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See the issue with all ALS ambulance in rural settings is if BLS Fire shows and determines ALS is needed odds are air medvac is needed and can deffiently provide expedited transport where an all ALS ambulance service might not provide the best level of patient care cause they will feel ground ambulance transport is warranted when air medvac is probably better for patient outcome. I have seen this first hand in rural settings. An all ALS ambulance company being short staffed cause they feel 1 hour plus time to a trauma center is acceptable. What happens if it's all ALS ambulance service and your short staffed cause your transport times are long and a MCI happens? Just makes sense to me that it's better to have a mix to avoid such situations as ambulance companies will always go after the high profits of long transports. Also I have seen the chopper beat ALS ambulances multiple times especially when the ambulance is coming from the other side of their AOR. It's better to have a BLS ambulance on scene instead of waiting for the magical ALS ambulance which is still 20 plus minutes out.
It sounds like a provider problem and not an ALS/BLS problem. If that services understaffed ALS, what makes you think they will appropriately staff BLS? It sounds like better response time standards are the answer for that problem. Where I work, we use industry standard response times. My agency had over 98% response time compliance to all zones this last quarter for example, so it is possible. I do not disagree that it is better to have a BLS ambulance on scene rather than no ambulance. It is always good to have the transporting unit on scene as soon as possible. They can rendezvous if it is necessary. If your provider shuns or doesn't support rural BLS ambulance first response then again, it is a provider problem. My service provides training and CEs to the few volunteer BLS services we have in my area for free, and driver training. We restock them for free whether it is a nasal canula, or quick combo AED pads. We refill their O2 for free. They are always welcome to come train with us on drills and they sometimes do. However....most of the county areas do not have the volunteers, funding, or the desire to be in the BLS ambulance business, so we are the only ambulance responding through no fault of our own. Considering our ALS units are 1:1 staffing, the cost of our 4 units, even if we went to all BLS, would still be great enough that we wouldn't have the funding to add even one more BLS unit 24/7. With so few ambulances, the conversion to BLS simply doesn't add resources with the cost savings. (Paramedics do not make that much more than basics here and ALS medications are not that expensive in the grand scheme of things.)
Also, in reply to a couple of other posters........
I also do not buy the argument that just because you are in a rural area you should not have the "big city" resources. If it is cost effective and needed, then there is nothing wrong with an ALS system. Yes the isolated mountain cabin with someone who is purposely trying to live off the grid miles from civilization will not get the service someone in a major urban center will, neither will the desert dweller who lives in the middle of nowhere miles down a dirt road and I can agree with that. Most of those people do not call EMS that often at all. If you try and avoid people by living in the middle of nowhere with no industry or agriculture then it makes sense nobody will stick resources there. However, most people in rural areas are not that type of people.
One thing to consider:
Many rural areas are vitally important and have hardworking people who provide a desperately needed resource that can not be produced in mass in the cities. It is a resource that the production of has many work related accidents. That resource is FOOD! Simply put, our country needs both city and rural areas. I work in California's Central Valley. This area produces 25% of the nations's food. We have numerous small farm towns here. Every one of them has access to ALS EMS. Until them fancy city folk can grow their own food in congested, overbuilt urban areas, us rural folk are needed. Why, because you are a farmer, rancher, field worker, rural truck driver for a packing house, etc. are you not deserving of the same care available in the cities? You work hard, pay taxes, and provide a needed resource. I also think a small percentage of my more urban counterparts almost picture us (rural ALS services) as redneck cowboys with P cards who are either doing needless interventions for the heck of it because we do not know better, or who freak out when we get an actual emergency because we are soooooo inexperienced. I can tell you that while every service has it's better and worse paramedics, most rural EMS workers are skilled and knowledgeable. I have worked urban EMS in the past and the level of care in my rural area at least is excellent.
For all the people who have hopes and dreams of HEMS being readily available and able to replace some ALS and CCT units, that is a perfect world scenario. My region has 2 ALS helos for over 12,000 square miles. Additionally, we have dense fog which grounds helos for days at a time. The fog also slows down response times and lengthens transport times. Why should someone not get ALS level care because of the weather? The fog is a daily occurrence in my area so it is not uncommon or unforeseen. In those cases ground transport is the only option, and if it is a critical patient being transported for an hour, then ALS is better. That is just my opinion of my rural area. There is no one size fits all in EMS. We are a country of 50 states with thousands of jurisdictions each with it's own unique problems and challenges.
