ALS Intercept Opinions

But are they the same protocols the ALS agency operates under?
 
Exactly my point.

These are the protocols of the system the ALS units and my company both are supposed torun under. However, this is NOT the way calls are ran. I've complained to the EMS Coordinator and the Medical director, never getting answers. I'm not sure where to go next with my complaints. So I came on here to vent.

This thread was not supposed to stray off into what treatment should be given for ab pain.
 
vfpd28pac17 said:
I was trying to show that the hospital's act as though all patients ought to have ALS transport, and if they aren't having a fit over not giving pain meds for abdominal pain the medic was probably correct.
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That is horrendous logic.


And your protocols seem pretty straight forward, what exactly is happening that you aren't happy about?
 
vfpd28pac17 said:
FNG here so if this has been covered I apologize. I haven't been able to find similar.

I'm an EMT-B with a volunteer non-profit agency. I will keep the question simple and provide background or further explanation if required later.

When providing ALS upgrade should a patient be transferred from the BLS rig to the ALS rig, or should the patient remain in the BLS rig and the Paramedic jump on board and finish transport in the BLS rig?

I am VERY opinionated about this.:angry: Looking to find out if my opinion is in line with the majority.
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First, Welcome.

Second - You've come here with an agenda. Your last line makes that clear. That often isn't a good way to start a conversation here on the board, and can set an argumentative tone to the discussion.


Third: I'll take a stab at this and give you my personal opinion.

I work in multiple EMS systems... Depending on the day and circumstances, I may be assisting BLS as a fly car (solo medic), or I may be assisting a BLS crew when I'm in a MICU (B/P or P/P Ambulance)

If I'm in a fly car, well - we're all going in the BLS rig. Ideally, someone will drive my truck behind, so that the BLS crew doesn't have to bring me back to it before both of us can clear up - but that depends on crew makeup and how stable the patient is.

If I'm in an ambulance, it depends. Often, the patient goes in the BLS rig because it is their first-due, and this way, they get to bill for at least part of the transport. Depending on the situation, it might make more sense for the patient to go in my rig. If it is a true "intercept" call - I'm going to just take my stuff and join the party in the BLS truck.
 
vfpd28pac17 said:
My opinion. The patient needs to stay on the BLS rig for completion of transport for many different reasons.
1) Safety of the patient and crew.
2) Patient comfort.
3) BLS education
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I really don't buy any of these arguments. Around here, the issue is often $$$... and if the patient remains in the BLS rig, the BLS service gets a chunk of the billing revenue - sometimes most, or all of it. I'm not expressing an opinion of this system - just throwing it out there.

vfpd28pac17 said:
Moving a little slow here, as I said, I'm a FNG. I will try and answer questions and explain as quickly as possible. That being said, "trying to dodge runs" is not my goal at all. The education I'm talking about is not how you are all taking it, if the EMT-B does not see what interventions the Paramedics are able to use in different situations, how are we supposed to know if ALS would be benefitial to the patient? I've seen basics call for ALS for patients with abdominal pain, stating pain control as the reason. They don't understand ALS cannot give pain control for abdominal pain. It's a matter of getting unneeded ALS requests to STOP. Thus, keeping the ALS unit in service.
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I was an EMT for 8 years before I was a medic. I still run on a BLS unit as a volunteer. An EMT will learn VERY LITTLE from "watching the medic work." I think it's a poor use of resources to tie up operations personel like that.

As a medic, playing a basic, I get to see other medics and what they do/don't do with the same info I have... Not every medic treats patients the same way - some medics are simply lazy, and some are negligent... but somehow we all get to wear the same patch.

vfpd28pac17 said:
As far as the patient and crew safety goes. Every time a patient is moved on the cot there is a risk of the cot falling over, or patient falling from the cot & those lifting the cot being injured. While I've never dropped a patient and I've not hurt my back lifting a patient, all it takes is ONE time and I'm sure all of these HAVE happened. These things can happen at the ambulance bay of the hospital, why risk it happening in a gas station parking lot? I'm not even going to bring in the busy road way argument. We all know there are risks in this job, my thing is why increase the chances of accident occurrence when unnecessary.
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I'm gonna go ahead and call BS on this one. It SHOULDN'T be an everyday occurrence, but it won't be the end of the world.


vfpd28pac17 said:
What I've been told, is that the hospital wants the patient to have no pain meds onboard for abdominal pain for examination at the hospital. As I've said, I'm only a B and I'm going off what I've been told and seen happen.
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Yeah. Stone Age Medicine. Does this hospital do ritualized bleeding as well?


vfpd28pac17 said:
We are not waiting on scene for ALS, and no it does not make sense for an ALS unit to repeatedly tell you they have been called for incorrect reasons. However, it does make sense to assist in the treatment of a patient and see that ALS does no more than BLS treatment. You will know the next time ALS is not required, and this knowledge can be passed on to the other members of the agency.
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That's a LAZY MEDIC. If you, as an EMT, call me - especially after you've assessed your patient - I will come. I will assess your patient. I will treat your patient. Sometimes that treatment is me riding the patient in BLS... I may :censored::censored::censored::censored::censored: about it in general, later - but I will NEVER argue with you as an EMT that you called me out unnecessarily.

If I'm dispatched on the call with you, I may or may not look to YOU to tell me if you're comfortable and want to cancel me - Or I may even call and get released. But if you add me as an assist unit, I'm not going to leave the patient with you alone - you already said that you were concerned enough about the patient to bring me out.


PoeticInjustice said:
It seems more common that the nurses want the convenience of it already being there than them thinking everybody is an ALS patient.

And just because the hospital isn't *****ing that something wasn't done does not mean that it shouldn't have been. They may not know what capabilities the ambulance has, or may already have a low opinion of the providers and expect no more.
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Amen. I semi-routinely bring patients in BLS (when I'm on a BLS squad) even though they "should" have an ALS workup - but it's faster for me to just GO than call for an intercept - Especially when an intercept with some medics means we'll sit on the side of the road for 10 minutes while they get a 12 lead and start an IV... I can be at the ED in less time than that.




~~~~

In short, OP - if you want to learn how to be a better EMT - go to medic school. Or better yet, go take A&P at a local school, then think about medic... or nurse, or PA... or Doc.
 
I want to thank you all for your opinions. I see that my opinion is not in the majority and that is okay. I won't learn anything if I don't ask. I was not trying to be or come off as argumentative. I honestly just wanted to know others thoughts. Thank you all for your input and I'll continue to look back for any more comments.

I've also learned I need to take more time and give full details and support to my ideals before hitting submit.

Thanks again
 
vfpd28pac17 said:
I've also learned I need to take more time and give full details and support to my ideals before hitting submit.

Thanks again
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That's a good thing to remember no matter what you are doing.
 
vfpd28pac17 said:
I want to thank you all for your opinions. I see that my opinion is not in the majority and that is okay. I won't learn anything if I don't ask. I was not trying to be or come off as argumentative. I honestly just wanted to know others thoughts. Thank you all for your input and I'll continue to look back for any more comments.

I've also learned I need to take more time and give full details and support to my ideals before hitting submit.

Thanks again
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Alright.

Just because we may not agree with what you say... doesn't mean that we don't want you here... Please stick around and get to know us!
 
For us it depends on patient acuity. If the call can be handled by a single medic, we will try to keep the BLS truck in service and just swap stretchers. If the patient needs two medics we usually skip the swap, they grab their bags and monitor, and hop in the BLS truck and ride in. The original BLS attendant might stick around of needed, but in a van that's not all that practical. Usually we just let the medics do their thing and get both trucks the hospital.
 
vfpd28pac17 said:
Exactly my point.

These are the protocols of the system the ALS units and my company both are supposed torun under. However, this is NOT the way calls are ran. I've complained to the EMS Coordinator and the Medical director, never getting answers. I'm not sure where to go next with my complaints. So I came on here to vent.

This thread was not supposed to stray off into what treatment should be given for ab pain.
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I know the abdominal pain thing was not your question, but not medicating abdominal pain is archaic and I wanted to reiterate that point so you wouldn't think that one misguided medic's attitude on the matter was gospel. Then I found your protocols online and saw that pain medication for abdominal pain was "only on the order of the EMS physician." Furthermore, the only non call-in standing order for pain that I could find (quickly skimming) was a whopping 2 mg of morphine for severe burns. So it seems like your system is extremely stingy with the pain meds and the medics there probably don't routinely medicate abdominal pain.
 
Slinky said:
I know the abdominal pain thing was not your question, but not medicating abdominal pain is archaic and I wanted to reiterate that point so you wouldn't think that one misguided medic's attitude on the matter was gospel. Then I found your protocols online and saw that pain medication for abdominal pain was "only on the order of the EMS physician." Furthermore, the only non call-in standing order for pain that I could find (quickly skimming) was a whopping 2 mg of morphine for severe burns. So it seems like your system is extremely stingy with the pain meds and the medics there probably don't routinely medicate abdominal pain.
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Archaic?

2mg for burns as well?

This system is barbaric.
 
I find if anything,Paramedics here are more liberal with pain meds than ED staff. For example, we can give unlimited IV morphine to adults. Put in a busy ED a patient has to get the nurses attention, convince them they are in pain. After this the nurse has to chase down a Doctor who writes up the order, etc etc and eventually receive the drug.

Sure, its probably not a good idea to narcotise a pt with abdo pain so much that they cannot be assessed, but it is cruel to not give analgesia to someone for example with severe cholecystitis or renal colic to aid diagnoses. Coupled with that we have 2 paramedics to look after the patient as opposed to 1 nurse looking. We often give analgesia in the hallways of hospitals while waiting for beds, as its often fruitless asking if the staff can give the patient something.



In regards to ALS intercepts we dont really have much choice. Here Intensive care paramedics drive in fly cars and will jump on baord a truck to help out.

That being said out stock standard paramedic level is somewhere between EMT-I and ALS so we dont have to call them too often. We dont have BLS at all.
 
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No intercepts in NB as we all have the same skill set.(for now). In Maine the services I have worked with or precepted at would run intercepts by waiting for the bls truck at the edge of their coverage area. Bls to intercept is usually 20 to 30 . And another 20 to 25 to the hospital. P/P or P/I for the most part. Medic jumps in back with monitor, als bag, and drug box. Als plus a few from bls ride in als the rest of the way. Some times it is like a clown car in the back. A driver plus 2 to 4 basics in the back. Most get booted and the driver is told to downgrade and take it easy the rest of the way in. They will also only do an intercept if another truck is available.
 
All our vehicles are the same regardless every ambulance carries a 12 lead capable LP12, IV kit, resuscitation pack etc

The only difference is that an ALS officer will have their green AP bag so they just bring that if needed for backup

the patient never changes vehicle nor should they
 
if BLS is already transporting to the ER, ALS hops in the BLS truck.

if the BLS is all loaded up and still on scene, and it's a stable ALS patient, and you are of the same agency and have identical stretchers, switch stretchers.

if it's an unstable ALS patient, go in the BLS truck with both medics treating. or the ALS truck with both medics treating, and BLS driving.

in 95% of all the ALS calls I have seen, the ALS operate out of a drug bag, an airway bag, and a cardiac monitor. most of the time this has enough supplies to handle 95% of all calls, so going in the BLS truck isn't a problem.

and vfpd28pac17, it sounds like you work in some of the Jersey EMS systems have I have worked in. very very very rarely give pain meds for abd pain.
 
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