I'm curious as to opinions of the efficacy of non transporting ALS services, i.e: The medic in a chase car or QRV in conjunction with a BLS ambulance.
In the system I'm looking at, the medic is dispatched simultaneously with a BLS ambulance for calls that meet EMD criteria for an ALS response. If an ALS transport is warranted, the medic climbs onto the BLS rig and transports ALS. If once on scene, the situation does not call for any ALS interventions, following an eval, the medic will send the patient BLS, with an EMT.
If you've worked in, or have experience with this type of deployment, can you tell me pros and cons.
I worked for five years in New Jersey for a MICU project that was all chase cars. Hands down, I prefer it over being in an ambulance. But, my preference for the chase-car is tied to my preference for the tiered system.
I can only speak for where I worked. Generally, ALS was dispatched on about 50% of all EMS calls; ALS was usually canceled while enroute or shortly after arrival on scene for 40-60% of those dispatches. There were no protocols for BLS to follow when it came to canceling ALS, so there was a lot of variation between BLS squads and even between EMTs of the same squad. Some EMTs had no problem cancelling ALS for all but the truly critical and other would keep ALS coming just because ALS was dispatched. As far as triaging to BLS - again, no solid protocols, but all triages were reviewed by the medical director if it came back that the patient was admitted to tele or a higher level of care. In my opinion, we didn't triage to BLS enough, which was a product of the QA/QI system as it was almost always considered to be inappropriate if the patient was admitted regardless of whether the patient needed any ALS intervention or could have possibly required it at some point during transport. So, without a doubt, the a biggest con of the system I was in was the extremely poor oversight and QA/QI of BLS and dispatchers, and unrealistic criteria to determine appropriate triage by paramedics, which when combined created many instances of medics being tied up on calls where they really weren't needed, which is problematic when the county of 450,000 has only 5 medic units (they're now at 6 during peak hours). So yes, there were times where there would be no medic units available or if there was one, its response time would be prolonged due to distance.
The biggest pros of the system is concentrated paramedic experience. Intubation and cardiac arrests were not 2 or 3 times a year events for medics. I was per-diem, working one day a week for 9 months (due to school) and then 36 hours a week for the balance and I would average around 8-10 tubes a year. (Most, if not all fulltime medics in SE PA that I knew wouldn't get that many; the ones that did were usually working 60-80 hours a week.) It wasn't uncommon to have a couple shifts a year where you'd have multiple codes or multiple intubations. I know some medics that have worked 4 codes in one shift, though that is pretty rare. Our ETI stats could have been better, but we had an overall ETI success rate of 94% when I left. I know ASA admin and 12 leads were being tracked for appropriate use and we were in the high 90s (averaged over a year) for both.
As the trucks were staffed with 2 medics, you always had someone to confer with (this was great when I was fresh out of medic training). When on scene, one medic would get the history while the other did an assessment and initiated treatments, as needed. If the patient was really sick, both would ride in the back and an EMT would drive our truck. Though it was not an every shift occurrence for both medics to ride with a patient, I found it to be beneficial when we did, and I think we should have done it more often. Overall, I think we were generally able to get more done in a shorter amount of time than if it were just one medic and an EMT on the call.
I'm not sure what else to touch on as I need to get going. But any questions, I'll do my best to answer them.
