ALS Intercepts

[Richard B the EMT]

FYI:

FDNY EMS Command, and it's predecessor, the NYC Health and Hospitals Corporation EMS, operate on the premise that the majority of calls don't require the higher level of training of ALS Paramedics, and only require BLS EMT-Bs. In essence, someone with a broken arm from a soccer match (Congrats to Spain yesterday, by the way, in a game I usually don't follow) doesn't really require the services and expense of a Paramedic team response, and can quite easily be handled by an EMT team, at lower cost.

[mobey]

In essence, someone with a broken arm from a soccer match (Congrats to Spain yesterday, by the way, in a game I usually don't follow) doesn't really require the services and expense of a Paramedic team response, and can quite easily be handled by an EMT team, at lower cost.

Ahh, yes.... once again the penny pinchers care not about patient care.

[BushyFromOz]

Ahh, yes.... once again the penny pinchers care not about patient care.

Someone should sue for personal damages "pain and suffering"

Fuck, how can we be so inhumane?

[Richard B the EMT]

Someone should sue for personal damages "pain and suffering"

Fuck, how can we be so inhumane?

I don't know about inhumane.

The ratio is 2 or 3 BLS to 1 ALS, and when the call matrix doesn't have the ALS dispatched in the first place, the BLS crews can always request them (preferably at the soonest opportunity of recognition ALS is needed, as already described).

[BushyFromOz]

I don't know about inhumane.

The ratio is 2 or 3 BLS to 1 ALS, and when the call matrix doesn't have the ALS dispatched in the first place, the BLS crews can always request them (preferably at the soonest opportunity of recognition ALS is needed, as already described).

Delaying pain relief is inhumane no matter which way you cut it

[Kiwiology]

Delaying pain relief is inhumane no matter which way you cut it

I know mate it's bonkers hence why both here in NZ and AU Paramedics have morphine and Intensive Care has additional options.

[BushyFromOz]

I know mate it's bonkers hence why both here in NZ and AU Paramedics have morphine and Intensive Care has additional options.

And even then it was 15 years later than it should have been

[p3medic]

I am a believer in pre-hospital pain management, however not everyone with a complaint of pain needs two paramedics and a bolus of morphine. Most people with a simple fx would get a ride to the hospital and sit in the waiting room, and would eventually be triaged and recieve medication. I think BLS level care, i.e. splinting, ice and elevation do a good job to reduce pain. In a city like New York, tying up an ALS unit to provide MS to an isolated extremity fx would likely mean someone else would go without. In a perfect world people would call for EMS only when needed and not for every ass ache, bug bite and fever. Urban areas are overwhelmed by minor illness/injury patients looking for a ride, and as a result resources are stretched thin. It would be great if everyone who called got a doctor, but it isn't going to happen, too much $$$. The folks who believe in an all ALS service need to realize how difficult it would be to maintain good clinical oversight and ensure skill retention, i.e. intubation. I don't have the answer.

[AnthonyM83]

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?

Doing a lot right actually, but those interventions would be considered ALS procedures (even if it's a non-ALS unit), no? Oh, if only Dust where here, he'd go off about that. In the US, non-ALS tends to be more ... well non-ALS (for the most part).

I feel like this is an easy problem to solve. Give clear cut ALS criteria (similar to Ruff's list) and be able to recognize need for additional resources and call early, otherwise just transport. Someone with CP might be stable, but the c/c itself warrants ALS even if they might not be doing too much for the patient.

[JakeEMTP]

I am a believer in pre-hospital pain management, however not everyone with a complaint of pain needs two paramedics and a bolus of morphine. Most people with a simple fx would get a ride to the hospital and sit in the waiting room, and would eventually be triaged and recieve medication. I think BLS level care, i.e. splinting, ice and elevation do a good job to reduce pain.

P3medic, I feel I have to disagree with you here. Obviously you have never broken anything before. If a service has the ability to control pain, then it needs to be done. Who are we to say whether a pt. needs pain control or not? If they hurt, they get relief.

In a city like New York, tying up an ALS unit to provide MS to an isolated extremity fx would likely mean someone else would go without.

Not if every ambulance had the ability to perform ALS interventions. Other major cities in the rest of the modern world do provide all ALS services. Why can't it be done here?

The folks who believe in an all ALS service need to realize how difficult it would be to maintain good clinical oversight and ensure skill retention, i.e. intubation.

Nonsense. See above. Other major urban centres World wide can do it. It is the responsibility of the provider and the service he works with to maintain their skills. Here we have to perform BLS/ALS skills annually in a clinical setting to be able to continue as a provider. Sure it's a pain in the a$$, but a necessary one at that. Intubation is falling to the wayside BTW. Basic airway interventions will do in most cases. I have only had to intubate 3 times this year but still manage to do it in under 10 seconds. Again, it is up to the individual to keep up to date and proficient.