BLS vs. ALS

[FR Wrath]

That's how it is in Central Louisiana. We have basic units, but they only handle transfers. All other units have at least 1 ALS medic. Some have 2 ALS.

 

[firecoins]

BLS ambulances, ALS fly-cars. ALS car responds to call along with the BLS ambulance, if ALS clears them, they go BLS. If not, one (or both) of the medics ride with the BLS ambulance, and one of the BLS providers takes the fly car and follows to the hospital.

Gee that sounds like the system I work in.

 

[HotelCo]

Gee that sounds like the system I work in.

Does it work well?

 

[firecoins]

Does it work well?

yes it does. Its much better than what I see elsewhere. Medics and BLS crews work on scene together and quite well...most of the time. Patients get taken care of very well.

 

[MrBrown]

All 911 units need to be staffed at the ALS level

A good point. What about if we went a step further and made ALS or at least some heavily upskilled ILS the minimum level like Australia, Canada and the UK does? We're trying to do it here.

This new Agenda for the Future where salbutamol is considered an "advanced" procedure and an Intermediate is not trusted to obtain an ECG or manually defibrllate just drives me mental!

Intermediates here (at most) can...
- insert an LMA,
- start IVs,
- defibrillate and cardiovert,
- morphine IM/IV,
- naloxone IM/IV,
- adrenaline IM for anaphylaxis, asthma, croup
- adrenaline IV for cardiac arrest,
- amiodarone IV for cardiac arrest,
- neb salbutamol,
- SL GTN,
- PO ASA,
- IM glucagon,
- 10% glucose IV

Now that seems to be a pretty good scope to deal with almost anything.

I think we need to do away with this BLS vs ILS vs maybe a bit more ILS vs ALS vs fifty million scopes of practice and education programs that deliver inconsistent care and confuse the heck out of the public ... maybe we should, gasp, do away with our egos and call everybody a Paramedic?

You know I was initially very against the idea of just one or two levels and titles but the more I read up on it the more I am sold.

 

[Sasha]

I was just thinking of an idea, and haven't had a ton of time to think it through, tell me your thoughts..

BLS ambulances, ALS fly-cars. ALS car responds to call along with the BLS ambulance, if ALS clears them, they go BLS. If not, one (or both) of the medics ride with the BLS ambulance, and one of the BLS providers takes the fly car and follows to the hospital.

Like I said, I just thought of it, and haven't looked too deeply into it.

Thoughts?

My thought is...once again... why not just send an ALS ambulance to begin with? Why do you need a BLS ambulance and an ALS fly car? What is the point besides wasted resources? That way, when "BLS Stable" calls decide to bite you in the butt and go south, the medic is already there.

I don't get why an ALS ambulance is taboo.

 

[HotelCo]

My thought is...once again... why not just send an ALS ambulance to begin with? Why do you need a BLS ambulance and an ALS fly car? What is the point besides wasted resources? That way, when "BLS Stable" calls decide to bite you in the butt and go south, the medic is already there.

I don't get why an ALS ambulance is taboo.

I don't see wasted resources. I see maximizing a single ALS unit's potential.

You have 1 (or 2) medics on a fly car that respond with a BLS ambulance, you assess, and if needed stay. If not, you're back out there able to respond to another call. In my mind, it would save money. You don't have to pay to have so many medics. It may not be a huge difference, but there will be some. I'm glad that Florida has the resources, structure and funds to provide all ALS ambulances that respond. That's awesome. However, it doesn't mean it can happen everywhere right away. Compromises will be made in some places for a while.

 

[Sasha]

I don't see wasted resources. I see maximizing a single ALS unit's potential.

You have 1 (or 2) medics on a fly car that respond with a BLS ambulance, you assess, and if needed stay. If not, you're back out there able to respond to another call. In my mind, it would save money. You don't have to pay to have so many medics. It may not be a huge difference, but there will be some. I'm glad that Florida has the resources, structure and funds to provide all ALS ambulances that respond. That's awesome. However, it doesn't mean it can happen everywhere right away. Compromises will be made in some places for a while.

Split up the fly car and instead of one medic unit, you have two.

 

[HotelCo]

Split up the fly car and instead of one medic unit, you have two.

And you've just committed a medic to a call that may not need ALS treatment.

 

[TransportJockey]

And you've just committed a medic to a call that may not need ALS treatment.

Medics run non ALS calls all the time here, and I don't see it hurting response times or draining the medic pool

 

[HotelCo]

Medics run non ALS calls all the time here, and I don't see it hurting response times or draining the medic pool

Yes they do, and you have to pay that medic to run a BLS call. When you could just pay a basic to do it.

 

[Sasha]

And you've just committed a medic to a call that may not need ALS treatment.

The medic can downgrade to BLS and let the EMT treat it. I don't see the issue. Take a dual medic flycar and put one medic on each ambulance. Instead of responding to one call at a time you have two capable ALS units.

 

[TransportJockey]

Yes they do, and you have to pay that medic to run a BLS call. When you could just pay a basic to do it.

The medic is still going to get paid, due to the fact that he's the Basics partner. And besides, one of the few things I like about the protocols here in ABQ is that to run a 911 call you must have a medic in the back. Basics are EVOs only.


And before you say that we sure can't have enough medics or that that's only FD... ABQ runs dual tier. First tier is FD, which runs dual medic rescues. Second tier is the private transport service which maintains at least 1 medic on every truck, 24/7

 

[Micro_87]

The medic can downgrade to BLS and let the EMT treat it. I don't see the issue. Take a dual medic flycar and put one medic on each ambulance. Instead of responding to one call at a time you have two capable ALS units.

best answer i have heard in this thread

 

[46Young]

I've heard it said before, that EMS as a whole would be better off if there was only one main certification level, which would be paramedic. This can be a two year degree, with maybe a few pre reqs, and a paid internship afterward not unlike a MD residency. That way, you can marry your newfound knowledge with real life "street" situations under the watchful eye of your FTO. All paid EMS positions would be paramedic level as a minimum requirement.

Increase the scope of a MFR/CFR to that of a current BLS provider. That way volly organizations will always have at least BLS, and medics will have providers onscene that are at least competent enough to support their efforts properly.

CCEMT-P would be a legit specialty, maybe an additional one or two years of schooling, and would be able to replace txp RN's.

Gaining (true) licensure would be great as well.

 

[TransportJockey]

I've heard it said before, that EMS as a whole would be better off if there was only one main certification level, which would be paramedic. This can be a two year degree, with maybe a few pre reqs, and a paid internship afterward not unlike a MD residency. That way, you can marry your newfound knowledge with real life "street" situations under the watchful eye of your FTO. All paid EMS positions would be paramedic level as a minimum requirement.

Increase the scope of a MFR/CFR to that of a current BLS provider. That way volly organizations will always have at least BLS, and medics will have providers onscene that are at least competent enough to support their efforts properly.

CCEMT-P would be a legit specialty, maybe an additional one or two years of schooling, and would be able to replace txp RN's.

Gaining (true) licensure would be great as well.

I truly wish that in my career I see a system like this come to pass nationwide