senior medics your advise is needed

[sjdr1976]

If your boss puts you "Paramedic" on an Ambulance and tells you there is no time to check your truck ... and he makes you leave without drugs without monitor.. to a general BLS transport pick up... is that legal?

What if my "BLS" hospital to Nursing home Patient suddently turns into a "ALS" case? just the thought of that creeps me out... I dont want to be disrespectful to my supervisor but I worked hard for my Paramedic cert and I feel like I would do the wrong thing jumping on a BLS stocked unit as a Paramedic.

also are you required to have a 12 lead on a Als unit?

 

[Veneficus]

If your boss puts you "Paramedic" on an Ambulance and tells you there is no time to check your truck ... and he makes you leave without drugs without monitor.. to a general BLS transport pick up... is that legal?

Of course it is.

What if my "BLS" hospital to Nursing home Patient suddently turns into a "ALS" case?

Then you would call an ALS unit.

just the thought of that creeps me out... I dont want to be disrespectful to my supervisor but I worked hard for my Paramedic cert and I feel like I would do the wrong thing jumping on a BLS stocked unit as a Paramedic.

Find a better job.

also are you required to have a 12 lead on a Als unit?

No.

 

[Shishkabob]

If your boss puts you "Paramedic" on an Ambulance and tells you there is no time to check your truck ... and he makes you leave without drugs without monitor.. to a general BLS transport pick up... is that legal?

Yup

What if my "BLS" hospital to Nursing home Patient suddently turns into a "ALS" case?

Then you do what you can with what you have.

also are you required to have a 12 lead on a Als unit?

Your state EMS authority should have a list as to what is required on ambulances.... but I don't know of any state that requires 12-leads. There's still FDs coming out with news articles going "Look at us, we're advanced, we can do 12leads and send them to a cardiologist!".... a decade after others started to.

 

[46Young]

Simply go over the air (or on a taped line) to dispatch and advise that you're en-route, unchecked vehicle. This way you're not liable for any missing equipment for the first call.

 

[abckidsmom]

Simply go over the air (or on a taped line) to dispatch and advise that you're en-route, unchecked vehicle. This way you're not liable for any missing equipment for the first call.

I never understood why people thought this was a defense against anything. Especially in the fly-by-night ambulance companies I am used to, I would not think that tape would be there if any trouble arose.

I guess I would do the call, call 911 if something happened, and be looking for a new job.

 

[Medic Tim]

Not sure what it is like in all states but where I have worked (USA and Canada) there are minimum standards and equipment for bls and als units. If you are a licensed als agency you need to have a Medic on the truck with said minimum equipment. Monitor with defib and 12 lead was considered a minimum standard.


Truck checkes were required at every shift change (not sure if this was state or company policy)

While it technically may not be illegal to not have these things it is at the very least a violation of state standards and policy that can result in major fines or the service losing their ability operate/transport. From the Sounds of it your state seems like it is different . You may want to check with them.

 

[DrParasite]

If your boss puts you "Paramedic" on an Ambulance and tells you there is no time to check your truck ... and he makes you leave without drugs without monitor.. to a general BLS transport pick up... is that legal?

yes. you are working on a BLS ambulance, with BLS equipment. nothing wrong with that, nor is your cert in danger.

What if my "BLS" hospital to Nursing home Patient suddently turns into a "ALS" case? just the thought of that creeps me out... I dont want to be disrespectful to my supervisor but I worked hard for my Paramedic cert and I feel like I would do the wrong thing jumping on a BLS stocked unit as a Paramedic.

nothing wrong with it at all. if the patient crashes, than you call for an ALS unit. As a paramedic, you can work on a BLS truck, as a BLS provider. You are just a highly educated person operating with BLS equipment.

We do it quite often, esp when we have a paramedic who no ALS partner, and a BLS provider with no partner. put them both together, and you have a BLS crew (NJ requires 2 medics on every ALS ambulance).

also are you required to have a 12 lead on a Als unit?

varies by state, but generally nope.

 

[MMiz]

There were times as a BLS crew that I was paged for a priority call while I was checking out the truck. Sometimes you have to hop in and go. For a general BLS pick up you shouldn't need much more than a working truck and oxygen.

If a BLS turns into an ALS call then I'd call 911, even as an ALS provider. It happens.

As DrParasite already posted, this is actually quite common in a larger service where a medic calls in sick. I never heard my ALS partners complain much.

I was once on a BLS rig with a medic and was called to an unknown. We arrive, the guy is having a suspected AMI, and we call for an ALS intercept. ALS arrived, hopped in the back, and we were suddenly an ALS unit. By the time ALS arrived we had vitals, history, had him on O2, he was in the back of the rig, and we were ready to go.

Good luck!

 

[Handsome Robb]

We have medics working as EMT-Intermediates. It's pretty common actually. Either to get experience or while they wait for a medic spot to open up. Lots of purely BLS IFT companies in California, for example, have paramedics working as an EMTs. There's nothing illegal about that.

If I'm working with an EMT-I who carries a paramedic cert, they still can't do ALS interventions or attend ALS patients. They're employed as an EMT-I and haven't been cleared by clinical development to operate as a paramedic and haven't been able to promote to a medic position.

If they're calling you an ALS ambulance but you're not carrying a monitor or appropriate medications, that'd be illegal.

12-leads generally aren't a piece of equipment required by law. One of the FDs just across the state line from me just recently got 12-lead capable monitors.

Are you employed as a paramedic or an EMT? Doesn't matter what your card says, if you were hired as an EMT and carry a medic card it doesn't authorize you to operate at the ALS level.

As far as not being able to check your truck completely, that sucks, but at the same time at the BLS level there isn't a whole lot you're going to need. As long as you have an AED, O2, Masks/NCs, a gurney, sheets and some bandages you can work with that. After the run finish your truck check. If the truck you're on was completely decimated by the crew before you that's a different story but in my experience that's usually pretty obvious.

Not to be an *** but why do you feel you'd be "doing the wrong thing" working on a BLS truck as a paramedic? You don't have all the toys but can still pass on a better report than, most EMTs can to help get the care they require at the hospital faster... I understand where you're coming from about having worked hard for your cert though.

 

[Tigger]

Is it poor practice? I suppose. You would hope that your employer would you utilize you for what you were hired to do, but that's on them.

It is certainly not illegal.

Not all states require 12 lead capable monitors.

12 lead capable monitors have been required on all paramedic ambulances in Massachusetts since 2005.

 

[46Young]

I never understood why people thought this was a defense against anything. Especially in the fly-by-night ambulance companies I am used to, I would not think that tape would be there if any trouble arose.

I guess I would do the call, call 911 if something happened, and be looking for a new job.

Could the employee "FOIA" the tape, or does that only apply to 911 departments?

 

[46Young]

If your boss puts you "Paramedic" on an Ambulance and tells you there is no time to check your truck ... and he makes you leave without drugs without monitor.. to a general BLS transport pick up... is that legal?

What if my "BLS" hospital to Nursing home Patient suddently turns into a "ALS" case? just the thought of that creeps me out... I dont want to be disrespectful to my supervisor but I worked hard for my Paramedic cert and I feel like I would do the wrong thing jumping on a BLS stocked unit as a Paramedic.

also are you required to have a 12 lead on a Als unit?

I've worked on a BLS-only ambulance as a certified and authorized paramedic for my former hospital based 911 job, and also on OT where I work now. Your company should have a sheet that lists all of the required items for a BLS unit to be in-service, and an ALS unit to be in-service. If not, your state OEMS should have these checklists. If you're deficient for any listed ALS item, you're BLS only. If you're deficient in BLS items, you're OOS.

 

[Handsome Robb]

Is it poor practice? I suppose. You would hope that your employer would you utilize you for what you were hired to do, but that's on them.

It is certainly not illegal.

Not all states require 12 lead capable monitors.

12 lead capable monitors have been required on all paramedic ambulances in Massachusetts since 2005.

I still don't understand how it's even poor practice?

They're filling a hole in the schedule to transport a patient, either scheduled or unscheduled. Whether it's medically necessary is an entirely different debate, but I don't understand how it could be argued that it's poor practice. Would it be better to leave that patient where they're at if they truly do need an ER or would it be better to utilize the resources available to get them transported? Personally I would think the latter would be better practice, but that's just my opinion and those are like :censored::censored::censored::censored::censored::censored::censored:s, everyone has one and they all stink

Sure, the medic isn't being allowed to act or treat the patient to their full potential, but how is putting a provider with more education on a call that is BLS poor practice? If the call turns ALS and you have to call 911 or for an ALS intercept from your company how is it any different than how it would have gone down had that been the regularly scheduled EMT on the truck rather than the medic that got placed on a BLS truck?

 

[sjdr1976]

We have medics working as EMT-Intermediates. It's pretty common actually. Either to get experience or while they wait for a medic spot to open up. Lots of purely BLS IFT companies in California, for example, have paramedics working as an EMTs. There's nothing illegal about that.

If I'm working with an EMT-I who carries a paramedic cert, they still can't do ALS interventions or attend ALS patients. They're employed as an EMT-I and haven't been cleared by clinical development to operate as a paramedic and haven't been able to promote to a medic position.

If they're calling you an ALS ambulance but you're not carrying a monitor or appropriate medications, that'd be illegal.

12-leads generally aren't a piece of equipment required by law. One of the FDs just across the state line from me just recently got 12-lead capable monitors.

Are you employed as a paramedic or an EMT? Doesn't matter what your card says, if you were hired as an EMT and carry a medic card it doesn't authorize you to operate at the ALS level.

As far as not being able to check your truck completely, that sucks, but at the same time at the BLS level there isn't a whole lot you're going to need. As long as you have an AED, O2, Masks/NCs, a gurney, sheets and some bandages you can work with that. After the run finish your truck check. If the truck you're on was completely decimated by the crew before you that's a different story but in my experience that's usually pretty obvious.

Not to be an *** but why do you feel you'd be "doing the wrong thing" working on a BLS truck as a paramedic? You don't have all the toys but can still pass on a better report than, most EMTs can to help get the care they require at the hospital faster... I understand where you're coming from about having worked hard for your cert though.

Hi I was hired as a Paramedic but every now and then it happends that they say jump on xyz truck and pick up this patient... dont worrie bout drugs, vent, monitor.. I am new to this i have been a paramedic for about 2 month now

 

[sjdr1976]

Thank you for your reply...
like i said I am new to this... and new to the company.. and it was something that worried me.. ( I was an EMT in indiana went to medic school in missouri and had my first medic job in GA) I dont really have a mentor here in GA that why i put this question out there... Thank you all for your replies

 

[ExpatMedic0]

I have been forced to go on a call before the rig is checked also. Even for BLS Its not good practice and if your suctions not working, or the AED is missing patches, ect ect that silly little BLS call could go south, before you know it your sitting before a judge and jury.

I have done it when I was younger, but I would really put my foot down now. If the boss is going to be like that I suppose the way to avoid conflict would be to show up a little early and check your rig off the clock if your willing.(note this may not work if its a roving system status management) Or could simply put your foot down and say your not leaving until you check the rig.

I have arrived with a broken portable suction because of a sloppy rig check before and it became a very serious matter.

 

[epipusher]

Ride in back while enroute to the call and check it out then.

 

[Veneficus]

I would say it is poor practice not from the medical standpoint but from the dispatching standpoint.

If you send out an unchecked truck, you might get away with a call or two before you may need to take them out of service.

I have been sent on a cardiac arrest with a unready truck and I can tell you, it sucks.

The crew just got back from the pre-shift change arrest, and despite informing dispatch the truck should be considered out of service we were sent "as the closest unit" anyway.

At the time, no laryngoscope, no suction, less than a full set of cardiac arrest meds, it was a stressful day.

A decade later, we now know all we needed was to do CPR and defib as needed. If that didn't work, nothing we had would have.

 

[Hunter]

I still don't understand how it's even poor practice?

They're filling a hole in the schedule to transport a patient, either scheduled or unscheduled. Whether it's medically necessary is an entirely different debate, but I don't understand how it could be argued that it's poor practice. Would it be better to leave that patient where they're at if they truly do need an ER or would it be better to utilize the resources available to get them transported? Personally I would think the latter would be better practice, but that's just my opinion and those are like :censored::censored::censored::censored::censored::censored::censored:s, everyone has one and they all stink

Sure, the medic isn't being allowed to act or treat the patient to their full potential, but how is putting a provider with more education on a call that is BLS poor practice? If the call turns ALS and you have to call 911 or for an ALS intercept from your company how is it any different than how it would have gone down had that been the regularly scheduled EMT on the truck rather than the medic that got placed on a BLS truck?

It's poor practice because I've heard of a BLS crew being sent to a call without having checked out their truck, the patient almost coded during the transport which was almost an hour long. The crew was low on O2, didn't have aed pads, and was missing a bvm. The patient thankfully did not code until 5 minutes after they got them to the hospital.

 

[RocketMedic]

I would say it is poor practice not from the medical standpoint but from the dispatching standpoint.

If you send out an unchecked truck, you might get away with a call or two before you may need to take them out of service.

I have been sent on a cardiac arrest with a unready truck and I can tell you, it sucks.

The crew just got back from the pre-shift change arrest, and despite informing dispatch the truck should be considered out of service we were sent "as the closest unit" anyway.

At the time, no laryngoscope, no suction, less than a full set of cardiac arrest meds, it was a stressful day.

A decade later, we now know all we needed was to do CPR and defib as needed. If that didn't work, nothing we had would have.

That being said, it left you in quite the legal predicament. Had that patient's family decided to sue, a defense of "well, we weren't ready" probably won't fly, especially with expert witnesses preaching the thoughts of the times that your 6th round of epi or atropine or an ET tube would have definately saved Grandma's life and allowed her to spend another thirty years knitting and rocking grandkids to sleep. Your agency would have been panned in court, and you would probably have been unemployed soon after.