Code calls, load & go or wait for ALS?

[DrParasite]

Arrests come out as ALS calls the vast majority of the time. Whether it be an active seizure, unconscious, arrest, syncope, difficulty breathing whatever you want to make it.

obviously you have never been dispatched to a SNF for the fall fall vic and found them in cardiac arrest. or the general weakness that turns out to be a cardiac arrest. or the MVA where the driver in later found to be unconcious because he was shot 4 times in the torso. or my personal favorite, the man down called in by the passerby, where the situation is completely unknown (which codes as a Bravo/BLS only) dispatch in MPDS, and when someone gets there, finds the person in cardiac arrest. it happens. I've seen it happen, both as a field provider and a dispatcher. And all the calls you listed should be ALS dispatches immediately (unless your medical director wants otherwise).

All calls that ALS should be dispatched initially. Sure on rare occasions they come out as a non-critical call but that's the minority, most will get upgraded as the call-taker gathers more information and calms the RP down, you as a dispatcher should know that.

your right. but they do happen, especially when you deal with (un)SNF during shift change.

A cardiac arrest is not a "minor call" and should not have a BLS ambulance as the sole responder and you know that. You've been doing the dispatch and EMS thing long enough to know that working arrests rarely come out as non-life threatening calls. All a patient or RP has to say on the phone is they're or the patient having trouble breathing or breathing irregularly and it automatically bumps into a possibly/life threatening call. I'm not even a dispatcher and I know that.

now you are putting words in my mouth. you SHOULDN'T dispatch BLS solo to a cardiac arrest, nor did I ever said you should. But what you get dispatched to and what is actually going on can be two different things (again, speaking as both a dispatcher and field provider). sometimes it's the fault of the calltaker/dispatcher, more often it's the fault of an ignorant caller (caller doesn't know what is going on). Again, if they don't say they are having diff breathing, or don't know if they are having diff breathing, the call doesn't get bumped up.

How many working fires are there annually when compared to working cardiac arrest? Answer me that one. You not wanting to dispatch a fire apparatus to a cardiac arrest because they [I/might[/I] get a working fire in their first due is retarded. 80% if not more of FD runs are EMS related. I don't care if that fire crew doesn't want to be there, assisting EMS is part of their job description.

I couldn't even tell you. why don't you ask your FDNY about that, and ask them what the union uproar would be if two kids died and officer and FF burned because the first due engine was tied up on a medical, so the truck was on solo doing a search with no water supply. that actually happened in NYC btw.

I didn't say we need fire on every run, but on a Delta or Echo level call (you could even argue Charlie level calls as well) they should be going. That's the point of EMD and MPDS, to appropriately allocate resources to EMS calls. Whether they like it or not fire is part of the EMS system. Especially since they are generally going to be faster than EMS since there are more fire units than EMS units in most systems.

actually, I don't like the FD going on ANY calls; I'd rather EMS be able to handle its call volume on it's own, without having to call any other agency for routine operations. yes, I am biased, but you don't see the PD calling the FD to handle a fight at a bar when they have no units to take the call.

An arrest should not tie up a fire apparatus for an hour. If you're working an arrest for that long something needs to be addressed. They come, they help, ride in if we transport or get released when we pronounce. If they want to sit around on scene with their thumbs up their asses after we are finished that's their own fault they aren't available to cover their first due, not dispatch or the EMS crew's fault.

it can if they are transporting to the ER with the ems crew assisting with CPR. or driving the truck with the post ROSC so both providers can treat the patient, esp if it's just the two person ALS crew.

So you're advocating tying up two transport units for one call that could easily be handled by an ALS ambulance and a two man light rescue? If you're so short on resources how does that even make sense? You always talk about how you consistently have pending 911 calls. If that's truly the case then why on earth would you advocate tying up two transport units rather than utilizing fire resources and keeping the second transport unit available for all those pending calls?

absolutely. but EMS should handle EMS calls. Again, you don't see the FD asking for the ambulance to respond to the car fire because they don't have an engine available do you?

and sometimes you have calls that you want more than one provider in the back. in theory, if you have a stable ALS patient, the ALS ambulance transports. but for an unstable ALS patient, you can have both ALS providers teand and the BLS crew acts as drivers.

Sure BLS is probably faster than ALS, fire is just as fast if not faster than BLS most of the time. If you're so short on ALS resources your system needs to be restructured. It's not like it's difficult to find paramedics looking for an ALS gig in this country, hell we have plenty of medics working as Intermediates waiting for a medic spot to open up here.

If you want, we are hiring medics. true, we only pay 20 and hour to start, but its a job. We have more BLS units than ALS units posted around the city, because we have a 4:1 ratio of BLS calls to ALS calls. BLS is usually closer.

I'd love to know what the community thinks about BLS ambulances staffed with glorified first-aiders (no offense to the basics on here) being the sole responder to a life threatening emergency, especially in an urban/suburban environment.

they seem to like it. in fact, we get a lot of support, and the community considers us as equals to fire and police. sadly, the politicans don't, and our funding shows.

If BLS and ALS are simultaneously dispatched then BLS transporting shouldn't even be a question now should it?

because we aren't are in the same location. in fact, we have more BLS than ALS, so if we are requesting an mutual aid ALS unit, it can take them 7 minutes from the time of request until they call in service, and then they need to respond into our town.

Anytime you are on the east coast, come for a visit.

 

[Aidey]

Ok, if anyone wants to continue to debate the merits of different systems they can make a new thread.

Back on topic.

Now.

 

[46Young]

Why is BLS being dispatched to a cardiac arrest rather than ALS? I understand them being simultaneously dispatched, especially if BLS is going to beat ALS to the scene, but why on earth is BLS showing up to a arrest or peri-arrest call then having to request medics? Why aren't they already on the way with the initial dispatch?

I guess I'm not used to having BLS ambulances. Where I work every ambulance has an EMT-I and Paramedic on board, sometimes two Paramedics.

In the NYC 911 system, BLS and ALS are both automatically dispatched to a cardiac arrest. BLS are dispatched for any ALS job where the medics have an ETA greater than ten mins.

In my fire based system, the county wants a minimum of two ALS providers on-scene. All of our engines are ALS. Engines are dispatched to all ALS calls. If the txp unit only has one medic, and the call is in an an area that the engine is already on a call, the EMS supervisor will be dispatched to be the second medic. EMS supervisors are also dispatched to all cardiac arrests.