ALS fire/ BLS transport

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brdeca

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Hey everyone,
So I have kind of a legal question and I apologize if this seems like a dumb question but I've always worked in an ALS system so I was just wondering about something. If you have an ALS fire engine and a BLS transporting ambulance can the fire medic transfer care to the transport EMT or would that be considered abandonment because he's leaving the patient in a lower level of care?
 
Deferring a low-acuity patient to the proper level of care (EMTs/BLS in this case) is not abandonment. Most of the time this happens when the medics get to the scene before the EMTs and started the evaluation earlier.
 
brdeca said:
Hey everyone,
So I have kind of a legal question and I apologize if this seems like a dumb question but I've always worked in an ALS system so I was just wondering about something. If you have an ALS fire engine and a BLS transporting ambulance can the fire medic transfer care to the transport EMT or would that be considered abandonment because he's leaving the patient in a lower level of care?
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It's all it what your local protocols say. Most will allow for a transfer of care to a lower level provider if the patient doesn't need any higher level of care encounter to the hospital.
 
You can absolutely hand over care to a lower level. I work in a targeted ALS system, where we have paired ALS ambulances and paired BLS ambulances. ALS frequently hands off to BLS. Most patients don't require ALS care. Keep in mind that as ALS in that scenario, you do have to do a good assessment. You are still responsible for the patient after you've handed off.
 
@Jim37F didn't your old department do this? I know in some systems allows the medic downgrade the call to BLS. Just depends where you work.
 
CALEMT said:
@Jim37F didn't your old department do this? I know in some systems allows the medic downgrade the call to BLS. Just depends where you work.
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Both my old department and my current one do this. At my old department I was a Fire Department Ambulance Operator (AO). We were single role EMT only on the ambulance, with each Engine company being a 4 man crew with a minimum of 2 Paramedics on board. If the call was BLS transport the engine would go back in service while us EMTs on the BLS ambulance transported to the hospital. If it was an ALS transport, the Paramedics would ride in on the ambulance with the patient (the EMT attendant would be in back helping out...taking vitals, patching up the 12 lead, spiking bags, etc) and the engine would follow up to collect the medics at the hospital.

My current job is very similar in that I'm an EMT for an ambulance service that responds a BLS ambulance with ALS fire. Only instead of a fire department employee working out of the fire stations I'm a private ambulance employee, we have our own dispatch with a mix of street corner posting and our own deployment stations (fire sends our dispatch the call info and they send the closest ambulance from there whilst juggling units around between stations and posts for coverage). Otherwise we show up in a BLS ambulance for all calls, fire shows up with a 3 man Engine company and a 2 medic non transport capable squad. If it's BLS we take it same as before, and both fire units go back in service, and same as before if it's ALS the fire medics on the Squad follow up, one medic riding in back on the ambulance, one driving the squad to the hospital. Meanwhile the engine goes back in service and is thus available for first in assessment of the next call in its district.

In busy areas it actually works out fairly well. The engine can cancel the squad if they determine it'll be a BLS run before the squad ever gets there. And when we have rigs stacking up at the hospitals on busy days it keeps ALS units from being needlessly tied up on BLS patients. (Likewise if the squad is on scene first they can cancel the incoming engine if they don't need the manpower)

Like I said, it seems to work in busy areas that get 10-15+ runs a day where even being cancelled enroute a portion of the time and only transporting ALS runs and being able to clear the hospital quicker than the ambulance ALS squads can get spread pretty thin. For the less busy areas....yeah its slightly redundant lol


But in answer to the OP's original question, yes ALS Fire here can legally assessment a pt, determine them to only require BLS monitoring for transport and have a (private or not) BLS ambulance transport the patient while the fire unit goes back in service...our entire system concept kinda depends on that lol.
 
Jim37F said:
Both my old department and my current one do this. At my old department I was a Fire Department Ambulance Operator (AO). We were single role EMT only on the ambulance, with each Engine company being a 4 man crew with a minimum of 2 Paramedics on board. If the call was BLS transport the engine would go back in service while us EMTs on the BLS ambulance transported to the hospital. If it was an ALS transport, the Paramedics would ride in on the ambulance with the patient (the EMT attendant would be in back helping out...taking vitals, patching up the 12 lead, spiking bags, etc) and the engine would follow up to collect the medics at the hospital.

My current job is very similar in that I'm an EMT for an ambulance service that responds a BLS ambulance with ALS fire. Only instead of a fire department employee working out of the fire stations I'm a private ambulance employee, we have our own dispatch with a mix of street corner posting and our own deployment stations (fire sends our dispatch the call info and they send the closest ambulance from there whilst juggling units around between stations and posts for coverage). Otherwise we show up in a BLS ambulance for all calls, fire shows up with a 3 man Engine company and a 2 medic non transport capable squad. If it's BLS we take it same as before, and both fire units go back in service, and same as before if it's ALS the fire medics on the Squad follow up, one medic riding in back on the ambulance, one driving the squad to the hospital. Meanwhile the engine goes back in service and is thus available for first in assessment of the next call in its district.

In busy areas it actually works out fairly well. The engine can cancel the squad if they determine it'll be a BLS run before the squad ever gets there. And when we have rigs stacking up at the hospitals on busy days it keeps ALS units from being needlessly tied up on BLS patients. (Likewise if the squad is on scene first they can cancel the incoming engine if they don't need the manpower)

Like I said, it seems to work in busy areas that get 10-15+ runs a day where even being cancelled enroute a portion of the time and only transporting ALS runs and being able to clear the hospital quicker than the ambulance ALS squads can get spread pretty thin. For the less busy areas....yeah its slightly redundant lol


But in answer to the OP's original question, yes ALS Fire here can legally assessment a pt, determine them to only require BLS monitoring for transport and have a (private or not) BLS ambulance transport the patient while the fire unit goes back in service...our entire system concept kinda depends on that lol.
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There is no good reason to be sending three units to a run of the mill EMS call, just not an efficient use of resources. California does things in ways that befuddle the rest of the country, but I am sure this is not news to you hah.

Also lots of paramedic/EMT ambulances out there and in most places the EMT can take low acuity calls following a paramedic's assessment.
 
To the OP, this is perfectly acceptable in many places, and lll just underscore the most important piece... if a medic is going to "down triage" to BLS, it's imperative they document their assessment and findings, and why they released to BLS. That documentation protects you.

Sent from my XT1254 using Tapatalk
 
Getting a patient turfed on you? Legal and even preferred business in some systems.
 
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