one did the patient care and transported. If you screwed up, it was on you.

Most of the priority calls would have 2 medics working and the atmosphere was very collegial. Certainly never adversarial. "Hey, what do you think about some calcium?" "Sounds prudent." Or something like that.

I really wish you guys could see how Sussex worked. It makes this whole discussion seem like EMS in a foreign country.

 

[hometownmedic5]

As I've mentioned in other threads, the biggest problem I deal with is lazy hacks. Medics who dont do their job out of ignorance or apathy. That's where the quarrels come from.

 

[VentMonkey]

As I've mentioned in other threads, the biggest problem I deal with is lazy hacks. Medics who dont do their job out of ignorance or apathy. That's where the quarrels come from.

Perhaps start a thread?

 

[NomadicMedic]

As I've mentioned in other threads, the biggest problem I deal with is lazy hacks. Medics who dont do their job out of ignorance or apathy. That's where the quarrels come from.

Those guys are in abundance here. When I work with one, I always tech every call.