Medics BLS'ing Traumas

[Jon]

Please tell me that by "junior member" you mean "a new basic that we call a "junior member" because we have to have a hierarchy in place to feel good about ourselves" (I'm not a fan of the entire probational period shenanigans that goes on some places) and not someone under the age of 18.

Why?

In PA, you can take the class and get the cert at 16, but can't be "on your own" until you hit 18. LOTS of time to learn and experience lots of stuff. I did it for 2 years.

I've known some good juniors.... I'd rather have them on my truck than lots of other EMT's.



As for the intital topic. First, around here, our medics ONLY carry NSS (No Ringers). If a trauma is going to a TC as a trauma alert/transport... you should have a medic onboard, because you've already recognized that they could have serious problems. If you don't have a medic, you better have a good reason and GREAT documentation, to CYA. (IE: super-extended ALS response time and you beat feet for the TC).

 

[Topher38]

"Blinkies and Woo-Woo's!"

LOL but I don't know why.

LMAO!!!!

Young EMS proffesionals works just fine =]

17 turning 18 in a month by the way =]

 

[ResTech]

In PA, if you assess and dont feel ALS is needed... CANCEL THEM! Not sure how it is in other states but I cancel ALS all the time.

 

[Ridryder911]

In PA, if you assess and dont feel ALS is needed... CANCEL THEM! Not sure how it is in other states but I cancel ALS all the time.

What occurs if ALS so happened to be needed? What if there was an injury because at your level of education and training was not able to detect? Would you be held responsible for litigation?

R/r 911

 

[ResTech]

you assess ur pt. and determine priority... if ALS is not needed... u cancel based on pt presentation at that time. You cant be held liable cause a pt. was stable at the time ALS was cancelled and then 30mins later the pt dies from an AAA. It doesnt take a mastermind to have a firm grasp on the ALS scope of practice and a knowledge of their modalities and to be able to know if ALS is needed.

There is a specific BLS protocol for cancelling ALS in PA so litigation wise its not a concern as long as you didnt cancel for something that blatantly required ALS for example CP, dyspnea, hypoglycemia, anaphylaxis, exacerbated COPD, etc, etc and a negative consequence was had as a result of your decision to cancel.

Again, EMT's ARE MORE THEN CAPABLE OF DETERMINING IF A PATIENT NEEDS ALS!! THIS IS VERY SIMPLE! Should only paramedic's and nurses now do triage? What happens if a basic triages a pt as a wrong priority? Im tired of this level of care thing be taken way to far.

I agree, make everything an ALS level of care... I wish they would... pay for my education and Ill go back and finish paramedic school tomorrow. But its not gonna happen... EMT's who work in a two-tiered system are more versed then EMTs in all ALS model systems where all EMTs do is drive. As an EMT-Basic I am very confident in my assessment skills and clinical decision making and am well aware of my limitations. There are many times I would cancel ALS but dont because I dont have a cardiac monitor or glucometer to base my decision on. There are many times ALS arrives, and they call medical command for a release to BLS.

It works... and works well.

 

[Outbac1]

Here the closest available unit is sent to a 911 call regardless of how it is staffed. If an ALS truck is sitting beside a BLS truck the ALS will get the call. When a BLS unit is sent first if the call sounds serious eg: cardiac arrest, mvc with multiple or trapped pts the ALS will roll behind a BLS unit. If once on scene its not serious, everyone out walking around denieing assessments or doa. we (BLS) will cancel the ALS. Otherwise we will call for ALS if we want it. To make that decision you need education, experience, and diagonistic equipment. Sometimes its easy. You know what you need when you walk thru the door. Other times you have to start assessing to see what you have. I never wait on scene for ALS. Despite all the things that can be done by an EMT-P or ACP, an ambulance is still a transportation device to take pts to definative care, (hospital). The ALS can do what they need to in the truck enroute. Sometimes we end up with three medics in one unit and the lone one left over follows to the hospital as a first response unit if required before they get there. Once at the hospital four medics and one pt means you can have a crew available almost immediatly.

If you want the higher skills you have to get the course. This means you have to make sacrifices to make it happen. I wanted to be a paramedic so I paid $12,000 for tuition for my PCP course and supported my family while I attended the 10 month program away from home. I now have a mortgage on a previously paid off house. I'm now taking my ACP course. Tuition $15,000 plus travel expenses. It's a distance program so I'm working full time too. I'm fortunate that my company will pay $8,000 towards it. I still have lots to pay.
It depends how bad you want it and what sacrifices you are prepared to make. I wouldn't do it if I was a volunteer, but I'm not. I'm a paid EMS professional.

 

[Ridryder911]

you assess ur pt. and determine priority... if ALS is not needed... u cancel based on pt presentation at that time. You cant be held liable cause a pt. was stable at the time ALS was cancelled and then 30mins later the pt dies from an AAA. It doesnt take a mastermind to have a firm grasp on the ALS scope of practice and a knowledge of their modalities and to be able to know if ALS is needed.

There is a specific BLS protocol for cancelling ALS in PA so litigation wise its not a concern as long as you didnt cancel for something that blatantly required ALS for example CP, dyspnea, hypoglycemia, anaphylaxis, exacerbated COPD, etc, etc and a negative consequence was had as a result of your decision to cancel.

Again, EMT's ARE MORE THEN CAPABLE OF DETERMINING IF A PATIENT NEEDS ALS!! THIS IS VERY SIMPLE! Should only paramedic's and nurses now do triage? What happens if a basic triages a pt as a wrong priority? Im tired of this level of care thing be taken way to far.

I agree, make everything an ALS level of care... I wish they would... pay for my education and Ill go back and finish paramedic school tomorrow. But its not gonna happen... EMT's who work in a two-tiered system are more versed then EMTs in all ALS model systems where all EMTs do is drive. As an EMT-Basic I am very confident in my assessment skills and clinical decision making and am well aware of my limitations. There are many times I would cancel ALS but dont because I dont have a cardiac monitor or glucometer to base my decision on. There are many times ALS arrives, and they call medical command for a release to BLS.

It works... and works well.

You make some very valid points. Unfortunately, they are against your emphasis.

Tools do not make the assessment, only the knowledge behind using those tools. That is why more and more EMS services no longer require documentation of oxygen saturation. It is useless. One should never treat a patient based upon the numbers.. the same as an ECG. I have seen numerous normal ECG's with the patient having an AMI! Sorry, a good attorney will shred you apart for not recognizing that AAA, when in fact a better history or better assessment might or would had detected that. Ignorance is not excusable in patient care.

In regards to "Should only paramedic's and nurses now do triage?" actually YES! In fact the Federal Government position is that only RN level or above can perform triage at the ED's, they don't feel Paramedics are quite adequate enough.

Sorry, there are too many variables out there. Sure, if it is an isolated injury such as simple laceration, bumps and boo boo's, but in the event of a medical call or those involving potential real trauma ..NO! A 150 hour first aid course is not detailed enough to clear injuries and potential illnesses.

In regards to "them" paying for your education, why should anyone pay for your education? What makes EMT's any different and more special than anyone else? For say nursing, physicians, truck drivers, ministers? If you really wanted to progress, then do like majority of Americans and get a student loan. You could pay it off with the raise you would receive.
Should there be programs to encourage and assist EMS students, sure that would be nice but do we really have to have it, to get providers to want to perform at the gold standard? Shamefully, we have made to many excuses and provided a comfort level for those below.

R/r 911

 

[Jon]

In this area, ALS is dispatched when they aren't "really" needed (liek they would be on a Chest Pain or Respiratory call). If the patients present as BLS, or simply B.S., I'm inclined to cancel/recall ALS. Some medic EXPECT to be recalled.. but I usually won't let a medic "allow me to cancel them" (IE: cancel themselves) until I've done a brief exam and at least gotten a B/P and pulse. Oftentimes we will cancel the medic and then get a refusal ourselves. I agree that many of these patients could benifit from an ALS assessment, but that isn't "how we roll" around here... and I don't want to be the lone person insisting that ALS evautes every patient. (Enough people hate me already).

I am thrilled to be going to a all-ALS enviroment, working on an ambulance with a medic for a partner. If the patient is BLS or just BS, then I get to ride it in. Otherwise, the medic gets to ride.