ALS Intercept Protocol

[MMiz]

This was brought up in another thread, so I'll go ahead and start a new one devoted to the topic.

First, for those that don't know, I work for a private company with several ALS and BLS, and Paramedic First Responders on the road at a time. While ALS is always dispatched for our 911 contract city, and they're stationed around the city, the same is not always the case for a call to nursing homes in our county.

Often a nursing home will call us right after someone's condition declines significantly. It's the "I dont want them to die here" syndrome, the same one EMS have. They say "Not in my nursing home," and we say "Not in my ambulance." Point said, the nursing home will sometimes request a BLS unit for a "Sick aid" when in reality the guy is barely breathing and needs an ALS unit. In those cases, we often can for an ALS intercept.

If BLS transports with RLS (Red lights/sirens), then we need to call for an ALS intercept. Automatically if you say "Transporting Priority X", the dispatch will send ALS. All RLS transport calls go to CQI, 100%, so you know you will get in trouble if ALS isn't requested. The problem is, we have several hospitals in our county. Sometimes the transport is only a mile or two, but that doesn't matter to management, they want ALS requested. That said, transport is not to be held up for an ALS unit. We are to transport and meet them enroute to the hospital.

Many BLS units think its not the brightest idea to call ALS a mile or two away from the hospital. We can say "Unit X does not need ALS, we have a 2 minute ETA to the hospital," and they won't send one, but it will still go to CQI.

What's your department's policy?

So what's it like where you are?

 

[croaker260]

In our county (7 fire departments, 2 cities and 2 large communities. as well as multiple small clusters of people) , an ALS unit is dispatced to ALL calls. Its not to say that an EMT can or can not assess a pt. It is the result of a descision made in the 70's on a philisophical and moral standard, that the highest level of care (the medic) will be dispatched to the tax paying (and non tax paying) public. In addition on 90% of calls we also get a BLS response or an ILS respose, depending on location and comminuty. These are, with one exception, non transport. We'll talk aboutthat one exception in a second.
Now what often happens, once BLS gets on scene, is BLS may advise the respondig ALS unit to downgrade or cancel, if further info is required, the crews will go to a secodary channel to exchange infomation..and 90% of the time the ALS crew will down grade or cancel. A prime example is a fall pt that is lifting assist only, or a injury accident that turns out to be non injury. It also happens on cardiac arrrest where the BLS crew noted rigor and lividity, then they can cancel the responding ALS crew.
Also of note is just because an ALS unit is dispatched, doesnt mean they are dispatched RLS, sometimes they are dispatched non RLS. Sometimes the BLS crew even upgrades the ALS crew. We've all been there, huh?

Now with that exception, which I think is closer to what your thinking of. In a remote community in a rural part of our county, there is a paid/volie FD that runs an ILS level transport unit. ILS here is IV and combitube. No real drugs (except BLS drugs). But they are transport. Again we get dispatched to all EMS calls with them. Once on scene , they update us, advise us to cancel, downgrade/upgrade, or what ever. NOTE the senior medic has ultimate descretion in this matter, by policy agreed on by both services. They can attempt to hook up with the ALS crew, transport, or wit on scene. Typically we get on scene just as the pt is loaded up, so we hop on teir rig with our equipment to assit if needed. If it is a BLS call, then the medic cancells, and the FD unit transports.
The key is cooperation, use of a secondary channel, and trust on both sides of the fence. It helps that we as a service often assist in training of the BLS agencies in our area, so we dont just see them on calls.

 

[cbdemt]

In my county we use a tiered response system. Dispatch will ask the caller a series of questions to rapidly assess the severity of the situation. From the info that the caller gives, dispatch will send units accordingly. The levels are:
Alpha – BLS no RLS
Bravo – BLS w/ RLS
Charlie – BLS w/ RLS ALS no RLS
Delta – BLS & ALS w/RLS
Echo – BLS, 2+ ALS & FD all RLS ( hurry the he!! up cuz people are trying to die!)
Beyond that; any time that BLS feels ALS needs to be started they can be requested and any of the above levels, at the discretion of the BLS unit on scene. They can also be upgraded or canceled accordingly.
Our protocols state that ALS is to be requested for several reasons including, altered LOC, compromised airway, allergic reaction, seizure, accident with entrapment with prolonged extrication, poor general impression… I’m sure I left something out but there’s a few.

 

[ffemt8978]

Simple rule:

When in doubt, make sure ALS is in route.

 

[rescuecpt]

Or, just become ALS, then you never have to call for it!

 

[ffemt8978]

Originally posted by rescuelt@Aug 3 2004, 07:55 PM
Or, just become ALS, then you never have to call for it!

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