LA County Fire.....

[Chris31]

It should also be noted that out of the 10+ hospitals in our area which we transport to, only about 3 are base contact hospitals... So oftentimes, we are not even transporting to the hospital where base contact was made.

 

[socalmedic]

It should also be noted that out of the 10+ hospitals in our area which we transport to, only about 3 are base contact hospitals... So oftentimes, we are not even transporting to the hospital where base contact was made.

Thats fairly common, the medic is assigned a base hospital to contact based on their station location. The base hospital will (should) call the destination ER to inform them of your arrival. there are also catchment areas where you contact a particular base depending on your physical location. Its all sorts of messed up.

IMO they should just staff the MAC with call takers and have residents/attendings available to consult with. it would save tons of money by using economies of scale, provide one number to call, and be much more efficient with diversion and updates. they already have reddinet computers in every ER, just send a notification that they are getting a patient... no need to waste the time calling.

for those of you wondering what the MAC is, it is the Medical Alert Center. a big room down at county where you can call if you cant get through to your base hospital. they already coordinate diversions and MCIs, if you need a copter they can get you one...

http://ems.dhs.lacounty.gov/MAC/MAC.htm

 

[Bullets]

my statement should say that on any patient where an ALS tool has been used in the assessment or a complaint listed in policy 808,

I would argue that if a paramedic did his assessment, an ALS tool has been used, because an assessment alone by a paramedic is infact ALS in its scope. So pretty much any time a Medic makes visual contact and takes vitals, (which should include a BGL and 3-lead) they need to call to release to BLS

 

[Angel]

no, because by that logic every call is ALS and they arent. IF 4 lead and BGL are indicated and preformed then I cant release the patient BLS. If they arent and I deem it a BLS call, then guess what.
What the OP is stating, clearly a medic should be riding a long but he/she isnt which is the issue.

 

[socalmedic]

I would argue that if a paramedic did his assessment, an ALS tool has been used, because an assessment alone by a paramedic is infact ALS in its scope. So pretty much any time a Medic makes visual contact and takes vitals, (which should include a BGL and 3-lead) they need to call to release to BLS

I am not sure if you are calling the paramedic himself a tool or that his assessment is a tool....

I do not check a BGL and ECG on every patient, there is no reason to be wasting the test strips and stickers if there is no indication.

 

[JPINFV]

Also, in a logical world, the determination of EMT or paramedic transport should depend on the outcome of the assessment, not on what tools are used in the assessment. Of course So Cal is such a silly place.

 

[Jim37F]

I've never seen a patient here go ALS simply because a 12 lead or a BSG was taken or even an IV started (though usually they'll only start one on a patient going ALS anyway but starting one doesn't equal automatic ALS transport. Our medics will routinely push 4mg of morphine for pain management , then excluding any other reason for ALS will call base to BLS the otherwise stable trauma patient).

 

[luke_31]

If ALS starts an IV they have to go with the patient. Granted EMTs can take patients with IVs but only if they are IFTs between facilities or the IV was already present and not started by the paramedics on scene. If they are giving the morphine and the base hospital is clearing the patient to go BLS the responsibility falls to the base hospital allowing it, but routinely once meds are given the paramedics have to transport. I was a Los Angeles county paramedic for a few years before I moved on and in all the time I was there, I never saw a single protocol that would have allowed me to start an IV give any medication and then ship the patient BLS. If anything was to happen to those patients enroute a lot of people including yourself could get into some trouble. You would probably be ok overall, but you would be dragged into the issue since you were there.

 

[Tigger]

I've never seen a patient here go ALS simply because a 12 lead or a BSG was taken or even an IV started (though usually they'll only start one on a patient going ALS anyway but starting one doesn't equal automatic ALS transport. Our medics will routinely push 4mg of morphine for pain management , then excluding any other reason for ALS will call base to BLS the otherwise stable trauma patient).

That is bad juju.

 

[SandpitMedic]

All I can say is... I don't miss CA at all.

 

[Danner777]

That's what the page 2's are for. When there is a transfer of care in the field a page 2 should be done, at least if transferring from als unit to bls unit. The page 2's are submitted to dhs in a certain time frame. That's your chance to throw someone under the bus.

 

[RedAirplane]

I lived in LA County (Pasadena) for four years and we had great fire based ambulances staffed with paramedics who really loved the medical side and appreciated us as first responders.

Then I hear about the rest of the county, and begin to wonder how that system still makes sense to anyone.

 

[Uclabruin103]

This thought process by private ambulance emts is prevalent and perpetuates rumors. Learn your protocols. I used to do the same too, thinking if I heard the word chest pain then it was automatically Omg the big one. When in fact it could be a multitude of non cardiac bls type transports.

Also where in the protocol does it have to say bgl over 400 goes ALS.

Yes LA County ems isn't the best in the world as far as protocols go, but you all make it much worse than it really is. There are bad medics everywhere you go. There's also some great medics everywhere you go

 

[Uclabruin103]

And despite what all the emts are all the private companies say, there's no protocol, outside 516 or whatever the trauma protocol is, with with a specific blood pressure that gets mandatory ALS transport. It's only if they're showing signs of shock.

LEARN THE PROTOCOLS FOR YOURSELF INSTEAD OF GOING OF WORD OF MOUTH.

 

[RocketMedic]

Ucla, the thing is that some assessments are literally impossible without ALS equipment. The OP is talking about the FD blatantly lying about and failing to perform such assessments.

 

[Jim37F]

Where are you reading an ALS assessment requires ALS transport? Just because you used a 12 lead and a glucometer to determine the patients complaint is BLS, doesn't mean the medic squad needs to follow the ambulance just because an ALS assessment tool was used.

Now ALS TREATMENT is a different story...start pushing meds or Edison Medison or invasive bits of plastic, etc. Then yeah, that generally requires the medic squad riding in with the patient (I say generally because our base hospital at least is generally fine with BLSing an otherwise BLS transport minor trauma who got a dose of morphine or an otherwise BLS N/V patient given zofran. That does require base contact and approval first of course)