ALS Intercept Opinions

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vfpd28pac17

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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.
 
Depends. How is the BLS rig stocked? If its stocked as a BLS, then put him in the ALS unit. If they're stocked the same, it really doesn't matter. Personally though: 1) I probably trust my partner to drive more than someone I'm not familiar with. 2) I know the layout of the back of my ambulance blindfolded. 3) Putting the patient in my ALS unit gets the BLS unit back in service (a good thing).
 
Personally, it doesn't matter to me what unit you (collective you) are in.

But I think it would depend on how sick the person was.
 
It is entirely up the the ALS crew which rig they want to ride in.
 
All the ALS equipment that the Medic needs will be in his original rig. It might be a pain to transfer the PT onto their gurney but you've got to do it. It's that or the Medic could grab all his kit etc and just... stick it on the seat next to him?

And has been said, if you hand your PT over to ALS then you can go back in service.

You said you're highly opinionated, what's your opinion?
 
The BLS unit is stocked as BLS. However, the intercepts are performed with ALS units that only have to transfer three items, the ECG monitor, jump bag, and drug kit, to have all ALS needs. While I agree with the BLS unit returning to service being a good thing, I feel it is acceptable to be out of service if treating/transporting a patient. Not to mention, after transferring the patient, we have been asked to move to the ALS rig to assist.
 
Depends on the situation. I've done it both ways. I prefer being in my own ambulance with a driver I know. We intercept with some agencies that have less than stellar reputations when it comes to their driving.
 
If the balloon goes up and they want you to help then that's fine, go help. But I'd bet a weeks wages that most of the time that doesn't happen.

I can understand that you don't want to just 'hand over' your PT but sometimes you'll have to do just that.

You're saying that two units should be taken out of service just in case the medic needs help. I'm saying put your PT in the Medic's better equipped rig and let him get on with it. If he wants your help he'll ask for it and if he doesn't, you can go back to work.
 
There are other questions that influence the decision...

1) At what point do the medics intercept? While still on scene? During transport? It doesn't make patient care or billing sense to move the patient from one vehicle to another mid-transport (perhaps it makes more sense if both vehicles from the same department).

2) How is the ALS truck staffed? PP? PI? PB? How is the BLS truck staffed? BB? B/MFR? Third person aboard?

3) How familiar is the ALS crew with the BLS truck and it's equipment/layout? Will there be a crewmember from the BLS truck in the back with the medic during transport? Can crewmembers from the BLS service drive the ALS truck (either follow to the hospital or back to garage)?

4) What type of organizations responded? Who's billing? If the BLS vehicle is fire department or third service, they may not bill for citizens, but the ALS service will bill the BLS service. Do they then pass that on to the patient or absorb the cost themselves?

5) Patient acuity and truck layout. Thinking of my area, most BLS trucks are vans and many ALS are boxes. Put simply, some (many) complex calls go a lot simpler with more space (codes being the prime example where having a "CPR Seat" is almost crucial.

6) How is the ALS service set up to operate? (Hopefully), Can they take their crucial equipment and easily transfer into BLS trucks (2 bags or 5?) How familiar are the crews with eachother? Do the medics and EMTs train or drill together? What is their working relationship like?

As usual, I've answered this question with more questions, but it should encourage the OP to go to management and ask for a policy (or at least guidance) on this issue, because it likely isn't as simple as you'd expect.

Good Luck!
 
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
 
Here all amb. are stocked the same so we leave the pt in the original amb. and transport. If we have to keep an amb. available we can. Two medics (BLS), get in the original ALS rig and follow the other to the hosp, unless they get a call, and the crews switch back.
For those who switch the pt. Where do you do that? Side of the road? I would think that moving a pt between vehicles and between stretchers would not be good pt care. What about the liability issues doing it at roadside? Could the ALS medic not just take their bags and monitor with them? All they would need then would be O2 and suction.


I see there have been some more post since I started writing mine.
 
Last edited by a moderator:
I second the opinion of not taking two ambulances out of service.

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vfpd28pac17 said:
The BLS unit is stocked as BLS. However, the intercepts are performed with ALS units that only have to transfer three items, the ECG monitor, jump bag, and drug kit, to have all ALS needs.
Click to expand...

That are typically stocked with the bare minimum of everything, IF it indeed is everything (I doubt). So if something isn't stocked right, or something goes wrong with the little equipment that's in the bag, you're SOL. In the ALS unit, you've got all you need.

If the ALS unit takes a BLS rider for hands, then so be it. But how often is that really necessary (it shouldn't be very often).

What reasoning do you have to keep them in the BLS unit? Anything more then "well they're already in here..."
 
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
Click to expand...

1) What safety concerns? Are you unloading the patient on the side of the highway???

2) If ALS is part of the same system, just trade stretchers. If not, it is a VERY brief uncomfortable move, if at all.

3) If you want education, go back to school. You'll get a much better education that way than having some medic try and explain (likely poorly or incorrectly) something that you have zero training on. Get back in service and stop trying to dodge runs.
 
Can you expand on your 3 points?

1) Safety of the patient and crew.

Pull over somewhere safe. People are going to be getting in and out of Ambulances no matter what happens, so just make sure you do it somewhere safe. Can you not stay on scene and wait for ALS?

2) Patient comfort.

The PT's standard of care out weighs PT comfort. It's not just a case of transferring a few bags across. The medic's rig is set up in a certain way, that is most likely different to yours. His job will be a lot easier if he doesn't have to ask you where everything is.

3) BLS education

I'm all for continued education and I understand that it will be very interesting for you to watch / help out but it is not this medic's job to teach you. There are schools for that.

And besides all this, your three points aren't a good reason to take an extra rig out of service.
 
Luckily, our system is designed around "intercepts". We respond in dual medic, non transporting squad unit and ALWAYS transport in the BLS ambulance, with a BLS provider helping out. Obviously, a critical patient will get both medics. We have all of our ALS gear in a couple of bags, designed to be easily transported from truck to scene to ambulance.

While I don't love everything about this system, I still believe it is the best way to deploy paramedics to where they are needed without tying up two transport units.
 
All depends on the medic crew here. Our BLS units are stocked as BLS. But all the medics gear is in their first in bag and on the monitor. So the ambulance is just used to restock the first in bag.

I've never have had to do an ALS intercept yet.
 
Yeah yeah... Not all of us are able to work in Sussex... ;)
 
Alot will depend on why you were called. If ALS arrives on scene it's easy. The medic assesses and if they have work to do, load in the ALS rig. If the intercept is in mid transport it's safer for the pt to stay where they are.
 
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