BLS vs ALS

[daedalus]

"BLS has better patient outcomes than ALS" "You may think your a cool paramedic with all those fancy skills but remember OPALS..." I hear this and variations of this on multiple EMS forums a the time. The same people that say these things all the time like to also push the idea that BLS is solely in the domain of the EMT, and ALS is solely the domain of the paramedic. Somehow in their mind, the fact that limited scene time in severe trauma is better than stay and play equates that EMTs are the gold standard for patient care in the prehospital setting. These people also like to point out that ambu bag ventilation with a "BLS" airway may be better than intubation in some patients. True. However these same people seem to interpret that as EMTs are better for these patients than paramedics.

Who is better at BVM ventilation: An EMT who bagged a mannequin a few times in class and MAYBE once during the ER observation, or, the paramedic who was an EMT and than spent time with an anesthesiologist in the OR learning the right way to hold a mask before they even touched the laryngoscope? It was in the OR that I learned that a BVM is not a BLS tool, but a medical device that required expert training to use properly. Can you get expert training in a EMT tech school that has no access to experts in airway management?

It blows my mind that certain things are considered basic and advanced when they are not. They are just medical care.

[BushyFromOz]

Dude, you didn't REALLY just go there did you??

[Kiwiology]

It blows my mind that certain things are considered basic and advanced when they are not. They are just medical care.

Welcome my friend, welcome to the other side. Now, I know I'm going to be preaching to some of the converted here but still:

If it is one thing that annoys me the most about EMS it's this American attitude of "BLS vs ALS" and its like you blokes think they are somehow an actual procedure to be carried out like splinting a broken arm "oh I gave this patient BLS" mmmm yes .... Because this patient is stable he is a "BLS" patient even tho he's been shanked in the stomach but only has a teeny-weeny hole despite the fact he is gonna crash ten minutes into his "BLS" transport.

All patients to not require "life support" and I think this is an outdated term, as you said they require care. Most care is very simple and carried out by all levels of Ambulance Officer be they a "BLS" level Technician or an ALS level "Intensive Care" officer. Included are the essential primary elements of practice like communication, safety, history taking, vital signs, physical assessment etc and does not vary between practice levels except maybe for 12 lead ECG monitoring, you can also include fundamental patient care like splinting and transporting, oxygen, salbutamol etc. This is one of the reasons I am really pleased with the way Ontario has structured its education program for Pirmary Care Paramedic; it's two years and includes the in-depth education in A&P, patho etc so that they can go in and conduct a good, detailed assessment and differential diagnosis of a patient and begin to hone and develop thier skills and knowledge rather than just a two page four hour class on how to take a few vitals and ask SAMPLE questions, for example. Australia with it's Advanced Care Paramedic (ILS) internship and post-graduate qualification for Intensive Care Paramedic (ALS) also offers a good comparison to draw here as they should offer simmilar outcomes. Ask your basic EMT to tell you how to differentiate between say indigestion and .... a gallbaldder attack for example.

Some care that ambo's offer patients is quite invasive and advanced; such as rapid sequence intubation, thrombolysis and chest decompression. These advanced skills require a solid grounding in bioscience and extensive experience, competency and overall a high level of confidence which is inherently linked back to the other competencies I outlined. It takes four to five years to become an Advanced Care (Canada) or Intensive Care Paramedic (Australia/NZ). Contrast this with some dude who has 700 hours of education over 14 weeks at the Houston Fire Department's Paramedic-R-Us patch factory.

You mentioned fundamental skills like bag mask and this is often a problem I see with people. They bag the snot out of patients and don't understand the reasons why they shouldn't. Try to explain to them about hyperoxemia, hypocapenia or dynamic hyperinflation and they just give you a glazed over look. Ask any ambo how GTN works and they'll tell you "dialates blood vessels" and no more.

So who does which? Which what? Well if we want to refer to "life support" my argument is that ambo's don't really do that and I am sure a lot of intensivits and ICU RNs will agree with me. My spin is that "care" is provided. Therefore we should do away with this "life support" nonsense and embrace what Canada has done; term everybody some level of "Care" (ehem, Alberta and Manitoba excluded, whacky Albertobaians...) because that's what 99% of my jobs have been .... providing CARE and not "life support".

Two level systems (US)

Primary Care (old BLS)

Intensive Care (old ALS)

Three level systems (US)

Primary Care (old BLS)

Advanced Care (old ILS)

Intensive Care (old ALS)

Everywhere else in the world smart enough to not have a "BLS" level

Advanced Care (old entry to practice)

Intensive Care (old ALS)

Until you guys fix that whole BLS vs ALS crap it'll continue to be what makes your system a joke.

[Jinketsu]

BLS before ALS

you have to be an emt for a year atleast before you can start to be a medic.good emt skills is what makes a good medic.i dont give a damn if you are ALS is you cant to the basics then you are no good to me.think about how many ALS calls really go down on any given day,where i work(in manahttan) alot of calls get upgraded by the callers because they want an ambulance to get there faster but when you get there its bullshit.

yes ALS is hard,i was in medic school til i got hurt at work and had to drop out but so is emt work.medics need us and we need the medics.alot of places double as bls/als and are usually run by fire and thats the true issue imo. if you are a fire fighter then thats great but the system should be kept seperate.ems should be run by someone who has medical traning and not by a fire fighter.

getting back to which is better,neither is better,its what you know and how you do it.i can start a line,do the leads and push drugs better than some of these medics out here but i have seen als do better immoblization and basic bleeding control better than some of the techs who have been on the job for 20 years.

if you are an medic then you need to keep up your emt skills because all als protocols say BLS interventions first and just because we are on scene there to help you otu doesnt mean have us do all of that because you dont want to.learn the new tricks from your emts as for the techs learn the simple things from the medics like how to spike a bag or how to put the leads on the pt.

ems isnt going to go anywhere if we keep bashing eachother,als saves bls but its bls skills that saves als

[JTpaintball70]

BLS before ALS

you have to be an emt for a year atleast before you can start to be a medic.good emt skills is what makes a good medic.i dont give a damn if you are ALS is you cant to the basics then you are no good to me.think about how many ALS calls really go down on any given day,where i work(in manahttan) alot of calls get upgraded by the callers because they want an ambulance to get there faster but when you get there its bullshit.

yes ALS is hard,i was in medic school til i got hurt at work and had to drop out but so is emt work.medics need us and we need the medics.alot of places double as bls/als and are usually run by fire and thats the true issue imo. if you are a fire fighter then thats great but the system should be kept seperate.ems should be run by someone who has medical traning and not by a fire fighter.

getting back to which is better,neither is better,its what you know and how you do it.i can start a line,do the leads and push drugs better than some of these medics out here but i have seen als do better immoblization and basic bleeding control better than some of the techs who have been on the job for 20 years.

if you are an medic then you need to keep up your emt skills because all als protocols say BLS interventions first and just because we are on scene there to help you otu doesnt mean have us do all of that because you dont want to.learn the new tricks from your emts as for the techs learn the simple things from the medics like how to spike a bag or how to put the leads on the pt.

ems isnt going to go anywhere if we keep bashing eachother,als saves bls but its bls skills that saves als

Wow... Just wow...

Ok, I do agree with you about fire needing to get the hell out of EMS. But not about anything else. You're focusing all on skills, which I know is the basis of this thread, but not going into education. I'm a fan of making medic the entry level with a CC level that is a BS degree'd provider. An AAS medic might have the knowledge to start to understand what's going on with the basic patients, but if we want to grow as a profession we need to stop the emergency only mindset and actually concentrate on those 'bs calls'. We can do a whole lot more good if we became a real branch of medicine instead of the bastard step child of both medicine and public safety.

If we started working community health as a full provider, we could help bring down the clog that ERs all over the country have. Look at Oz and NZ, those countries are closer to what we should be.

But of course, none of this can happen without us getting our asses in gear and standardizing EMS throughout the country. None of this volly vs paid vs private bullshit. None of this glorified boy scout (basic) vs ALS level arguments. We need to pull our heads out of our asses and look at it as medicine.

Oh, and BTW soem of the best medics I've worked with never spent a day in the field as a basic. They concentrated on their education and being the best at patient care. Not mastering a few skills you could teach a monkey to do.

[Kiwiology]

...its bullshit.

Sorry mate, but you're bullshit. Your poor spelling and atrotious grammar are just wrong.

...yes ALS is hard...

ALS is not "hard" maybe because you don't need any actual education in the United States to practice as an ALS level Officer you find it difficult. Look at why frusemide is being pulled off trucks, why standing orders in Los Angeles are two pages and why you still have "medical command" and practice piss poor remote control medicine in your part of the world.

You can write down on ONE SIDE of A4 what you need to do for a cardiac arrest; ask the resuscitation council they have done it. Doesn't mean it's "easy" it takes "skill" but very little "knowledge".

Now, try to write down on ONE SIDE of A4 the treatment and management flow-chart for a patient who presents with undifferentiated abdominal pain.

Sorry to say, acute stuff like cardiac arrests and intubation is easy, it takes SKILL but very little KNOWLEDGE.

Less acute patients which lets be honest, is 90% of the workload, well, my workload anyway, are HARD they take high levels of KNOWLEDGE and little skill.

getting back to which is better,neither is better.

[daedalus]

BLS before ALS

you have to be an emt for a year atleast before you can start to be a medic.good emt skills is what makes a good medic.i dont give a damn if you are ALS is you cant to the basics then you are no good to me.think about how many ALS calls really go down on any given day,where i work(in manahttan) alot of calls get upgraded by the callers because they want an ambulance to get there faster but when you get there its bullshit.

yes ALS is hard,i was in medic school til i got hurt at work and had to drop out but so is emt work.medics need us and we need the medics.alot of places double as bls/als and are usually run by fire and thats the true issue imo. if you are a fire fighter then thats great but the system should be kept seperate.ems should be run by someone who has medical traning and not by a fire fighter.

getting back to which is better,neither is better,its what you know and how you do it.i can start a line,do the leads and push drugs better than some of these medics out here but i have seen als do better immoblization and basic bleeding control better than some of the techs who have been on the job for 20 years.

if you are an medic then you need to keep up your emt skills because all als protocols say BLS interventions first and just because we are on scene there to help you otu doesnt mean have us do all of that because you dont want to.learn the new tricks from your emts as for the techs learn the simple things from the medics like how to spike a bag or how to put the leads on the pt.

ems isnt going to go anywhere if we keep bashing eachother,als saves bls but its bls skills that saves als

BLS before ALS? How about we just give our patients the medical care they require. Putting a patient on oxygen is not a BLS skill, its medical care that is preformed by CNAs all the way up to MDs. Also, what is the obsession with calling medical procedures "skills" instead of "procedures". No one else calls intubation a skill, it is a procedure. Are we in 1st grade again going to motor skills class? And as mentioned by multiple posters above, doing procedures requires education not training.

Edited February 9, 2010 by daedalus

[armymedic571]

BLS before ALS

you have to be an emt for a year atleast before you can start to be a medic.good emt skills is what makes a good medic.i dont give a damn if you are ALS is you cant to the basics then you are no good to me.think about how many ALS calls really go down on any given day,where i work(in manahttan) alot of calls get upgraded by the callers because they want an ambulance to get there faster but when you get there its bullshit.

yes ALS is hard,i was in medic school til i got hurt at work and had to drop out but so is emt work.medics need us and we need the medics.alot of places double as bls/als and are usually run by fire and thats the true issue imo. if you are a fire fighter then thats great but the system should be kept seperate.ems should be run by someone who has medical traning and not by a fire fighter.

getting back to which is better,neither is better,its what you know and how you do it.i can start a line,do the leads and push drugs better than some of these medics out here but i have seen als do better immoblization and basic bleeding control better than some of the techs who have been on the job for 20 years.

if you are an medic then you need to keep up your emt skills because all als protocols say BLS interventions first and just because we are on scene there to help you otu doesnt mean have us do all of that because you dont want to.learn the new tricks from your emts as for the techs learn the simple things from the medics like how to spike a bag or how to put the leads on the pt.

ems isnt going to go anywhere if we keep bashing eachother,als saves bls but its bls skills that saves als

Ummmmmmm. I cannot even comment. I am less intellegent for reading this.

[EMT City Administrator]

I am keeping an eye on this thread.

If this turns into an ALS vs BLS bash fest, I will close it.

[Eydawn]

Again, this is an issue of education. The principle behind the idea of "BLS before ALS" is solid- you must master the building blocks and basic understanding of what you're working with before you move on to more advanced ideas and practices.

The problem is that our education is not structured correctly. You are given the wrong building blocks at the BLS level and with that a false understanding of medicine. It is MUCH more important to understand the biology of medicine than it is to understand how to use a BVM or apply a LSB. Your patient history is one of your most important assessment tools, and if you don't have the correct understanding to inform how you go about your line of questioning, you're simply muddling around and missing the point.

Anyone can be trained to master the physical skills of medicine... whether it's IV's, intubation, cardiac monitor placement... not everyone has the capacity to figure out how it all fits together at the level which allows you to make sound treatment decisions. I will, however, say that once you master the intellectual part of it you must also master the physical skills... because knowing what's wrong does you no good if you're incapable of performing the right actions to treat it. BUT! Without the correct thinking, all the skills in the world are useless to you.

Wendy

CO EMT-B