Non-transporting ALS or ALS chase

[flight-lp]

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...

It may work great for the FD, but it sucks for their patients! HFD is a prime horrific example as to the bad reputation Fire based EMS has. Decent concept, piss poor execution and QA.

[HERBIE1]

It may work great for the FD, but it sucks for their patients! HFD is a prime horrific example as to the bad reputation Fire based EMS has. Decent concept, piss poor execution and QA.

Why do you think it has such a poor execution? What are the specific problems associated with that system? I've heard that EMS runs a high call volume with not enough rigs. Is that still the case? Didn't TriData do a study of that system some years back? DId they actually address the problems the report brought up, or correct any deficiencies?

I'm not arguing, just trying to compare problems. I would bet the HFD's problems are not unique to that city either.

[EMS49393]

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.

It must not be working out so well in South-Central PA because they've had two ambulance services start MICU services in the past year. From what I understand, my company was a little sick and tired of having the hospital-based ALS chase cars show up on scene and say one of the following phrases to them (on nearly every call they were duel dispatched on):

"Why didn't you cancel me?"

"You can't handle this call?"

"So, what am I doing here?"

"What do you think I'm going to do for this patient that you can't do?"

They would then go out of their way to berate the BLS crew throughout the duration of the call. I really thought they were exaggerating how poorly they were treated, and that perhaps their perception was a little skewed, but I had to work strictly BLS for the first three weeks I worked until our inspection and paperwork was finalized with the federation. Now I'm spending time trying to instill in them that if they are uncomfortable, if they have a patient that needs pain management, if they have any patient that makes them uncomfortable at their level, that they are to call me out and I'll transport in my MICU.

It's still far from a perfect system here, really unbelievably far from perfect, but it's better then it was before the MICU was placed in service.

The biggest problem I see with ALS chase cars that are not a part of your specific employee pool is accountability. These guys could treat people any way they felt because there were no repercussions. It's not as though my boss could reprimand them for attitudes or laziness. There is also a question of Q/A. They could do nothing on a patient that really does require ALS intervention (I've seen it here first-hand) and no one has any idea what they are documenting. They didn't see our reports, and we didn't see theirs. Now that I'm a paramedic that actually works for the service to which I provide ALS coverage, I am held to a standard regarding how I treat my fellow employees, and how I take care of patients, because everything I do can be traced though the company.

Wait, there's more. I'm classified a second-due BLS ambulance in a large service area that has first-due ALS coverage via hospital-based chase car. So I will be dual dispatched as a paramedic unit along with a chase car that can conceivably have two other paramedics on board. A complete waste of resources, but it's "how the fire chiefs do things here." Which is ironic considering a few of us aren't even associated with the fire department.

Thumbs down for ALS chase cars.

[armymedic571]

It must not be working out so well in South-Central PA because they've had two ambulance services start MICU services in the past year. From what I understand, my company was a little sick and tired of having the hospital-based ALS chase cars show up on scene and say one of the following phrases to them (on nearly every call they were duel dispatched on):

"Why didn't you cancel me?"

"You can't handle this call?"

"So, what am I doing here?"

"What do you think I'm going to do for this patient that you can't do?"

They would then go out of their way to berate the BLS crew throughout the duration of the call. I really thought they were exaggerating how poorly they were treated, and that perhaps their perception was a little skewed, but I had to work strictly BLS for the first three weeks I worked until our inspection and paperwork was finalized with the federation. Now I'm spending time trying to instill in them that if they are uncomfortable, if they have a patient that needs pain management, if they have any patient that makes them uncomfortable at their level, that they are to call me out and I'll transport in my MICU.

It's still far from a perfect system here, really unbelievably far from perfect, but it's better then it was before the MICU was placed in service.

The biggest problem I see with ALS chase cars that are not a part of your specific employee pool is accountability. These guys could treat people any way they felt because there were no repercussions. It's not as though my boss could reprimand them for attitudes or laziness. There is also a question of Q/A. They could do nothing on a patient that really does require ALS intervention (I've seen it here first-hand) and no one has any idea what they are documenting. They didn't see our reports, and we didn't see theirs. Now that I'm a paramedic that actually works for the service to which I provide ALS coverage, I am held to a standard regarding how I treat my fellow employees, and how I take care of patients, because everything I do can be traced though the company.

Wait, there's more. I'm classified a second-due BLS ambulance in a large service area that has first-due ALS coverage via hospital-based chase car. So I will be dual dispatched as a paramedic unit along with a chase car that can conceivably have two other paramedics on board. A complete waste of resources, but it's "how the fire chiefs do things here." Which is ironic considering a few of us aren't even associated with the fire department.

Thumbs down for ALS chase cars.

I am not sure what system you are working in, or what system you are referring to, but I think it is safe to say that you are mistaken.

You as an ALS provider, are a pt advocate and should be an advocate for your fellow BLS providers. Why are you not going to management with their concerns, or helping quantify their concerns so they can present them themselves.

As far as accountablity and QA. We have one of the most stringent QA systems in this part of the state. Please stop making generalizations about a system you don't know or understand.

I think your underlying issue here is you have a bone to pick, but thanks for your opinion. If your system is that bad, sorry for you....

Besides, If your MICU is a second due for BLS then that is mis management of resources. Hhmmmm......very skewed indeed.

[EMS49393]

I am not sure what system you are working in, or what system you are referring to, but I think it is safe to say that you are mistaken.

You as an ALS provider, are a pt advocate and should be an advocate for your fellow BLS providers. Why are you not going to management with their concerns, or helping quantify their concerns so they can present them themselves.

As far as accountablity and QA. We have one of the most stringent QA systems in this part of the state. Please stop making generalizations about a system you don't know or understand.

I think your underlying issue here is you have a bone to pick, but thanks for your opinion. If your system is that bad, sorry for you....

Besides, If your MICU is a second due for BLS then that is mis management of resources. Hhmmmm......very skewed indeed.

I'm not mistaken, I work more than 60 hours a week in this system.

Management is well aware of the concerns from the BLS providers about these hospital based ALS chase medics. In fact, I have made them aware of numerous problems I personally witnessed the few weeks before my MICU went in service.

Perhaps your QA system is different or better, or perhaps there are some ALS providers here that aren't exactly forthcoming in their documentation. I'd be interested to see if BLS reports in any way match ALS reports on some of the calls I've worked before the MICU went available. I'm actually only interested in one report in particular.

I don't have any bones to pick. I was posting my opinion on the chase car system, as many have done before me. I could care less about any ALS chase provider here because I rarely have to deal with them. MY company is not bad, although the county-wide system itself is flawed, and I am not the first person to admit that fact.

It is a waste of resources, as I said in my original post. I do not make the rules here, the fire chiefs do. I was told there is little the EMS departments can do about box areas, assignments, or anything relating to response because the VOLUNTEER fire chiefs make all the decisions.

Unless you directly work in my system, I suggest you refrain from telling me how wrong I am.

[armymedic571]

I'm not mistaken, I work more than 60 hours a week in this system.

Management is well aware of the concerns from the BLS providers about these hospital based ALS chase medics. In fact, I have made them aware of numerous problems I personally witnessed the few weeks before my MICU went in service.

Perhaps your QA system is different or better, or perhaps there are some ALS providers here that aren't exactly forthcoming in their documentation. I'd be interested to see if BLS reports in any way match ALS reports on some of the calls I've worked before the MICU went available. I'm actually only interested in one report in particular.

I don't have any bones to pick. I was posting my opinion on the chase car system, as many have done before me. I could care less about any ALS chase provider here because I rarely have to deal with them. MY company is not bad, although the county-wide system itself is flawed, and I am not the first person to admit that fact.

It is a waste of resources, as I said in my original post. I do not make the rules here, the fire chiefs do. I was told there is little the EMS departments can do about box areas, assignments, or anything relating to response because the VOLUNTEER fire chiefs make all the decisions.

Unless you directly work in my system, I suggest you refrain from telling me how wrong I am.

Gee, I was going to tell you the same thing. Agree to disagree.

[Nate]

I've worked in management for a service that operates a mix of MICU trucks (EMT-P/EMT-, ALS truck (EMT-I/EMT-, and BLS trucks with a squad paramedic at each station. It works, and it doesn't matter what type of setting you're in (urban, rural, metro, or combo of any of these) as long as your dispatch is efficient and they constantly stay focused on planning ahead with unit allocation. It takes a great deal of team work, putting one's ego in check, and working efficiently as a crew to turn the call in a respectable amount of time. The most common reasons these systems fail is because of the individual employees attitude, the lack of efficient dispatching, and when the system starts putting the paramedics on the squads on ambulances due to staffing issues.

With that said I honestly think that it is often used as an escape method to avoid hiring and/or meeting the compensation requirements needed to retain (or recruit) additional paramedics. It works great to supplement the ambulances, it however should not be the primary source of ALS care that is provided.

I honestly think the most cost effective ambulance type to run is the EMT/Paramedic unit, however this is outside of most services finical boundaries. This is just another example of why the government needs to shift more funding towards EMS. There is no reason that when you call 911 and say you're having a problem (legit life threat) that you're not guaranteed a paramedic every time. Often the dual paramedic trucks are really a waste of money. If the call volume is so high that the second paramedic is there to trade off, then maybe the service should consider hiring additional EMTs and staffing another truck. A well trained EMT can be just as valuable as a second paramedic (more so if the service has EMT-I/EMT-P trucks).

-Nate

[WolfmanHarris]

ALS in my region works in one of three ways

- ALS truck (ACP/PCP Crew staffing a transport ambulance)

- ACP Superintendent (can self-dispatch but usually 90% of their job is administrative)

- ACP Paramedic Response Unit; there are between three and six of these trucks on at a time during peak hours spread around the region. They self-dispatch and redeploy to help bump up resources on large calls, cover busy areas, first respond and can provide ALS intercept when a regular ALS truck isn't available. These ACP do not always transport though. I had a difficult extrication from a horse trail yesterday and requested ACP attend for pain management. He arrived, took report verified necessary info with the pt. gave 50mcg fentanyl and then hung around until we cleared the scene and we were sure we didn't need anything else from him. The PRU are recognized and meant to be a stopgap though and are not meant to replace regular trucks. A PRU will be downstaffed to keep a regular ACP truck online.

[armymedic571]

I will say this. EMS 49393 has a point. The system is what you make it...

The key is that every part of the system has to be in link with one another. This tricky in systems where you have multiple agencies working next to one another, but not necassarily in cooperation with one another.

In PA, as stated by EMS 49393 box cards are influenced greatly by fire chiefs. The underlying issue here is that to many fire chiefs that are undereducated in EMS, have ego problems or are just is p!ssing matches with other fire chiefs to do the right thing.

As much as I like my system, we have had some similiar problems in the past. Thankfully, our service director got everyone to sit down and they started hashing out their differences. It is an ongoing process, and not always a peaceful one. But never the less, a step in the right direction.

[HERBIE1]

In PA, as stated by EMS 49393 box cards are influenced greatly by fire chiefs. The underlying issue here is that to many fire chiefs that are undereducated in EMS, have ego problems or are just is p!ssing matches with other fire chiefs to do the right thing.

Here lies the fundamental problem. Fire based EMS is run by FIRE CHIEFS, who treat EMS work like fire duty. Fire service is a static deployment system, and depending on the area, it may also work for EMS, but often times it does not.

A fire chief will provide a fire service solution to address an EMS problem, and often times it does nothing to address the actual problem.

Call volumes, resources, type of system, size of response area all are key to proper utilization of assets within a system, but a fire chief's first choice will be to protect fire service jobs.