Public Agency - Poor ALS Skills

[MMiz]

When I worked for a private service in Michigan, one of the selling points for our contracts was that our ALS units only performed ALS calls, meaning their ALS skills were constantly in use. This was marketed as a benefit over a traditional system, where a public agency would respond to all calls, both ALS and BLS, meaning they could go weeks or even months without using an ALS skill.

The argument always seemed flawed to me, but what do you think?

 

[fma08]

How many ALS calls are in that area? Over here, somewhere around 60% of our calls are BLS. There's also the whole saying of "BLS before ALS". You can't make every call an ALS call. If you someone is concerned about staying proficient in their ALS skills the service they work for should have some way of helping out. Ex. if someone is concerned about intubating, their service should see if they can do a clinical in an OR. Just because the service says they only do ALS calls, doesn't mean they will keep up on all of their ALS skills.

 

[KEVD18]

if the medics only respond to als calls, then presumably they are using their skills more and are therefore better at them. the hole in the theory is the amount of als calls. if there are only 5 als responses a month, then the fact that the medics only respond to als calls is irrelevant.

i think its a selling point to prospective paramedic employees, but not really relevant when say bidding a contract.

 

[Ridryder911]

It is a known national fact that ALS is utilized on about <20% of EMS calls and only needed on about <10% of the responses. The point though is that level is there to determine if it is needed or not, and if it is, it is rapidly available.

R/r 911

 

[mikeylikesit]

yeah but how often have we seen those BLS calls become ALS calls? how often are we required to respond to BLS ambulances to help out? not a bad idea, but not a good one for business purposes. ALS personal should not mind taking BLS calls.

 

[mdtaylor]

When I worked for a private service in Michigan, one of the selling points for our contracts was that our ALS units only performed ALS calls, meaning their ALS skills were constantly in use. This was marketed as a benefit over a traditional system, where a public agency would respond to all calls, both ALS and BLS, meaning they could go weeks or even months without using an ALS skill.

The argument always seemed flawed to me, but what do you think?

Of course it's flawed. In two ways....


Take an area. Put a BLS/ALS crew there. In the course of a month there are 25 BLS calls and 10 ALS calls. Therefore the crew gets experience in ALS to the tune of 10 and BLS to the tune of 25.

In that same area, put a BLS crew across the street from the ALS crew. In the course of the same month the BLS crew get to hone their skills in BLS 25 times. The ALS crew get the same 10 calls, and their BLS skills diminish.

Not only that. The cost of providing EMS services just increased massively. More equipment, more personnel, more quarters, more CE, more of everything.

 

[MikeRi24]

not really sure what you're referring to by "public agency" but around here, <10% of the fire companies do thier iwn transports. one of the 2 major ambulance companies does the, and all ambulances are either ALS or a BLS one can be dispatched with an ALS fly car. way it usually works is the call goes out, FD gets tapped out along with the ambulance, FD is usually on scene first doing preliminary car, and we are usually there shortly after (we have a 6 min response time and dont have a problem meeting it). when we get there we take over pt care and transport. works good for us.

 

[MMiz]

On the flipside, wouldn't having a dedicated BLS fleet for BLS calls (dialysis, stable patient hospital transfers of non-mobile patients, etc) be a good thing? I know some public county agencies here in North Carolina that run all of the aclls, even the BS BLS ones.

Back home, our selling point was that the BLS EMTs did the BLS calls, leaving the Paramedics to serve the city contracts. Every city wants ALS, but doesn't want to pay for it. Letting our BLS units do the city's BLS calls lets our ALS units stay on top of their skills by only answering emergency/ALS calls.

 

[KEVD18]

uh oh. i can actually hear R/r coming to reiterate that EVERY SINGLE CALL DESERVES AN ALS CREW.

about a year ago, i was sitting around the station having a little stitch and whine with my crew when i had an epiphany. now, i know this idea is going to come under fire from the folks that think there are too many rating in ems but hear me out.

a new rank. not of emt, but of what i would call the medical transportation technician. they would have a vehicle configured like an ambulance but without all the "emergency" stuff. no lights, no siren. a basic first aid kit. they would still have 02, a stretcher, stair chair and a few other things.

their purpose: the "boring" stuff. dialysis, radiation, dr office visits, day surgery, anything that the doc says is ok that would normally go by bls ambulance because theres nothing in between char van and ambulance. think about all the people that go in and out of facilities for this sort of thing by ambulance because of minor reasons. i cant walk down the stairs, im on oxygen, force of habit. they dont need an ambulance so much as they need somebody capable of doing some of what emts do.

the mtt's would be trained in:
loading, lifting, carrying
monitoring of oxygen systems
cpr/first aid

basically what im envisioning here is a souped up wheelchair van driver. teach him how to work a stretcher and a stairchair. give him truck and a partner and send them out. medicare is happy because the cost of sending patient x round trip to dialysis just went from 800 to 300. the bls guys are happy because they get to run actual medical calls and take the taxi sign off the roof. this is win win.

 

[MMiz]

The service I worked for only had one wheelchair van, so every so often the BLS crews would pick up the slack when calls were stacked up (at a rate of $39 per call).

It was during these calls that I realized that these patients were no different than the BLS transfers we did. 95% of our transfers could wheel around in a wheelchair, and very few actually required O2.

Come on, how many BLS patients have you taken home and stuck in a wheelchair? A lot. Do they really need an ambulance, let alone an ALS crew?

 

[Ridryder911]

uh oh. i can actually hear R/r coming to reiterate that EVERY SINGLE CALL DESERVES AN ALS CREW.

Your right! There is NO such thing as a BLS call! Either they need a thorough assessment or really do not need EMS. Such things as a minor abrasion, boo-boos; should be handled by the squad as a first responder... not an EMS call.

R/r 911

 

[Jon]

Kev,

I was looking online at a Great Britain ambulance service. They seem to have a similar position, for exactly that reason.

I like the idea... but don't think we'll see it here anytime soon.

Jon

 

[el Murpharino]

Kev,

I was looking online at a Great Britain ambulance service. They seem to have a similar position, for exactly that reason.

I like the idea... but don't think we'll see it here anytime soon.

Jon

It could...if you made really cool T-shirts with the words "Medical Transport Technician" emblazened in fire and cool slogans like "We take people where noone else dares"...

 

[fma08]

Your right! There is NO such thing as a BLS call! Either they need a thorough assessment or really do not need EMS. Such things as a minor abrasion, boo-boos; should be handled by the squad as a first responder... not an EMS call.

R/r 911

Have a band-aid, sign here... NEXT! B) If only... I'm just hoping for the day when EMS gets to the point where we can actually say no, you don't need to go by ambulance, instead of well it's your choice weather you want to come with us or not, (and not have all the legal liability).

 

[KEVD18]

well, there is an art to making it seem like ambulance transport isnt such a good idea without actually soliciting the refusal.

mentioning things like wait time at the er, cost of the ambulance and er bill etc can sometimes do it.

remember, we have to fully disclose the entirety of the situation. "sir, if you dont come with us, theres a very minute, almost indescribably low chance your stubbed toe could deteriorate into death. there is also a 100% chance this trip will cost you a minimum of 5 hours and at the very least your er visit copay. oh, and we dont do returns so a ride home is up to you."

 

[triemal04]

Have a band-aid, sign here... NEXT! B) If only... I'm just hoping for the day when EMS gets to the point where we can actually say no, you don't need to go by ambulance, instead of well it's your choice weather you want to come with us or not, (and not have all the legal liability).

Uh...that day has come in many places. It'll be nice when it becomes the norm, but we're still a long way off from that.

 

[Code 3]

I'm just hoping for the day when EMS gets to the point where we can actually say no, you don't need to go by ambulance

I've denied ambulance transportation twice in my career. The first, a woman flagged us down and told us her car was stolen and wanted a ride to work. The second, a man took the wrong bus and wanted a ride back home. -_-