BLS vs ALS

[Kiwiology]

I would have Emergency Medical Responders and Paramedics....There would be no ALS or BLS.

That is my ultimate utopian fantasy (as far as EMS goes) and is pretty much how Seattle works with Boston and Tulsa not far behind.

I'd like to take that one step further, if I may.

Now when I say "Paramedic" here I am referring specifically to Intensive Care (ALS) but in this model we can make excellent use of Community Care (ECP/Paramedic Practitioner) and also alternate referral pathway programs like CARE in NSW, ECPs in the UK and our very own extended care/community paramedic service here in New Zealand (Wellington).

In my little utopia there would be lots of guys out and about in rapid responder 4WDs that can be high impact; go to calls and triage, treat and dispose either to self care, a referral pathway, treat and release or transport them somewhere appropriate (which may be, but does not have to be, the ED). It might be entirely appropriate to transport a broken arm in the car and not have to take them in an ambulance which would free up resources for when they really are needed.

There would be no "BLS" and no "ALS" there is just one level of a "Paramedic" who is your off-the-shelf standard ALS Paramedic (what we call Intensive Care) and throw in expanded pathways plus one or two select skills; none of thos million extra skills blowout crap just something like suturing and limited independant prescribing for some antibiotics or one or two common GP meds.

A complete change in the dispatch grid is also needed; this off-the-shelf AMPDS send everything on a 1 (red lights) is inappropriate and would change. You would have several variants

- Somebody in a 4WD + am ambo (for things like a cardiac arrest)

- Somebody in a 4WD (either an ECP or an Paramedic)

- Send the caller to a phone advice line coz they're not dying anytime soon

This is sort of how the UK works; send somebody in a 4WD and get him there quick, assess and cancel the ambulance if it's not needed so it can be sent somewhere more appropriate.

While retaining the "emergency" role of what ambo does now I think we need to shift more towards recognising the "community health" role too because lets be honest 90% of the jobs I've gone to are not "emergencies" and the patient needs "care" not "life support". New Zealand's new term for our model going forward is "emergency community health".

Obviously this would require very high levels of education, Bachelors Degree is a good place to start but Post Grad Dip or a Masters degree is more appropriate here.

Now this model may be easier to implement here or in other nations e.g. Australia and the UK because we have nationalised healthcare including a nationalised health information system (the National Health Index) but I think it would be a struggle in the US.

/End fantasy

Edited February 10, 2010 by kiwimedic

[ERDoc]

I haven't been around in quite some time but it is good to see I haven't missed much.

[BushyFromOz]

How about I don't care about your silly non-american systems. In a big urban fire systems your emt's are firefighters and have very little but a fast ride to offer as patient care/skills. Paramedics are king here and minus burnout and laziness if you want advanced care you hope you get them.

Get over the terms they are not going to change.

i agree with welsh, very ordinary.

Maybe you have a thing or two to learn from those silly non-american systems, if you can swallow your pride that is.

[ambodriver]

HEY GUYS!!!1!!

Screw your fancy medicine, 15 LITER NRB AND GO GO GO!!

Practicing good medicine is for suckers. BLS > ALS!!! You guys suck!!!!11!

sarcasm off.

this whole thread makes me want to puke.

[armymedic571]

HEY GUYS!!!1!!

Screw your fancy medicine, 15 LITER NRB AND GO GO GO!!

Practicing good medicine is for suckers. BLS > ALS!!! You guys suck!!!!11!

sarcasm off.

this whole thread makes me want to puke.

You Sir, need to get into a new line of work.

If that is the most intellegent reply that comes to mind.......FAIL!

It is basic issue like this, that effect OUR profession. Disappointing to say the least.

[ambodriver]

obviously someone doesn't comprehend sarcasm. I even posted 'sarcasm' after my reply.

[ccmedoc]

And the wheels keep turning...These threads should not be allowed to propagate..

But on an intelligent note = This is it...

[armymedic571]

obviously someone doesn't comprehend sarcasm. I even posted 'sarcasm' after my reply.

I am not convinced

[spenac]

obviously someone doesn't comprehend sarcasm. I even posted 'sarcasm' after my reply.

When you follow the sarcasm with makes me want to puke really does not lend credibility to your position.

[NRPinNEPA]

How about I don't care about your silly non-american systems. In a big urban fire systems your emt's are firefighters and have very little but a fast ride to offer as patient care/skills. Paramedics are king here and minus burnout and laziness if you want advanced care you hope you get them.

Get over the terms they are not going to change.

Really? If you notice, the NREMT-P patch has already dropped "Emergency Medical Technician - Paramedic" in favor of "EMT-Paramedic". There is also talk of dropping "EMT" and making it just say "paramedic". With the advent of AEMT, the crackdown on accreditation, and waning volunteerism throughout the country, you're going to see EMT and "BLS" shift closer and closer to a first responder type role until EMTs are essentially confined to volunteer first-response. EMTs won't be on ALS trucks for long. Give it 10 years and see how things are different.