Difference between BLS and ALS calls?

[Medic Tim]

Now these statements just irk me. What makes you think an EMTB has less education anyways? I am just a basic, and I have a degree in biology, as well a engineering background, and did I mention 6 years in the Navy.

How about treating basics as something other than under educated half wits.

Really... :angry:

That really has nothing to do with my point about basics being undereducated, but whatever...

For the most part they are.... Where I volly there is a basic with a degree and it is night and day difference compared to those with no other education. The others I take just about every call as I am responsible for the pt. There are many that are satisfied with doing the bare minimum. MAybe it is location dependant but I have seen very few basics with and associates degree let alone a bachelors.
It is no myth that emt education is lacking. It is also true that medic education is lacking but there is a big difference between a couple hundred hours and a couple thousand.

Sorry to hear that about your dog.

 

[Thricenotrice]

That really has nothing to do with my point about basics being undereducated, or the myth being perpetuated that they are, but whatever...

I work as a basic right now, and I have only worked with one good partner (education/common knowledge wise) in the past 4 months. He was a failed medic student. Not saying that all basics are dumb, but there is definitely not a good case out there right now, at least in my area.
That's roughly 45 shifts with countless partners. I would not want a family/friend sick or injured in the county which I work.

There are always exceptions and different circumstances. This is just my experience.

 

[Sandog]

Yet, that is a generalization, and yet I know many people that have their basics and are still advancing their skill set with schooling. For me, EMT was just an ends to a mean. to reach my objective.

My point is, quit assuming basics are Xbox playing no nothings, and stop portraying basics as such in post.

I am sure I could learn much from medics, but at the same time I am sure they could learn from me.

Bottom line is, treat your basic with respect, educate your basic, and in the long run, realize your a team. Make your basic an asset to you and those you serve.

 

[Sandog]

I work as a basic right now, and I have only worked with one good partner (education/common knowledge wise) in the past 4 months. He was a failed medic student. Not saying that all basics are dumb, but there is definitely not a good case out there right now, at least in my area.
That's roughly 45 shifts with countless partners. I would not want a family/friend sick or injured in the county which I work.

There are always exceptions and different circumstances. This is just my experience.

I am sure there are many bad basics, as well as medics, but that is not to say all basics are bad, and are know nothings.

Recipe for success:

Give basics respect until they do not deserve it.

 

[leoemt]

I hope you're kidding about that. Most of those, if not all, are ALS calls. Especially the anaphylaxis. Absolutely NOT a BLS call

Per Protocol Anaphalaxis is a BLS call with either ALS Eval or transport to ER for DR eval. We carry Epi Pens for a reason. Yes, I have given one.

We don't have enough medics to come to every boo boo and owie. Believe it or not BLS stands for Basic Life Support, not Taxi.

I can manage all of those calls for the 5 minutes it will take me to get to the ER. ANY complications, or indications and I will get a Medic. My protocol manual has very few ALS indicators in it. Most of which are Cardiac or Airway related.

ABC's.

 

[the_negro_puppy]

Per Protocol Anaphalaxis is a BLS call with either ALS Eval or transport to ER for DR eval. We carry Epi Pens for a reason. Yes, I have given one.

We don't have enough medics to come to every boo boo and owie. Believe it or not BLS stands for Basic Life Support, not Taxi.

I can manage all of those calls for the 5 minutes it will take me to get to the ER. ANY complications, or indications and I will get a Medic. My protocol manual has very few ALS indicators in it. Most of which are Cardiac or Airway related.

ABC's.

Epi-Pen / adrenaline / epinephrine is not the only treatment for anaphylaxis. But you are quite- quick transport is often under-estimated. As medics we tend to stay and play a bit more because of all the drugs and tools were carry. Sometimes this can be extremely beneficial for the patient. Other times detrimental.

 

[abckidsmom]

Yet, that is a generalization, and yet I know many people that have their basics and are still advancing their skill set with schooling. For me, EMT was just an ends to a mean. to reach my objective.

My point is, quit assuming basics are Xbox playing no nothings, and stop portraying basics as such in post.

I am sure I could learn much from medics, but at the same time I am sure they could learn from me.

Bottom line is, treat your basic with respect, educate your basic, and in the long run, realize your a team. Make your basic an asset to you and those you serve.

I make no such assumptions. I base my decisions off of real life experience with actual people. Some are great, some are 19 yo guys who had a semester long course in high school and can't believe they are living the dream.

There are a whole range of people, and I am speaking of the reality in my situation. There are so many different people out there, if your experience is only with driven, smart, aware and thinking basics, you really haven't seen the half of it.

 

[Bullets]

Could not disagree more. How about judging on WHERE a patient should go, especially working in a high population like Seattle with I'm sure many different receiving types. Are your assessment skills strong enough to determine the best destination vs killing a pt because you took them to an inadequate facility? So on and so forth? Could go on and on. I was an EMT for 3 years in a busy system before going to medic school, so I'm not just paramedic thinking.

You really think it requires a paramedics level of training to determine where to take a patient? You must have some classically stupid providers in your system...

If you are out in the country you probably only have one option as a hospital

If you are in the cities, you have 5-6 options and most do everything. In NYC every hospital is a Trauma center...where i work every hospital can handle STEMI, CVA, and Trauma.

Since ive been here my view of ALS has expanded and i have been keeping them on calls my younger self would have loaded and went. My inital thinking went like this

2-3 Minutes for medics, they assess and treat fr 5-10, 5 minute transport=at best 12 minutes, usually more like 20 before we hit the door at the ER.

Cancel medics, 1 minute to the ambulance, 5 minute transport= 5 minutes till the door

A medic then said that on scene, the provider to patient ratio is usually 4:1 in the hospital its more like 1:10.

So ive been holding medics on scene and waiting, only to have them show up, connect the LP15 draw bloods and stare at the patient while we transport, and im thinking "Shoot, i could have done this without the IV (which the hospital is gong to pull anyway)"

Or just this week, i had a classic closed midshaft femur fracture, patient was lying on her side with minimal pain at rest, i got medics, hoping they could give a little pain before we reduce this with the traction splint and carry her up a narrow staircase. Medics arrive and upon hearing what i want reply "Thats not going to happen"

So i subjected my patient to pain while this Medic unit literally held analgesics in their hands but wouldnt even try to get permission to administer it.

 

[NYMedic828]

You really think it requires a paramedics level of training to determine where to take a patient? You must have some classically stupid providers in your system...

If you are out in the country you probably only have one option as a hospital

If you are in the cities, you have 5-6 options and most do everything. In NYC every hospital is a Trauma center...where i work every hospital can handle STEMI, CVA, and Trauma.

Since ive been here my view of ALS has expanded and i have been keeping them on calls my younger self would have loaded and went. My inital thinking went like this

2-3 Minutes for medics, they assess and treat fr 5-10, 5 minute transport=at best 12 minutes, usually more like 20 before we hit the door at the ER.

Cancel medics, 1 minute to the ambulance, 5 minute transport= 5 minutes till the door

A medic then said that on scene, the provider to patient ratio is usually 4:1 in the hospital its more like 1:10.

So ive been holding medics on scene and waiting, only to have them show up, connect the LP15 draw bloods and stare at the patient while we transport, and im thinking "Shoot, i could have done this without the IV (which the hospital is gong to pull anyway)"

Or just this week, i had a classic closed midshaft femur fracture, patient was lying on her side with minimal pain at rest, i got medics, hoping they could give a little pain before we reduce this with the traction splint and carry her up a narrow staircase. Medics arrive and upon hearing what i want reply "Thats not going to happen"

So i subjected my patient to pain while this Medic unit literally held analgesics in their hands but wouldnt even try to get permission to administer it.

I would have written them up/filed a complaint.

 

[Bullets]

I would have written them up/filed a complaint.

My medical director is not their medical director and they have a different OLMC. However i did shoot my MD and email and asked him to review the chart

After consulting with my MD, apparently their OLMC is about 90 miles north of where we are in a urban setting. The doctors there deal with a lot of drug seekers so they are not inclined to give orders for analgesics for fear of giving a drug seeker a high. Basically they only give the orders for things like amputations or multiple long bone fractures

 

[systemet]

After consulting with my MD, apparently their OLMC is about 90 miles north of where we are in a urban setting. The doctors there deal with a lot of drug seekers so they are not inclined to give orders for analgesics for fear of giving a drug seeker a high. Basically they only give the orders for things like amputations or multiple long bone fractures

Wow! So a single long bone fracture does cut it any more? Personally, I don't agree with trying to identify drug seekers prehospitally. I've got to say, though, if this guy's broken his own femur to get pain meds he probably earned them, and hardly counts as a drug seeker any more. Sounds like poor providers and a medical director just collecting a pay cheque (at least an unethical paramedic has the excuse that most of us never took ethics).

 

[medichopeful]

That really has nothing to do with my point about basics being undereducated, or the myth being perpetuated that they are, but whatever...

Coming from a basic, we are WAY under educated! It's kind of scary that they release us on the world with, to put it bluntly, first aid training.

 

[JPINFV]

Now these statements just irk me. What makes you think an EMTB has less education anyways? I am just a basic, and I have a degree in biology, as well a engineering background, and did I mention 6 years in the Navy.

How about treating basics as something other than under educated half wits.

Really... :angry:

1. When talking about specific fields, you have to be specific to that field. Someone who has a PhD in Womyns Studies has more education than you, but that doesn't mean that you would let Dr. Womyn Studies take over for you when they have no EMS training.

2. Basic science degrees provide an excellent jumping off point both for applied education (like paramedic training, and both for self an formal studying), however it does not, on its own, make an EMT able to practice as a paramedic.

3. Ditto for military experience. Actually, why is it that people who were employed by the military all of a sudden think they don't have to jump through the same hoops or that it gives them some sort of divine knowledge about anything and everything? Ok, congrats, you did a handful of advanced procedures on a group of people that, by and large, are very healthy when it comes to chronic diseases. You know, a population that's completely different than the non-military population.

So, yes, when talking about EMS specifically, the only thing that matters is the amount of training in emergency medicine, emergency nursing, or EMS.

 

[NYMedic828]

Wow! So a single long bone fracture does cut it any more? Personally, I don't agree with trying to identify drug seekers prehospitally. I've got to say, though, if this guy's broken his own femur to get pain meds he probably earned them, and hardly counts as a drug seeker any more. Sounds like poor providers and a medical director just collecting a pay cheque (at least an unethical paramedic has the excuse that most of us never took ethics).

I see bullet mentioned NYC, so I am going to assume this took place within NYC.

In NYC, medics seem to think that administering analgesia is beneath them and not worth their time. They would rather let you suffer and take you to the hospital.

Thank god I am officially done with them.

 

[AnthonyTheEmt]

Per Protocol Anaphalaxis is a BLS call with either ALS Eval or transport to ER for DR eval. We carry Epi Pens for a reason. Yes, I have given one.

We don't have enough medics to come to every boo boo and owie. Believe it or not BLS stands for Basic Life Support, not Taxi.

I can manage all of those calls for the 5 minutes it will take me to get to the ER. ANY complications, or indications and I will get a Medic. My protocol manual has very few ALS indicators in it. Most of which are Cardiac or Airway related.

ABC's.

So what?! You carry a damn epi pen! You don't carry advanced airway equipment for when their airway closes? Think outside the box. Anaphylaxis is more than just allergic reaction. It's a true ALS emergency!

 

[Bullets]

I see bullet mentioned NYC, so I am going to assume this took place within NYC.

In NYC, medics seem to think that administering analgesia is beneath them and not worth their time. They would rather let you suffer and take you to the hospital.

Thank god I am officially done with them.

Not in the City, but not far south.

BLS calls are things that require no treatment or minimal treatment. They are most often simply "Im Sick" and they want to go to the hospital because they feel like it. And you could also include simple falls on sidewalks, from beds and chairs, commodes, ect, and seizures with a history. Everything else is most likely an ALS call.

 

[NYMedic828]

So what?! You carry a damn epi pen! You don't carry advanced airway equipment for when their airway closes? Think outside the box. Anaphylaxis is more than just allergic reaction. It's a true ALS emergency!

Wo brah. Who pissed in your cereal this morning?

Gonna have someone write a script for Xanax.



For the record, an epinephrine injection is the only proven effective treatment (as far as I know) in the presence of true anaphylaxis.

Benadryl and corticosteroids are all secondary treatments that may not have any worth in that stage of the condition. (KellyB wrote a blog entry on it somewhere)

Sure you can intubate but many BLS services have supraglottic airways now too. You can argue that intubation is more effective for ventilation but the bronchiconstriction is not localized to the upper airway. To my knowledge it mimics an asthmatic response and if you ever tried to ventilate a constricted asthmatic it doesn't work so wonderfully. Epinephrine to reverse the underlying cause is what matters.

 

[EpiEMS]

Coming from a basic, we are WAY under educated! It's kind of scary that they release us on the world with, to put it bluntly, first aid training.

I totally, totally, totally agree with this one.

So what?! You carry a damn epi pen! You don't carry advanced airway equipment for when their airway closes? Think outside the box. Anaphylaxis is more than just allergic reaction. It's a true ALS emergency!

Intramuscular epinephrine is the gold standard of treatment for anaphylaxis (http://www.ncbi.nlm.nih.gov/pubmed/11692118, http://millhillavecommand.blogspot.com/2012/08/new-guidelines-for-anaphylaxis.html). Not to mention that there is evidence that people don't even THINK to use epi as the first line treatment (http://www.ncbi.nlm.nih.gov/pubmed/22712745).

Yes, ALS is great -- start a line, give some fluids, give some diphenhydramine, but epinephrine IM is more important.

 

[Tigger]

Just have to hope there are enough epi pens on board, right?

 

[systemet]

Yes, ALS is great -- start a line, give some fluids, give some diphenhydramine, but epinephrine IM is more important.

To a point, though, right?

A supraglottic airway may help if they're horribly bronchspastic, but in that situation we might want some combivent, mag, IV ventolin, etc. We may also get stuck in that horrible place where BVM isn't effective, but we need drugs to place an ET or SGA.

What if they're profoundly hypotensive? We might need a lot of fluid, maybe even some dope or glucagon.

What if the early benadryl or steroids is makes a critical difference at + 1 hour in the ER or ICU?

What if the patient's stridorous? Do we want some nebulised epi as well? Do we want to risk early intubation? Is a cricothyrotomy the best way to manage the airway?

What if they're pre-code? Do we want the ability to push IV epi or run an epi drip?

Yes, IM epi is the cornerstone of treatment, but it's not the only therapy nor is it going to work if the patient isn't perfusing their vastus.