Tiered response or all out response?

[mycrofft]

(Please see the thread prior to this, I don't want to bury Sasha's)

Reading about Australian EMS and their vehicles, I see they are using a flexible tiered response model (get EMS resource on scene as fast as possible, but not necessarily a big modular ambulance with everyone aboard); you can quickly add higher level EMS to a response already in progress by sending them to the scene in progress in their separate vehicle (including motorcycles!).
I'm curious as to which type you have, and if you are rural or not, to look for a correspondence.

 

[mycrofft]

Kicking it off

I live in a residential suburban area with tax paid fire EMS, and all responses get three paramedics plus a pumper unless you call AMR privately. (If you called 911 first, that might be a "reverse-tiered response"?).

I have lived and worked under tiered response where BLS went on all calls, ACLS was sent either by the nature of the dispatch or put on alert if BLS called in for support. That model is cheaper and can potentially cover two incidents at once while the "highest response" model can only cover one, but tiered response can delay highest prehospital care when a pt "gets the dwindles" all of the sudden or the dispatch had flawed information.

 

[Veneficus]

In both my residences response is full and the highest level.

In the US I would get a fire based squad with 2 EMTs and a fly car with a medic or the squad with 2 EMTs and a medic depending on staffing for the day. Considering the call volume and the acuity of the calls received I have to say this is the best that could be done with the resources and political climate available. (the better solution would be to regionalize all the small departments, but politically that is unfeasable)

In Europe I would get a hospital based squad with either 3 medics or a doc and 2 medics (depending on staffing that day) The bright side to the doc is that he retains prescriptive powers so when people call for "non emergencies" the issue is usually handled w/o transport. While this is a major city, culturally people will usually only call when things are very dire or if they have no other means to seek medical care. (aka homebound)

 

[emtbill]

I need to retract my vote to option three...where I work we have at least two ambulances to serve a first due area of about 17,300. Those trucks have at least one ACLS provider on board. For calls that come in as emergent (chest pain, dyspnea, etc) a fire truck is also dispatched which has at least one ACLS provider on it. In this way every call has ALS available and aditional help from the fire department is available if needed. Although the ambulances and fire trucks are sent from different agencies, we have a (fairly) good working relationship with each other, and the system works well.

 

[MMiz]

Working for a suburban EMS provider, an ALS ambulance and Paramedic "fast-car" were sent on all 911 calls. As a BLS provider I'd get to fill in as the quick response unit if if we were near the scene.

 

[Epi-do]

All of our ambulances are ALS, staffed medic/basic. Depending upon the information dispatch is able to gather, the ambulance may be dispatched by itself, or may be accompanied by a firetruck. CP, SOB, MVCs, cardiac/respiratory arrest, basically all the "big" runs get both apparatus. Things like a check out with the police, an assist a person, some injured/sick person runs (this goes back to info gathered by dispatch) will get just the ambulance. Either way, the patient always gets a medic on the initial dispatch.

 

[Sasha]

All of our ambulances are ALS, staffed medic/basic. Depending upon the information dispatch is able to gather, the ambulance may be dispatched by itself, or may be accompanied by a firetruck. CP, SOB, MVCs, cardiac/respiratory arrest, basically all the "big" runs get both apparatus. Things like a check out with the police, an assist a person, some injured/sick person runs (this goes back to info gathered by dispatch) will get just the ambulance. Either way, the patient always gets a medic on the initial dispatch.

That's pretty much how it goes here with the EMS based fire service. Any call that sounds like there is a slight possiblity it needs more than two people, you get at least one engine and one rescue and all the lights and sirens. The only time I've been at the FD and only the rescue responded was a call that came in as "abnormal labs" from a nursing home.

 

[MSDeltaFlt]

Ya'll live in some pretty good surroundings. You have all the help you need. I'm rural. No. Wait. I'm BFE. Trucks are medic/basic. On 911 calls, that's all you get. Even on MVC's, the only times you get fire/rescue are for car fire, and extrication. I might, repeat, might get a second unit to help lift a 500lb'er who just decided to stroke out from the back of the back bedroom from between the bed and chest of drawers, down the hall, down the stairs, through the kitchen, to the car-filled carport, in the summer time in the delta with all the bugs at 2300hrs.

Glad I fly fulltime. That was getting old.

 

[medic417]

We do not get fire response unless requested which we do not request except for wrecks. Fire is not needed on 99% of the calls, even not needed on most wrecks. But we now have ALS on every response.

 

[mycrofft]

Define "fly car"?

Do they go on every single owie and asthma call, can they be diverted from one dispatch to another, "code-4'ed" by the first-in unit, or witheld althogether? If they do not go on every single call, you have an example of a tiered response.

 

[jochi1543]

Rural, only ever gotten fire/rescue for MVCs. We've never called police for backup since I started working here 2 months ago, but we've been called out by them for assistance with medical issues. I don't think our dispatch sends out multiple services at the same time very often. It's often a big hassle to send out a lot of services when the population is so scarce and driving times so long. Just last night we got called out to assist a victim of assault, it took us 40 mins to get there lights and sirens. Then we had to wait 15 mins for the police to arrive, because our cops live in different towns, so the farthest one out took the cruiser, then had to stop by in another town to pick up her partner, and only then drove to the scene. Fire is even worse, given that it's volunteer - you never know who's gonna respond and who is not even in town.

 

[mikeN]

It depends what city I get dispatched to. If I'm dispatched to a city we have the 911 contract for then we get everything. If I get dispatched to a city where we back the fire departments Ems then we are either there with everyone or by ourself or just meeting police. Depends on the call and city.

 

[artman17847]

Our dispatch system uses CAD, so depending on the nature of the call is what dictates the response. All calls dispatched ALS i.e. CP, SOB or UNC will automatically get a BLS unit also. So 2 trucks will show up at your house. If its a BLS dispatch only the BLS goes.

 

[lightsandsirens5]

We are a BLS agency with a few ILS people onbord, so there is not much option! If BLS gets on scene they can have dispatch tone out any available EMT-I and they respond POV. (Assuing you aren't 10 mile out of town, or further.)

 

[BossyCow]

We tone out for all available personnel. We are rural and volly so it's a crap shoot what is going to be available. With certain types of calls, I will tone out for ALS support just in case as I can cancel them later if they are not needed. But since they are so far out, I'd rather get them moving towards me in the case of a chest pain, DIB, or multi-system trauma.

The first one to arrive on scene gives a short report, which allows responding officers to determine what resources are needed. We can call off responding units or request a second tone for manpower, depending on the call and who shows up on first tone.

 

[Aidey]

I was with a rural volly service for 4 years and it was a crapshoot what you got. It was mixed Fire/EMS with very very few Paramedics. Where I'm from there are 4 main levels, Basics, I-85 and I guess what would be an I-85 with cardiac training and some advanced meds, and then the MICPs.

Anywho, they allowed the I-85s to take charge on calls and transport without the higher level or MICP ever seeing the patient. If there was no ALS EMT on scene the I-85 was supposed to call for one, but they never did and management never enforced it. Let me tell you I had more than one arguement with someone about the liability that involved!

My service once sent an I-85 mutual aid to a clinic for a patient with an abnormal heart rhythm, and the I-85 accepted the transport from the PA! The EMT justified it by saying the patient was stable and they were only 8 minutes from the hospital, conveniently forgetting the fact that in that state it was illegal for the PA to turn over care to someone who couldn't continue cardiac monitoring!

 

[marineman]

I typed up a long response the other day but it seems to not have gone through. For 911 calls we use priority dispatching based on a computers interpretation of the information that the com center receives. Our response codes are A, B, C, D, and E. For A they only dispatch ambulance and we go non-emergency. For B they dispatch ambulance and a fire engine but both go non-emergency. For C they dispatch ambulance and fire engine, both go emergency. For D they dispatch ambulance and fire engine and whichever cop is closest at the time all running emergency. For E they dispatch ambulance, fire engine, local cops, county cops, state troopers, national guard, president obama whoever they can get that can be at the scene 5 minutes ago.

For areas outside of the city you can replace fire engine with first responders. Also the ambulance in this area is always a 2 medic crew, the fire engine all members are trained to EMT-B level, cops are trained to first responder level.

 

[yowzer]

Closest fire department BLS unit, possibly a private BLS ambulance for transport, medics (Either FD or county agency) depending on nature of call or if the first-on company requests them. EMTs can cancel medics before they get on scene. Medics can downgrade a patient to BLS transport (And usually do.)

 

[emtjack02]

My service is a volunteer rural (not really) service. Hospital is 15min from the edge of our district that's why I say "not really". We typically staff w/ a medic, basic, and driver(could be a medic, basic, or non lic person). Sometimes we'll have additional help show up if it sounds bad.

 

[downunderwunda]

(Please see the thread prior to this, I don't want to bury Sasha's)

Reading about Australian EMS and their vehicles, I see they are using a flexible tiered response model (get EMS resource on scene as fast as possible, but not necessarily a big modular ambulance with everyone aboard); you can quickly add higher level EMS to a response already in progress by sending them to the scene in progress in their separate vehicle (including motorcycles!).
I'm curious as to which type you have, and if you are rural or not, to look for a correspondence.

Before you try to compare the aussie system to anythin you have there, you need to consider that to us, a Basic is for more qualified than your basics, our intermediate levels are far more highly trained than yours & our education is continual & ongoing with skills upgrades on a regular basis.

At the level I am trained to, the difference between me & a medic is 4 drugs & 3 skills.

With this in mind, the main reason for calling in back up is to assist with larger patients or difficult extrications. We also have policies of skills sharing, where a Paramedic will work with a lower skill level.

The other main point of difference is we do not & are not associated with a fire brigade in any way shape or form. This is vital as it provides us with independance & removes reliance from another profession.

So if you want an answer to your question, there is no need for a tiered response here, train your people properly, then you will not need it either. Remove EMS responsibilites from the Fire Dept. & allow them to operate independantly, see how lon people are prepared to pay for a fire dept that sits around doing nothing.