Philadelphia EMS

[rockyfortune]

I should say the city wants to replace all Rescue Squads that have two paramedics with one medic and one emt to spread out their available resources...understandably the union is against this while the city says its not really necessary to send out two medics on 65% of the calls...thoughts?

 

[Chewy20]

P/B trucks are becoming the norm. A lot of major systems are already doing this, or adopting it. There is benefits and cons, but the cons are not that substantial in my opinion.

 

[LACoGurneyjockey]

I work in a system that exclusively staffs P/B, and I've worked in a system with all ALS squads. If you don't have endless money and resources, P/B is the best way to go. Of course everyone wants all paramedics all the time, but in most areas it's not financially feasible, as Philadelphia seems to be finding. And the idea that you need 2 medics on "critical" calls is certainly a nice luxury, but far from necessary. I've run plenty of arrests, 6 patient MVAs, whatever with 1 Paramedic, 1 EMT, and a few competent FF's without issue. It's all dependent on having solid paramedics who can delegate to the BLS manpower on scene.

 

[Mjolnir]

Our system recently making the change, after realizing that almost every call can be handled by a P/B combo...naturally, the medics got ticked off, but the company runs on money, not joy. I personally don't mind it, I think the combo is often better...

 

[AtlasFlyer]

My agency (large urban 911) does P/B combo. It works just fine. For situations like a cardiac arrest the immediate supervisor usually will also be on scene, those immediate supervisors are ALL paramedics. Also FD is almost always onscene for manpower or can be quickly called, they often have a medic on their crew too and are all EMT qualified.

Dual medic is "nice", but really not necessary.

 

[broken stretcher]

The combo has its ups and its downs..


Ups-
-Basics learn ALS assist skills and can pick up other knowledge not normally gained on a BLS only truck, that will give them a leg up in medic school should they choose that route.
-Calls can be handled A/BLS and that call can be made on scene not in dispatch.
-An ALS hookup means turning to the guy/girl sitting next to you
-Stronger medics, can't always turn to your other medic if you're jammed up.

Downs-
-Some days get slammed ALS and the basic ends up driving all day
-Some basics are weaker and can always pawn the call on the medic if they're not comfortable
-Some medics have that complex and are better than their basic instead of being partners


I work with dual trucks only and I personally love it. Its the way to go

 

[Mjolnir]

Basics learn ALS assist skills and can pick up other knowledge not normally gained on a BLS only truck, that will give them a leg up in medic school should they choose that route.

I would like to make a small, but (I think) important point: when I was doing my ride-along, the BLS driver had been riding with ALS so long, he actually started believing he was better than other BLS...so much so, he started forgetting to handle his BLS responsibilities and rather focused on "assisting" with IVs and ECG.

Point being, sometimes blending ALS with BLS is not the best thing when it comes to a knowledge transfer.

Disclaimer: I'm not at all against the idea, if anything, I'm a proponent. I'm just clarifying that not everyone can use the extra knowledge properly.

 

[broken stretcher]

I would like to make a small, but (I think) important point: when I was doing my ride-along, the BLS driver had been riding with ALS so long, he actually started believing he was better than other BLS...so much so, he started forgetting to handle his BLS responsibilities and rather focused on "assisting" with IVs and ECG.

Point being, sometimes blending ALS with BLS is not the best thing when it comes to a knowledge transfer.

Disclaimer: I'm not at all against the idea, if anything, I'm a proponent. I'm just clarifying that not everyone can use the extra knowledge properly.

Oh yes we have 2-3 of those in our agency. Thats no secret either.

We also have medics who trust and medics who don't trust bls. some medics will let bls, bls until its time to start als... some medics just want you to set up the lock set, apply the leads, and drive.

 

[medicsb]

There is little triage of calls and dispatches are frequently sent according to proximity or order of availability, not need. So, plenty of ALS jobs are sent to BLS medic units while the ALS trucks are sent to BLS jobs.

I don't usually argue for "all-ALS", but considering how much it would cost to implement MPDS and train dispatchers, Philadelphia isn't about to do it. So, the approach proposed will be an improvement for patients.

I suspect that the real reason that the union doesn't like it is because it will result in the loss of FF/EMT jobs since at peak hours there are about 14 BLS trucks and the majority are in service 24/7. With the Fire Service EMT being implemented, the city will be sure to cut some FF/EMT jobs, which cost more than the proposed EMT positions.