ALS IFT Vs. 911

[Jim37F]

Did 1&1 as an EMT with a Medic for ALS IFTs at my last company. We also did 911 response...we were stuck as a BLS unit on 911s (but then again so were the dual medic ALS units of they got one)...but on IFTs, I remember one time we responded to an Urgent Care for a monitor transport to ER...and found a STEMI. Medic called into the base station and we ran it by ourselves as if a normal call just w/out the Co medics (nearest station with a Squad was a block or two away so that didnt factor in)...never got any grief from it either.

 

[NPO]

Did 1&1 as an EMT with a Medic for ALS IFTs at my last company. We also did 911 response...we were stuck as a BLS unit on 911s (but then again so were the dual medic ALS units of they got one)...but on IFTs, I remember one time we responded to an Urgent Care for a monitor transport to ER...and found a STEMI. Medic called into the base station and we ran it by ourselves as if a normal call just w/out the Co medics (nearest station with a Squad was a block or two away so that didnt factor in)...never got any grief from it either.

Let's extract the details.
Ran a non-emergency call from an urgent care.
Found a STEMI.
Made made to make sure it's okay for you to treat the patient.
Treated the patient

To be clear, I'm not poking at you, in poking at the system.

 

[Peak]

Where were you working? I left LA County about six years ago and as a one to one Paramedic I carried narcotics on duty all the time. We just had to do the narcotic sign off every morning with the oncoming crew so there were two paramedics to witness the narcotics being changed over between crews.

Not in LA county but I would sign off narcotic counts and waste with our station officer if we didn't have a second medic.

 

[Jim37F]

Let's extract the details.
Ran a non-emergency call from an urgent care.
Found a STEMI.
Made made to make sure it's okay for you to treat the patient.
Treated the patient

To be clear, I'm not poking at you, in poking at the system.

Well now that I'm I a non LA system where us firefighters stick to BLS only and and have a municipal Third Service, and a private with their own medics going to all the transfers across the spectrum of IFT from BLS discharges to ALS UCC emergent and CCT and everything else...I fully agree LA Co and Orange Co fully deserve every bit of poking lol

So yeah, a bit ridiculous the medic on that call had to pause for a moment to consider calling fire, but only a moment. The calling base thing is an LA thing in general, and the exact same the Co medics would've done.

Our medics here still call the hospital, though it seems more of a "Hey I'm coming in with this" and while LA per protocol its written more as "call base for orders" in practice the two seem really similar to me, though I'm just the BLS guy listening in from the outside, probably some extra context I'm missing ha.

Here I think the medics call enroute when they get the chance, vs LA I think they wanted the medics to call early to officially give the orders. LA also has 2 levels where certain agencies are pre approved to advance deeper into the treatment algorithm before calling base, others had to call sooner, where you have to be approved to do that...yeah I'm glad I'm not in that county anymore ha

 

[EMT Rookie]

In Orange County ALS Unit is more fire union terminology than anything else....the minimum standard per County policy is one paramedic per unit, also known as a paramedic assessment unit. 2 medics per unit or ALS Unit was dreamt up by the fire union looking to add more dues-paying bodies to their ranks.

 

[DrParasite]

I know for BLS, we cant transfer pts that aren't in our scope. If our pt crashes, we pull over and call 911 for a Fire Medic (Jurisdiction Protocols), unless 5 minutes away from Destination. Lets say a IFT Paramedic transfer a pt. and they crash, my Manager told me they still need to pull over and call 911. My question is why? There's a Medic in the back already. Doesn't make sense to me to waste resources and time? If anyone could clarify please help.

Has anyone actually been penalized for not calling for a fire medic on a patient who didn't experience a negative patient outcome? I don't mean a simple inquiry by DOH, I mean an actual punishment for doing this?

I'm not in California at all; I had experienced sick patients without the availability of the local 911 system's resources, have transported patients who needed ALS without any paramedics directly to the ER, and know that, while the rules exist for a reason, if you use good judgement and are looking out for the patient's best interests, the most the regulators will do is give you a slap on the wrist / don't do it again if they do investigate a protocol variance.

my region of NC is almost entirely all ALS ambulances, however there are still plenty of counties that run with BLS or ILS ambulances. Our IFT system is mostly BLS, with a few paramedics working in the system. I can't see the DOH ordering an ambulance to pull over to the side of the road and wait for a 911 system paramedic to show up, especially if there is a paramedic on board with all the tools and knowledge needed to treat the patient.

NJ did have a two paramedic rule to be considered an ALS ambulance; so if a CCT ambulance (staffed by 1 or 2 EMTs and an MICN) was dispatched for a BLS 911 call, and the patient needed ALS, they were technically not permitted to use any ALS tools or interventions. But if that did happened, they were expected to request ALS, and continue on to the nearest ER or the nearest ALS unit, whichever was closer. none of this "hey, pull over and wait for the 911 system paramedics to show up" foolishness.

The only time a BLS unit was expected to pull over and wait for a paramedic was if the patient codes on you, so you pull over and call for help, and then the driver hops in the back and does CPR.

 

[NPO]

I had my hand slapped a few times but it never left the supervisor's desk. I think it was more CYA for the company because common sense said I did the right thing.

I know a few medics (I was an EMT at the time) who had similar experiences for not calling the FD for ALS or for doing "unauthorized" treatments, namely pacing.

 

[CbrMonster]

In Orange County ALS Unit is more fire union terminology than anything else....the minimum standard per County policy is one paramedic per unit, also known as a paramedic assessment unit. 2 medics per unit or ALS Unit was dreamt up by the fire union looking to add more dues-paying bodies to their ranks.

they also say it's because fire medics are always superior to private company medics. cause you know all fire medics are perfect and are always 100% on point.

 

[Qulevrius]

I worked at an OC private ALS company and we didn't need to involve fire unless we needed manpower. I did CPAP and other ALS interventions multiple times and we just ran it with the two of us. The shady thing with the company was that we'd get stroke like symptoms/chest pain/insert acute medical problem here dispatches to nursing homes with 30-40 minutes etas. These clearly should have been 911 activations.

When I was in LA, if you didn't have two medics you couldn't carry narcs, thus wouldn't be a transporting ALS unit, only assessment. If you were dial medic then you could transport ALS patients without issue.

A little late to the discussion, but:

This is a classic case of “let’s reinvent the wheel”.

LACo is a very creative place when it comes to ways of circumventing the system, and privates (AMR specifically) came up with a brilliant idea of renaming non-emergency ALS transports. If 911 was activated - oh well, FD “handles” it (cue in whatever private transport they’re using, with a x2 BLS crew and a fire medic). If however, a non-emergent ALS transport is required (and it doesn’t fit the CCT criteria), let’s call it a RAPID. Which is the same as Urgent, but ALS. On Rapid calls, the unit responds and transports L&S and FD is nowhere to be seen.

Are these in any way different from other ALS calls ? Hell no. When I was still with Bowers, we had a few gnarly ones, with at least one fatality that I know of (triple A, 15 min away from the nearest ER).