There are NO BLS patients.

[Airwaygoddess]

To put it simple and to the point, In the last 10 years, the patients that are seen in the field and in house are much sicker and do require more care. Part of the BIG problem is lack of funding for health care, insurance companies cutting back services for "what is covered". I know that it is frustrating to get a 911 call and it can turn out to be either BLS or bull. The bottom line is the patients are the ones that need care. The 911 provider is a good part of the time that patient's first contact with medical care. Is the system perfect? no not by a long shot, but what is most important someone can call 911 for help and help will come, whether it is first responders, BLS, or ALS. It is a team that faces some pretty hard adversaries and responds to some of life's toughest plays. From the little old lady that tripped and fell needing a medical assist to the 10 car accident, with 8 red tags, it is the patients that are relaying on "The Team". Be safe everyone!

 

[yowzer]

Here if you don't give morphine for a patient in obvious pain then you could count on an investigation by the med control doc, the service director, and the loving State EMS office's field investigation staff. This all would likely lead to losing your job, and maybe your cert.

Different areas, different rules. Pain control in the field is not a priority here. If it becomes one, it could probably be handled at BLS via laughing gas.

Secondly, I hope to never get sick in your area, as far as I know a basic cant transport an MI anywhere, at least not do it and meet the National Standard's, and I sure would be getting a lawyer to look into malpractice, negligence, and possibly criminal complaints...but this is just my personal thoughts on the matter.

While BLS skills in King County are about the same as anywhere else, the impression I've gotten from the medics is that they don't want to lower their standards to a mere national level. (To work as a medic here, you have to go through the University of Washington's program, which goes way beyond the NR curriculum. Rumor is that they flunk their probationary period if they don't turf enough patients to BLS transport, as part of their 'We only transport SICK people' attitude.)

I'm not sure how they consider someone having an MI (Even if it was 3 days ago) a BLS patient, but it happens on a fairly regular basis. I've never had one of these dumps get significantly worse before we get to a hospital, where they can get a definitive diagnosis and treatment -- which is the important thing.

It does make a nice change from the usual hospital discharges and stubbed-toe calls.

 

[FFEMT1764]

Well like I said, I hope I never get sick in King County, WA. As for the laughing gas, I wish we had it, but its very hard to maintain here as we tend to have patients whom can't hold the demand valve due to their pain, and usually because they are already holding a puke deflector.

I am just glad that here pain management is a BIG deal, if I ever get hurt and need morphine, I sure want the medic treating me to give me some so I can bear the ride in the truck!

 

[Pablo the Pirate]

i find this discussion quite interesting and i must say even an eye opener. i couldn't help but reply. My first thing is WOW how spoiled we are in my neck of the woods. I know that basics in most part of the country are not allowed to do much but i guess I never figured they actually operated on such a minimal level. I am by no means belittling basics. I just recently got my medic status but i don't feel that it's such a big deal. Let me explain. I work on a volunteer part time ALS service, meaning if we have a medic then we go with one otherwise we're BLS. However, our basics on our service and many in this state are actually varianced upto Intermediate status...we just don't carry that title. As a basic we are varianced to start normal saline IVs, give ASA, nitro, glucagon, and albuterol nebs, we also carry the zoll hm and defib and most of are basics know at least a little about interpreting ekgs, and we combitube. with that said you see why it's such a "big whoop" that I'm now a medic. I still use my basic skills way more than I do ALS procedures. basics really do save medics. you can't get tunnel visioned with say intubating when your basic partner can tell you hey relax and here's a combitube you want me to do if for you? I think its great, I dont have to "worry" about everything. Also since our basics have all these skills we run primarly as BLS and you know that 90% of the time if the crew is made up entirely of basics and they call for a medic its needed. Our trucks aren't marked as ALS or BLS. I guess were just an ambulance. and a rural one to boot.

 

[FF/EMT Sam]

Here if you don't give morphine for a patient in obvious pain then you could count on an investigation by the med control doc, the service director, and the loving State EMS office's field investigation staff. This all would likely lead to losing your job, and maybe your cert.

Secondly, I hope to never get sick in your area, as far as I know a basic cant transport an MI anywhere, at least not do it and meet the National Standard's, and I sure would be getting a lawyer to look into malpractice, negligence, and possibly criminal complaints...but this is just my personal thoughts on the matter.

You can't always get ALS where I work. And I'd rather be transported BLS if I was having an MI than be transported after a long delay because ALS was unavailable.

 

[FF/EMT Sam]

Our basics on our service and many in this state are actually varianced upto Intermediate status...we just don't carry that title. As a basic we are varianced to start normal saline IVs, give ASA, nitro, glucagon, and albuterol nebs, we also carry the zoll hm and defib and most of are basics know at least a little about interpreting ekgs, and we combitube. QUOTE]


Holy cow. You. Are. Lucky.

 

[FFEMT1764]

I realize that in in VA there are areas that only have BLS available. When that is the case I have no problem with BLS starting the transport and meeting the ALS enroute. I just have a problem with ALS providers dumping ALS calls on BLS providers. Where I work we hire all levels of EMT, and we have medics who will push an ALS call off on their basic or intermediate partner (we only operate at the I85 level thanks to our lovely med control).

 

[RH3075]

Wow

Not even transport and MI and wait for ALS? that seems odd to me.I am in an urban setting with hospitals nearby, but i would never dream of not transporting someone suffering from and MI or other life threatening condition because ALS was not on scene. If they can make it and meet me in route great, if not, I am still going to the ER with them pronto. As for not meeting national standards, I do not think that national standards require we let a patient die or suffer serious heart tissue damage because we did not transport....just my thought pn the matter.

To put it simple and to the point, In the last 10 years, the patients that are seen in the field and in house are much sicker and do require more care. Part of the BIG problem is lack of funding for health care, insurance companies cutting back services for "what is covered". I know that it is frustrating to get a 911 call and it can turn out to be either BLS or bull. The bottom line is the patients are the ones that need care. The 911 provider is a good part of the time that patient's first contact with medical care. Is the system perfect? no not by a long shot, but what is most important someone can call 911 for help and help will come, whether it is first responders, BLS, or ALS. It is a team that faces some pretty hard adversaries and responds to some of life's toughest plays. From the little old lady that tripped and fell needing a medical assist to the 10 car accident, with 8 red tags, it is the patients that are relaying on "The Team". Be safe everyone!

 

[pbjjdm]

If you are a competent EMT-B you are trained to know when your patient is in more need than your training provides for. The problem comes in when skills are not adequate for the job and you either think you can handle every call by yourself or you are the one that can't handle any call without your hand being held. And while I am on the soapbox, the biggest problem with most Paramedics is that they forget that 90% of the time the basic skills will suffice but they always think that care starts with I.V. and Monitor. This is becoming an epidemic as more schools are letting people begin training for paramedic before they have even gotten any basic skills utilized. Love to watch them when they test on the practical side of the test and they fly through the advanced stations to fail on proper Fx care or they go through airway and they put the patient on 15 LPM via Nasal Cannula.

 

[ExpatMedic0]

Your guys system is so crazy up there! I went to medic school with a couple AMR EMT-B's in King County. They implied sometimes medic 1 ALS interventions where started such as IV or intubation and then the pt. was dumped on BLS for transport and ALS would just leave. I also herd they dumped gunshots and stabbing victims for BLS transport. Is any of this true? If so how do you avoid abandonment laws?

Different areas, different rules. Pain control in the field is not a priority here. If it becomes one, it could probably be handled at BLS via laughing gas.



While BLS skills in King County are about the same as anywhere else, the impression I've gotten from the medics is that they don't want to lower their standards to a mere national level. (To work as a medic here, you have to go through the University of Washington's program, which goes way beyond the NR curriculum. Rumor is that they flunk their probationary period if they don't turf enough patients to BLS transport, as part of their 'We only transport SICK people' attitude.)

I'm not sure how they consider someone having an MI (Even if it was 3 days ago) a BLS patient, but it happens on a fairly regular basis. I've never had one of these dumps get significantly worse before we get to a hospital, where they can get a definitive diagnosis and treatment -- which is the important thing.

It does make a nice change from the usual hospital discharges and stubbed-toe calls.

 

[MrBrown]

All this talk ot ALS vs BLS patients is foreign to us down here. If I called up and said "oh send somebody else who is less qualified to transport this crew, they do not need Intensive Care (ALS)" I would probably get fired.

The crew that gets dispatched to the patient, be they Technicians, Paramedics or Intensive Care Paramedics will transport the patient.

As the OP said; THERE ARE NO BLS PATIENTS :wacko:

 

[VentMedic]

If you are a competent EMT-B you are trained to know when your patient is in more need than your training provides for. The problem comes in when skills are not adequate for the job and you either think you can handle every call by yourself or you are the one that can't handle any call without your hand being held. And while I am on the soapbox, the biggest problem with most Paramedics is that they forget that 90% of the time the basic skills will suffice but they always think that care starts with I.V. and Monitor. This is becoming an epidemic as more schools are letting people begin training for paramedic before they have even gotten any basic skills utilized. Love to watch them when they test on the practical side of the test and they fly through the advanced stations to fail on proper Fx care or they go through airway and they put the patient on 15 LPM via Nasal Cannula.

I seriously doubt if this is the biggest problem with most Paramedics.

For someone to be this bad they should have been washed out of EMT school. (See Scary Class Mates thread). If someone can not master the few skills taught in a 110 hour EMT class they have no business on either an "ALS" or "BLS" truck. It also shouldn't take one any longer than it takes to complete even the short Paramedic programs here in the U.S. to master those skills. If you need more than a year or even 6 months to be able to do first aid and take a set of vitals, you seriously need another profession that is not in health care.

Thus, this may be an example of how bad the EMT schools are in your area and not a reflection on the amount of time one should spend as an EMT before starting Paramedic school.