BLS vs. ALS

Yet another wrinkle

There is but another wrinkle in this ALS/BLS thread... Skill utilization and dilution of those skills. What I'm referring to is that in a given area, there's going to be a certain number of ALS skills (not just placing a line or ECG monitoring) that need to be performed. When you have an a lot of ALS providers, the liklihood of any given provider having performed that skill drops. So, even while you might have kept the providers "proficient" through training, the providers don't generally have experience in that skill, whatever it may be.

This becomes an issue in larger EMS systems.

Going to an all ALS system is not always the panacea that people make it out to be.
 
Akulahawk said:
There is but another wrinkle in this ALS/BLS thread... Skill utilization and dilution of those skills. What I'm referring to is that in a given area, there's going to be a certain number of ALS skills (not just placing a line or ECG monitoring) that need to be performed. When you have an a lot of ALS providers, the liklihood of any given provider having performed that skill drops. So, even while you might have kept the providers "proficient" through training, the providers don't generally have experience in that skill, whatever it may be.
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you mean 4 or 5 FF/Medics charing an IV line to put out dehydration? Yep.
 
Akulahawk said:
There is but another wrinkle in this ALS/BLS thread... Skill utilization and dilution of those skills. What I'm referring to is that in a given area, there's going to be a certain number of ALS skills (not just placing a line or ECG monitoring) that need to be performed. When you have an a lot of ALS providers, the liklihood of any given provider having performed that skill drops. So, even while you might have kept the providers "proficient" through training, the providers don't generally have experience in that skill, whatever it may be.

This becomes an issue in larger EMS systems.

Going to an all ALS system is not always the panacea that people make it out to be.
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I would respectfully disagree. A service goes all ALS. Yes in the field you may get less times doing a skill. But since you are with a quality service they will have worked with hospitals, etc to allow you to practice skills under the supervision of someone that can help you develope better skills. So instead of doing it in the field developing poor techniques you actually will see your Paramedics be better educated and qualified to perform the skills.
 
Flight-LP said:
Yeah, not so much around here. We really do not want these volunteer fire departments having anything to do with EMS. Besides, none of them have any ALS providers.
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Ah, perhaps that is your problem. Our fire department is career and staffed by EMTs AND Paramedics. There are a few with volunteer and paid, but the volunteers are only there to up their chances of getting hired. In smaller departments they aren't forced to go to paramedic if they don't want to and the ones that DO go to paramedic school do it because they want to be a paramedic, and that makes for some fantastic providers.

It works for my area.
 
Pudge40 said:
Well since we now have this policy of post whatever you want so long as the discussion is civil and no one hijacks the thread here goes. Do you feel that every ambulance should be ALS staffed?

I feel that it is better to have ALS but if BLS is around it is better than nothing.
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Yes, I think all 911 calls should have an ALS response.
 
medic417 said:
I would respectfully disagree. A service goes all ALS. Yes in the field you may get less times doing a skill. But since you are with a quality service they will have worked with hospitals, etc to allow you to practice skills under the supervision of someone that can help you develope better skills. So instead of doing it in the field developing poor techniques you actually will see your Paramedics be better educated and qualified to perform the skills.
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I would completely agree... as long as the service and the hospitals actually do work together to provide on-going clinical time/practice to actually improve skills, especially the underutilized skills. If you have a quality service and excellent hospitals, but the hospitals won't allow the prehospital providers get the time in OR, Peds, ICU, ER... because they're afraid of liability... (yes I've seen this first hand) it doesn't work well. I'm referring to the same hospitals that allow EMT-P students to get that time...

I actually worked in such a county. When I worked as a medic here, I couldn't get time in-hospital to improve any of my skills. However, if I was a paramedic student... those same hospitals would have not had an issue with me doing that through the school.
 
Sasha said:
Ah, perhaps that is your problem. Our fire department is career and staffed by EMTs AND Paramedics. There are a few with volunteer and paid, but the volunteers are only there to up their chances of getting hired. In smaller departments they aren't forced to go to paramedic if they don't want to and the ones that DO go to paramedic school do it because they want to be a paramedic, and that makes for some fantastic providers.

It works for my area.
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I have no issue with FD EMS. I do have an issue with Firefighters becoming, or forced to become Paramedics so that they can be Firefighters. I've seen LOTS of that. I'm a Paramedic who'd do Fire so that I could be a Paramedic. However, once I'm on a few years, I'd get promoted off the ambulance, and onto another apparatus where the most patient care I get is just walking on-scene with the transport guys right there with me. That's not what I want to do.
HotelCo said:
Yes, I think all 911 calls should have an ALS response.
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I would agree for the simple reason that sometimes, a cut finger call really is a CVA or an MI call...
 
Not every call requires ALS.

Having said that, and before Sasha gets on her "Every pt deserves an ALS assessment!" rampage: I agree.


So what was the point of the "Not every call requires ALS" then? Simple: Not every single provider needs to be a medic on a call. There is nothing wrong with having a basic response to a call arrive first. And who fulfills that first response? Basics. Therefor, getting rid of the EMT-B level is idiotic.

Train FF's to EMT. Train rural police to EMT. Train lifeguards to EMT. Train industrial security guards to EMT. Etc etc.



Does the education lack? Sure. But no reason why it cannot be upped. And no reason why the level as a whole should be abolished.
 
Linuss said:
\There is nothing wrong with having a basic response to a call arrive first. And who fulfills that first response? Basics. Therefor, getting rid of the EMT-B level is idiotic.
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Why do you not just take a basic off a truck and put a medic in it's place so the patient doesn't have to wait around while the EMTs wait for ALS?
 
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?
 
Sasha said:
Why do you not just take a basic off a truck and put a medic in it's place so the patient doesn't have to wait around while the EMTs wait for ALS?
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No one said they couldn't, but that wasn't my point, was it? My point was it'd be stupid to get rid of the EMT-B level completely.
 
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Linuss said:
Not every call requires ALS.

Having said that, and before Sasha gets on her "Every pt deserves an ALS assessment!" rampage: I agree.


So what was the point of the "Not every call requires ALS" then? Simple: Not every single provider needs to be a medic on a call. There is nothing wrong with having a basic response to a call arrive first. And who fulfills that first response? Basics. Therefor, getting rid of the EMT-B level is idiotic.

Train FF's to EMT. Train rural police to EMT. Train lifeguards to EMT. Train industrial security guards to EMT. Etc etc.



Does the education lack? Sure. But no reason why it cannot be upped. And no reason why the level as a whole should be abolished.
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Here Here!
 
HotelCo said:
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?
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This is the type of system I've always liked (I think Boston has it?) because again, NOT every call requires ALS treatment en route to the hospital.


The only downside I see to it is lazy medics who turf the pts who really need ALS, or if a pt drops in a BLS rig. I guess that could be taken care of by instituting a "IF the basic request a medic on the truck, the medic has to stay" rule.
 
Linuss said:
This is the type of system I've always liked (I think Boston has it?) because again, NOT every call requires ALS treatment en route to the hospital.


The only downside I see to it is lazy medics who turf the pts who really need ALS, or if a pt drops in a BLS rig. I guess that could be taken care of by instituting a "IF the basic request a medic on the truck, the medic has to stay" rule.
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That happens when you have an ALS ambulance response too. Medic doesn't want to do the work, and the patient isn't in a life or death situation, so they just transport, and perhaps start an IV.
 
Oh, that I know, just you have a medic more readily availble on a basic/medic truck.



Here in Ft Worth, the FD has a basic engine response, with some engines that carry medics. Response time is short.

MedStar then gets dispatched, and they do a basic/medic truck.


I haven't heard any bad about the system we have going on here. Heck, the FD wants to stay out of EMS aside from a first response group. They don't want to do fire based EMS.... weird.
 
Here in Milwaukee all the ALS is run by the fire department and BLS calls are contracted out to private companies. The problem is the fire departments meics refuse to run BLS calls and have even been known to pawn off calls that should have been ALS to the BLS crew.
 
Linuss said:
Oh, that I know, just you have a medic more readily availble on a basic/medic truck.



Here in Ft Worth, the FD has a basic engine response, with some engines that carry medics. Response time is short.

MedStar then gets dispatched, and they do a basic/medic truck.


I haven't heard any bad about the system we have going on here. Heck, the FD wants to stay out of EMS aside from a first response group. They don't want to do fire based EMS.... weird.
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Not wierd at all. FD recognizes that they often have a shorter response time... so they'll go out on those calls. They're up-front about the desires of their people. They don't want to do EMS. That results in a better overall level of care than forcing EMS on a FD that doesn't want it. One of the key things in getting good FD EMS going is buy-in by the line personnel. If they don't buy-in, it isn't going to be good. The same could be said for PD based EMS.
subliminal1284 said:
Here in Milwaukee all the ALS is run by the fire department and BLS calls are contracted out to private companies. The problem is the fire departments medics refuse to run BLS calls and have even been known to pawn off calls that should have been ALS to the BLS crew.
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I've seen that happen in the Private Ambulance world too. I've seen ALS crews pawn off ALL of the BLS calls to BLS crews... when running a short distance/time BLS call or two can make a world of difference to the BLS guys and the overall transport schedule... and that can create openings to schedule more BLS runs... while generally remaining available for ALS (usually transfers) calls.
 
subliminal1284 said:
Here in Milwaukee all the ALS is run by the fire department and BLS calls are contracted out to private companies. The problem is the fire departments meics refuse to run BLS calls and have even been known to pawn off calls that should have been ALS to the BLS crew.
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LOL...noooooo..do tell? It's an age old problem with ALS, be they fire based or private. Thus just one of the several good reasons to keep EMS, EMS and fire, fire and Basics right where they are! ;)
 
I can agree with that, EMS is a professional all by itself. It shouldn't be the :censored::censored::censored::censored::censored::censored::censored: child of the FD or PD (I've worked for a PD/EMS before, horrible idea).
 
in my area there are still BLS trucks but i think that it should all be ALS, the dispatchers never really know whats going on all they can go by is what the person on the phone tells them... So I get a call the patient on the phone says he has the flu i ask a few more questions and by what he tells me its a BLS call i send a BLS truck on it... they get there the patient is not breathing (its happened to me but all we have is ALS trucks) the chance should not be taken to send a BLS truck just send the ALS its better for everybody
 
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