ALS Intercepts

[spenac]

In Australia every Ambulance Paramedic (non ALS) can give adrenaline and IV analgesia.

In New Zealand from 2012 every Paramedic (non ALS) will be able to give adrenaline and morphine, and many already can.

In Canada every Primary Care Paramedic can give IM adrenaline.

Perhaps we are doing something wrong?

Again you are comparing your educated "non ALS" to the USA's trained not educated emt basic. By educating to a higher level you guys are doing much more right than the USA is.

[CBEMT]

Here Here!

Boggles my mind to know that the majority of ambulances in the US are incapable of providing something as basic as pain relief!

Bet I could boggle it again.

At my first job as an ALS provider, I had neither pain relief nor the ability to stop a seizure. The justification from the owner was "if they (the contract nursing home patient) need that stuff, then they (the contract nursing home staff) should've called 911."

I also did not have the ability to intubate anyone smaller than a 7.0. "Assorted sizes" apparently meant 7.0, 8.0, and 9.0 according to the state. No glucometers, and whether or not you had SPO2 capability depended on what your assigned truck was that day. No bag to carry anything in- get called for the unresponsive, I had to jump in the back after arriving and load up the back end of the stretcher with a BVM, ET kit, the little clear plastic box the OPAs come in, and the monitor. The Plano box was just too big and bulky, it stayed behind.

Trucks staffed by two EMT-Bs did not carry AEDs until about 3 years ago. The license carried by all our ambulances allowed the stocking of ALS equpment, like the LP10s that we had, under the provision that ALS personnel to use it might not always be on board. Management's rational was that our ALS-level supervisor's could "intercept" with any unit needing defibrillation- ignoring the fact that since the supervisors never left the main office, it was a 99% certainty that the BLS crew could make an ED before the supervisor could get anywhere near them.

I am curious, though how the rest of the world ended up using nitrous, which I don't think can be found on any American ambulance, yet some of those same systems can't even, say, cardiovert an unstable VT.

Edited July 12, 2010 by CBEMT

[BushyFromOz]

I am curious, though how the rest of the world ended up using nitrous, which I don't think can be found on any American ambulance, yet some of those same systems can't even, say, cardiovert an unstable VT.

ambulance was using entonox since the 70's here, well before all cars had defibs.

And yeah, you did boggle my mind

[Richard B the EMT]

I have vague memories of Nitrous Oxide/Oxygen machines from the mid 1970s in JEMS, but aside from printed and electronic ads, never seen the unit, or similar units, in person. Link for brand name "Nitronox" follows.

http://www.class1inc.com/product.php?nv=&cat=product33

[Kiwiology]

ambulance was using entonox since the 70's here, well before all cars had defibs.

And yeah, you did boggle my mind

We have had entonox for well, many decades and methoxyflurane for maybe five years.

Our ambulances first got defibs in 1972, nubain/foratol in 1985, morphine in 1990, morph+midaz in 2000 and ketmaine in 2005.

[Mateo_1387]

I am curious, though how the rest of the world ended up using nitrous, which I don't think can be found on any American ambulance, yet some of those same systems can't even, say, cardiovert an unstable VT.

Well, since you mentioned it...

NC state protocols allow for the use of Nitrous Oxide. The only system I am familiar with using Nitrous Oxide is Medic, from Mecklenburg County. JakeEMTP may know of others...

[Kiwiology]

According to the new National EMS Scope of Pracitice model the Advanced EMT can use entonox as well

[Carl Ashman]

Hi all,

We stopped using Entonox a few years ago when it was linked to foetal abnormalities in the first trimester (I've searched for the link high and low but can't seem to find it). We are now using alfentanyl and/or ketamine for short, sharp analgesia.

I think I may be getting a little off topic..

Carl

[JakeEMTP]

NC state protocols allow for the use of Nitrous Oxide. The only system I am familiar with using Nitrous Oxide is Medic, from Mecklenburg County. JakeEMTP may know of others...

Yeah, MEDIC is the only system wide service I am aware of that has Nitous. There is one service in our County that carries Nitrous Oxide, Eastern Pines EMS. I have never used it in pt. care personally. We have Toradol, Fentanyl and Morphine for pain control.

Regarding the topic, ALS intercept never really made sense to me. Why not just have all ALS providers, then the pt. doesn't have to wait for treatment other than having their face blown off by 15lpm high flow O2?

[Just Plain Ruff]

I just completed a Non-internet/non-texting weekend. Kind of clearing of the head weekend. I did check my work email but not much of anything else.

I agree with the majority of those here in their opinions.

ALS intercepts if done correctly can provide compromised patients who are receiving BLS care to get advance care. Correctly done I mean by saying is the BLS Crews recognize the need for ALS and call early.

Don't call me 10 minutes outside the hospital when you've had the patient for 20 minutes already. By then it's a piss in the bucket of what I can do for the patient.

Once the BLS Crews realize they need ALS the ball is already circling the proverbial toilet and there are many factors that help this ball get where it is.

1. The caller themself - what did they tell dispatch

2. Dispatch - what did dispatch ask of the caller or patient. Did they take it seriously or not

3. The BLS crew on scene - do they recognize the need for ALS quickly?

I would consider any patient with the following signs and symptoms as needing ALS intercept if you are a BLS provider

1. chest pain

2. shortness of breath

3. Altered level of consciousness

4. trauma that fits in the class 2 or 1 category

5. stroke symptoms

6. intractible pain

7. any pediatric patient with resp distress, chest pain or many other assorted problems.

8. Pregnant patients who are due within 1 -2 days having contractions or other assorted symptoms or if they are premature and in labor

There are others but getting some of the BLS Crews I've worked with in the past to think critically is like spitting at fish.

BLS providers seriously can handle most generic emergencies but the GOOD BLS providers recognize when they may need help and call for it early.

My 2 cents worth, maybe not worth 2 cents but my thoughts.