Any states besides NJ that only have hospital-based ALS?

I know of no states that are as restrictive regarding ALS level of care as NJ.

I work IFT out of Philly. I do IFT's in NJ sometimes. What I can do in PA, requires a RN in NJ. I don't understand how that makes sense.

I've seen countywide tiered systems. They can work quite well. Jersey EMS is just dysfunctional overall.
 
Another issue I've seen is that the for-profit ALS services' competition with each other compromises patient care. I have heard of a few incidents when a BLS crew was told that no medics were available by the ALS dispatch center run by one ALS company, when another company's ALS unit was available.
 
HaleEMT said:
As medicsb stated, NJ does have one of the lowest paramedic per capita rates it is also the most populated state per square mile. Not every call requires a medic and not every call requires an EMT either. Some people call 911 fore the ride, and you know it happens.

It almost seems as if you think ALS is not present at all. We do have ALS on calls that have life threats such as the ones you listed. Again BLS does have ability to assist some of those life threats if ALS is not available. As for low BGL, oral glucose is carried.

What I like most about the model NJ has is that just because a call starts as ALS does not mean it ends the same. The NJ model allows us to recall medics if they are not needed and allows medics to triage back to BLS if the patient is not ALS. If you work in a system with 1emt/1medic or medic/medic that medic will be on every truck regardless of call type. Financially not sound.
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If they are alert enough for oral glucose is not what I am speaking of as that is almost not an emergency as they could just eat a candy or drink a coke and be fine w/o your help. I am speaking of the patients that are low and can not take oral and need IV access followed with D-50.

As to finances having Paramedic available on the truck means actually more calls are able to be billed ALS as a proper assessment of many calls that BLS transports still use ALS equipment, which means better return on the call. So finances are going to come out basically same as your emt only ambulances when you factor in the no pays etc.
 
I believe New Jersey is unique across the 50 states in the way its EMS system is set up. Hopefully it is only a coincidence, but no where do I hear of more stories of lack of analgesia than New Jersey. Maybe Seattle or NYC, but that's hardly a compliment.

HaleEMT said:
So you believe every EMS call requires ALS for proper assessment and treatment?
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I believe every patient deserves a competent and thorough assessment. This something that can not be taught in 120 hours, much less the time it is actually given in a basic class. Given this, since BLS providers are not able to provide this, ALS is warranted.

ALS and BLS is an arbitrary distinction, as has been said before, medicine is medicine. I don't need ALS, I need someone that can assess the patient.

I work in a broken system. Many EMS systems are. So perhaps I am a hypocrite, as I rarely get medics and just take the quicker option, transport to hospital. In a better system, I would show up with or after the medics.

Medics may not be all that much better with their assessments, but make no mistake, they are better.

And please spare me the "CVAs and penetrating trauma (perhaps most trauma patients in general) have better outcomes with basics than medics." If the medic has any common sense, he or she will scoop and screw just like a BLS unit would. In a broken system, they do not. That does not mean the overall model is unsound.

To add: Can someone explain to me why nowhere else in the developed world maintains a system like this?

Sure there are places that have ambulances and flycars, but the flycars have paramedics with close to masters degrees or in more than a few places, doctors. The ambulances also have providers who can treat patients and not just take them to the hospital in the position of least discomfort.
 
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Jon said:
I know of no states that are as restrictive regarding ALS level of care as NJ.

I work IFT out of Philly. I do IFT's in NJ sometimes. What I can do in PA, requires a RN in NJ. I don't understand how that makes sense.
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Paramedics were implemented for emergencies in NJ and no one has felt a need to change the regs in terms of IFTs. I imagine the nursing lobby would prefer this to remain RN dependent and there aren't many medics who care to do ALS IFT anyways. Also, if any if those RN staffed units encounter an emergency, they usually call medics. I met up plenty of times with an RN truck because they werent to initiate treatment. However there are a few medic only staffed IFT trucks in NJ.

Also, billing is higher if there is an RN, so no company cares to have medics do IFT.

Anyhow, I've done plenty of ALS IFT in Philly and a lot of it sucks, it's the true SCT level stuff that is fun.
 
medic417 said:
As to finances having Paramedic available on the truck means actually more calls are able to be billed ALS as a proper assessment of many calls that BLS transports still use ALS equipment, which means better return on the call. So finances are going to come out basically same as your emt only ambulances when you factor in the no pays etc.
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Billing is probably the worst justification for any medical intervention. EMS agencies all over have been gouging patients with "monitor and IV" for decades. In NJ, somewhere around 20-25% of calls are treated as ALS, and I'd still suspect that is over-treatment. Medicare is slowly catching on and you will see them crack down on services that over-treat (I've already heard of them auditing 911 services and questioning IV starts, etc.)... or they'd just stop paying ALS rates for IV and monitor. This will put many "all-ALS" agencies in a bind.
 
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Tigger said:
To add: Can someone explain to me why nowhere else in the developed world maintains a system like this?

Sure there are places that have ambulances and flycars, but the flycars have paramedics with close to masters degrees or in more than a few places, doctors. The ambulances also have providers who can treat patients and not just take them to the hospital in the position of least discomfort.
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You basically just said no one else in the world does what NJ does, but then refuted yourself. Whether the highest level is a physician or a IC paramedic, there is a stepwise approach unlike most of the US which likes to use a shotgun approach and send their highest level of care to every call even though the overwhelming majority do not need it. It's silliness. Maybe a lot of patients need pain management, but it doesn't mean they need fentanyl and even if so, it doesn't mean they need a medical provider also trained in intubation, IVs, cardioversion, etc. to give it. (Afterall, pain management is probably one of the safest treatments in the back of the ambulance.)

[If a moderator wants to combine my 3 separate responses into one post, go ahead.]
 
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medic417 said:
If they are alert enough for oral glucose is not what I am speaking of as that is almost not an emergency as they could just eat a candy or drink a coke and be fine w/o your help. I am speaking of the patients that are low and can not take oral and need IV access followed with D-50.
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Just so you are aware, an unconscious diabetic patient is an ALS call in this wonderful state, as is every other patient you have mentioned...

I actually think that the ALS system is one of the better aspects of NJ EMS. It begins to acknowledge the idea that EMS is an extension of the ER and brings the ER to the patient.

Now there are times when your patient is literally on the opposite side of the street from the ER entrance, we dont wait for Medics in those cases
 
medicsb said:
[If a moderator wants to combine my 3 separate responses into one post, go ahead.]
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We don't need your permission but thanks. I don't see a reason to combine them.
 
Bullets said:
It begins to acknowledge the idea that EMS is an extension of the ER and brings the ER to the patient.
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:blink: I think EMS is far from that concept
 
Chase said:
:blink: I think EMS is far from that concept
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I like to think it is an ideal system that we kinda want to achieve. Otherwise we're just a van with some bandaids and a bit of obesity.
 
Bullets said:
Just so you are aware, an unconscious diabetic patient is an ALS call in this wonderful state, as is every other patient you have mentioned...

I actually think that the ALS system is one of the better aspects of NJ EMS. It begins to acknowledge the idea that EMS is an extension of the ER and brings the ER to the patient.

Now there are times when your patient is literally on the opposite side of the street from the ER entrance, we dont wait for Medics in those cases
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And if you had sent a Paramedic there would be no delay in care. As it sits if the dispatcher gets the info wrong ( I know never happens :blink: ) bls shows up can do nothing but either load and go or sit and wait. In both cases patients proper care is delayed.

As to billing. You are not padding a bill by doing a proper assessment. I disagree with unnecessary treatment and refuse to do anything unnecessary for proper assessment or treatment even if it would mean we get no payment. The one I hate most and many bls services are guilty of is putting oxygen on everyone so they can bill. Thankfully we have the right to say no to transport when patients don't need it. Thus we are only out response to location and patient will be billed a response fee even though not transported.
 
medic417 said:
And if you had sent a Paramedic there would be no delay in care.
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But we do send a paramedic there, two of them actually...:huh:
 
ffemt8978 said:
So hospital based ALS is dispatched to all 911 calls?
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No, not to things like sickness, weakness , abdominal pain, falls with no LOC, minor MVC, and what they call "emergency transport" which can be stuff like bouts of colitis, feet swelling, bloody nose, or any of the myriad of ridiculous reasons people call 911

All of our dispatchers are EMDs, its pretty much a requirement to work at any PSAP or PSDC.

But for an unconscious, regardless of the cause, we get ALS. Besides the obvious chest pain, LOC, breathing problem, arrest, allergic reaction, diabetic, we also get ALS on any OB call, any vehicle roll-over, and any time the dispatcher isnt sure what is going on

As said previously, this allows the ALS to respond, do an assessment and then determine if this is something they need to treat or something that can be turffed to BLS and they can become available. In my suburban town we have two medic units (P/P) within 5-10, 2 more at 15 and then like 4-5 units at 20. We obviously share our medic truck with a few surrounding towns, but we are the busiest system by far. In the three years i have worked here there was one time i needed ALS and did not have them.

In some cities it can be as many as a 6-7 als trucks being supported by 12-15 bls units
 
To jump back to the original question, I know of three areas in northern California that have hospital based ALS. Of note, Fort Bragg staffs ALS ambulances at their hospital, and further south in Gualala there is both an ALS and a BLS ambulance that are at a clinic, and due to extended transport times I understand that they can transport back to that clinic for minor medical complaints. As far as I know, those areas that still have hospital based EMS are pretty rural, so response times can be quite long...
 
medic417 said:
And if you had sent a Paramedic there would be no delay in care. As it sits if the dispatcher gets the info wrong ( I know never happens :blink: ) bls shows up can do nothing but either load and go or sit and wait. In both cases patients proper care is delayed.
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sure, but in most cases, you aren't sending a paramedic. you are sending a fire engine, who is either BLS, or a paramedic who (lets be honest here) is only doing ALS because it was required to do the job not because they want to do it. So the engine shows up, and then you wait for a paramedic to show up.

Do dispatchers get it wrong? SURE!!! do callers lie to dispatchers? all the time. But in your example, the patient has to wait until they get proper care (which is in the ER, not a paramedic), while in my example, they can actually start going to that definitive medical are, even if they are with a lower trained BLS crew.

and as Bullets said, many of the calls you as asking about already get an ALS unit sent. It's rare to have ALS unavailable (many medic units have a primary, secondary, and tertiary response area), but if you do have one, at least you can start going to the hospital, instead of having to do the circle of death that is common in many all ALS systems (NYC, DC, and Detroit all come to mind, the latter 2 being designed as all ALS systems).

it's ok, you can admit your wrong. or not. your baseless, incorrect emotional argument isn't backed by science, your "common sense logic" isn't a valid argument (nor is it even accurate), but I think everyone else here sees exactly where you head is located. thanks for playing
 
DrParasite said:
sure, but in most cases, you aren't sending a paramedic. you are sending a fire engine, who is either BLS, or a paramedic who (lets be honest here) is only doing ALS because it was required to do the job not because they want to do it. So the engine shows up, and then you wait for a paramedic to show up.

Do dispatchers get it wrong? SURE!!! do callers lie to dispatchers? all the time. But in your example, the patient has to wait until they get proper care (which is in the ER, not a paramedic), while in my example, they can actually start going to that definitive medical are, even if they are with a lower trained BLS crew.

and as Bullets said, many of the calls you as asking about already get an ALS unit sent. It's rare to have ALS unavailable (many medic units have a primary, secondary, and tertiary response area), but if you do have one, at least you can start going to the hospital, instead of having to do the circle of death that is common in many all ALS systems (NYC, DC, and Detroit all come to mind, the latter 2 being designed as all ALS systems).

it's ok, you can admit your wrong. or not. your baseless, incorrect emotional argument isn't backed by science, your "common sense logic" isn't a valid argument (nor is it even accurate), but I think everyone else here sees exactly where you head is located. thanks for playing
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I'll ignore your continued attacks. It is obvious you refuse to acknowledge there is a need for change in the nj system. In my examples there would be no delay required in getting a patient to definitive care they would just arrive either with pain greatly reduced or fully alert with a blood glucose level in a livable state. But you seem fine leaving people to suffer and just allow them to wait for the doctor to do anything.

Having Paramedics does not always equal better if the system is broke. If their hands are so tied by outdated protocols they might as well just have basics go load and go as that's about all they allow their Paramedics to do. NJ is not the only broke system it is just the worst broke as far as large scale broke.
 
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