ALS FLY CARS

[mobey]

OOps...... decrease it is!!

The health centre thing is touchy.

We are hospital based now and really all we are ever offered to do is hold down a youngster to have blood drawn.

The nurses here are very old-school (and just plain old) and they are very aware of thier "turf". There is even some grumblings when we start an IV and give nitro since this is seen as "Hospital work" and not ambulance.

However if said Paramedic also had some in hospital qualification it may be easier to accept.

As you may be able to tell there will be a HUGE learning curve when it comes to ALS out here, and the first few medics will have some real challenges ahead of them with both the nursing staff and current bls employees. There is not a single EMT here that has worked ALS before.

Anywhoo..... sorry to hijack

[tniuqs]

OOps...... decrease it is!!

The health centre thing is touchy.

We are hospital based now and really all we are ever offered to do is hold down a youngster to have blood drawn.

The nurses here are very old-school (and just plain old) and they are very aware of thier "turf". There is even some grumblings when we start an IV and give nitro since this is seen as "Hospital work" and not ambulance.

However if said Paramedic also had some in hospital qualification it may be easier to accept.

As you may be able to tell there will be a HUGE learning curve when it comes to ALS out here, and the first few medics will have some real challenges ahead of them with both the nursing staff and current bls employees. There is not a single EMT here that has worked ALS before.

[aussiephil]

Squint,

my service have what we cal Rapid (Rabid) Responders. These are either Intensive Care or Extended Care Paramedics. We also have Intensive Care Paramedics on Motorbikes.

As a call comes in, it is run through a ProQ&A series of questions. Depending on te response, they will resopns one of the above, as well as a normal double crewed ambulance. In the city, the motorbike is on scene post haste & can then advised how they need the larger vehicle to respond. They are stocked with a full drug kit, defibrillator & small O2 kit. Enough to get them by until the other car arrives to back them up.

The other 2 are used to deploy in more urban areas, but still respond quicker than a normal ambulance. Again, they are deployed on the ProQ&A questioning & dispatched with a double crew to back them up.

Extened care is different again. They are called in by a double crew to treat the patient at home, with a view to non transport. They can perfom a number of additional functions & proceedures & assess the competency of the patient & appropriateness of non transport options. This means that one person is tied up, in a vehicle not designed for transport, instead of 2 with a transport vehicle.

With healthcare becomeing a bigger & bigger issue, options cuch as Extended Care, Competency Assessment & Refferal, non transport are what all progressive forward moving services will have in their arsenal. Pre Hospital medicine is moving away from Pick em up, Pack em in, Piss em off, no treatment ambulance drivers, to highly trained professionals who have learned to recognise & distinguish when a person will need a hospital visit, & when they are better served at home.

Phil

[Lone Star]

In some counties in Michigan, the Sheriff's Department has a 'Paramedic Division'. These Deputies have full arrest authority, and operate as any other patrol unit until they're called out for a 'Tier 1' call (DIB, chest pain, etc).

In the event that the medic Deputy has to accompany the patient to the hospital because of ALS care being rendered, usually the EMT from the transporting service will follow in the medic's patrol unit.

On scenes where the Deputy paramedic is on a fire scene, and a patient is transported, they'll usually snag a Firefighter to drive the Deputy's vehicle, and then the deputy will either return them to the fire ground or if the call is over, back to the station.

All things considered, this is a system that does work, as it frees up the Medic/Medic and Medic/Intermediate units for other calls.

GCSO Paramedic Division

[jjd]

Hi all,

(This is my personal opinion based on my experience and should be taken with a pinch of salt *and a shot of tequila if you feel like it *. Below is just what i have heard through various documentaries and are not based on an actual study)

I am aware that this thread is quite old, but i thought i would give my 2 cents anyway. The "fly cars" that have been mentioned are standard operating practise for ALS medics in SA (South Africa). Primary reason for this being the lack of ALS units available. Standard level of training at the moment is Basic with very few Intermediate or Advanced practioners. I work in Johannesburg, Gauteng... one of the largest cities in Africa with an estimated population of 7.5 million (2007 census). The area i work in (Ekhurleni) has an estimated population of 2.5 million, with on average 3 - 4 ALS medics practising at any given time. The 3 - 4 ALS medics i mentioned are entirely provincial/government based and the majority of calls for higher LSM's are handled by private ambulance services which have their own ALS units. Provincial ambulance services cater for the majority of the population while the private ambulance services cater for the more afluent individuals that can afford medical aid.

I recently watched a well known and reliable TV show that had a documentary on EMS in SA. It is estimated that at present there are only +-330 ALS medics currently practising pre-hospital emergency care (the rest working for private companies or have left to pursue greener grass in another country). 330 ALS medics in SA with a population of over 47 million. On a typical call a BLS or Intermediate will be dispatched to the scene (obviously depending on the severity), once an initial assessment has been done an ALS unit may be requested but not guaranteed due to the dwindling number of ALS medics. Generally what happens is that a particular fire station (housing both EMS, Fire, Hazmat, Rescue) would operate over a small designated area. ALS units would operate over many areas at any given time and are asked to drive long distances to respond to calls. So essentially what is happening is that non ALS units who respond to calls primarly in their designated area get very few calls and spend majority of their time bored and watching TV. ALS response units who span multiple areas and are few and far between are constantly being overloaded with calls and driving huge distances.

I can't comment on how the private EMS services operate but within provincial/government our ALS response cars are constantly being pushed to their limits and are extremely over worked. What i have found in the past is that many of the calls that should be regarded as BLS/ILS are being handled by ALS, which given the limited amount of ALS in this country doesn't seem like a good idea.

[gemini1030]

Here we utilize ALS ambulances on the street. However. it a paramedic calls in sick and no other paramedic can cover, we will make two BLS units and place a paramedic in the fly car. Dispatch determines ALS need for these units. The BLS ambulance and or fire will arrive on scene prior to the fly car. Once the fly car arrives, the paramedic will ride the call on the ambulance and one of the basic providers will drive the fly car to the hospital (Non emergent of course) to swap back. If extra manpower is needed on the ambulance (CPR) a fire fighter will ride in since they are all at least EMT-I on the fire department. Once the patient is transferred to the ER and the report done, the paramedic goes back into the fly car and the ambulance goes back to a basic unit.

Should there be 2 ALS calls in the areas of the basic units, the supervisor will respond or the next ambulance over. So far it seems to work well when needed.

[Richard B the EMT]

In the late 1980s, and again in 1996-1997, what is now the FDNY EMS Command experimented with PRUs, or Paramedic Response Vehicles. In the more recent version, they'd team up a Paramedic with a Paramedic Lieutenant, in a vehicle that kind of looked like a roadside motor repair truck. They would attempt stabilization of the patient, if the call so warranted, until the ambulance, usually a BLS, could respond and effect transport, with the Paramedic riding in with the BLS crew. In between calls, the Lieutenant could take care of field supervision of both ALS and BLS ambulances in the district. It developed into problems, as, if on a response, the lieutenant couldn't supervise, and if supervising, were unavailable for handling assignments.

I mentioned the late 1980s for a reason. Due to mismanagement, half the fleet, on a citywide basis, were down for various mechanical reasons, at one time. The "spec-sheets" for the majority of these ambulances supposedly was a book about 2 foot thick, so obviously something was bound to break.

During this time, with no ambulance to go into, BLS teams would use department sedans, and use the radio designation of a "Triage" car. They would treat and stabilize as needed, and remain on the scene until a working ambulance could respond to transport. The ALS teams would do likewise, but under the designation of a "Union" car.

My own opinion of this is, they keep coming up with the concept of Paramedics in Fly-cars, but consider it an either/or type deal. This translates, as I see it, into Paramedics in Fly-cars only, versus Paramedics in ambulances.

We currently use a "Pair-a-Medics", where one can doublecheck the other, or trade off if one cannot get an IV going on any particular patient. This is why we mostly object to the so-called "Mensa-Medic" single Paramedic type responders. Consider it a kind of built in safety for patient treatment.

[jjd]

I forgot to mention, our ALS response cars have a single Paramedic on board (no BLS/ILS unit accompanies them). More often than not the response car will arrive first at a scene, making a single individual paramedic responsible for handling the entire situation regardless of the amount of casualties. I believe in our scenario this is extremely unsafe as ALS units are often sent into unsafe areas with no partner and no additional backup most of the time.

[Richard B the EMT]

I forgot to mention, our ALS response cars have a single Paramedic on board (no BLS/ILS unit accompanies them)... ...I believe in our scenario this is extremely unsafe as ALS units are often sent into unsafe areas with no partner and no additional backup most of the time.

Partners are important for scene safety. If one sees an evolving danger, they can alert the other that it's time to, if temporarily, "Get out of Dodge". Also, 2 people working from a bag containing narcotics is harder to rob than one person working from that bag. Another set of eyes to keep a lookout.

I do have to say that even teams of BLS or ALS don't constitute safety. I know a woman, now a former NYC Health and Hospitals Corporation EMS EMT (retired before they became FDNY EMS Command), with her partner, went on a call that wouldn't have had the NYPD also dispatched (I think a sick child type call). There was no answer at the door, and they started back to the ambulance. As the elevator doors opened in the lobby, she and her partner found themselves looking down handgun barrels! The 2 men who robbed them took their radios, and the keys to their ambulances, as well as their cash. They actually "hit" several EMS crews that month, in more or less the same way: crews set up by being sent to empty apartments, and the callers not leaving a callback number (prior to caller ID services being available). While the ambulance keys were all recovered IN THE LOCKED AMBULANCES, the radios were being stolen by this duo, for radio communications for a security patrol these geniuses were trying to start up.

[rock_shoes]

Bump. It looks like BC Ambulance is getting ready to try deploying ALS fly-cars throughout the Greater Vancouver Regional District (GVRD). Something about reducing ALS response times to the most critical calls. That's all well and fine but ALS or not you can't effectively run a code by yourself. More stop-gap banking on first responder deployment foolishness in this particular case I suspect.