ALS Intercepts

[Just Plain Ruff]

While the system I described that FDNY EMS, and units covered under the NYC 9-1-1 system, can always stand for improvement, (and what system can't stand improvement?), I operate on the premise that it has to be better than where we were, only a few years ago. Again, I believe that can be applied to all EMT City's members and their departments.

Actually Richard, I'm going to have to be the odd man out.

The most recent service that I worked for has gone from a great service to a embittered/embattled service that is lucky to keep 1 ambulance staffed on a 24 hour consistent basis.

The majority of employee's are very unhappy. The employee's live under constant fear of discipline and a place where being on the cell phone "too much" will get you fired.

Three management changes in less than 2 years. A distrust of management and a belief that management lies to them on a consistent basis.

It used to be that there was pride in going to work for them, they were the service that was in demand to work for.

The protocols are a mess, there is minimal oversite of the staff in protocol usage. No M&M reviews, no call reviews. A slim QA program.

Overuse of the helicopter service.

When asked where I worked at I would tell people in other services and they'd say "What is going on with your service. All we hear is bad things about it" This from at least 8 different ambulance services spread out over two states.

Instead of evolving and growing as a service, they seem to be devolving and self destructing.

I used to have pride in saying I used to work for this one service and now I just say "I used to work for a service in the mid part of Missouri"

[BushyFromOz]

Ok, I'm sorry that I am not medic and cannot administer pain medications, but what I am trying to say is that instead of waiting on scene for 15 minutes or more for a medic who can take care of them to a higher level than I can, I will make them ans comfortable as I can and cut the time they have to wait. If the intercept is 15 minutes away and I meet them halfway, it will take 5 min or more the patient will have to deal with the pain. Sure it would have been better to have sent out a ALS unit out in the first place, but sometimes that is not possible or just not done. I do the best I can with my scope of practice.

see, people here still miss the point...... BLS is not equipped to deal with basic complaints, either up educate and skill it or lose it like most of the rest of the world has, or keep providing substandard care.

[Kiwiology]

see, people here still miss the point...... BLS is not equipped to deal with basic complaints, either up educate and skill it or lose it like most of the rest of the world has, or keep providing substandard care.

What about those of us who are just substandard to begin with despite what is in our bag of tricks?

[BushyFromOz]

What about those of us who are just substandard to begin with despite what is in our bag of tricks?

What about us? Not only am i card carrying member i founded that club!

[uglyEMT]

see, people here still miss the point...... BLS is not equipped to deal with basic complaints, either up educate and skill it or lose it like most of the rest of the world has, or keep providing substandard care.

Bushy you make it sound like we, as providers here in the US, keep ourselves below ALS level of care deliberatly. Unfortunatly, my friend, this is just how it is in our country as a whole. In the US ALS is a specialty and not a norm. Most providers staff with BLS and keep ALS in reserve. Please do not fault the BLS guys and gals for being part of our broken system. As was stated previously in some parts of the country being ALS is actually a hinderence to employment because the system only wants a few ALS level providers and keeps them hospital based vs company based.

BTW in my area even ALS does not provide pain managment. Its against SOP. Yes we are behind the world in our level of care but dont fault the men and women working inside the system because of broken SOPs, we do the best with what we can. So even being a Medic we would, by your terms, still be providing substandard care no matter how big our bag of tricks is.

In a perfect world every EMT would be at the highest level of cert and provide a patient with the highest level of care but unfortunatly this is not the case. I wish it wasnt but again dont fault the men and women for working inside the system provided.

Edited July 22, 2010 by UGLyEMT

[JakeEMTP]

Uglyemt and BoCat,

Don't take everything so personally. Far be it for me to speak for Bushy, but from what I took from his post was he was advocating ALS (or total pt. care, which I personally prefer) everywhere for all patients. I don't think he was slamming you personally.

I don't think your comment about all ALS providers would be detrimental to employment is valid. What we do is about treating the pt. accordingly. If that means that non ALS providers need to step up and increase their education then so be it. No matter what the level of provider the crew members are, there will ALWAYS be a need for 2 of them.

I also have to disagree with your hospital based ALS theory. Outside of NJ, this is the exception and not the rule. As an example, here in NC very few EMS agencies are Fire based and even less are hospital based. I can't off hand think of even one. Hospitals provide critical care inter-facility ground/air transport. The flight services are also hospital based. Most EMS is provided by the Counties. There are only a few of the 100 NC counties that do not provide paramedic level care, and that is going to change in the future so all residents will have access to ALS care I have heard.

So you see it can be done. It just is a different way of thinking as to providing for the citizens the best care possible. You no doubt are an excellent provider. It isn't fair though to your pt.'s that they are denied advanced care because your scope is limited.

Edited July 22, 2010 by JakeEMTP

[uglyEMT]

I understand Jake. I do agree he was advicating ALS for all but I guess I disagree with the statement of educate up or be substandard.

I know my experience is limited to NJ and we are the backasswards state when it comes to ANY care. I hear it all the time. We suck and I know it. Do I wish it were different? Of Course. Will it ever happen? Doubt it. Too many hands int he cookie jar keeping it the way it is.

As far as my being a detriment comment, here in the NJ area it is. Folks that are ALS level are dying for jobs but being all are hospital based and are not hiring they go without. If they were BLS jobs aplenty.

I wish everyone would get the care they need at the appropriate level. It should be the norm. I always have advicated better level of care.

I always call for ALS when I get on scene if just by my initial impression the patient needs it and they haven't been dispatched already. My response area actually does very well getting ALS out just as we get out so meet time is reduced and on the rare ocassion they even beat us there (happened twice so far that I know of). Do we sometimes dont get ALS support? Yes it does happen and on those occasions when I wish they were there and were not available I feel for my patient. I really do. But thats when i buckle down and try my best to reach way deep into whatever we are allowed to do and try to get my patient as comfortable as possible (not that I dont always try that, not saying I dont. I just go that extra little bit). Can I do much, NO. But hopefully what I do do helps even its just a shoulder. I know its lame for me to say that and I am not doing anything other then a placeibo effect but hey its what i got and I work with what I got.

I guess I just get upset (not directly at anybody just in general) when folks put down BLS as just basics and nothing else, we dont do a service to our patients, we a substandard, yada yada yada. I feel we are an intrical part of the whole system, a cog in the wheel so to speak. I just feel folks look down on us and for no ligitamit reason other than we are not paramedics. I know this gets us into the whole argument thats been beaten to death, runover, shot, stabbed, burnt, rerunover, beaten some more, then finally thrown on the side of the road so i will not go there and I will leave it at that.

I guess we all come from different areas, different providers, different systems and we will all never agree on anything other then the patient DESERVES the highest level of care available.

Edited July 22, 2010 by UGLyEMT

[Kina]

new skills and drugs invariably become ALS when new until services are sure they can be handled by less experienced officers...BGL ? GTN..etc

still, once the skill proves beneficial, and easily done, then why not move it down. Long gone are the days of Ambulance drivers.

Just imagine though if GP's could place IV's....Oh thats right they can they just dont. LOL

[Kiwiology]

More and more procedures and interventions are being moved down to Technician and Paramedic level Officers here with only a small handful being kept exclusively to Intensive Care Paramedics.

Adrenaline? 12 lead interpretation? cardioversion? fluids? GTN? naloxone? Our Paramedic level Officers can do all that and more and they have the educaiton to back it up.

From a strategic management perspective it makes so much sense!

[Lone Star]

Until EMS in the United States is taken out of the direct control of the Department of Transportation and National Highway Traffic Administration (USDOT/NHSTA), the need for higher educational standards is going to be a lost argument.

With organizations like NAEMS and NREMT focusing on 'minimum required hours of education', EMS is going to have a difficult time advancing from the 'dark ages'.

All other allied health providers have recognized that the need for 'evidence based medicine', unlike EMS; who still operates in the 'protocol driven concept'.

Each patient that we come in contact with deserves the best that medicine has to offer. With the fractured systems that are currently in place, the patient will not always recieve the best care until they get to the hospital.

Another aspect that must be investigated is a standard scope of practice throughout the U.S.. Until EMS becomes aligned with a MEDICAL ORGANIZATION, this will be difficult at best to achieve.

It't time that EMS does some serious introspection, and stops teaching EMT-B's that they can 'save the world' with O₂, glucose and a 'diesel bolus'.

*DISCLAIMER*: THIS IS NOT INTENDED TO DISMISS BASICS AS 'UNNECESSARY', OR TO DIMINISH THEIR ROLES IN EMS!

A lot of the success of ALS intercepts is dependant on early activation, along with the considerations of transport times, patient condition/stability and availability of ALS in the first place.