What is considered a BLS call in your area

[Jayxbird521]

In my area chester county pa a accadent/entrapment, fall, stabing, or chest pains and maternity are bls i think some of them need to be als becase half the time we end up requesting the medics.

 

[JPINFV]

Chest pains are handled as a basic first response? I think I'd need to know a little more about your area before I know how to respond to this situation.


In the area that I worked (Southern California), all 911 calls were paramedic first response.

 

[KEVD18]

well, i dont know about your area but in some places every call has a bls first in with medics to follow if need be. some places only have a few medic rigs to cover several counties so youd better be damned sure you need em before they get toned.

i have what some would call the benefit of working in a densly populated urban setting. most of the fire depts are als and there are a hundred privates that run als with it seems a new one starting up every week. i very rarely find myself in the situation of not having a -p truck when i need one. quite the opposite, i end up cancelling medics on calls that "sounded bad" and thus were dual dispatched.

 

[JPINFV]

i have what some would call the benefit of working in a densly populated urban setting. most of the fire depts are als and there are a hundred privates that run als with it seems a new one starting up every week. i very rarely find myself in the situation of not having a -p truck when i need one. quite the opposite, i end up cancelling medics on calls that "sounded bad" and thus were dual dispatched.

I worked between the two extremes. 911 first response via "EMS based fire suppression," but there weren't any paramedics with the private companies in the county. Thus, SNF->ER calls were either 911 or BLS. Yea, lets just say that the SNFs defaulted to BLS if there were any doubts on the patient's condition.

 

[KEVD18]

Yea, lets just say that the SNFs defaulted to BLS if there were any doubts on the patient's condition.

well yeah, i mean its cheaper right?

in my area, every nursing home is required to have a transport contact with a private service. its supposed to be just for routine txp but, well, some people are stupid. some nurses think that they are supposed to call their contract provider for EVERYTHING. ive seen my dispatcher have to call the local fd for arrests they called us for. us being a company whos base is 40 minutes away. ive also been present for the phone call for the pt complaining of diff breathing. so my dispatcher asks all the assesment questions to ascertain the level of difficulty. when he figures out the pt is really in trouble and says ok well we cant help you but ill call the local rescue, the story suddenly changes and the pt gets better. they dont want a box assignment showing up and causing a ruckus. they just want an ambulance.

oh stupid people....

 

[fma08]

pretty much anything where and IV isnt place, the monitor isn't put on, or a med, other than O2, isn't given... so that leaves pretty much psychs, domestics, and b.s. calls

 

[mikie]

In my area chester county pa a accadent/entrapment, fall, stabing, or chest pains and maternity are bls i

I know an EMTB can handle all of those emergencies, but I would feel more comfortable if, in addition to the basic, someone else was on the rig, such as an I or P. Like I said, BLS providers can indeed treat those patients, but often I think ALS should be needed (ESPECIALLY depending on the longer response time. Few minute transport? not as much). Not saying this about your particular area, there is only so much a BLS crew can do with a cardiac arrest, for example, before ACLS is needed.

***I am NOT at all saying Basics can't do anything; I completely disagree with that, but we can argue this in a different thread (I think there is one already out there) if need be***

 

[KEVD18]

I know an EMTB can handle all of those emergencies,

**please dont intrepret the following as bls bashing. im a bls provider so it really wouldnt be logical to bash myself**

define handle? are we able to reduce preload and afterload, reduce myocardial oxygen demand, treat hypotension, complete the thrombolytic checklist, examine the electrical conduction of the heart so as to accuratley prepare the er, draw labs so as to reduce the door to drug time etc et al.

sure, we can control bleeding, asa and nitro(either prescribed or unit supplied), stabalize c-spine. we can even deliver a baby(assuming nothing goes wrong right). but real treatment isnt in our scope. medics can really treat the problems, maybe not definatively but certaintly better than we can. remember, high flow diesel really isnt treatment, its what you do when you cant treat or treatment fails.

as a side note, i know some places have basics that can start lines and what not. this was written as a generalization

 

[Ops Paramedic]

It appears from reading all the posts, that there are different call out criterias for the different areas with regards to the level of care which is dispatched. I would think these call out criterias are used to manage the resources available for a certain area.

I work for a private service, yet have very good relationships (Personal) with the ALS from the the other private and government services, and we help each other out a lot, should the the one be busy. What I am trying to say is that at the end of the day we all have one common goal: The patient, no matter the level of care.

To answers your original post, although we have call out criteria, i don't follow them (My bad) strictly. Our BLS are dispatched to any call, and then back up will follow as soon as it is available (if not already dispatched). I don't think that ALS is only there for patient management, there are many other things for them to do, such as, quality control, training, scene safety and extra hands even for a green code. It would however also largly depend on the resources available, prior to dispatching on every call.

It is sad to see that: "you better be sure you need them before you tone them" it is an attitude that is not only witnessed on this side. It should not the end of the world if an ALS gets cancelled, but rather a case of would the ALS have been needed, he/she would have been there halfway already!!

Just to shed some light...

 

[mikie]

define handle?

I guess not loosely enough you: we can treat them as we are trained to do in the situation until higher care (ie hospital) is available.

 

[MedicPrincess]

All of the rigs for my service are staffed P/B, so all of our calls start out ALS. After the Medics assessment, the patient can be determined BLS. So long as the patient as stable vitals, does not require cardiac monitoring, IV access, or medications the patient can be BLS'd.

 

[emtwacker710]

hmm..in my lovely area (Warren County, NY) anytime there is chest pain, diff. breathing, serious trauma, sometimes head injuries if there is another problem..those all go out as ALS, I'm probably forgetting some but that all I can think of off the top of my head after a sleepless night of calls..also rectal bleeds go out as ALS here...I believe because 99.9% of the time an IV is started to replenish lost fluids so they just tone it as ALS

 

[Ridryder911]

There is no BLS or ALS, rather emergency or not. If they are emergency, then they should be considered to need a Paramedic. Period.

If it is regarded as an emergency then why would you want to send a so called BLS unit only? Sounds like a litigation in the making...

R/r 911

 

[skyemt]

we have no BLS or ALS...

all calls are answered by the highest available provider... if ALS care is not needed, transfer of care to BLS crew will happen.

if ALS is not available (rural area), then BLS will do the best they can, and request ALS mutual aid...

but... there is no such thing a "BLS or ALS" call...

the way atypcial presentations work for a variety of ailments, as well as pain management considerations, i just don't see how you could qualify most of those calls as "BLS" before seeing the patient anyway.

 

[Ridryder911]

Exactly, one cannot really determine a call before responding. The routine "fall" many times turns out to be that they "fell" dead. The back pain can turn out to be a AAA. Even without advanced assessment skills, someone can misdiagnose or wrongfully make a determination.


R/r911

 

[skyemt]

Exactly, one cannot really determine a call before responding. The routine "fall" many times turns out to be that they "fell" dead. The back pain can turn out to be a AAA. Even without advanced assessment skills, someone can misdiagnose or wrongfully make a determination.


R/r911

to add, what is very common here, is a call for an elderly person "fall"... sounds innocent enough...until you get there and find out he fell due to syncopizing, secondary to a cardiac event unfolding...

so much for the BLS "fall" call...

 

[BossyCow]

ALS is not always available to us. It is provided as a mutual aid on an 'as needed basis'. Our protocols state clearly which incidents require us to call for ALS support. But those calls do not always get a medic and sometimes we just have to go like heck and hope we make it.

We must call for ALS support if... unconscious pt, respiratory distress, multi-system trauma, diabetic emerg, cardiac,. We transport the tourist fell down go boom calls, the faintings, the puking stomach flu, MVAs (unless multi system trauma)

I have transported several of each of the 'must call ALS' examples in my BLS rig just because I didn't have a medic available.

 

[skyemt]

ALS is not always available to us. It is provided as a mutual aid on an 'as needed basis'. Our protocols state clearly which incidents require us to call for ALS support. But those calls do not always get a medic and sometimes we just have to go like heck and hope we make it.

We must call for ALS support if... unconscious pt, respiratory distress, multi-system trauma, diabetic emerg, cardiac,. We transport the tourist fell down go boom calls, the faintings, the puking stomach flu, MVAs (unless multi system trauma)

I have transported several of each of the 'must call ALS' examples in my BLS rig just because I didn't have a medic available.

i have transported these cases as well, when ALS was not available...
HOWEVER, regarding this thread, that did not make them "BLS" calls.
i wouldn't want your comments to be misunderstood.

 

[MikeRi24]

we have 4 types of rigs we roll: BLS rig (2 basics), ILS rig (1 basic, 1 intermediate), ALS rig (either 1 basic or 1 intermediate and 1 medic), and Medic fly-cars (Tahoe with ALS supplies and a medic). we mostly use the BLS rigs for privates and, well, "Basic" calls. the majority of the 911 calls we get we will send ALS to. Our Basic rigs do handle a lot of 911 calls, and in a sense, if we get a call for someone thats coding and all we have available at the time is a BLS rig, then guess what the BLS rig is going, happens all the time. it pretty much depends on who is in the area at the time and so on.

I just now got transfered out to a more rural area, but when I worked in the city, theres enough hospitals in Buffalo that you can pretty much get to one within 5-10 min taking your time. If a basic rig goes on a call that should really be ALS, 9 times out of 10, the amount of time it would take to get an ALS rig there is more than if we just loaded and went to the hospital, which is what we do. why stay on scene for 10 minutes waiting for an ALS car to come screaming across town then have the medic do thier thing and then have transport time on top of all that when we would have the pt in the ED in 8 minutes? thats really how we make a lot of our decisions like this, if by the time ALS gets here we can have the pt in the ED's care then why bother waiting?

EDIT: skyemt, i agree with a lot of stuff you say, and I see you're in NY, where abouts?

 

[Outbac1]

Here it is the closest available unit to a 911 call that is sent regardless of how the truck is staffed. If two rigs are parked at a base then the ACP truck will get the call. Most urban areas have almost enough ACPs (Advanced Care Paramedic = EMT-P), to have one per truck for every shift. The balance are ICPs and occasionally PCP. Many rural trucks have only PCPs. Unless the call really sounds bad the ACP won't roll unless called for. Transfers are generally dropped on crews the other way around.

As an aside most Canadian PCPs have a much wider scope of practice than US Basics.