Call for ALS?

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Linuss said:
Aww man you edited it :sad:

Always ruining my fun!
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What did I misspell? My keyboard is acting up again. lol:P Really seriously. ;)
 
perspective

I know for the past 20 or so years we like to argue ALS vs. BLS and while we all have our opinions on what is better and why, I wonder:

What is BLS?

What is ALS?

a certification? a set of skills? a knowledge base?

None of our EMS titles are even equal state to state, to say nothing of the significant part of the world that requires a 4 year degree.

I could list off examples for hours that are grey areas at least.

What if a nurse has a part time job as a basic? Is his knowledge base less than ALS?

If a BLS provider stabs somebody with an epi pen is that ALS?

In my home state the treatment for a scorpion sting is a moot point, there are none. (except at the zoo, where they have their own people to help who know far more about it than I ever will) At the same time, treatment for environmental effects like hyper/hypothermia are both everyday occurrences.

In my home town GSWs are not if, but how many. Providers are quite accustomed to them.

What if the IV opioid abusing, chemotherapy, dialysis patient from another country, who is noncompliant with his meds and was bitten by an indigenous spider at an airport somewhere in his travels that day with 3 lay overs suddenly goes unresponsive?

Is that an ALS call? A BLS call? does it really matter?
 
Veneficus said:
IIs that an ALS call? A BLS call? does it really matter?
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Actually patient care is the priority but the way the USA is set up causes this division. If the minimum education was raised and the number of levels was dropped to one possibly 2 nationwide we might finally make progress.
 
I made it so ALS response is always requestsed (if available, both from our service and other services since ALS isn't always assured). The other service's ALS is only stood down by BLS if BLS on scene can make a solid judgment that ALS is not required... which basically means assessment of a stable patient with isolated nondistracting trauma to a limb not requiring pain control or immobilized transport... or a patient with no discovered medical issues or complaints at all. Otherwise ALS continues in to assess and possibly treat. ALS and BLS can certainly discuss over the radio and make a determination that ALS is not required.
 
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Summit said:
ALS is only stood down if an EMT-B can make a solid judgment that ALS is not required... which basically means assessment of a stable patient with isolated nondistracting trauma to a limb not requiring pain control or immobilized transport... or a patient with no discovered medical issues or complaints at all.
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Basically only if they want a free ride to lunch at the hospital cafe'.
 
medic417 said:
Basically only if they want a free ride to lunch at the hospital cafe'.
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We only take them to the trail head where they will always find an ALS ambulance. :)

Certainly ALS from another agency can discuss with BLS on site as to whether response is needed since committing another agency's medic for several hours of tromping around a mountainside is a decision that affect the rest of the areas EMS response system. Of course this requires that ALS provider to know and trust the assessment skills of that BLS provider.
 
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medic417 said:
UMMM what to say and how to say it. That is stupid. Sorry but knee pain can be indicative of many things and warrants an ALS response.
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Ok list some.

And lets not insult providers by squaking about how knee pain, tooth aches and finger nail pain can be indicative of a cardiac event.

If it walks like a duck, talks like a duck its usually a duck.

However if your BLS personel cant competently assess a patient that a possible cardiac event is present, you are spot on they shouldnt be responding to emergencies.

This is discussion is headed in a familiar direction.

By the way the original poster stated what reasons BLS providers would call for ALS intercepts.

Not should every emergency call be an ALS response.
 
CAOX3 said:
Ok list some.

And lets not insult providers by squaking about how knee pain, tooth aches and finger nail pain can be indicative of a cardiac event.

If it walks like a duck, talks like a duck its usually a duck.

However if your BLS personel cant competently assess a patient that a possible cardiac event is present, you are spot on they shouldnt be responding to emergencies.

This is discussion is headed in a familiar direction.

By the way the original poster stated what reasons BLS providers would call for ALS intercepts.

Not should every emergency call be an ALS response.
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I guess you missed the section about how women may present with cardiac problems. There was also a good article posted on this forum in the news section although the thread was about someone being offended by the words ambulance driver which distracted from a serious article.

Unfortunately without an ECG, many serious cardiac problems might be missed and even that is no guarantee.

Knee pain, especially if it is on the on posterior region can be extremely serious. The fact that you do not recognize some of these things as symptoms of more serious conditions does concern me and definitely makes medic417's point. It is the knowledge of many different pathologies and not just the few learned in an EMT-B course that must be considered. If all diagnoses fit into just the categories listed in just the EMT or even EMT-P book, medicine would really be so simple and not the complex beast it truly is.

How many precious minutes are wasted by first sending a BLS truck to have a little look before calling frantically for ALS? How many lives could have had a better chance for quality of life or even life if it was an all ALS 911 system? Every U.S. citizen deserves access to quality medicine and not this fragmented BLS/ALS stuff. EMS has gotten to the point of justisfying its inadequacies to preserve the minimum standard of care as being adequate medicine for the people.
 
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VentMedic said:
I guess you missed the section about how women may present with cardiac problems. There was also a good article posted on this forum in the news section although the thread was about someone being offended by the words ambulance driver which distracted from a serious article.

Unfortunately without an ECG, many serious cardiac problems might be missed and even that is no guarantee.

Knee pain, especially if it is on the on posterior region can be extremely serious. The fact that you do not recognize some of these things as symptoms of more serious conditions does concern me and definitely makes medic417's point. It is the knowledge of many different pathologies and not just the few learned in an EMT-B course that must be considered. If all diagnoses fit into just the categories listed in just the EMT or even EMT-P book, medicine would really be so simple and not the complex beast it truly is.

How many precious minutes are wasted by first sending a BLS truck to have a little look before calling frantically for ALS? How many lives could have had a better chance for quality of life or even life if it was an all ALS 911 system? Every U.S. citizen deserves access to quality medicine and not this fragmented BLS/ALS stuff. EMS has gotten to the point of justisfying its inadequacies to preserve the minimum standard of care as being adequate medicine for the people.
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For the betterment of all, and since CAOx3 asked and you ignored it, perhaps you could explain what issues knee pn can be indicative of, and posterior knee pn in particular, as well as covering what treatements will be done by a paramedic vs a basic. This way someone may actually be able to learn something from this thread beyond the fact that many people here, at ALL levels, are way to full of themselves.
 
CAOX3 said:
However if your BLS personel cant competently assess a patient that a possible cardiac event is present, you are spot on they shouldnt be responding to emergencies.
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Not to be rude but many cardiac events occur w/o hardly any outward appearance. You need an ALS exam to even begin to rule in cardiac. Just because they look fine and vitals look fine doesn't mean they are.

Now the text book MI chest pain, Left arm and neck pain, moist pale skin. Even a monkey could be trained to learn that is bad. But someone educated would know most patients don't present like the text book.

And OP asked when would you call ALS. Some of us are just showing maybe you should be calling more often if you work in a broken system that still sends BLS only ambulances out.
 
medic417 said:
Not to be rude but many cardiac events occur w/o hardly any outward appearance. You need an ALS exam to even begin to rule in cardiac. Just because they look fine and vitals look fine doesn't mean they are.

Now the text book MI chest pain, Left arm and neck pain, moist pale skin. Even a monkey could be trained to learn that is bad. But someone educated would know most patients don't present like the text book.

And OP asked when would you call ALS. Some of us are just showing maybe you should be calling more often if you work in a broken system that still sends BLS only ambulances out.
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For the betterment of all, and since CAOx3 asked and you ignored it, perhaps you could explain what issues knee pn can be indicative of, and posterior knee pn in particular, as well as covering what treatements will be done by a paramedic vs a basic. This way someone may actually be able to learn something from this thread beyond the fact that many people here, at ALL levels, are way to full of themselves.

Yes, this also applies to you.
 
Let me expand on my thought here. Every system needs to be taylored to its needs. ALS and BLS can and do succesfully work together in many systems.

My belief is in a large Urban system that I have experience with, is there is no need to have ALS responses to every EMS call. The majority of these calls are and will always be BLS in nature. Truthfully the majority are cabulance in nature.

A competently trained BLS provider will have no problem handeling 95% of these calls. The other 5% are handeled by highly educated and experienced ALS providers who do not spend there whole day carting around every Tom, **** and Harry who thinks finger pain from slamming it in a car door requires a full EMS response.

When they are summoned and they do have predetermined compalints they respond to. They institute proffesional, NEEDED and warrented care.

The benefits of these systems are you dont get tired, burn out, rather be somwhere else ALS providers who have been humping drunks (not CVA or diabetics)and lonely old ladies all day. You get seasoned, educated and experienced ALS providers that do nothing else then responding to and treat ALS pts.

The ALS providers care for ALS pts, they use and refine their skills by using them on a daily basis, not on a monthly basis, which is where problems arise.

The other side is you have EMTs that gain valued experience and along with continued education become those seasoned, educated and experienced ALS providers of the future.

Seems like a win win situation to me. Flooding a system with ALS providers is not always answer.
 
triemal04 said:
For the betterment of all, and since CAOx3 asked and you ignored it, perhaps you could explain what issues knee pn can be indicative of, and posterior knee pn in particular, as well as covering what treatements will be done by a paramedic vs a basic. This way someone may actually be able to learn something from this thread beyond the fact that many people here, at ALL levels, are way to full of themselves.
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Honestly!


You are a supposedly a Paramedic who should be just as capable of explaining this also.

You have already tossed your insult with the "full of themselves" remark.
So no, I am not going to waste anymore of my time typing out everything for you. And don't bother PMing me with more of your insults and profanity either. If you had an ounce of credibility or sincerity, I wouldn't mind, but you don't have either.
 
CAOX3 said:
Ok list some.

And lets not insult providers by squaking about how knee pain, tooth aches and finger nail pain can be indicative of a cardiac event.

If it walks like a duck, talks like a duck its usually a duck.

However if your BLS personel cant competently assess a patient that a possible cardiac event is present, you are spot on they shouldnt be responding to emergencies.

This is discussion is headed in a familiar direction.

By the way the original poster stated what reasons BLS providers would call for ALS intercepts.

Not should every emergency call be an ALS response.
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DVT, Gullian-Barre,local tissue ischemia, osteomalasia, sickle cell crisis, and tick borne typhus, are serious conditions that may present with lower leg/ knee pain.

Toothaches could be unusual cardiac presentation, sepsis, menigitis, and acute tosilitis. Depending on certain crainial nerve involvement could also be unusual stroke presentation due to compression.

Fingernail pain could be a sign of scurvey or another collagen forming pathologies, in addition local compartment syndromes from infection, particularly from dog and human bites. Oh and sickle cell again.

Places I have worked nobody was dispatched to knee pain. It usually came in as a "general malaise" or "orthopaedic injury" which always should carry high suspicion of a train wreck. Especially when the caller is withholding information from the dispatcher as in cases of rape or other genitalia issues.

Furthermore EMS is not only about saving lives, but limbs too. Western medicine in general is about return to function.
 
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VentMedic said:
Explain "competently trained" as it stands for the 110 hour EMT-B.
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My thoughts exactly.

Veneficus did list a number of the possible problems that could be indicated by what many a BLS provider would dismiss and sadly so would many diploma mill paramedics.

If BLS only responded nothing really could be provided to help those that rapidly crash. If ALS responded many possible interventions could be started that might get the patient to the hospital with a chance of leaving the hospital alive and basically intact.
 
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