There are NO BLS patients.

MedicPrincess

MedicPrincess

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We were having a discussion with our Shift Commander a couple shift back about giving pain meds to an ankle fx. The patient stated he didn't want any, so the medic on that truck BLS'd the call. Basically, if the patient would have wanted the Morphine, the call would have been ALS, complete with IV, Monitor, and O2. Patient said no, so it was BLS. Patient got a pillow splint and O2. Essentially the EMT on that truck had come to my partner to complain about her Medic making that BLS. My partner agreed. No pain meds, and a non-complicated fx is BLS. She puts me with them all the time.

Now we were talking to our Shift Commander about it. He made the statment to the effect of "If it is possible that we can do more for our patients, then the person who is capable of providing that level of care should be attending to the patient, so that more can be given." He says there are no could go either way patients.....cut and dry...BLS or ALS.

That being said, in my opinion, all patients who have called 711 are technically ALS patients then. Even the guy we pick up at the bus stop who wants to go to the ER for eval of that mosquito bite. I have been thinking about that. On your "BLS" 911 calls, could you possibly do more for that patient? They called for an ambulance, why shouldn't they get the highest level of care available on that truck? And doesn't that relagate the EMT back to "Ambulance Driver" status?

I disagree with the cut and dry theory. If a patient has refused pain meds, I am perfectly capable of sitting in the back and riding in with the patient. I can monitor vitals. I can assess and reassess. And if the patient decides he just can't take the pain of my partner driving (heck, I have asked for Morphine after one of her finest drives), I am capable of sticking my head up front and telling her to pull over, he needs pain relief.

What do you think, are all or should all 911 patients receive ALS care all the way to the hospital? All of ours get an assessment by the ALS person on scene, but IMO not everyone needs ALS level of care, even if we can technically "do more."
 
Ok, my agency is in a rural area thats pretty much county ran ambulance service. We have BLS units around the county that are a volunteer service with three full time ALS rigs that are sationed in the middle of the county at a hospital that is located in our county seat. When we are dispatched out based on the severity of the call the dispatcher actually makes the call on whether ALS or BLS shows up. However, whatever the call may be if my BLS service is inservice then we are dispatched out regardless of the what the call is, but if its an ALS call then they will run dual response so they dispact both BLS and ALS and we usually arrive on scene much quicker than they do so we do a primary assessment and get the needed information so when ALS arrives on scene we give them the information and turn over care. Only, if the call is severe or IV's are needed something that needs extended care we dont page out the ALS we run only BLS because we are trained enough to handled the situation without tying up the ALS service. That is our service though and we are rural so i am sure things are completely different in your area, but thats what i can tell you from our stand point.B)
 
My service is owned by a large EMS provider that at one time was 100% ALS. For a short period my service attempted to transition to an all ALS service, but failed.

Around here you either go in a wheelchair van, BLS ambulance, or ALS. There are far too many dialysis patients and old ladies that need a ride home to make an all ALS service work. Our ALS units were hating having to work the BLS calls, and our BLS patients weren't liking the ALS bills.

We provide ALS service to the communities we have 911 contracts with, and that's that. BLS may end up transporting a psych or maybe a trauma during a large MCI, but the company believes that all patients should receive ALS care.

Since the great ALS craze of 2005, we've more than doubled our BLS units on the road. BLS units almost always do the interfacility transfers, dialysis runs, and psych patients.

I think you may be comparing apples to oranges though. The bread and butter of my service is the BLS runs, where it seems as though others focus more on emergency runs and rescue.

As I ramble on... and on... and on... I believe that a tiered EMS system, with both BLS and ALS capabilities, is the best system. Unfortunately not all places have the ability to provide adequate BLS and ALS coverage at all times.
 
I agree it is either ALS or BLS. The person making that decision better do a darn good assessment.

There are people have called 911 for BS. Those people don't need a medic in the back. You all know the ones I am talking about..... toe pain , arse hurts etc.

I would make an assessment.....if they appeared stable where no ALS was needed (or I wasn't going to start any) I would ASK my partner if they wanted to take it.

If at anytime my partner stated they didn't want to or didn't feel comfortable, I still took the call.

Think about it though....a guy with an ankle fx that didn't want any pain meds or IV etc.... could have just as easily refused and said "Thanks for putting the pillow splint on, I would like to let my wife, mom, brother etc. take me to th EER to not tie you guys up"

I would say "Sir, I would prefer we take you, but sign here if you are sure."
 
I agree there are BLS s a waste of and ALS, and having to have ALS to transport such time, money and resources. Compare this with the emergency department triaging those that can go into "fast track or clinic side" to those that needs to go into the ER side. That is part of the problem with U.S. health care, thinking that all patients needs monitors, pulse ox, etc.. when a mosquito bite, rash (non- allergic reaction) etc.. way over use of equipment and inappropriate assessment and actually treatment. Does you when physician always apply ALS equipment to you when you see him at his office?

There are several studies revealing we are still trying to treat patients as we did in the 70's and 80's..Studies have revealed that we are no longer seeing the old "typical" emergency patient, like we used to. Most EMS, ER patients would have been and should be considered minor, or clinic type injuries and should be treated as such.. overkill treatments and use of assessment tools, just increase costs and debt, that will never be paid. As others have mentioned, a good thorough history and physical should be performed, then and only then determination of ALS and its personal should be utilized.

R/r 911
 
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My fire department runs the BLS ambulance for our town. We have a regional ALS intercept system in place. We run 3 BLS EMTs in our rigs and the intercepting ALS truck usually comes with 2 Medics. When we arrive on scene, collect the info on whatever the call is, I (or the crew) has to determine whether they want ALS to continue in to assess. Anything heart, SOB, etc. they always do. Once on scene, ALS does their assesment and determine whether they believe they should ride with us. We are really lucky to have 2 great services that we work with a lot and we have a very good working relationship with both. Like I said, anything heart, breathing, or obviously ALS needed they will ride. If its questionable, they will ask us if we want them to ride or not. They would never refuse to come with us if we said we felt like we needed them. However, a situation like this, I would feel very comfortable going BLS and clearing them. With 2 Basics in the back, they can handle an ankle. We have to keep ALS available for a call actually requiring their services. What if we had them xport with us and once they are commited there is an MI on the other side of town. I would feel horrible.
 
I would say I cancel ALS when i get to scene about 95 percent of the time. Most of the call descriptions end up being wrong, and the "unconscious pt" ends up being a walkie-talkie with a headache wehn we arrive. I also cancel them just based on ETA most of the time in PT who might be ALS pt's. Being in the inner city, we are never more than three or four minutes to the hospital, and I can have a pt in the ED in 12 minutes from dispatch time to when Im walking in the doors with them. The only times I am really not leaving scene before ALS arrives is for the cardiac arrest because I have to work on ABC's first before going anyway.
RH
 
RH3075 said:
I would say I cancel ALS when i get to scene about 95 percent of the time. Most of the call descriptions end up being wrong, and the "unconscious pt" ends up being a walkie-talkie with a headache wehn we arrive. I also cancel them just based on ETA most of the time in PT who might be ALS pt's.
RH
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I'm rural EMS and my favorite scenario was having to call for ALS to evaluate 74yo female, ground level fall, "fallen and can't get up". Arrive to find pt. screaming on any movement, HBD and on the floor in a locked mobile home. While the volunteer ff tried to determine if he could fit through the dog door, I got a halligan tool from the back of his rig and made an entrance.

Now.. rural EMS generally means we know most of our pt's and this gal is not a whiner. She is letting out involuntary screams of pain with any movement and is a tough old retired military broad who worked in law enforcement until retirement.

I call ALS for evaluation because mainly, the voices in my head told me to, but also because she was hypothermic, down for about an hour before she called us, laying on an unheated water bed. Yes she was drunk.. that's why she fell!

I got all kinds of abuse for calling for an ALS eval on this one. The medics who responded were fine, but captain back at the hall gave them and me a ration about 'abuse of the system' 'disturbing his sleep' and being a nervous nelly emt-b afraid to be alone with the pt.

Turns out the gal had undiagnosed ("don't need no damn doctor's to tell me I'm old") osteoporosis and her ground level fall fractured 2 lumbar vertabrae and shattered her sacrum. Damn that diagnosis was sweet! The hardest part was being grown up and not doing the 'I was right neener neener' Dance
 
Our agency has had some of the same issues. Often times BLS will tech if the pt refuses pain meds. EMT-B's can start IVs with a cert here, so we don't have to worry about not doing an IV. However, we still can't do ECGs.

After thinking about some of the calls that I have teched (I am a basic) I felt the call probably should have been run by ALS. I don't know if a couple of our medics just don't like running calls (or maybe it's writing reports), but they seem to push calls to BLS before really assessing the pt's needs fully. Our agency has been working on updating protocols in order to distinguish whether a call should be run by ALS or BLS.

I don't think ALS should always have to run the calls, they would tire out too quickly. I feel that if you really have to question who should run the call, the ALS person should take it. And as BLS, if I don't feel comfortable running the call for any reason, I tell my ALS partner and they take the call.
 
Als/bls

Where I work, all units are ALS units, but depending on the volunteers who respond, there may or may not be an ALS crew. If there's an ALS crew for a BLS pt, the ALS provider usually drives so that the BLS provider can be AIC.
 
Around here no, BLS and ALS are 2 separate entities. There are no transport ALS rigs. BLS responds to the scene, if ALS is needed we request it and the truck usually comes from a nearby hospital. ALS is also usually simultaneously dispatched for more urgent calls, (Ex: Cardiac, Respiratory calls.) Instead of being dispatched for common calls (Ex: Slip and falls, cut finger.) If we don't need ALS and it is something that can be handled entirely on a BLS factor BLS will cancel the ALS truck and BLS will transport to the hospital. But if we feel ALS is needed, ALS will come and evaluate, and if it is serious enough, they will ride with us to the hospital and the other medic will drive their truck following the Ambulance. Or in some cases, both medics will be in the ambulance and one of the EMT's will follow in the ALS truck.
 
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EMTBandit said:
Around here no, BLS and ALS are 2 separate entities. There are no transport ALS rigs. BLS responds to the scene, if ALS is needed we request it and the truck usually comes from a nearby hospital. ALS is also usually simultaneously dispatched for more urgent calls, (Ex: Cardiac, Respiratory calls.) Instead of being dispatched for common calls (Ex: Slip and falls, cut finger.) If we don't need ALS and it is something that can be handled entirely on a BLS factor BLS will cancel the ALS truck and BLS will transport to the hospital. But if we feel ALS is needed, ALS will come and evaluate, and if it is serious enough, they will ride with us to the hospital and the other medic will drive their truck following the Ambulance. Or in some cases, both medics will be in the ambulance and one of the EMT's will follow in the ALS truck.
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Where are you...Jersey? :)
 
FF/EMT Sam said:
Where I work, all units are ALS units, but depending on the volunteers who respond, there may or may not be an ALS crew. If there's an ALS crew for a BLS pt, the ALS provider usually drives so that the BLS provider can be AIC.
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How does this work? Here in Florida if the ambulance is "stickered" ALS by the state it must be able to perform as an ALS unit. If there is not a paramedic on our ambulance then that unit is not in service.

Now our BLS units can used for ALS calls, so long as the medic rides the call in. There is not a single piece of "ALS" equipment (Meds, IV supplies, needles, intubation gear, etc.). The EMT's that work the BLS units take manuel BP's, no need for a Lifepack. They carry the same AED as the BLS FD's carry. If the BLS truck is sent on a 911 call, there must be a paramedic responding with them. Either an ALS FD or the shift commander.
 
I don't believe in any cut and dry BLS or ALS, however, it is largely determined by WHERE you run, HOW you run, your PROTOCOLS and whoever is in charge.

Where I run BLS or ALS is determined by patient status, mental, medical, etc, who is on the call and which squad it is. Pt. status is determined by the first person to contact them. Given the same situation as yours where your patient had a possible fracture and did NOT want any drugs, we would have BLSed it too. IF it was our first out squad. We only have TWO squads so if the first one got BLSed our P would have gone back to the station and awaited a second out call as long as there were two other B's aboard. Which happens sometimes. On the other hand if it was one P and one B the P would have decided whether or not they wanted to drive or do pt. care.

This could go on and on and on. I'm just saying in our jurisdiction it would have gone the same as yours went. BLS. And no one would have said a thing.
 
EMTPrincess said:
How does this work? Here in Florida if the ambulance is "stickered" ALS by the state it must be able to perform as an ALS unit. If there is not a paramedic on our ambulance then that unit is not in service.

Now our BLS units can used for ALS calls, so long as the medic rides the call in. There is not a single piece of "ALS" equipment (Meds, IV supplies, needles, intubation gear, etc.). The EMT's that work the BLS units take manuel BP's, no need for a Lifepack. They carry the same AED as the BLS FD's carry. If the BLS truck is sent on a 911 call, there must be a paramedic responding with them. Either an ALS FD or the shift commander.
Click to expand...

In Virginia, the ambulances can be certified as either ALS or BLS transport units. Both of our ambulances are ALS units with a full set of ALS equipment (intubation kit, drug box, IV box, etc.) If a BLS volunteer crew shows up, we can respond as a BLS unit. If an ALS volunteer crew shows up, we respond as a Medic unit. We have paid ALS crews M-F 6AM-6PM, and are all volunteer from 6PM-6AM M-F and all day on the weekends. However, the county does pay for one ALS provider to assist the three rescue squads in the county during "off hours" ie. when the stations don't have a paid ALS crew on duty.
 
Most of the rural areas here have BLS units as part of their volunteer fire departments. The first choice for ALS support is a private ambulance company in town. They only have one ALS rig so if they are doing another call or a transport, we just hope one of the 3 paramedics who also volunteer are available for a mutual aid. Otherwise its 'scoop and run' otherwise known as 'go like hell'
This has caused some rather interesting billing issues. Medicare won't allow the ALS agency to bill a patient that they did not transport. But, at O'dark thirty, in the pouring rain, do you transfer an MI from one stretcher to another on the side of the road so the private company can bill them? We would have the paramedic jump into our rig but then our department would get the bill for the paramedic service from the private company and we didn't bill for our services.
 
My area is mostly BLS. There's (deliberately) very few medics; Seattle, with over 500000 people, normally has 7 medic cars, and that's dense coverage.

Most EMS calls get a BLS fire company, and often a private ambulance as well, to transport. Medics go to possibly severe things where they can be useful, like chest pain or difficulty breathing or shootings. They can be cancelled by the first-on BLS unit. Lots of times, someone will get a medic eval, and they'll send the person in to an ER by BLS ambulance, sometimes after doing minor ALS level interventions (Breathing treatments and IV glucose are the most common of these).

I really don't think asking for medics to transport someone just because they're in pain would go over very well.
 
BLS with ALS

Where i run PA (mont, Berks, and northhampton counties) we have ALS and BLS squads. Depending on which county i am running in ALS is almost always dispatched with BLS. However if the call is the ALS territory they run by themselves. But if it's in our area they are dispatched as a medic responder to assisst the BLS crew. I run with both an ALS and BLS crew. I havent reall yhad any calls where there was no medic dispatched. actually i find it kinda, well, like they think EMT's don't know their job because i think we could have handled alot of the calls as BLS, i mean a cardiac or something liek that i would understand a medic but not the normal run of the mill calls. :)
 
AMR is the service provider here in Santa Barbara Co. it is all ALS rigs with a EMT and paramedic. We just started having a CCT rig with a CCTRN and 2 EMTs to try to do all of the critical care transports from hospital to hospital. This helps to keep the 911 rigs from getting so tied up. Some times if an EMT calls off they will staff a medic with the nurse and the EMT. But as we all know that always does not work out perfect but it does help alot!
 
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