Medics leave it to the Basics

[micsaver]

Just a general question to clear up my mild confusion....

If you're on an all Basic truck and call for a Medics assistance, when they arrive is it ok for them to decide that the Basic should be able to handle the call without the Medic and leave?

I have not actually seen this happen or been in this situation (I'm a total newbe) but it has been expressed to me that a Medic might do just that.

I also thought that on a Basic / Medic truck that the medic has to tech all the calls (I guess if its a routine transport that might not be the case).

Did i get my wires crossed somewhere or is the ball being dropped some how?
Is this one of the "it depends" kind of issues?

 

[ResTech]

Each State will differ with how the whole ALS/BLS interface works but Ill give it to ya from the Pennsylvania perspective...

I've been on the ambulance driving when my partner felt they needed ALS or just forgot to cancel them and ALS arrived and asked my partner if he/she needed them.... if they said no, then ALS left.... once ALS makes pt. contact they are stuck with care unless they call Medical Command to get a refusal. So ALS kinda stands back until the EMT states if they need ALS or not on patients that are seemingly obvious to ALS that they are not needed.

But regardless, if the EMT says I want ALS, they have to ride along. The EMT has to agree with not having ALS.

 

[medic417]

Unless an advanced skill is established patient care can be downgraded to basic level.

 

[NomadicMedic]

Happens all the time here.

Just write "Medic Eval" in your SOAP. Document everything.

 

[rescue99]

Local protocols and company/department policy has some jurisdiction on this issue. Here, ALS can hand off after appropriate assessment determines a call to be of basic nature. If a lower level says no, "I am not comfortable with this patient's condition being basic", then ALS is obligated to transport. Depending on policies and protocols, a Medic/Basic until may use its Basic EMT on basic calls. We didn't allow a lower licensure level to attend on basic calls until maybe 7-8 years ago while the neighboring counties did.

 

[imurphy]

perfectly normal. Called "Triaged to BLS" here in MA. Well, in my service anyway.

 

[EMTinNEPA]

In my area, medics can release a patient to a BLS Unit with online medical command. However, more often than not what happens is a BLS unit will get on scene, perform and assessment, discover that they have no need for ALS, and cancel the paramedics.

 

[Sapphyre]

Yes, medics downgrade calls for me (on a basic/basic truck) all the time. And, just so you know, where I am, we don't call for ALS, they are dispatched at the same time we are. I've had a few patients that should have been ALS dumped on me (one was more of a "what if" situation, patient had a potential for going downhill fast on me, and there wouldn't have been much I could do for him, luckily he didn't; and another was one where it was obvious there was major distress that the medics could have treated, but, they didn't want to ride).

It happens all the time, and the best way to deal with it is to continue your education, and make sure you're involved with the assessment, so that you can see what you may be facing, and be ready.

 

[piranah]

every single call a medic fly car is automatically dispatched...we clear it BLS and they take off...then move our equipment over if needed.

 

[ResTech]

ALS isn't dispatched on every single call here. Priority Medical Dispatching determines the call priority and if ALS is determined as being needed, then it gets sent. No point in sending ALS for a broken toe.

Sometimes however, BLS gets a call with no ALS responding and needs to request ALS after they assess. That doesnt happen very often. Priority Medical Dispatch (or EMD) is a very good system for prioritizing calls and assigning resource.

 

[Epi-do]

Here, our BLS trucks are allowed to disregard ALS if it is deemed a BLS call. On the flip side, ALS can hand off a patient to a BLS provider, as long as no ALS interventions have been performed. If an EMT requests a medic to ride in, they must go along for the ride. That being said, I have seen medics just provide moral support and the EMT still tech the run into the ER. Just because the medic is requested & then required to ride in, that doesn't mean they have to actually tech the run if it truly is a BLS patient.

 

[PapaBear434]

With us, if it's a presumed ALS call like a possible stroke or something of that nature, ALS is automatically called out along with a BLS unit. If ALS decides that they aren't needed, they'll call it in to dispatch and mark it in the report that ALS decided it wasn't needed.

However, if BLS decides they aren't comfortable with it, no matter what the call, ALS has to ride along. Of course, if it was a simple twisted ankle and BLS makes the medic ride in, they can get a reprimand from the Chief for being a tool and tying up ALS needlessly. But I have yet to see anything like that. When I was still running as a basic, I asked ALS to ride along for a lot fo things I didn't feel comfortable with. Anything from probable dehydration or heat stroke to a leg fracture that seem to be swelling and discoloring way faster than it should be (making me think arterial bleed and thus not comfortable.)

They never had any problem with it save one, but she's not a very good medic. Tries to pass everything off on BLS. I don't think I've seen a possible stroke that she hasn't said "You guys got this?" to the BLS crew. Though, I suppose a stroke isn't the BEST example, because it's not like ALS can do that much anyway. Start IV, KVO, haul tail to hospital. But you get my point.

 

[WuLabsWuTecH]

We have very few squads (Basic/basic) anymore, but when I was working for the privates we did and if you requested ALS they could ride or they could clear it as a BLS. If you insisted on ALS though they would have to go with you (at that point there is a higher level of care so he is in charge. If he wants to transfer the patient back to you, you can refuse that transfer of care).

For the privates, Medic/Basic truck, the medics were allowed to make the basics take all of the BLS calls and write them up while they only did the ALS calls. Usually, if your medic didn't hate you and you got along well, you guys would just switch off and try to get the number of calls the same. I got alont with all of my partners and we didn't even bother to count. If he was still working on his ALS report I'd take the next 2 or 3 BLS runs.

Working for the FDs, all trucks in our country are required to have at least 2 medics. That being said, the few around here that run 3 man crews (mine included) will let the basics write the BLS runs and switch in the rotation. At any time the ranking In Charge Medic can assign any run to any member so if he felt lazy he could make the Medic take charge of every single ALS run and the basic take every single BLS run while he kicks back and watches, but that never happens in real life!

 

[Buzz]

Here, medics contact medical control to get permission to transfer care to the basics. Seems to happen most often when interacting with the ALS response from the non-transport fire departments.

Echo calls hospital, gives report, requests permission to transfer care to basic, then leaves after permission is granted. Bravo transports.

 

[wyoskibum]

If you're on an all Basic truck and call for a Medics assistance, when they arrive is it ok for them to decide that the Basic should be able to handle the call without the Medic and leave?

As mentioned by others, rules vary by state and agencies. From a medical-legal aspect, this is very common. The problem arises when the Medic "turfs" a call that really should be ALS to the BLS provider.

I also thought that on a Basic / Medic truck that the medic has to tech all the calls (I guess if its a routine transport that might not be the case).

How do you expect EMT's to get any experience if the MEDICS tech all of the calls. Most of the EMT'S I work with want to tech calls whenever possible. Depending on the dispatch information and the nature of the call, I try to let my EMT partner know in advanced that they are going to tech the call. The EMT then does the assessment and asks the questions. I'll listen while doing vitals and if something sounds funny or it looks to be an ALS call, then I'll jump in from there. I always make sure that my partner is comfortable with riding the pt in.

 

[firespec35]

The way it works here is: if B/B car calls for Als. Als can assess and turf to basics if they're comfortable. if it is a B/M als car the basic can attend on routine transfers. if it goes to the ER medic has to tech.

 

[vquintessence]

Depending on the dispatch information and the nature of the call, I try to let my EMT partner know in advanced that they are going to tech the call. The EMT then does the assessment and asks the questions. I'll listen while doing vitals and if something sounds funny or it looks to be an ALS call, then I'll jump in from there. I always make sure that my partner is comfortable with riding the pt in.

Agree and disagree with some of your points. Disagree about your scene management. When there are Paramedics and EMT's on scene, the EMT's role changes dramatically. They (EMTs) are no longer asking questions but instead take on a supporting role for the paramedics.
Pro's:
1) The pt wont get confused/irritated by being asked questions from 2-4 people at once... this isn't an interrogation folks! Having one provider ask questions keeps the conversation focused and concise. It just makes sense to have the highest level of provider lead the working diagnosis!
2) The Paramedic is ultimately responsible for the call should anything happen, be it triage or otherwise. So lets have the person with the most risk run the call!
3) Everyone learns from listening from a higher provider! I don't interrupt MDs/RTs/NPs when they're talking/assessing THEIR pt. Same should go for EMS, ya know the whole hierarchy/ICS thing.
Con's:
1) The EMTs will think you're a paragod... I know, I had that sentiment once. Education, experience and maturity have all changed that. I'm sorry folks, but if your feelings get hurt because you're asked to take on other functions while a higher level provider is obtaining an assessment/general impression...
2) Confrontations. Can't count the number on all fingers and toes!

p.s. Wyoskibum, I'm not implying your methods as inappropriate or your care sub-par! Just my $0.02

dislaimer: Lets not muddy the water by implying I won't help carry the pt or do the other grunt work. The focus is simply providing the best pt experience and assessment possible through their encounter with EMS.

 

[wyoskibum]

Agree and disagree with some of your points. Disagree about your scene management. When there are Paramedics and EMT's on scene, the EMT's role changes dramatically. They (EMTs) are no longer asking questions but instead take on a supporting role for the paramedics.

What works for me, may not work for you. I'm lucky to work with some very good EMT's on an EMT/Medic truck. I like to approach patient care as a team effort. Two heads are better than one.

1) The pt wont get confused/irritated by being asked questions from 2-4 people at once... this isn't an interrogation folks! Having one provider ask questions keeps the conversation focused and concise. It just makes sense to have the highest level of provider lead the working diagnosis!

Usually not a problem. My EMT partner is asking the questions and doing the assessment. Occasionally, the call turns out NOT to be the routing BLS call, then I take over where the EMT left off. Just like when an EMT takes over pt care from first responder, or Medic takes over from BLS provider.

2) The Paramedic is ultimately responsible for the call should anything happen, be it triage or otherwise. So lets have the person with the most risk run the call!

Absolutely. If there is any doubt at all, then I tech the call.

3) Everyone learns from listening from a higher provider! I don't interrupt MDs/RTs/NPs when they're talking/assessing THEIR pt. Same should go for EMS, ya know the whole hierarchy/ICS thing.

IMHO, everyone learns more by DOING than observing. In Medic school we didn't observe our preceptors during field rides, we ran the calls, made mistakes and learned from them.

As I learned in my first anatomy lab, there are many ways to skin a cat! Every system and even every situation is different. We all do what works best for us.

 

[Sail195]

the medics where I am are great about letting the basics do everything that is in there protocol... I have even seen medics drive and let the basic tech the call if pt is stable and its a true bls call