It is the mentality behind the "ALS" and "BLS" that has made EMS here so ridiculous.
If a doctor places a nasal cannula on a patient does that make it "BLS" even if the patient is headed for the ICU? If the patient is brought in by "BLS" does that make them less sick because less or no "ALS" procedures were done on them? If a BLS truck brings in an acute stroke patient does that make the patient less sick? If an ALS truck rushes a patient in cardiac arrest to the ED that they have not established any "ALS" interventions on, is that patient "BLS" and less sick?
In the U.S. we tend to get more hung up on labeling the patient by a skill or procedure rather than the knowledge of the provider or the actual patient care where assessment is concerned or whether that patient might actually be sick. If the Paramedic does not see where they can or want to do a "skill" the patient becomes "BLS". Thus, it is then assumed the patient is "less sick".
We can take a severely injured trauma patient as an example since the BLS vs ALS is argued. The fact that only "BLS" procedures are done does not make that patient less sick. It should be the fact that an ALS assessment determined less is best rather than stay and play. Either way the patient needs Advanced Patient Care regardless of whether it is initiated in the field or in the ED. They may not need "ALS" skills but they are entitled to an assessment by someone capable of determining if immediate intervention is required and one that can do that procedure be it "BLS" or "ALS".
Where I work now, virtually every unit its a medic unit. So, there's no "BLS or ALS", just the crew's assessment and treatments. When I worked in NYC , there were both BLS and ALS units. If the BLS assesses the pt and determines that their limited diagnostic capabilities are inadequate for the pt, then they will call for ALS. As medics, our PCR's had a section for treatment codes. The first code, every time, is "ALS Assessment", regardless of the pt's condition. "BLSing or ALSing" a pt is more to say if the pt required any interventions that BLS would not be able to provide. This is after proper diagnostics, such as pulse ox, ECG, 12 lead, BGL, and a paramedic level physical assessment/interview, of course.
If the paramedic level was entry level, BLS and ALS categories would be unnecessary.
Bottom line, when we, the double medic unit in the city would advise the pt is BLS, that means that the we decided that the pt didn't require any further Tx under ALS protocols other than those diagnostics already provided. In the city, when giving a note to the hosp, we would say "ALS in progress" rather than "ALS established" if interventions were in progress. As far as what interventions were established were left intentionally vague, as the medics need to work, not answer a plethora of questions during transit. The advised R/O along with the pt's mental status, vitals and general condition would suggest the actual "ALS" established or in progress. That's how it works in NY. Also, the stubbed toe wouldn't require a 12 and a BGL, and the diff breather with significant Hx needs more than air and chair.
I don't understand why some ED's need to know every detail during transit (when we need to work and also watch the pt), when they've already been advised of the pt condition, suspected Dx, diagnostics, interventions, and applicable reassessments. That's what the pt transfer portion of the call is for.
