Would you ALS or BLS this patient and why?

[Arizonaffcep]

According to our instructor and the paramedic book we are using, it is considered abandonment to leave a patient with some one certified at a lower level than you regardless of where you live in the US. That would mean every time these medics assess a a patient then send him/her with a BLS truck, they are abandoning their patient and could be charged accordingly.

In Arizona, we can downgrade to BLS, but only with medical control's ok. It's not considered abandonment. Actually, depending on the crew you get in Tucson...it could be considered an upgrade

[Just Plain Ruff]

Not to be argumentative, but did ALS care change her outcome?

Sounds like calling 911 instead of bellying up to the bar might've given her a chance at a different ending. Or not.

didn't take it as argumentative but fluids were this ladies best chance of survival and a BLS crew would not have been able to do that.

But in the end, nah, she was a goner.

[FormerEMSLT297]

Did i read correctly that you need a "patch" to autorize you to go directly to a trauma center????????

That sounds very much like 1970's medicine..

I cant believe that there are system like that still ....

Why do you not have a trauma protocols that address that... ??? ... With trauma, where time is of the essence WHY should you need to "patch" Consult, or whatever, Penetrating injury to the Head, Neck, or trunk, should be automatic Trauma center candidate ........... WTF over. ????

[Arizonaffcep]

Did i read correctly that you need a "patch" to autorize you to go directly to a trauma center????????

That sounds very much like 1970's medicine..

I cant believe that there are system like that still ....

Why do you not have a trauma protocols that address that... ??? ... With trauma, where time is of the essence WHY should you need to "patch" Consult, or whatever, Penetrating injury to the Head, Neck, or trunk, should be automatic Trauma center candidate ........... WTF over. ????

It's not a matter of "authorization" to go to the trauma center. If it's a level one trauma, UMC must accept (unless its a PURELY "mechanism" style level 1 trauma, with no apparent injury AKA a "green" vs a "white" AKA a "yellow" or a "red," red being life threatening injuries). UMC is the only level 1 trauma center south of the Phoenix area...thus there is no option to "refuse" so to speak. Couple that with a "no divert/bypass" policy for southern arizona hospitals. The "patch" is to give them a heads up on what's coming in, vs. an "administrative order" which would be something like "Medic XX enroute with a level 1 trauma." That gives no info. What's the mechanism, where is the injury, etc. The patch isn't long...honestly it can consist of "I don't have time to do a full patch, XXyom shot in the chest. 1 big hole and unstable vitals, eta 5 min." Or, if you have a minute...give more info. Just something more than a nebulous nothing report.

[jbanagas]

You could go either way with this patient, depending on your department policy and county protocols will determine ALS, or BLS.

[Odorono]

Going back to the whole issue of ALS transport showing up on scene and then calling for a BLS ambulance to take the patient instead-- I have no first-hand experience with this and it seems quite ridiculous to me. This seems to be more of a Western/ Southwestern phenomenon. Where did it come from? Is it because local FDs have a lock on ALS staffing and then get lazy and private companies are looking to make money any way they can, or is there a more rational explanation?

Another topic brought up the current economic crisis and the possible impact it could have on all of our jobs, whether city, county, hospital or private. If EMS begins to face greater scrutiny regarding efficiency and cost-effectiveness, how is a practice like this going to help us justify our field?

[Dustdevil]

Going back to the whole issue of ALS transport showing up on scene and then calling for a BLS ambulance to take the patient instead-- I have no first-hand experience with this and it seems quite ridiculous to me. This seems to be more of a Western/ Southwestern phenomenon.

Southwest of what? Newfoundland? :?

I never really considered New York and Boston to be "southwestern".

But yes, it does seem to have originated in Southern California, the birthplace of firemonkey EMS.

[Odorono]

Sorry Dust--

I have no knowledge of Boston and only cursory knowledge of NYC. Maybe RichardB can fill us in, but I wasn't aware a FDNY medic on scene would actually call a BLS bus or voluntary to transport, especially since the hospitals are so close.

Of course, if every ambulance in this fine country was ALS, this would never be an issue...

[p3medic]

In Boston a call triaged as needing an ALS response gets an ALS and a BLS ambulance. Calls are frequently triaged at a higher acuity, only to find out its not. In cases like this (not the OP's stab senario) ALS can and do refer the patient for BLS transport after ALS assessment, and document accordingly. All ALS charts have MD review, and it seems to work well. If the patient is ALS, the ALS transport, sometimes the BLS will drive the ALS allowing both medics to treat the patient.

[Odorono]

Gotcha-- I suppose as long as both are simultaneously dispatched and scene time isn't delayed to wait for the BLS, this isn't too bad. Especially since some of those on the BLS bus may actually be medics acting in a BLS capacity, correct?