ALS using Lights and Sirens back to the hospital

[spenac]

Not to start a fight with Dust, who'd win, but I'd like to talk about the idea of not having BLS rigs. I worked in a county where we were contractually obligated to have a medic on every rig, and that seemed really wasteful. A large percentage of our patients, like 80%, could have been managed on the BLS level. They were stable, didn't need drugs/pain control. It costs the system a whole lot more to have a medic on every truck. A well trained EMT should be able to handle a lot and get ALS backup when they are in over their head. (Clearly ALS should be dispatched immediately to certain calls, like chest pain, SOB, etc.) Thoughts?

Please search. We have beaten this horse so much it turned to dust and has blown away.

[Dustdevil]

A large percentage of our patients, like 80%, could have been managed on the BLS level. They were stable, didn't need drugs/pain control.

Every one of those patients required a skill that an EMT-B is not educated to provide: Competent medical assessment.

Until the patient receives that, you don't know what care he needs.

And if your medics are sitting around waiting for calls from BLS, isn't that a much bigger waste of medic resources than having them evaluate and treat the sick and injured? And, of course, aren't those ALS patients you are making wait an extra fifteen to twenty minutes the very last people who need to be waiting for BLS to figure it out? It would make much better sense to have ALS respond to everybody and call BLS to dump their patients on. That way, it isn't the critical patients that are getting screwed.

Nothing good comes from such a system.

Dust, I'm disappointed in you. It took you 4 pages and about 4 days to get into this conversation. You are slacking off in your days of being head over heels in love.

Ruff, it only took 12 hours! I have to sleep sometime, you know? :wink:

[Just Plain Ruff]

come on Dust, you are a lean mean fighting machine that doesn't get to sleep. You have to be on duty at all times ready to respond to every little nick and scratch that comes your way.

Was it only 12 hours?

[BushyFromOz]

come on Dust, you are a lean mean fighting machine that doesn't get to sleep. You have to be on duty at all times ready to respond to every little nick and scratch that comes your way.

Was it only 12 hours?

Chuck Norris needs no sleep, all he needs is a are some fresh rounds and a clean shirt to freshen up

[AnthonyM83]

Chuck Norris does not sleep.

(Neither does Jack Bauer)

[JPINFV]

^

He waits.

[BushyFromOz]

^

He waits.

So he's into voyeurism then?

[JPINFV]

It's not stalking till you get caught.

[JakeEMTP]

I blame all this on President Bush.

[triemal04]

In our service L&S rarely used during transport to hospital. Exceptions include Penetrating trauma, S&S AMI needing interventional cath, Stroke, any life threatening or quality of life threatening condition that cant be managed by the crew. I must admit I can understand the rationale for running emergency in California traffic though. Traffic around Raleigh, Durham, Greensboro and for sure on I-77 around charlotte has reached a point that easily delays transports for an hour and sometimes three unless you take measures to get around it. Even a BLS to the hospital can be "urgent" simply due to limited resources, patient and crew comfort and the need to return crews to service as quickly as possible.

I'll go a different way. I can see transporting code 3 simply to get back into service if a true ALS call is pending and there is no available unit to handle it. But for patient or crew comfort...unless I'm missing something, that has never yet, and almost definitely never will determine if I transport code 1 or 3. If you could explain that more that'd be great.

For my 2 cents...MI's...CVA's with a confirmed onset of less than 2 hours, trauma entries, and post ROSC codes are the only pt's that will get a code 3 transport every time. Other's do pop up sometimes, but much more often than not it's a slow trip to the hospital. With a well-trained medic, most (not all) situations can be handled in the car.

Far as BLS units go...if they're part of the system, they should only rarely be going code 3 to a call. When someone calls because their finger is dislocated due to a volleyball game, that does not warrant using the siren to get there. If for some reason they have to be the initial responders to an ALS call, that's a no brainer, but that hopefully won't happen often. And if the wankers in dispatch can't figure out using their flipbooks if it's emergent/non-emergent, then maybe they go code 3, but at that point it'd be better to send an ALS unit. Going to the hospital they should never be using their lights and siren. The only time is if it ends up being a true emergency that needs ALS care and there is no way to do an intercept.