Can you downgrade to BLS?

JohnTheEMT said:
LA county loves to BLS patients even if they are ALS
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Another good reason fire should only be BLS first response and have ALS ambulance.

And LA and OC Fire/medics are lazy. This just creates more unnecessary tension/hatred between Fire and EMS.
 
This issue came up many years ago at my volley and we took it to the state to get an answer. The state said that unless a call is an ALS call, everyone is an EMT and therefore any EMT be given the pt to transport. People only become ALS providers when the call is ALS. This was in NYS back in the early 90s so your rules may be different.
 
ERDoc said:
This issue came up many years ago at my volley and we took it to the state to get an answer. The state said that unless a call is an ALS call, everyone is an EMT and therefore any EMT be given the pt to transport. People only become ALS providers when the call is ALS. This was in NYS back in the early 90s so your rules may be different.
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I didn't realize patients came with designations BLS/ALS. I thought it was just providers. What is considered a BLS patient?
 
RedAirplane said:
I didn't realize patients came with designations BLS/ALS. I thought it was just providers. What is considered a BLS patient?
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A patient where basic life support is all they need (the majority of the patients we get). For example last week I had a patient with the complaint of penis pain x 2 weeks. There is nothing that ALS is going to do for that patient.
 
My company says yes. When I was an EMT I worked with a medic who would downgrade anything that didn't require a monitor (that was his rule) which was pretty annoying. I've heard from friends who work at the Fire Depts in my area that they cannot downgrade. But that's second hand stuff so take it with a grain of salt.
 
RedAirplane said:
I didn't realize patients came with designations BLS/ALS. I thought it was just providers. What is considered a BLS patient?
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Chest pain. ALS patient. Charlie/Delta EMD.
Stubbed toe. BLS patient. Alpha/bravo EMD.
 
DEmedic said:
Chest pain. ALS patient. Charlie/Delta EMD.
Stubbed toe. BLS patient. Alpha/bravo EMD.
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Fair enough. I'm slightly skeptical about the accuracy of EMD (but it beats nothing). It does make sense that a person would only require BLS interventions after an assessment.
 
RedAirplane said:
Fair enough. I'm slightly skeptical about the accuracy of EMD (but it beats nothing). It does make sense that a person would only require BLS interventions after an assessment.
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EMD is very effective when utilized properly. Unfortunately it's biggest flaw is the RP. EMD relies on educated, level headed people to be on the other end of the phone, and it also assumes that the person calling 911 has an actual emergency. IE; EMD wants to assume back pain is a AAA and not a chronic obesity issue.
 
RedAirplane said:
I didn't realize patients came with designations BLS/ALS. I thought it was just providers. What is considered a BLS patient?
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A BLS pt is one that an ALS provider has determined doesn't need ALS level care.
 
Pt assessment is a BLS skill, unless it leads to needing a 12 lead, or blood glucose check (depending on your protocols). My BLS partners can do the 12 lead, I just have to interpret it.
 
No BLS response here is Bay Area, all 911 service are ALS, even the engines, except during a MCI.
 
TimRaven said:
No BLS response here is Bay Area, all 911 service are ALS, even the engines, except during a MCI.
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I believe in Alameda County they will send BLS ambulances on the Alpha responses.

In more rural parts of the Bay Area, fire first response is BLS (volunteer companies).
 
RedAirplane said:
Fair enough. I'm slightly skeptical about the accuracy of EMD (but it beats nothing). It does make sense that a person would only require BLS interventions after an assessment.
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As mentioned, the RP is the one who throws this off. Leg pain becomes a Delta because the pt is "not breathing normally". However, I also have had some of my most septic pts come in as an Alpha because they underreported the severity of symptoms... Additional delay is caused when we need to call out FD for manpower (some FDs do not respond to Alpha calls).

That being said, we certainly remember the 20% of calls that are WAY off without acknowledging that 80% are fairly appropriate.
 
In most cases I've seen of inappropriate EMD, dispatchers seem to err on the side of caution, overriding the suggested ProQA alpha or bravo dispatch and sending ALS as "dispatcher discretion". Also, there are some automatic upgrade questions that get used incorrectly. For example, an IFT or "33 card" often gets upgraded to ALS by asking "is the patient alert or acting normally" or "is this a medical professional requesting an ambulance". Both of those questions will get a dementia patient a paramedic ambulance requested by a CNA. :)
 
Tony Ippolito said:
Th

there excuse being that every transport is so short. Try going code 3 down Venice in rush hour and tell me how short the transport is lol
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Usually thats the case to bls someone even if they do meet als criteria, now im not saying fire is being lazy but they hate to put someone on a monitor and pretend our patient isnt having an MI so they can go back to their bunks and sleep . I heard venice is bad lol.
 
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