Non-transporting ALS or ALS chase

[Richard B the EMT]

In the late 1980s, the idea was tested by the NYC EMS, but borne of necessity: Due to a managerial problem, over half the EMS fleet was mechanically "down" for repair. Until that issue was corrected, and the Chief of EMS fired, we had EMTs in Command cars (Supervisor's vehicles), with radio designations like "T" for "Triage" cars, that would respond to calls to at least start patient care, until an ambulance could arrive to effect transport. If the Command car was manned by Paramedics, the designation was "U" for "Union", and same concept involved. Then EMS Station 41 had a lot of their transports done with 41-Union assisted by 94-Larry, also known as Peninsula Volunteer Ambulance Corps.

Part of the problem was, the "specs" for the ambulances were incredibly complicated, to the point that at least one manufacturer or vendor went out of buisiness trying to supply NYC EMS with the ambulances.

Another problem was, Central Repair Service was running Monday through Friday, daylight tour only. To get the fleet back up, EMS farmed out the busted down ambulances to the NYPD and Department of Sanitation CRS facilities, just down the street, and a few more to "Red Square", the FDNY CRS a few miles away. A few also got sent to private venders for servicing.

FDNY CRS was called "Red Square" because they could, on any day, have more (pumper) engine and (hook and ladder) truck vehicles in and around the building for repair, preventive maintenance, or new vehicle final preparation, than some countries have fire service vehicles within their borders, and, of course, the vehicles are "fire engine red", hence the name.

The department purchased a bunch of ambulances that didn't have to be matched to a "spec book" that reportedly was a yard thick, hired a civilian to run the EMS, fired the chief, and got away from Triage or Union cars as the new ambulances got assigned to stations, and then to crews, and started Monday through Friday around the clock mechanic schedules, and daylight on Saturdays. There are also Roadside Repair crewman and vehicles assigned full time for any vehicle breakdowns

After the FDNY/EMS merger, the FDNY tried going back to using something like the televised LACoFD "Squad 51", manned by one Paramedic, and one Paramedic Lieutenant, who would bring the start of "definitive care" to a patient, and also do field supervisor duties. The teams were called "PRUs", for Paramedic Response Units, and kind of looked like the iconic Dodge truck from the "EMERGENCY!" series.

It didn't work, as the Lieutenants also had to do duties in the stations, so they had to decide if they were more useful in the field or the stations.

They eventually took the concept, and the PRUs, off the road, reassigned the Paramedics to Paramedic ambulances, with a partner of course, and turned the former PRU vehicles over to the Roadside Repair crews from FDNY EMS CRS.

And, again, I mention we keep turning down the use of the concept of "Mensa Medics" (single field Paramedics) in favor of a "Pair-A-Medics".

So, fenwayfrankee, take this as one system's attempt to use non transporting ALS, and list it as a concept failure.

[Laura Anne]

Ha ha! This is why I work in Montco and Bucks...NOT Delaware. Unfortunately, I do work for one place in Chester CO, but we run medic units, not chase cars.

I had a run in with a guy who was a "MEDIC" on a BLS ambulance a few weeks ago during a call. NOw, I know that most of the area is BLS and there are chase cars, so I assumed when this a$$hole showed up and was stating, " I'm a medic...I'm a medic..." that he was on the chase car that was dispatched.

Then I realized this guy was a tool.

Thats when I asked him where his chase car and his OWN equipment were at and he replied, "Uhhh, well....I went thru the medic program, but I never got command anywhere. I'm on the BLS unit as a third person." Apparently the medic showed up, saw us there(duel dispatch to a car into a house) and left w/o really informing anyone except county dispatch!!!

I don't like it in Chester County anymore because of this horrific experience....there's more to this debacle, but I don't want to get into it.

Bottom line... my experience with a chase car, as well as the entire county system, was simply ridiculous.

[fenwayfrankee]

In the late 1980s, the idea was tested by the NYC EMS, but borne of necessity: Due to a managerial problem, over half the EMS fleet was mechanically "down" for repair. Until that issue was corrected, and the Chief of EMS fired, we had EMTs in Command cars (Supervisor's vehicles), with radio designations like "T" for "Triage" cars, that would respond to calls to at least start patient care, until an ambulance could arrive to effect transport. If the Command car was manned by Paramedics, the designation was "U" for "Union", and same concept involved. Then EMS Station 41 had a lot of their transports done with 41-Union assisted by 94-Larry, also known as Peninsula Volunteer Ambulance Corps.

Part of the problem was, the "specs" for the ambulances were incredibly complicated, to the point that at least one manufacturer or vendor went out of buisiness trying to supply NYC EMS with the ambulances.

Another problem was, Central Repair Service was running Monday through Friday, daylight tour only. To get the fleet back up, EMS farmed out the busted down ambulances to the NYPD and Department of Sanitation CRS facilities, just down the street, and a few more to "Red Square", the FDNY CRS a few miles away. A few also got sent to private venders for servicing.

FDNY CRS was called "Red Square" because they could, on any day, have more (pumper) engine and (hook and ladder) truck vehicles in and around the building for repair, preventive maintenance, or new vehicle final preparation, than some countries have fire service vehicles within their borders, and, of course, the vehicles are "fire engine red", hence the name.

The department purchased a bunch of ambulances that didn't have to be matched to a "spec book" that reportedly was a yard thick, hired a civilian to run the EMS, fired the chief, and got away from Triage or Union cars as the new ambulances got assigned to stations, and then to crews, and started Monday through Friday around the clock mechanic schedules, and daylight on Saturdays. There are also Roadside Repair crewman and vehicles assigned full time for any vehicle breakdowns

After the FDNY/EMS merger, the FDNY tried going back to using something like the televised LACoFD "Squad 51", manned by one Paramedic, and one Paramedic Lieutenant, who would bring the start of "definitive care" to a patient, and also do field supervisor duties. The teams were called "PRUs", for Paramedic Response Units, and kind of looked like the iconic Dodge truck from the "EMERGENCY!" series.

It didn't work, as the Lieutenants also had to do duties in the stations, so they had to decide if they were more useful in the field or the stations.

They eventually took the concept, and the PRUs, off the road, reassigned the Paramedics to Paramedic ambulances, with a partner of course, and turned the former PRU vehicles over to the Roadside Repair crews from FDNY EMS CRS.

And, again, I mention we keep turning down the use of the concept of "Mensa Medics" (single field Paramedics) in favor of a "Pair-A-Medics".

So, fenwayfrankee, take this as one system's attempt to use non transporting ALS, and list it as a concept failure.

Thanks for the info. I never knew NYC*EMS tried that.

[CTXMEDIC]

Then I realized this guy was a tool.

Thats when I asked him where his chase car and his OWN equipment were at and he replied, "Uhhh, well....I went thru the medic program, but I never got command anywhere. I'm on the BLS unit as a third person." Apparently the medic showed up, saw us there(duel dispatch to a car into a house) and left w/o really informing anyone except county dispatch!!!

Did you kick his ass off your truck?

[stcommodore]

For what its worth I belive that a paramedic responder system in the urban setting, and ideally with two paramedics per unit should be the gold standard.

[Kaisu]

I ran in a hospital based EMS system. We were the only paramedic service in the two largest counties - one in Wisconsin, the other in Michigan. We were a dual medic system that ran in transporting rigs UNLESS BLS services in either of the counties requested a paramedic intercept. We jumped into the intercept car, which was a souped up station wagon. Our gear was kit based, and the wagon had the peds bag, trauma bag, airway bag, drug box, monitor/defib and an infusion pump. We would haul towards the BLS rig. When we met up with them, each paramedic would grab some gear and we would hop into the back of the BLS rig. One of the EMTs would jump into our intercept vehicle. The other EMT would drive the ambulance. The system worked great. Two paramedics in the back of the rig working on the critical patient, and an EMT driving the ambulance and the intercept vehicle.

I currently work in a EMT/paramedic rig in Arizona. Supervisors will respond with us on calls that sound like an extra pair of hands will be useful. I will always prefer dual paramedic rigs, but this is the best we can provide in this area at this time.

[WTEngel]

The Houston Fire Department has primarily BLS ambulances with ALS squads (Suburbans, Excursions, etc.)

Basically in the urban downtown area where the most calls come in, the cluster the ALS squads and BLS ambulances, and outside the downtown area where lower call volumes are encountered, they have ALS ambulances. It seems to work pretty well for them...

They have two paramedics in the squad, and an EMT and a driver on the ambulance. The only downside is that the squads get the crap run out of them. Some have volumes around 25 or 30 per 24 hour shift. They may only do 2 or 3 transports, but they run all day and all night...

[Medic One]

We are a larger service that was one of the 1st in the country to use ALS fly cars starting in the early 70's. We cover over 1500sq miles have 56 vehicles in totals with 9 ALS fly cars.

We run three to four supervisor vehicles per shift then the other fly cars are in sub-stations covering other towns that primarily have volunteer EMS systems. In one division we staff the fly car but if they are short VOL Crew members the medic can ride the ambulance as part of the legal crew (they are based in VOL Station).

The system works very well for us as far as busy days when the ER turn around time is very long. Good to use for lift assists and crew assists where they only need one extra body for lifting etc...

The "Fly Cars" are all set up as Command Vehicles with MCI gear (tarps/supplies/body bags/haz-mat books etc....)

Besides the three or four supervisors on shift any other employee wishing to get cleared on the fly car must complete additional training and get clearence to staff the car for OT/vacations etc...

Some of that training includes Incident Command / MCI Command(more indepth than what is taught in medic class).

The fly car also allows us to staff more BLS ambulances and with the occasional errors of EMD by the 911 center it allows the BLS car to call for a medic fly car and not commit a second Full ALS Ambulance for advance life support.

Edited November 6, 2009 by Medic One

[streethealer535]

fenwayfrankee

From your name I am going to assume you are in the Boston area. If this is the case Two of the best Intercept "chase car" systems I know of are in your area. Lawrence and Lowell Mass both run BLS trucks for transport (privatly run) with dual paramedic intercept vehicals (Hospital based). These systems work very well and are very progressive with their protocols.

Just out of curiosity what was your interest in this type of system?

[armymedic571]

This system is great for the quasi urban/surburban/rural systems. However, for a strictly urban system bad idea. This works well for us in Central PA.