ALS needed or no?

[bakertaylor28]

They definitely are part of registry.

Inexplicably, LA County doesn't seem to require that "BLS" units carry AEDs. It really is nuts!

http://file.lacounty.gov/SDSInter/dhs/206307_710.pdf



In the U.S., one of the main things that is seen as differentiating BLS care from ALS (or, perhaps, Intermediate Life Support) care is venipuncture & administration of medications via the IV route. Most U.S. BLS ambulances do not carry cardiac monitors and nitroglycerin, nor are most U.S. BLS providers permitted to administer non-patient prescribed nitro, or start IVs. For your reference, here's the national scope of practice document adopted in 2007 (more of a set of guidelines, really, because there is no "national" licensing body).

Interesting. Our local protocols here in Oklahoma require BLS to use 3-lead monitoring and obtain 12-lead where appropriate to the call, and we require Basics to use Narcan, Epi-auto injectors, Atropine Auto Injectors, SL nitroglycerin, and oral glucose gel where indicated in protocol, We've also allowed basics to place blind-insertion airway devices. (i.e. King, combitube) where indicated in protocol.

What's screwed up is that the Intermediates get IV access skills, but cannot start an IV with any 'active pharmacological agent' other than NS, D5W, etc. Doesn't make sense to start an IV if you can't push the necessary drugs through it. Otherwise it seems you haven't done much which is useful in the short run. (with perhaps the exception of making some RN love or hate you, depending upon the grade of one's IV skills.)

 

[DrParasite]

Interesting. Our local protocols here in Oklahoma require BLS to use 3-lead monitoring and obtain 12-lead where appropriate to the call

wow, so every one of your BLS only ambulances has a $40,000 piece of equipment on it? That's pretty cool awesome (I mean, if the state requires it be done, I can only assume they mandate that the ambulance have the equipment to do it).

I can think of many times when a paramedic would just want an IV, just in case, not because they were going to push meds. I think you might even find a happy medic who had an IV already started by the intermediate, so instead of turning the patient into a pin cushin, found a working IV and simply needed to give the required meds.

as for the OP, you did the right thing. 5 minutes from the hospital, you could ask for an ETA on ALS, but at the end of the day the patient was not in danger of imminently dying, and definitive cardiac care is provided by an MD, not a paramedic.

 

[bakertaylor28]

wow, so every one of your BLS only ambulances has a $40,000 piece of equipment on it? That's pretty cool awesome (I mean, if the state requires it be done, I can only assume they mandate that the ambulance have the equipment to do it).

I can think of many times when a paramedic would just want an IV, just in case, not because they were going to push meds. I think you might even find a happy medic who had an IV already started by the intermediate, so instead of turning the patient into a pin cushin, found a working IV and simply needed to give the required meds.

as for the OP, you did the right thing. 5 minutes from the hospital, you could ask for an ETA on ALS, but at the end of the day the patient was not in danger of imminently dying, and definitive cardiac care is provided by an MD, not a paramedic.

Basically what they did was buy a bunch of neutered defibrillators- to where they have AED functionality, BP, pulseox, and ecg capabilities on the same machine, and then paid minimally for laptop software and an interface converter for the 12-lead attachment. The reason why is because OLMC switched to Internet transmission only, due to the ability to use the Raspberry PI as a client-server gateway. Cutting out "cellular" technology actually saved more money on the state budget, or so they said.