Jobs not "trusting" emt-b?

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EMTJosh9

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So, I used to work in a fairly busy system that covers multiple counties, we had about 24 stations and at each stations there's usually 2 crews. On an average shift each crew does about 3-6 calls a day. now, they also have BLS crews that handle the transports, or do BLS calls. I had one BLS shift in my perm schedule and even if we were not on a transport , and a call comes over for injuries from a fall , or other BLS calls, they will not send a BLS unit. Mainly only for psych emergencies. I feel as if some companies have no faith in EMT-B's and have an ALS-always mentality. I know people will say " if you have a medic why not send them?" In my opinion that would be a waste of resources and take away from people that may need a medic for a true ALS call. Does/or has anyone every worked in a company that was ran like this?
 
Why send a BLS unit to someone who might need or at least appreciate actual medical care?
 
How do you know it's a BLS call based only on the dispatch?

It does not make logical sense for a lower level provider to determine whether or not someone is in need of education and intervention that they do not possess themselves. As the saying goes, you don't know what you don't know.
 
Maybe they code everything as ALS in the dispatch criteria?
 
When I was working a double Basic rig, we nicknamed ourselves the "BLS B**ch Car"; my partner and I would spend our dull days getting shopping done, errands run and taking sit-down meals. We understood we wouldn't get anything that wasn't inherently "safe", not because the agency didn't trust us, but because minimally trained 911 initial calltakers and the often hysterical callers themselves are not the best assessors of a situation, and we took full advantage of it. By sending a BLS car to a call that turns out to be poorly dispatched and in need of ALS, there are two choices; 1) take two units out of service to deal with the call or 2) risk not providing the patient necessary interventions. If you really hate having slow, relaxing days filled with nothing too serious then make a good enough impression on an ALS provider that they want you as their handpicked partner to tech all the BS calls they get, or better yet, become an ALS tech yourself; then you can have all the responsibility whether you want it or not! :p
 
Nice segue into one of EMS operational problems (in my humble opinion)....we have been doing many things wrong for many years but one of them is the initial dispatch of level of care.

We waste time and resources by sending BLS first and then seeing if they upgrade. As one stated above, you do not know what you do not know. The ideal system would be sending ALS resources first and then have them downgrade. This can be achieved by fly cars, squads, whatever you want to call them. Of course all of this would piggy back on improved dispatch triage criteria and the implementation of Community Health Medics...but what do I know? :)
 
Agreed. Fly car ALS, transport BLS. If you need a medic, get in the ambulance and have the other EMT drive the fly car to the hospital. No ALS needed, no medic out of service. Why more places don't do this is beyond me.
 
DEmedic said:
Agreed. Fly car ALS, transport BLS. If you need a medic, get in the ambulance and have the other EMT drive the fly car to the hospital. No ALS needed, no medic out of service. Why more places don't do this is beyond me.
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My company has a few divisions, but in the one I work in primarily that's how it works most of the time. BLS gets sent to all medical/trauma calls, regardless of complaint. Depending on the call, ALS may get sent as well (in a double-medic fly car). If BLS gets there first, they can cancel ALS (or request it if not already dispatched), and ALS can triage the call to BLS as well. The severity of the patient's condition dictates the driving configuration of the transport to the hospital (usually, one of the medics will drive their fly-car, with an EMT driving the ambulance and an EMT in the back for moral support for the medic*. However, if 2 medics are needed for the patient, one EMT will drive the ambulance and one will drive the fly car. In very odd circumstances, fire will step in and drive too if needed). The system has its flaws, but overall it works pretty well. The only exception to this procedure is when the medic truck in the city (which usually does transfers) gets dispatched to something. Per our contract, a BLS ambulance will get dispatched as well when possible, then one of the crews will transport unless both are needed for patient care.

*I kidd, I kidd :p
 
akflightmedic said:
Nice segue into one of EMS operational problems (in my humble opinion)....we have been doing many things wrong for many years but one of them is the initial dispatch of level of care.

We waste time and resources by sending BLS first and then seeing if they upgrade. As one stated above, you do not know what you do not know. The ideal system would be sending ALS resources first and then have them downgrade. This can be achieved by fly cars, squads, whatever you want to call them. Of course all of this would piggy back on improved dispatch triage criteria and the implementation of Community Health Medics...but what do I know? :)
Click to expand...

The blanket implementation of a priority dispatching system is a huge failure. If systems look internally and evaluate their responses, capabilities, etc. It can be made to work. The problem is agencies lack that level of motivation and thought, so they use the default A&B= BLS, C,D&E= ALS, and in more progressive systems O= a referral to a community health system. I remember talking to Claire a few month ago and learning how they have restructured their responses based on actual system and call evaluations... The way it really should be everywhere, not some cookie cutter response plan.
 
Remi said:
Because in 90% of cases, paramedics don't do any better than EMT'S?
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I used to believe a line of thinking like this, but I no longer do.

At a level in which skills are provided, yes, paramedics rarely use those skills. Meaning, we don't use a 12 lead on every patient, we don't give drugs to every person, etc.

However, very little time in medic school is spent on those skills. The majority of medic school is spent on very in-depth reviews of very basic information. Then, the physiology and pathophysiology behind everything is explained.

I would rather have a medic there even if it was a very basic call, simply from the standpoint that the "average" medic compared to the "average" basic is going to have much more in depth assessment skills to determine appropriate care and what is actually going on.

To give an example of this, EMT's in my area (Ohio) would perform a Cincinnati Pre-Hospital Stroke Scale for a possible stroke. Paramedics in my area would perform a MEND exam for the same patient.
 
^ joshrunkle... it isn't what you "believed" or "believe." The data show Remi is right.

DEmedic said:
Agreed. Fly car ALS, transport BLS. If you need a medic, get in the ambulance and have the other EMT drive the fly car to the hospital. No ALS needed, no medic out of service. Why more places don't do this is beyond me.
Click to expand...

Worked for a service that did this... it worked quite well.
 
joshrunkle35 said:
I used to believe a line of thinking like this, but I no longer do.

At a level in which skills are provided, yes, paramedics rarely use those skills. Meaning, we don't use a 12 lead on every patient, we don't give drugs to every person, etc.

However, very little time in medic school is spent on those skills. The majority of medic school is spent on very in-depth reviews of very basic information. Then, the physiology and pathophysiology behind everything is explained.

I would rather have a medic there even if it was a very basic call, simply from the standpoint that the "average" medic compared to the "average" basic is going to have much more in depth assessment skills to determine appropriate care and what is actually going on.

To give an example of this, EMT's in my area (Ohio) would perform a Cincinnati Pre-Hospital Stroke Scale for a possible stroke. Paramedics in my area would perform a MEND exam for the same patient.
Click to expand...

Clearly, paramedics have much more education and capability than EMT's. Better understanding, better assessment skills, more available interventions. No doubt. The thing is though, those better assessment skills and greater number of available interventions only really come into play on very few transports. Even if the paramedic does have a much better understanding of what it going on with the patient, that is not usually going to affect the disposition or outcome.

Who says EMT's couldn't learn to do a MEND exam?
 
Being a paramedic is learning 1000 ways to skin a cat, yet also knowing the cat may never had needed skinning to start with.
 
Remi said:
Clearly, paramedics have much more education and capability than EMT's. Better understanding, better assessment skills, more available interventions. No doubt. The thing is though, those better assessment skills and greater number of available interventions only really come into play on very few transports. Even if the paramedic does have a much better understanding of what it going on with the patient, that is not usually going to affect the disposition or outcome.
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And yet, on those very few times that the difference in assessment skills are needed, BLS would not know what they don't know and would have no clue that they might be missing something that may require intervention.

Why don't we have bus drivers or lifeguards transport people? Because intervention while enroute may be necessary. How would someone know when it is necessary? Through assessment training. If we could have doctors do the job, that would be ideal, however, it is unrealistic in nearly all systems. It is realistic in many systems to have some form of paramedic available, and their assessment skills should be utilized as often as possible and as often as affordable for the system.
 
I can see why many people advocate for all-ALS systems. There certainly are some transports where the interventions that a paramedic can provide are likely to promote a positive outcome as compared to what an EMT can do - refractory asthma or status epilepticus are always the ones that come to my mind. So even if we concede that the research doesn't support the necessity of ALS on most calls, we know they are needed sometimes, and we can simplify the dispatch procedures and never have to worry about ALS being unavailable or a call being under-triaged if we just send ALS to every single call. I get it. On some level it just makes sense. I don't necessarily agree with it, and I think there are unintended consequences (such as skills dilution and lack of experience, which are possibly a bigger problem than we realize) that result from all-ALS systems, but I understand why the idea is popular.

joshrunkle35 said:
I'd be all for making EMTs take Anatomy, Physiology and Pathophysiology. It's not about rote memorization of an exam, it's about what the findings of that exam indicate.
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Look, let's be honest here, and admit that neurophysiology is not something that most paramedics have a strong background in, either. Most paramedics can't really interpret the finding of these screening exams beyond recognizing an abnormality, in which case their intervention - putting the patient in the ambulance and driving them to the hospital - is the same exact one that an EMT would do.

These screening exams are actually designed, in fact, to be simple enough to be used in the field by folks who don’t have a lot of time and don’t have a lot of expertise in evaluating neuro patients. Anyone can follow a simple checklist.

We don’t necessarily need to summon the ALS gods from their perch high on the mountain of medical knowledge to come lay their all-knowing, all-healing hands on the afflicted in every case. Let’s not make it a bigger deal than it is.
 
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Remi said:
I can see why many people advocate for all-ALS systems. There certainly are some transports where the interventions that a paramedic can provide are likely to promote a positive outcome as compared to what an EMT can do - refractory asthma or status epilepticus are always the ones that come to my mind. So even if we concede that the research doesn't support the necessity of ALS on most calls, we know they are needed sometimes, and we can simplify the dispatch procedures and never have to worry about ALS being unavailable or a call being under-triaged if we just send ALS to every single call. I get it. On some level it just makes sense. I don't necessarily agree with it, and I think there are unintended consequences (such as skills dilution and lack of experience, which are possibly a bigger problem than we realize) that result from all-ALS systems, but I understand why the idea is popular.



Look, let's be honest here, and admit that neurophysiology is not something that most paramedics have a strong background in, either. Most paramedics can't really interpret the finding of these screening exams beyond recognizing an abnormality, in which case their intervention - putting the patient in the ambulance and driving them to the hospital - is the same exact one that an EMT would do.

These screening exams are actually designed, in fact, to be simple enough to be used in the field by folks who don’t have a lot of time and don’t have a lot of expertise in evaluating neuro patients. Anyone can follow a simple checklist.

We don’t necessarily need to summon the ALS gods from their perch high on the mountain of medical knowledge to come lay their all-knowing, all-healing hands on the afflicted in every case. Let’s not make it a bigger deal than it is.
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I'd be all for paramedics doing 4 years of college for a degree. I'd be all for EMT being a 1,000 hr certification. Regardless, what is in the best interest of the patient should always be at the forefront of our decision making, and more education is almost always more beneficial for patients.

Even after initial training, people should take as much ongoing training as possible. We owe our best to every patient.

We shouldn't only give our best when a dispatcher decides it might be necessary in a singular, limited circumstance.
 
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