ALS for BLS

[coloradoemt]

My volly dept has a class titled ALS for BLS every month. We get our CE hours from these classes. I am curious what some of you Paramedics like your BLS partner to know about ALS to help get the job done.

 

[domesticgodemt]

No ALS gets done w/o BLS done first. Don't wait for direction. Get it done, so you don't hold them up maintaining airway or gaining IV access

Any good Basic class will have a lab that spends an hour to explain how to spike a bag, the difference between micro/macro drip, extension sets, and maintaining aseptic technique, etc. Having 4X4's, alcohol/Iodine swabs, and teguderm ready. Medics may vary!!!!!!! Some will inspire you to go and get your own swelled head (just kidding). Others will make the experience such that you know after the call you are still at the bottom of the food chain in Prehospital care.

If you are extremely lucky you may get another hour to learn about how to aid w/ intubation.

When they ask for the intubation kit. Take some time and know what the parts are. Make sure the laryngoscope is light, tight, and bright. Know the difference between a McIntosh (curved) and a Miller, Wisconsin, etc. (straight) blades and SIZES. Once the tube is placed and verified you have a job Slick. Bagging and making sure the tube does not get dislodged.

Brady has a great book (and this is not an advertisement) ALS for BLS Providers.
If you read the first four chapters you will be more than just a 3rd or 4th hand.

Massachusetts has a 20 hr. course for this. 20 hours for a Basic would probably be much better spent on core content topics. And remember you have to continue to do your BLS Vitals and document everything that the ALS provider asks you to note Meds/interventions/times. If you are doing an intercept know your rig/equipment location so that the Medic does not think you are the Village Idiot!! Above All Stay Safe!

4/12 Lead placement. Familiarize yourself with the EKG/Defib the medic uses.


The variety of medics you intercept with can be awesome mentors and each one has their own style (within protocol of course). Be a sponge!!!!

Now will the experts please chime in?

 

[Jon]

I am a BLS provider almost done -P School.

Important "ALS assist" skills

3/4 lead placement
Setting up nebulizers
spiking bags - understand different fluids and drip sets.
SET UP the accu-check

Nice things to do for a medic:

Drawing up flushes if needed
12-lead placement
setting up code meds (Epi, Atropine - screw the two halves together)


I always saw my job when driving the medic as do everything I can to make his life easier - get a set of signs, o2, IV here or in the bus? spike the bag, get the blood tubes out for him, have everything I would want to start an IV out, accu-check ready, tear tape, etc...

Oh, and my BAAM was always handy (what good paramedic wannabe whacker doesn't have 1 or 2 or 3 or 4..... )

Jon

 

[PArescueEMT]

or that case under your bed...


I have to say, that when it comes to ALS assist, it should be common sense. Do what you would want done for you without going beyond your scope of practice.

 

[Jon]

Originally posted by PArescueEMT@Feb 6 2005, 05:19 PM
or that case under your bed...


I have to say, that when it comes to ALS assist, it should be common sense. Do what you would want done for you without going beyond your scope of practice.

Hey, easy on the case:

see my views on the case HERE: http://www.emtlife.com/index.php?showtopic...findpost&p=3961

Moving on:

The idea of remain in the scope of practice is an obvious one. All of what I do is within the scope, as I'm not actually giving meds or interpriting the EKG.

Oh, and in PA bagging a tubed PT. is considered ALS assist. An EMT must be "observed by the medic" when preforming the skill - DUH, he is there anyway 'cause he just tubed the guy....



Jon

 

[PArescueEMT]

I am oficially a "Paramedic Assistant" I even have the orange rocker to prove it. I got it from using common sense too. Work a code with a pre-hospital MD, he calls DOH, I get rockers and cert in the mail.


cheated me out of con-ed

 

[Jon]

Originally posted by PArescueEMT@Feb 6 2005, 05:49 PM
I am oficially a "Paramedic Assistant" I even have the orange rocker to prove it. I got it from using common sense too. Work a code with a pre-hospital MD, he calls DOH, I get rockers and cert in the mail.


cheated me out of con-ed

yeah - all it is is a cute little orange piece of fabric.

I've got the con-ed too..

that and $1 will get you a cup of coffee at WaWa

Jon

 

[coloradoemt]

Originally posted by domesticgodemt@Feb 5 2005, 11:38 PM
No ALS gets done w/o BLS done first. Don't wait for direction. Get it done, so you don't hold them up maintaining airway or gaining IV access

Any good Basic class will have a lab that spends an hour to explain how to spike a bag, the difference between micro/macro drip, extension sets, and maintaining aseptic technique, etc. Having 4X4's, alcohol/Iodine swabs, and teguderm ready. Medics may vary!!!!!!! Some will inspire you to go and get your own swelled head (just kidding). Others will make the experience such that you know after the call you are still at the bottom of the food chain in Prehospital care.

If you are extremely lucky you may get another hour to learn about how to aid w/ intubation.

When they ask for the intubation kit. Take some time and know what the parts are. Make sure the laryngoscope is light, tight, and bright. Know the difference between a McIntosh (curved) and a Miller, Wisconsin, etc. (straight) blades and SIZES. Once the tube is placed and verified you have a job Slick. Bagging and making sure the tube does not get dislodged.

Brady has a great book (and this is not an advertisement) ALS for BLS Providers.
If you read the first four chapters you will be more than just a 3rd or 4th hand.

Massachusetts has a 20 hr. course for this. 20 hours for a Basic would probably be much better spent on core content topics. And remember you have to continue to do your BLS Vitals and document everything that the ALS provider asks you to note Meds/interventions/times. If you are doing an intercept know your rig/equipment location so that the Medic does not think you are the Village Idiot!! Above All Stay Safe!

4/12 Lead placement. Familiarize yourself with the EKG/Defib the medic uses.


The variety of medics you intercept with can be awesome mentors and each one has their own style (within protocol of course). Be a sponge!!!!

Now will the experts please chime in?

Most of what you suggested I have already had classes for and used that knowledge in the field. IE Intubation (we actually as BLS providers practice on the manequins), 4 lead, 12 lead etc. We have quite a few waivers in our SOP's that allow me to hook up a moniter if I have ALS on the way etc. Past that I was just curious what some of you liked your Basics to know otherwise. Good sugestions from all and thank you. Looks like I will be buying some more reading material!!

 

[TTLWHKR]

I took the ALS Assistant Class when they first developed it, and we didn't get scrap from the DOH. No patch, no certificate... Just 16 hours of con-ed.

We were told that it was a certificate program, and we would get a patch. Then they decided it was just a con-ed class six months after it ended. Completely worthless, I didn't even need the credit.

Now I'm just pissed!

LTS Sucks!

 

[coloradoemt]

Originally posted by Blueeighty8@Feb 7 2005, 12:59 AM
I took the ALS Assistant Class when they first developed it, and we didn't get scrap from the DOH.

I am not aware of a class like this where I live so I continue to gain knowledge through my CE classes. I would take one here if offered though.

 

[rescuecpt]

I don't let BLS do much for me. If it's a hairy call (code) I usually have 1 - 2 other ALS providers with me. If it's a slower call, I do it myself. I have had too many "bad apples" ruin my trust. I do have certain basics I trust - the two guys on my crew, for example, and the guys on the Tuesday night crew I used to ride with. I'd let them spike bags, put leads on, and check med names & expirations (then i recheck).

Basics I don't know can radio the hospital, set up a nebulizer, and do other basic skills.

 

[domesticgodemt]

The book I referred to is The Basic Provider: Assisting with Advanced Life Support Skills. Authors: Dominguez and McPherson. Published by MosbyJems not Brady.

 

[coloradoemt]

Originally posted by rescuecpt@Feb 7 2005, 03:00 PM
I don't let BLS do much for me. If it's a hairy call (code) I usually have 1 - 2 other ALS providers with me. If it's a slower call, I do it myself. I have had too many "bad apples" ruin my trust. I do have certain basics I trust - the two guys on my crew, for example, and the guys on the Tuesday night crew I used to ride with. I'd let them spike bags, put leads on, and check med names & expirations (then i recheck).

Basics I don't know can radio the hospital, set up a nebulizer, and do other basic skills.

You treat your Basics like the Medics on my volly dept treat first responders...

 

[Jon]

Originally posted by Blueeighty8@Feb 7 2005, 01:59 AM
I took the ALS Assistant Class when they first developed it, and we didn't get scrap from the DOH. No patch, no certificate... Just 16 hours of con-ed.

We were told that it was a certificate program, and we would get a patch. Then they decided it was just a con-ed class six months after it ended. Completely worthless, I didn't even need the credit.

Now I'm just pissed!

LTS Sucks!

Some Co's in this area issue different things - some have an blaze orange rocker that goes over the EMT patch. at least 1 has "actual" paramedic assistant rockers for their EMT patches (special order)

Most in Chester Co. issue NADA. Nothing Zippo. Just a certificate (maybe) and con-ed (If you are lucky enough for the form to not be lost)

Jon

 

[rescuecpt]

Originally posted by coloradoemt+Feb 8 2005, 08:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (coloradoemt @ Feb 8 2005, 08:31 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt@Feb 7 2005, 03:00 PM
I don't let BLS do much for me.  If it's a hairy call (code) I usually have 1 - 2 other ALS providers with me.  If it's a slower call, I do it myself.  I have had too many "bad apples" ruin my trust.  I do have certain basics I trust - the two guys on my crew, for example, and the guys on the Tuesday night crew I used to ride with.  I'd let them spike bags, put leads on, and check med names & expirations (then i recheck).

Basics I don't know can radio the hospital, set up a nebulizer, and do other basic skills.

You treat your Basics like the Medics on my volly dept treat first responders... [/b][/quote]
No, I don't. My basics do plenty - their basic stuff and occasionally more - and I teach them tips and tricks and theory every chance I get - if they want it or need it. But ALS interventions are MY RESPONSIBILITY and around here, the County is VERY strict about that. If something happens, not only will I lose my license but I will be sued - but worse than all of that, I might possibly kill my patient. It isn't an "I'm better than you" thing with me... it's a degree of trust thing. Trust only comes from a lot of experience working together, because in this situation mistakes aren't "oops"es, mistakes are often life-and-death.

When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not.

 

[Summit]

RESCUECPT

I agree with coloradoemt.

Around here basics with training start IVs and you only have a select few you trust to spike a bag?

Originally posted by coloradoemt@Feb 8 2005, 08:31 PM

When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not.

You really need to get yourself better basics and keep them trained.

 

[rescuecpt]

Yeah, good luck with that. Recruitment is not an easy thing around here. In NYS basics are not trained to assist in ALS interventions in anyway.

 

[coloradoemt]

It isn't an "I'm better than you" thing with me... it's a degree of trust thing. Trust only comes from a lot of experience working together, because in this situation mistakes aren't "oops"es, mistakes are often life-and-death.

I hope that a comment I made didn't bring this comment out of you. I did not mean to make you think that I thought you were a "better than you" medic. If I did I apologize.

When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not.

If this is what you have to deal with day to day then I understand your reasoning. I also realize you have a job to do. Many of the medics I run with days have that opinion as well. I am not uncomfortable with the fact that EMT's need to prove themselves to the medics. On my volly dept. we often do not have many hands to help. It has often been just me a first responder and a medic on a call. So sometimes proof of performance is done with significant ammounts of trust. The first responder ends up being a gopher and a driver for the most part. My comment previous was just my opinion that the EMT's you have to deal with were given the same assignments and responsibilities that a first rsponder does out here with me.

 

[Jon]

Originally posted by Summit+Feb 10 2005, 01:16 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Summit @ Feb 10 2005, 01:16 AM)</td></tr><tr><td id='QUOTE'> RESCUECPT

I agree with coloradoemt.

Around here basics with training start IVs and you only have a select few you trust to spike a bag?

[/b]

Yeah - Around here we have basics who call themselves "Paramedic Assistants" who THINK they can intubate, start IV's, and play PARAGOD with a 8-hour con-ed class under their belt.

I have always been of the opinion that "what is said/ happens in the truck, stays in the truck" but that is rediculous. As a Paramedic student I have seen and done some stupid things with IV's, luckily I haven't gotten burned by these mistakes, but If I ever make it to an ALS provider level that is something I would be sure would NOT happen on my watch. If I make a mistake on an invasive procedure, I want to be darn sure I made the mistake, not some young whacker-wannabe EMT (NO OFFENSE, BLUE!)

On the other side of the coin, I recognize that there are quite a few ALS-skills that any semi-trained monkey (No Offense, Chimpie) could preform flawlessly - hooking up a monitor, preforming an accu-check (Yeah - DOH says medics are only allowed to do that), and spiking a bag.

From an ALS standpoint, I would want to be sure that the person spiking the bag / hooking up the monitor, etc. knew what they were doing, watched them closely the first few times, and always double-check them, but I would expect any GOOD BLS provider on a MICU to be able to preform these skills, set up the IV start stuff and set up nebs and code meds for me.

<!--QuoteBegin-coloradoemt@Feb 8 2005, 08:31 PM

When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not.[/quote]

Coloradoemt - you hit the nail on the head - As we all agree, you must be a good BLS provider to be a good ALS provider, and before I as an EMT help out my medic I make sure that there are vitals taken (or being taken) and that all BLS-level interventions are in progress or completed (O2 / CPR / Ventialtion, etc)

If I ever have an "EMT" like that as a partner on a MICU when I'm the ALS provider, they will be off the truck and back with an FTO on a BLS truck so fast.....



Jon

 

[rescuecpt]

Originally posted by MedicStudentJon@Feb 10 2005, 10:11 PM
If I ever have an "EMT" like that as a partner on a MICU when I'm the ALS provider, they will be off the truck and back with an FTO on a BLS truck so fast.....

He has been sent to the "EMT breaker" shift... and his replacement on our shift, a probie with no EMT experience surpassed him within the first month! She's a smart girl and a quick learner... she gets to do all sorts of fun stuff on the ambulance. :lol: