Ridryder911
EMS Guru
- 5,923
- 40
- 48
Okay.. long rant..sorry, but I do believe we have some common beliefs.
I totally agree initial BLS is essential such as in volunteers as a first response unit. ALS can never or ever work if proper BLS is not already put in place.
What I am still trying to promote is conjunction of the two not separation.
So many BLS and Vollies attempt to justify their actions or existence of "would you rather".. No; actually I would rather have both and one can. BLS trained first responders should be able to assess and treat and stabilize patients for at least 20 minutes. This is usually time enough for an ALS unit to arrive and stabilize for transport or even a rendezvous if it is to far. Again, I am not against BLS or volunteer providers rather I believe it is the way we are using them.
What is going to occur is that we will see less and less volunteers as we will require more and more training, responsibilities and costs to those persons. I much rather see them utilized appropiately and to have them on a call, then not to have them at all.
If a first response unit and ALS unit were dispatched simultaneously, the BLS unit would take approximately 10 to 15 minutes to arrive at the scene. ALS would arrive approximately 5 to 10 minutes later. The BLS unit would have initially performed the assessment, placed oxygen on the patient and possibly packaged the patient (LSB/CID). The patient is basically ready for another quick assessment and initial ALS treatment and transport. A hand in hand operation and thus a successful system.
As well the BLS unit is ready for another call, and vollies can return to their normal life or if paid squad first response can be available again. This would be a benefit for all. Decreased response time, decreased scene time for vollies and the patient will have ALS if needed, also decreased costs for the communities. I would hope the professional ALS service would recognize the need and provide education and possibly supplies.
We have such system and the first response guys are great! I know the patient is being taken care of and I have a possible viable patient to work upon. We provide in-services and trade out disposable equipment, since we are able to bill for the patient services.
Each patient should at least have the availability to be examined by an ALS provider. BLS/ALS or two ALS should staff all EMS transport units. If the patient does not require ALS, the BLS provider can tech and gain the needed experience and exposure. It is too costly to have separation of the two transport vehicles, as well many times those BLS calls have turned into ALS calls while enroute.
For some reason, we (EMS) are mind set in the 60's and 70's and refuse to go forward. Compare ourselves to EMS systems in Canada, Africa and Australia. We might had invented progressive EMS, but we have stopped and dropped the ball. It is a shame a person in the outback in Australia can receive ALS care faster than someone in metro U.S.... or even compare that to a pizza delivered. It is embarrassing, we only keep telling ourselves our courses are long and difficult, that communities cannot afford ALS. When other countries have succeeded.
The only reason EMT's think of "running back to the hospital" is for two reasons. You do not what to do or cannot be done. I call it running scared. In actuality "Running back" does not decrease time very much, maybe 3-4 minutes at the most, (that is if one is actually driving safe). But in reality, what it will do; will increase the sympathetic response, therefore increasing heart rate, increasing blood pressure..etc.. The heart has to work harder and faster... thus potentially increasing the heart attack. Personally, I believe it would had been much safer and more comfortable to transport them in their Ford from home.
The point of the authors on some of the posts (albeit, it was not done nicely) is we have to justify what we do. Saying it is the way we always done it, will not cut it anymore. Every IV needs a reason to be started. Every time oxygen is placed on a patient, there needs to be some justification (albeit may be for prophylactic reasons)
Such as oxygen at 15 lpm.. who idea was this? There has never been no research to show or demonstrate it actually increases oxygenation to an AMI patient (once the Hgb is full, no other 02 can bind). All AHA ever stated was high flow > 10 per mask could be beneficial for ischemia. Now for some reason we felt EMT's could not figure that out and started preaching and requiring 15 lpm per NRBM. Therefore everyone is covered (in case someone screwed up).
Side note
**Actually, now some researchers have discovered it might actually cause harm, that it might actually cause constriction (similar to arterial receptors in the brain). Wow, if they are right, think of all the changes!...(and people gripe now, about simple CPR changes )
We have to stop training our providers to follow step-lists and check lists. Patient verily rarely falls into a check list category. Each one should be treated accordingly. But this is for another rant...
We in EMS (volly, paid, BLS or ALS) have one important reason to be there... for the patients sake. Promote changes as they occur and evaluate the problems we have and correct those. EMS has never been a stagnant business... like patient care, it continuously changes.
R/r 911
I totally agree initial BLS is essential such as in volunteers as a first response unit. ALS can never or ever work if proper BLS is not already put in place.
What I am still trying to promote is conjunction of the two not separation.
So many BLS and Vollies attempt to justify their actions or existence of "would you rather".. No; actually I would rather have both and one can. BLS trained first responders should be able to assess and treat and stabilize patients for at least 20 minutes. This is usually time enough for an ALS unit to arrive and stabilize for transport or even a rendezvous if it is to far. Again, I am not against BLS or volunteer providers rather I believe it is the way we are using them.
What is going to occur is that we will see less and less volunteers as we will require more and more training, responsibilities and costs to those persons. I much rather see them utilized appropiately and to have them on a call, then not to have them at all.
If a first response unit and ALS unit were dispatched simultaneously, the BLS unit would take approximately 10 to 15 minutes to arrive at the scene. ALS would arrive approximately 5 to 10 minutes later. The BLS unit would have initially performed the assessment, placed oxygen on the patient and possibly packaged the patient (LSB/CID). The patient is basically ready for another quick assessment and initial ALS treatment and transport. A hand in hand operation and thus a successful system.
As well the BLS unit is ready for another call, and vollies can return to their normal life or if paid squad first response can be available again. This would be a benefit for all. Decreased response time, decreased scene time for vollies and the patient will have ALS if needed, also decreased costs for the communities. I would hope the professional ALS service would recognize the need and provide education and possibly supplies.
We have such system and the first response guys are great! I know the patient is being taken care of and I have a possible viable patient to work upon. We provide in-services and trade out disposable equipment, since we are able to bill for the patient services.
Each patient should at least have the availability to be examined by an ALS provider. BLS/ALS or two ALS should staff all EMS transport units. If the patient does not require ALS, the BLS provider can tech and gain the needed experience and exposure. It is too costly to have separation of the two transport vehicles, as well many times those BLS calls have turned into ALS calls while enroute.
For some reason, we (EMS) are mind set in the 60's and 70's and refuse to go forward. Compare ourselves to EMS systems in Canada, Africa and Australia. We might had invented progressive EMS, but we have stopped and dropped the ball. It is a shame a person in the outback in Australia can receive ALS care faster than someone in metro U.S.... or even compare that to a pizza delivered. It is embarrassing, we only keep telling ourselves our courses are long and difficult, that communities cannot afford ALS. When other countries have succeeded.
The only reason EMT's think of "running back to the hospital" is for two reasons. You do not what to do or cannot be done. I call it running scared. In actuality "Running back" does not decrease time very much, maybe 3-4 minutes at the most, (that is if one is actually driving safe). But in reality, what it will do; will increase the sympathetic response, therefore increasing heart rate, increasing blood pressure..etc.. The heart has to work harder and faster... thus potentially increasing the heart attack. Personally, I believe it would had been much safer and more comfortable to transport them in their Ford from home.
The point of the authors on some of the posts (albeit, it was not done nicely) is we have to justify what we do. Saying it is the way we always done it, will not cut it anymore. Every IV needs a reason to be started. Every time oxygen is placed on a patient, there needs to be some justification (albeit may be for prophylactic reasons)
Such as oxygen at 15 lpm.. who idea was this? There has never been no research to show or demonstrate it actually increases oxygenation to an AMI patient (once the Hgb is full, no other 02 can bind). All AHA ever stated was high flow > 10 per mask could be beneficial for ischemia. Now for some reason we felt EMT's could not figure that out and started preaching and requiring 15 lpm per NRBM. Therefore everyone is covered (in case someone screwed up).
Side note
**Actually, now some researchers have discovered it might actually cause harm, that it might actually cause constriction (similar to arterial receptors in the brain). Wow, if they are right, think of all the changes!...(and people gripe now, about simple CPR changes )We have to stop training our providers to follow step-lists and check lists. Patient verily rarely falls into a check list category. Each one should be treated accordingly. But this is for another rant...
We in EMS (volly, paid, BLS or ALS) have one important reason to be there... for the patients sake. Promote changes as they occur and evaluate the problems we have and correct those. EMS has never been a stagnant business... like patient care, it continuously changes.
R/r 911
I'd love to see the research about 15L O2 causing more harm than good. I regard O2 as a handy little tool in my toolkit that can (among other things) help a patient relax, reduce pain, and improve O2 sats. I'd be shocked if O2 could harm a patient in the way you mention, but if it could, we need to change the protocols stat.
