BLS Ambulance Staffing

[boingo]

I don't know. A medic on every truck is probably overkill. I think a better educated BLS provider on most trucks, with fewer, better educated ALS providers fits well. If you look around at systems that are all ALS, especially fairly busy ones you will generally find a lot of burnout and high turnover. Medics are competing for skills, less experience with truly sick patients and skills degredation unless they have a robust con-ed system in place. There is no evidence of all ALS resulting in better pt care overall. I won't argue against an ALS assesment, but tying up your ALS assets transporting non acute pts is a waste. ALS should be reserved for pts who truly need ALS, at least in my opinion.

 

[VentMedic]

ALS should be reserved for pts who truly need ALS, at least in my opinion.

And who determines that? A BLS provider who has very limitied training and assessment abilities?

 

[boingo]

No, it would either be a much better educated EMT-B or a much better educated P that would assess the patient and refer the pt to BLS for transport after an appropriate assessment. No medics on fire trucks, no medics in cop cars, no medics on every truck, fewer, better educated medics dedicated to taking care of patient that would benefit. It wouldn't be perfect, but from where I sit it would be better than what most of us have now.

 

[JPINFV]

Ok, so how would a "BLS" call go down?

Medic arrives, assesses, downgrades to BLS, calls BLS ambulance, waits on scene for BLS ambulance, transfers care to BLS ambulance and clears? At this point you might as well have just transported the patient to the hospital.

Alternatively, BLS and ALS ambulances respond. ALS downgrades to BLS, ALS clears, and the EMS system has trouble justifying to the city council why every patient needs 2 ambulances to respond.

 

[boingo]

The second option, without any need to justify the dual response. If the patient is acute, the patient get treated by both medics, the BLS crew will drive both trucks.

 

[JPINFV]

Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?

 

[medic417]

Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?

Brilliant idea.
Wish we could all convince people that instead of sending two ambulances and 20 fire trucks. You get my point way to much overkill.

 

[rmellish]

Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?

I like that. More so than my suggestion:

BLS on the ambulances

ALS in fly cars.

All ambulances have ALS loadout, medic grabs a jump kit with the narcs, jumps on the BLS ambulance if it is an ALS run.

 

[EMTinNEPA]

Around here, BLS ambulance staffing is virtually nonexistent and their apathy winds up taking one of the FOUR ALS UNITS IN THE ENTIRE COUNTY out of service to handle because they're too lazy and/or don't have enough people and/or are only interested in the "good" calls.

 

[FireResuce48]

Ok, so how would a "BLS" call go down?

Medic arrives, assesses, downgrades to BLS, calls BLS ambulance, waits on scene for BLS ambulance, transfers care to BLS ambulance and clears? At this point you might as well have just transported the patient to the hospital.

Alternatively, BLS and ALS ambulances respond. ALS downgrades to BLS, ALS clears, and the EMS system has trouble justifying to the city council why every patient needs 2 ambulances to respond.

That's nothing.
Let's say there is a diabetic emergency in my first due and the BLS ambulance from my station (48)is on another call. The station down the street (18)houses a BLS and a paramedic ambo (1 emt-b and a P). The station even further then that (30) houses a medic unit (2 medics)

This is how they would dispatch it.
Engine 48
Ambulance 18
Paramedic Ambulance 18
Medic 30

4 units for a diabetic emergency. Now the paramedic ambulance will usually cancel the medic unit. For some reason on all als type calls they dispatch a medic unit even though there is a paramedic ambulance on it. And all ALS calls get a basic ambulance on the call as well.
It's dumb. Really dumb.

 

[boingo]

Wouldn't just having 3 providers (2 medics and a basic) be cheaper then? Less personnel, less vehicles, less gas used?

Probably not. You would still need close to the same number of ambulances for transports, yet you would be paying for 4x the number of medics. Instead of 10 medics in 5 ALS truck you would have 40 medics in 20 ALS trucks. You would be paying for less EMT-B's, however in the end it would cost more. You would also decrease the paramedics interaction with acute patients by a factor of 4 as well. Instead of one tube a week you would get one a month. The evidence already suggests that if you don't use it you lose it. The level and quality of care would be reduced (my opinion) unless you could provide time for OR/ED rotations (cost). It is the medic on every truck mentality that the fire department uses to ovesaturate systems with medics. If one is good, ten is better. Sounds good on paper, but in practice it hasn't proven its worth.

 

[medicdan]

boingo, I am just going to say right out that the system you work in seems to be flawless in this way. You have EMT-B++ staffing BLS trucks, EMT-P+++ staffing ALS, but maintain fairly few ALS trucks, and fairly few ALS providers, so you all get an average of 1 tube/month (per your MD), and the BLS crews see acute patients. You train your basics well, your medics better, and everyone is happy.

 

[medic417]

boingo, I am just going to say right out that the system you work in seems to be flawless in this way. You have EMT-B++ staffing BLS trucks, EMT-P+++ staffing ALS, but maintain fairly few ALS trucks, and fairly few ALS providers, so you all get an average of 1 tube/month (per your MD), and the BLS crews see acute patients. You train your basics well, your medics better, and everyone is happy.

How do you train the basics? They are by themselves. Bad habits are developed and no one is available to correct them. At least on a basic/Paramedic ambulance the Paramedic can make sure the assessment is done correctly and teach the basic a thing or two and keep the basic from missing the problem or killing them.

Having two Paramedics is better. They can work together as equals. Then not one person is stuck making all the calls. As to the skills such as intubation all medics should be required to do them at least quarterly under supervision of professionals so they can be helped to improve and to not develope bad habits. So any suggestion that there are to many paramedics is a bogus arguement.

 

[medicdan]

Boingo, feel free to correct me, but as I understand it, before setting foot on a truck, new hires (already basics) sit through a 3 month recruit academy-- which covers everything from a review of EMT-B, to advanced skills (nasal narcan, etc), additional assessment skills, etc.
Only at that point do they go out on a truck, with an FTO, for an additional 3 months. Supervisors like to show up on scenes with recruits to review and critique, then at the end of the 3 months, they are re-evaluated, and cuts are made appropriately.

 

[BossyCow]

Okay, the thread is a BLS thread.. so lets keep the responses appropriate for BLS agencies.

 

[AJ Hidell]

Okay, the thread is a BLS thread.. so lets keep the responses appropriate for BLS agencies.

BLS ambulances are not synonymous with BLS agencies. There are a great many agencies that run a mix of ALS and BLS ambulances.

 

[EMTinNEPA]

Ok, so how would a "BLS" call go down?

Medic arrives, assesses, downgrades to BLS, calls BLS ambulance, waits on scene for BLS ambulance, transfers care to BLS ambulance and clears? At this point you might as well have just transported the patient to the hospital.

Alternatively, BLS and ALS ambulances respond. ALS downgrades to BLS, ALS clears, and the EMS system has trouble justifying to the city council why every patient needs 2 ambulances to respond.

OR, here's how it's done around here...

The medic assesses the patient, says "This patient does not need ALS", gets the ok from medical command, and releases to his partner, an EMT-B. The EMT rides in the back, takes vitals, reassesses, calls in the report, yadda yadda yadda, and the paramedic drives. The EMT does a chart as the primary patient caregiver and the medic does a chart for the initial ALS dispatch but ends with being released by medical command.

OR... the same scenario, only medical command doesn't get involved and the medic doesn't do a chart.

OR... the medic rides in the back, but doesn't start and IV or do any real ALS interventions.

Not saying it's right, but that's how it's done around here and it's a lot more practical than either of the scenarios you put forth.

 

[Foxbat]

...or a medic comes in a fly-car, assesses the patient, releases him to BLS ambulance and goes back in service.

 

[BossyCow]

How do you train the basics? They are by themselves. Bad habits are developed and no one is available to correct them.

MASSIVE BIG DISCLAIMER: I am not against ALS and would dearly love to have a Paramedic on every single call. However the reality of my current situation is BLS only with sporadic ALS support as available.

A decently run program has a run review process established with the Medical Program Director. Every run is reviewed monthly with discussion regarding treatment, time spent on scene, etc. Our MPD will ding us on everything from our handwriting on reports to "if ALS wasn't available, document it". It is a discussion. It is used as a teaching moment, we get our share of tongue lashings and kudos.

There is no excuse for shoddy treatment or the unchecked development of bad habits. Being BLS doesn't mean you have no obligation to maintain the highest level of skill and treatment within the BLS protocols.

 

[zacdav89]

We run 2 first responders one drives and one assists the EMTB IV or the intermediate we only have one emt pre bus