ALS FLY CARS

[tniuqs]

This quote from another thread:

rock_shoes:

Things like practitioner fly cars

I have some mixed feelings on this FLY car concept as of late. Agreed a great concept in some instances/situations but implementation on broad scale may NOT be the best idea in the long run for the future of Pre Hospital Care delivery.

Does it improve or delay timely care ?

What level of care (ALS or BLS) should the operator be ?

Is this tiered response effective when one cannot transport when required ?

In what geographical locations is it best applied urban, suburban or rural ?

Who drives the unit back to ER or Hall ?

This is a "work alone" situation on some calls, so should there be a safety mechanism in place for the practitioner ?

Could it be a waste of resources ?

Should it be operated under EMS (stand alone) or Fire Based services ?

Does it actually lower cost of ALS delivery (dispatch triaged) or increase the cost per call ?

Who is going to carry kits, monitor and my helmet ? (its all about ME )

Any thoughts pro or con ?

[FireMedic65]

These are used sometimes in my area. More often than not, when ALS is dispatched, there is BLS unit dispatched as well. The BLS is almost always volunteer, and they are destined to transport. When on scene, ALS does their thing, and they ride in the BLS ambulance with their driver and EMT. The driver of the ALS ambulance, follows to the hospital. (quite a waste of resources IMHO)

Sometimes though, the ALS will only have a paramedic. In this type of situation, they are dispatched along with the BLS. The BLS transports like normal, but the ALS fly car or chase car as we call it, is left behind. After cleared from hospital, the medic gets a ride back to the vehicle.

Again, I think this is a waste. Why do we need 2 ambulances for 1 patient? I can understand situations some have that deal with location. That is not the issue. Everyone deserves prompt and proper care.

In remote areas, where there is no ALS, I like the idea of the fly car IF THERE IS SOMEONE TO TRANSPORT. This ONLY works in areas where there are transport capable services, but not level of care capable.

[FredG]

Sometimes though, the ALS will only have a paramedic. In this type of situation, they are dispatched along with the BLS. The BLS transports like normal, but the ALS fly car or chase car as we call it, is left behind. After cleared from hospital, the medic gets a ride back to the vehicle.

This is how things are in my area. However, the BLS volunteer squads have an agreement with the ALS services that the EMT may drive the fly car to the hospital if the EMT is not needed in the back of the ambulance. If the ALS provider needs extra hands in the back, then the EMT stays with the ambulance.

It actually isn't a bad system for rural areas with low call volumes. There's a decent BLS response time and ALS intercepts are available for 85-90% of ALS criteria calls.

[JPINFV]

I think it really depends on why you have a fly car. If you have a limited number of advanced providers (e.g. Wake Forrest's APPs) who are doing additional jobs in addition to being a response paramedic, then it makes sense. After all, for example, fire inspectors in a lot of places drive around a car, not a fire engine. However, I'd personally prefer that the standard paramedics are on the ambulance because it takes away a reason for paramedics to abandon care to the basic. After all, if you're still going to have to go to the hospital, the patient might actually get the pain medication or antiemetics that they need.

[mobey]

We are looking at the "fly car" option in the remote area I serve.

We will have paramedics working a 4on4off schedule. That is to say, one paramedic on call at a time.

We are expected to back up at least 2 other services nearby.

Having us medics on 96hrs straight, I like the idea of responding to a scene, determining the need for als... then possibly handing off care to the bls crew and not having to make cot, wash rig, etc etc.

I believe it takes a responsible patient advocate-type Paramedic to work a fly car, for as JP says, it is pretty easy to pawn off pts on bls crews when your tired.

[FredG]

I believe it takes a responsible patient advocate-type Paramedic to work a fly car, for as JP says, it is pretty easy to pawn off pts on bls crews when your tired.

This is a very good point. In my case, the ALS service in my area runs 16 hour shifts and is very selective on who they hire (paying higher than surrounding services allows them to be more selective). Their procedures require that any time a paramedic hands off to a BLS crew, they must make sure the BLS crew is comfortable with that call. And, the director keeps an open line of communication with the volunteer BLS services that they work with, so there are very few problems.

In fact, over the past 2 years, I can only think of 1 instance where my department has had any complaints about a paramedic...and that was not a patient care issue or having a patient pawned off on the BLS crew, rather it was a complaint about the medic's attitude on scene made by a family member that we had to relay to their director.

No EMS resource model is perfect. But, in a low call volume rural area, a fly car can work if done right and with good leadership.

[rock_shoes]

Does it improve or delay timely care ?

What level of care (ALS or BLS) should the operator be ?

Is this tiered response effective when one cannot transport when required ?

In what geographical locations is it best applied urban, suburban or rural ?

Who drives the unit back to ER or Hall ?

This is a "work alone" situation on some calls, so should there be a safety mechanism in place for the practitioner ?

Could it be a waste of resources ?

Should it be operated under EMS (stand alone) or Fire Based services ?

Does it actually lower cost of ALS delivery (dispatch triaged) or increase the cost per call ?

Who is going to carry kits, monitor and my helmet ? (its all about ME )

Any thoughts pro or con ?

Just for a little more background I was referring to fly cars staffed by UK Emergency Care Practitioners. See the following link for some more information on what an Emergency Care Practitioner is in the UK.

Paramedic Practitioner

I have dealt with fly car use a couple of times myself and I did find it to be effective. Within BCAS we have staff members known as DUCs (Duty Unit Chief) whose primary role is to deal with any operational issues that come up through the course of the day. These DUC's are often ALS providers who are mobilized using SUV's stocked with all the standard portable ALS equipment. If all of an areas units are busy or an ALS designated call comes in when all ALS units are busy the DUC is sent in. If the patient does not require ALS level care the patient is taken to hospital by the first available BLS unit. If the patient does require ALS level care the DUC continues care and one of the crewmembers in the responding BLS unit drives the DUC's vehicle to the hospital. If the DUC needs the extra pair of hands the second BLS crewmember stays on the ambulance and the DUC either takes a taxi back to his unit or is dropped off by another crew.

[tniuqs]

We are looking at the "fly car" option in the remote area I serve.

We will have paramedics working a 4on4off schedule. That is to say, one paramedic on call at a time.

Mobey:

Well that certainly would be a good baby step in your area, if I can recall, ALS was not even funded prior to this. So perhaps the introduction of ALS and down the road with an increase in population and call volume it will provide stats to step up to a full ALS service ?

Or will this FLY CAR stay as a permanent feature ?

A better question may be just how effective can or will a single Paramedic be if (highly probable with a good dispatch system) arrives at Joe's Farm and to prior to arrival of a gut wagon, to find an arrest or AMI or an MCI ... and then must wait for a means to transport ? In fact not having a way to transport and we are back to a delay or a very serious lack of educated help on scene dang difficult to do CPR and ALS interventions of this I do have some experience in austere and industrial type settings.

That said a very advantageous position to treat and release but that said if permitted to operate to full scope of practice as in the UK, perhaps this is why our brothers and sisters in the UK are called "Super Medics"

cheers and thanks for the input ALL.

Edited March 18, 2010 by tniuqs

[mobey]

I think the fly car will have the ALS kits and it's own monitor. Therefor a Paramedic can start some sort of tx before the crew arrives.

Since we will be backing up a few other services It would only make sense to carry our als stuff in kits that are easily transferrable.

The idea is to not interrupt the bls car, but compliment it. We will/should get dispatched at the same time, I jump in my fly car, they in the ambulance and off we go.

I will probably get there first, but otherwise there would be no one there. This should actually increase our response times if the fly car is kept at the residence of the paramedic.

I do hope to be full time ALS at some point, but it is pretty hard to attract paramedics to a service that is 3hrs from any major centre, and only does 500calls/yr, so the fly car will prolly be the best we can do.

[tniuqs]

I will probably get there first, but otherwise there would be no one there. This should actually increase our response times if the fly car is kept at the residence of the paramedic.

I do hope to be full time ALS at some point, but it is pretty hard to attract paramedics to a service that is 3hrs from any major centre, and only does 500calls/yr, so the fly car will prolly be the best we can do.

Edited March 18, 2010 by tniuqs