Moving an agency to ALS

[starzolife]

Hi guys would appreciate some insight/advice/constructive criticism on a project I've been investigating for my volunteer squad. We're looking into the idea of upgrading our service to ALS.

 

[ExpatMedic0]

Who handles the budget? Have you guys considered a "Cost Benefit Analysis"?

 

[MonkeyArrow]

What type of operation are you currently running? Are y'all a municipality, county, etc. Where do you have jurisdiction? What is your population and average number of calls per year? Are you guys running with fire, independent, there is no fire?

 

[medicsb]

Prove that there is a need for ALS.

 

[Christopher]

Hi guys would appreciate some insight/advice/constructive criticism on a project I've been investigating for my volunteer squad. We're looking into the idea of upgrading our service to ALS.

My combination fire department went from EMT-I transport to EMT-P transport in 2008, after a long process with the county we operate within (in NC you report up through your county, which has primary oversight for all EMS within its borders).

If you believe ALS includes EMT-I, AEMT, or EMT-CC, then this is probably not something I can speak to. I'm not a huge fan of the intermediate levels as they add little to improving outcomes over a moderately expanded EMT. My suggestion would be to skip this step and just become "better" EMT's. It'll save the tax payers a boat load and provide equivalent care.

If you're going ALS (paramedics), your biggest concern is really not slapping patches on shoulders and equipment on the trucks. Those are just dollar signs, which can be worked out relatively easily considering. You really need to stress how you're going to handle the added responsibilities in a department with/without paid personnel.

Your big ticket items:
1. QA/QI process
2. Training
3. New "hire" orientation and precepting process

You certainly can do this with volunteers. I'm a volunteer paramedic and my department has others like me. However, we're probably not much like other departments in our regard for QA/QI/training of "volunteers". Basically once you step foot onto an apparatus whether or not you're drawing regular pay becomes irrelevant.

We do 100% QA/QI of all patient care reports. This will be a must if you're new to a level of care, or have providers who are infrequent providers. QA/QI must be non-punitive, assigning training with measurable outcomes to those who fall short of your standard of care.

You must set the same standard of care any paid ALS agency would, and you must treat your providers no differently. If they must do 48 hours of con ed per year, working for Other Agency X, then your ALS providers should have the same requirements without question.

What this boils down to is you need knowledgeable, experienced providers early in this process. Who can guide individuals into your organizational mold. This may mean paying providers to help jumpstart the organization's FTO process, QA/QI process, and training processes.

 

[TransportJockey]

I think the first step is making sure your medical director is on board with y'all upgrading to ALS. You can have all the shiny new ALS gear in the world, but if your medical director won't sign off on the upgrade it won't do you any good

 

[EpiEMS]

Who handles the budget? Have you guys considered a "Cost Benefit Analysis"?

It would definitely be worthwhile to evaluate

1) How many calls does the service responds to annually that end up requiring an ALS response?
2) How far out is the nearest ALS service, typically? How far is the closest hospital?
Decision rule example for this:
If ALS is typically 10-15 minutes out, but BLS responds in 5 and can be to the hospital in another 5, ALS isn't necessarily worthwhile.
3) Of the ALS calls that are predictable, how many could be handled by an ILS-level of service?

 

[Carlos Danger]

If you believe ALS includes EMT-I, AEMT, or EMT-CC, then this is probably not something I can speak to. I'm not a huge fan of the intermediate levels as they add little to improving outcomes over a moderately expanded EMT. My suggestion would be to skip this step and just become "better" EMT's. It'll save the tax payers a boat load and provide equivalent care.

If you're going

This.

Honestly, IMO, the best thing a service can do is provide excellent BLS care. Focus on QUALITY care rather than level of care.

Push the envelope as far as scope of practice for EMT's. Become sharp as a razor on the things that have proven to improve outcomes, don't worry about those that haven't.

Make it your agency's goal to prove that good BLS is far more important than run-of-the-mill ALS.

 

[ExpatMedic0]

You know the old expression "opinions are like A-holes, every body has one." That is exactly right in this instance, your going to get all sorts of answers from field providers based on peoples perceived notions of whats best or something based on there personal beliefs. It's good to hear what the guys have to say, but often this kind of advise or opinion is no better than some outdated anecdotal practice in medicine. Much like in medicine we strive to move away from anecdotal practices and towards evidence based medicine, the same can be said for a system analysis of any EMS system or agency.
What your talking about is a serious and big change for your agency. You need to go through some analytic framework to properly conduct a system analysis. A cost benefit analysis needs to be performed a long with some quantitative trials and predictions. I would work closely with whoever handles the financial management in your organization in terms of that, along with operations. Not only will this reveal the financial aspects of things, but also the impact on your community from a full spectrum perspective, including morbidity and mortality.

If your in over your head, get the book titled "Analytical Approaches to EMS" by Keith A. Monosky,; Jeffrey T. Lindsey. Its available on coursesmart and will walk you through whats needed.