Checking ALS equipment on a BLS truck

[broken stretcher]

Im playing devils advocate here... So you have a strong basic who knows all the ALS equipment inside and out. Know what it does and when its supposed to be used. Also has a basic understanding of ALS protocols and can set up all the meds needed for an arrest or something... (most of our basics can do all this stuff). Now lets say this knows how to test all the laryngoscopes and does just that at the start of shift. NOw a medic goes to get a tube and needs a mac 3 well what do you know the light on the mac 3 is out. who's fault is this? the basic was never formally trained how to check the blades...

 

[DesertMedic66]

Im playing devils advocate here... So you have a strong basic who knows all the ALS equipment inside and out. Know what it does and when its supposed to be used. Also has a basic understanding of ALS protocols and can set up all the meds needed for an arrest or something... (most of our basics can do all this stuff). Now lets say this knows how to test all the laryngoscopes and does just that at the start of shift. NOw a medic goes to get a tube and needs a mac 3 well what do you know the light on the mac 3 is out. who's fault is this? the basic was never formally trained how to check the blades...

I was formally trained how to check the blade out as a basic...

You don't need to know what ALS stuff does or when it is supposed to be used to check it out. Checking stuff out is a simple checkbox sheet. 5 18G needles? Check. IO Drill with good/extra batteries? Check. Needle thor kit? Check.

We have VST who will check out and make sure equipment works and that the ambulances are fully stocked. Our VSTs have zero medical training.

 

[mycrofft]

If a $20/hr tech with no medical qualifications can check it out at the factory or hospital, you can check it on your ambulance. Just make sure you do it right, get the manual and follow it and don't make any repairs, follow company procedure to tag it off service and get 'er fixed.

If I was the ALS using it, I"d want to check it myself. In fact, I would.

 

[EMT B]

For what do you use it at the BLS level? Not necessarily criticizing, just curious.

some docs like us to give it to them to get orders for a neb (more gradual slope in phase II with bronchoconstriction). helps determine metabolic status of patients. also helps monitor ventilatory effort in post-ictal seizure pts. and then you also have your ROSC for codes

also, in the case of the bronchoconstriction, you are most likely going to see that phase II slope go away before the patient states they feel better. it is an earlier indicator that your treatment (in this case the neb) is working

 

[Clipper1]

some docs like us to give it to them to get orders for a neb (more gradual slope in phase II with bronchoconstriction). helps determine metabolic status of patients. also helps monitor ventilatory effort in post-ictal seizure pts. and then you also have your ROSC for codes

also, in the case of the bronchoconstriction, you are most likely going to see that phase II slope go away before the patient states they feel better. it is an earlier indicator that your treatment (in this case the neb) is working

Some doctors will order a neb for a hang nail just to see if it gets a result or to look like they are doing something. More often than not the ETCO2 should be an adjunct to confirm what you are physically assessing. WOB, breath sounds, how the patient looks and how they feel will be better indicators at the BLS and even the ALS level.

There are many metabolic disorders which can give similar results. Many need further diagnostic testing along with the physical assessment.

I have not seen a BLS truck bring in a patient who has come out of a full arrest with just CPR. Does ALS not run with you on these calls?

 

[EMT B]

so where i go to school right now there is very little ALS. the shift crew is 2 drivers and 2 emts. sometimes a driver and an emt and a driver and a medic if your lucky. transport tiime is 7mins give or take to the nearest clinic. although i dont put all my faith in that clinic, most of the time we load and go to that clinic if it is urgent. the clinic toned out for a medic once to intubate cause the doc couldn't do it. but thats a different discussion.

 

[EMT B]

the other good one was an emergency transfer to another hospital for a guy to get a cast on his arm.

 

[usalsfyre]

Im playing devils advocate here... So you have a strong basic who knows all the ALS equipment inside and out. Know what it does and when its supposed to be used. Also has a basic understanding of ALS protocols and can set up all the meds needed for an arrest or something... (most of our basics can do all this stuff). Now lets say this knows how to test all the laryngoscopes and does just that at the start of shift. NOw a medic goes to get a tube and needs a mac 3 well what do you know the light on the mac 3 is out. who's fault is this? the basic was never formally trained how to check the blades...

It takes formal training to see if a lightbulb comes on? You're making this out to be more than it really is.

There's not "fault" to it. Bulbs burn out. Blades get lost. It's the medics job to know how to work around that. It's exceptionally rare that you can "only get the tube with a Mac 3".

 

[DrParasite]

thats annoying...what are you going to do when you get a paramedic intercept? waste time while the medic(s) carry all their gear onto the truck?

really? it's wasting time for a provider in a chase car to carry all their gear to the truck? sounds like a lazy provider.

As for the OP, BLS can check the BLS stuff, ALS can check the ALS stuff. is it really all that difficult?

 

[Jim37F]

I agree that on a B/P rig the EMT should be able to do an inventory/functional check of his/her partners ALS equipment. I also think the Paramedic should check their equipment, not because they don't trust their EMT partner but because it is still their equipment and their *** on the line. Plus it never hurts to double check.

For a medic doing an ALS intercept of a BLS unit, I can't see how you can expect them to just hop on another rig expecting there to be a full complement of ALS supplies ready to go. Especially if its two different services. The only way I can imagine that working is if they work for the same service that goes above and beyond to make sure every rig, BLS or not is fully stocked on all ALS supplies and are all in the exact same location. Even then I'd still question the medic that didn't spend the 30 seconds to grab his bags.

 

[ZombieEMT]

I agree with the idea that ALS equipment can be check by a BLS employee as long as trained to do so. When it comes down to it, its usually a matter of checking a box or putting initials. Just because a medic has more training than a basic does not mean that a basic does not know how to check ALS equipment.

For those of you (both medics and basics) that say you do it, not because you dont trust the basic, but its your butt on the line, what is is your opinion on a B/B truck or P/P truck? How is either situation different? If one medic checks part of the truck and the other medic checks the rest, its not really any different, is it? If as a basic, my basic partner does says they checked that the BP cuff was there and it wasnt thats just as much as his fault as mine.

To provide some background, I work in NJ and we run E/E ambulances and P/P chases cars. When CCT come into play there is a nurse. When I am on a nurse truck, I check everything other then drugs. It doesnt take a genius to check the monitor.

 

[Handsome Robb]

This was my argument... if we were doing an ALS intercept the medic would bring their own equipment, that they checked, and that they know is in good working order. I would not want t go on a truck and assume that the ALS stuff was checked by a basic and then have stuff missing or not working. that's why I don't think it is necessary for BLs to check ALS equipment. They have no training in the equipment therefor have no ability to say if it is ready to go or not.

Agreed 100%. I'd rather work out of my personal bag just because I know for a fact it is good. People make it sound like a huge deal to bring or monitor and a first out and airway bag with us. I can carry all three by myself...

Disposable supplies are a bit different, it's pretty easy to determine whether they're expired or not. Vent, monitor, ect are a different story.

I will say that where I work I wouldn't have an issue jumping into another crew's rig because the same people that stocked my unit stocked theirs. Every unit is ALS though, we don't do intercepts.

Im playing devils advocate here... So you have a strong basic who knows all the ALS equipment inside and out. Know what it does and when its supposed to be used. Also has a basic understanding of ALS protocols and can set up all the meds needed for an arrest or something... (most of our basics can do all this stuff). Now lets say this knows how to test all the laryngoscopes and does just that at the start of shift. NOw a medic goes to get a tube and needs a mac 3 well what do you know the light on the mac 3 is out. who's fault is this? the basic was never formally trained how to check the blades...

The medic's. It's their equipment they're responsible for it. Personally I don't let anyone touch my ALS airway kit that is velcroed (sp?) into my airway bag. If my partner is offering to check my stuff, awesome, but I'm gonna be right there with them. Not because I do t trust them, ok some I don't trust at all but that's a different conversation, but because I'm responsible for that equipment not my partner.

 

[EMT B]

really? it's wasting time for a provider in a chase car to carry all their gear to the truck? sounds like a lazy provider.

As for the OP, BLS can check the BLS stuff, ALS can check the ALS stuff. is it really all that difficult?

the other thing i forgot to mention is that some of us are rural...and the ALS chase car, is sometimes just a POV with nothing but an off-duty paramedic on it

 

[Christopher]

Just got ogg the overnight and had this debate with another provider... We run dual trucks (ALS+BLS provider)...most of the time. Every now and then we have a BLS only truck. If you are the BLS providers on the BLS truck, should you/ would you check the ALS equipment. In my opinion a basic is not required to check equipment they haven't been trained on. Sure most of them know where it all is and what it all generally does but should they be checking it off because who is a basic to say if ALS equipment is in good working order... what do yall think? Check it or write in the ALS sections of the check sheet "BLS only"?

Our check sheet doesn't really care what your card says. It doesn't take a rocket surgeon to ensure equipment is in its proper place, unexpired, and in good working order...

We run P/B and our other units may run ALS, ILS, or BLS depending on staffing.

We routinely hop other trucks too, and I bring all my stuff from my unit...even if the truck I'm hopping is my own service's BLS unit. This is what you should get in the habit of doing if you routinely intercept.

 

[Christopher]

That has absolutely no use on a BLS unit.

Our BLS crews have NC- and inline ETCO2, 12-Leads, etc.

Perhaps the most important feature of NC-ETCO2 is breath-by-breath monitoring of respiratory rate. Ignoring the utility of this feature is just plain silly.

 

[Medic Tim]

When I do an Intercept it is usually for another Industrial company or the provincial ambulance service (if they send a BLS truck to intercept me..I have to transfer the pt to their ambulance and resume care in their truck if it is an ALS pt). I really never know what stock or crew will be on board. I bring my monitor, airway bag and med/first in bag on all intercepts. I know where everything is and I am familiar with my equipment.

 

[EMT B]

Perhaps the most important feature of NC-ETCO2 is breath-by-breath monitoring of respiratory rate.

wanted to add this to my list of things cap was good for, but i didn't want to get slammed for using a machine for something a basic should be able to figure out without a monitor...sort of like the guys that use the NIBP function just cause they can

 

[Christopher]

wanted to add this to my list of things cap was good for, but i didn't want to get slammed for using a machine for something a basic should be able to figure out without a monitor...sort of like the guys that use the NIBP function just cause they can

Ignore the luddites. In the 1970's folks complained about computers (I complain about smart phones and doing charting on tablets...I'm officially "old" and "out of touch").

 

[mycrofft]

Our check sheet doesn't really care what your card says. It doesn't take a rocket surgeon to ensure equipment is in its proper place, unexpired, and in good working order...

We run P/B and our other units may run ALS, ILS, or BLS depending on staffing.

We routinely hop other trucks too, and I bring all my stuff from my unit...even if the truck I'm hopping is my own service's BLS unit. This is what you should get in the habit of doing if you routinely intercept.

But there are ineffective ways to check and leave equipment. I HEARTILY agree it ain't Werner Von Braun-territory, but the cursory checks I have seen stuff given and the poor configuration they leave stuff in sometimes makes me cringe.

Such as: leaving the E or D cylinder O2 tank valve on and relying on the yoke's flow knob turned to "OFF" to secure the oxygen setup ( can cause tank level gauge to jam on "FULL", and can leaks sometimes)

EKG electrodes already opened and connected to the wiring harness (adhesive is drying out) and harness is cramped over close to the machine and/or left tangled up. EKG paper level not checked, and no dry run on the EKG printer once new paper is inserted.

Need to palpate chemical cold packs to see if they've been ruptured or leaked.

Syringes preloaded by hand and left sitting around (even if labelled somehow).

Open up the airways and make sure they are ALL there, not just the unpopular sizes.

Test suction on a load (crimped hose at least), not just see if the motor makes noise.

Inspect manual suction units for whether or not they actually develop a suction or just blow air both ways (operate it by your check and ear, see if you can feel air puff back out).

Etc.

 

[Handsome Robb]

wanted to add this to my list of things cap was good for, but i didn't want to get slammed for using a machine for something a basic should be able to figure out without a monitor...sort of like the guys that use the NIBP function just cause they can

Why do people hate NIBP so much? How often do you see someone taking a manual BP in the hospital?

I can count on one hand in a touch over two years how many times I've seen it happen, that's including during paramedic clinicals. Just like any tool, calibrated, maintained, applied and used properly they're just fine.