When to call for ALS Backup

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Diddlemt

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Hey, new here..I have been an EMT -B for about two years and I live in an area where it's well...out there about 40 mins from any hospital. Our company has two stations and sometimes we have just BLS crew.. meaning sometimes its me and a driver which knows and does nothing. I rarely ever call for medic backup.. I usually know when to call, to cover my ***. The state has been QA several emt-b's for taking in things that should have been covered by a medic. I know that I can always tone out another station or meet enroute.
But last night I get a call at 3am for an allergic reaction, red skin, SOB, trimmers, and hes' feeling ill. I am on scene.. get my vitals. Initial BP was 230\138 and pulse was 140. He was tremmoring pretty well and had nausea. Got my history.. heart bypass and Hypertension. He was prescribed Nitro the day before. He thinks it was a reaction to his meds.. could be. I apply 02 and monitor vitals.. the full deal. We get down the road then he states.. my chest hurts.. pressure substernal non radiating. I got a little concerned and ask for a medic evaluation. Was I wrong? When the medic got one scene he states that the pressure comes and goes.. I just wanted to cya. I could have taken it in, but didn't want to have an oh :censored::censored::censored::censored: by myself. What is the standard for calling ALS in your opinon. Thanks so much
 
Sounds somewhat like ETOH detox too. Diarreah?

Pat answer: what are your protocols and agency rules?
 
Well, for true chest pain, als backup. But maybe it wasn't chest pain, maybe it was just discomfort from the reaction. As an EMT-B would you take it in own your own?
 
Tough one.

I agree that was a tough call. One of two different things or a combination of both could have been occuring. I think you did the right thing.
 
If the medic unit gets there and you don't need him, we'll you've got an extra pair (or two depending on his driver) of hands to twiddle their tuumbs with. But if you need him and didn't call, now you're in some trouble until they can get there.

I'd rather have them and not need them than need them and not have them. I think you made the right call as well.
 
I call for ALS:

Cardiac Arrest -rationale- I dont have meds or a monitor, and I will not transport a arrest because CPR sucks in the back. I will continue compressions, airway management and ventilation, and defibrillation until ALS arrives.

Unconsciousness -rationale- Paramedics can check blood sugar, give D50, and preform EKGs. There is great potential for this to be treated on scene.

Suspected anaplylatic shock -rationale- Lets face it, the patient is never going to have an epi pen when they really need it, patients may also need more than one round of epi.

Trauma with shock -rationale- I dont want the patient to die en route to ER.

and anything else I see fit. Suspected MI, CVA, etc, its better just to rapid transport where I am from. They will get to the ER about as fast as ALS can get there.
 
For us in my Department there is a list that if the call falls into ALS is automatically dispatched with the BLS truck. Of course we can always call if needed once we are onscene and we can always call them off if needed.

The system seems to work well enough to provide the necessary care.
 
If your not sure ALS is needed I prefer to be called rather than not called and be needed.
 
Diddlemt said:
Hey, new here..I have been an EMT -B for about two years and I live in an area where it's well...out there about 40 mins from any hospital. Our company has two stations and sometimes we have just BLS crew.. meaning sometimes its me and a driver which knows and does nothing. I rarely ever call for medic backup.. I usually know when to call, to cover my ***. The state has been QA several emt-b's for taking in things that should have been covered by a medic. I know that I can always tone out another station or meet enroute.
But last night I get a call at 3am for an allergic reaction, red skin, SOB, trimmers, and hes' feeling ill. I am on scene.. get my vitals. Initial BP was 230\138 and pulse was 140. He was tremmoring pretty well and had nausea. Got my history.. heart bypass and Hypertension. He was prescribed Nitro the day before. He thinks it was a reaction to his meds.. could be. I apply 02 and monitor vitals.. the full deal. We get down the road then he states.. my chest hurts.. pressure substernal non radiating. I got a little concerned and ask for a medic evaluation. Was I wrong? When the medic got one scene he states that the pressure comes and goes.. I just wanted to cya. I could have taken it in, but didn't want to have an oh :censored::censored::censored::censored: by myself. What is the standard for calling ALS in your opinon. Thanks so much
Click to expand...


Yes, you did the right thing about calling for ALS. Remember its better to be safe then sorry! There are many reasons here why it was a good idea to call for ALS intercept:

1) Of course the Chest Pain
2) Cardiac hx
3) High BP - 230/138

Remember that even tho a persons chest pain may sound as if is not of cardiac origin, you can never be sure without further assessment... aka 12-Lead

So, GOOD JOB on calling for ALS! I know many EMT's around here that are "too good" to call for ALS and its gonna bite them in the arse sooner or later. ;)

Take Care,
 
Here is a simple answer. If you think you should or should had called them, you probably have/had ought to.

There's a reason you thought so. There are very few (if any) ALS examination is not needed.


R/r911
 
Since you have such a distance to transport... I don't see any reason NOT to call for medics given what you present. Since you have long transport times, start transporting and meet enroute. Chest pain=ALS until proven otherwise.
 
It never hurts to call medical control either! Especially with a call like that.
 
tydek07 said:
Remember that even tho a persons chest pain may sound as if is not of cardiac origin, you can never be sure without further assessment... aka 12-Lead
Click to expand...

And you can rule out a non-ST elevation MI?
 
According to our protocols, the difficulty breathing with an allergic reaction would have been enough for me to call ALS without the chest pain.

I've called ALS and not called ALS on a chest pain call. Depending on the pt. A hyperventilating pt with a hx of anxiety and a history a mile long of calling us for various 'life threatening emergencies' who is talking in complete sentences, with skin pink, warm and dry, good cap refill, vitals wnl is probably not going to get ALS. Its a judgement call. I have though called ALS for evaluation on a pt just because the call felt hinky to me.

I tell my volunteers to be sure that they are calling ALS for the pt, not for themselves.
 
To me it shouldn't be a tough call. If you can meet ALS enroute you should. There are several possible problems and outcomes for this pt that a EMT-B can't deal with. If it is an allergic reaction that is or could compromise the airway can you give Epi, Benadryl, Zantac? A b/p of 230/138 with a HR 140 needs to be addressed. Can you do anything for this? You say you have long transports. ALS may not always be available prior to your arrival at hosp. Even though the pt may arrive at the hosp. with their condition unchanged from when you picked them up doesn't mean they should have been untreated.

Its not about protocols. It is about judgement and what is best for the patient.

In my mind you did the right thing.
 
Just based on your vital signs and patient history you should probably call ALS. Add to that the chest pain and distance to hospital and it absolutely becomes an ALS call. Without a 12-lead, you have no idea what's going on with this patient. I would transport this patient BLS only if I was close to the hospital (5min or less) and the ALS was more than 5 minutes away from me.
 
Outbac1 said:
If it is an allergic reaction that is or could compromise the airway can you give Epi, Benadryl, Zantac? A b/p of 230/138 with a HR 140 needs to be addressed. Can you do anything for this? You say you have long transports. t.

In my mind you did the right thing.
Click to expand...

Anything over Epi pen is considered Paramedic level here. Benadryl, Epi per IV or nebulized, and Zantac is considered ALS/Paramedic level. Actually, although I fail to understand most services do not carry Zantac or many other H2 blocker.

R/r 911
 
It more concerns me that you have to question as to whether you acted appropriately or not, if there's some type of pressure/prestige in your organization to cancel ALS and do it your ownself. Your job on the street isn't to prove to your partner or organization how brilliant you are when it comes to applying BLS skills and knowledge; it's taking care of the guy that called you guys out there. Sad, that many places turn PT care into an ego war. The prevailing question should be: "What's the best thing for this PT?" Often, it's not asked... or thought of TO ask.

You did the right thing. For reasons people more experienced than I have already stated. Remember that feeling you had when you were going to cancel, but decided against it. Remember it well. You're gonna see it again, and next time, you're gonna know you did the right thing.

Well done.



Later!

--Coop
 
Whatever was causing these symptoms, it was an ALS situation - at least in my state. My only concern would be the delay waiting for ALS could cause. PA protocols state it is generally inappropriate to delay transport waiting for ALS (unless long transport time and short ALS ETA).
 
Ridryder911 said:
Anything over Epi pen is considered Paramedic level here. Benadryl, Epi per IV or nebulized, and Zantac is considered ALS/Paramedic level. Actually, although I fail to understand most services do not carry Zantac or many other H2 blocker.

R/r 911
Click to expand...
Would Epi be good for this particular pt., given the hypertension?
 
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