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When the hospital is full and the ED is holding patients because there's no beds available in the hospital... yeah, there can be a hurry to discharge patients from hospital to skilled nursing. I have had the distinct pleasure of taking care of Med/Tele patients (and ICU, occasionally too) for HOURS because there's no beds available in the hospital. I'm an ED nurse, not a Med/Surg/Tele, not an ICU nurse.Nobody is in a hurry for a discharge from the hospital to your nursing home/rehab center.
I've mostly been a field guy too. Once I promoted to supervisor, I had to cross-train to dispatch. I know that BLS can only run BLS, ALS can run both. I try to keep the ALS units available to run ALS calls, but I also will send them on BLS calls if the call is going to be a short duration and with the understanding that I can peel that ALS unit off a BLS call right up to the point where they've made patient contact. So that ALS car is never going to be stuck doing a 40 mile d/c run. I'll bring a BLS car 30 miles over to do that run while I'll happily send that ALS car to d/c a patient from a hospital to a SNF that's 5 or 10 minutes down the road, knowing that the ALS crew is going to be rather speedy in getting that call done so they can be available and I'll even give the sending facility as accurate an ETA as I can.
Where things really get "interesting" is when you have contracts with facilities for "private emergency" runs. Those are basically 911-avoidance contracts. If my company had an availability contract like this, then I'll keep the ALS crew available and let the BLS crews run all the BLS calls. The dispatchers likely won't know the specifics of a contract, but will be told what they must do because of it, like literally: Keep an ALS crew available over in this area at all times unless they're running an ALS call from X facility. BLS units are to take all BLS calls in that area, ALS is not to take those, even if they ask to.