ALS versus BLS

[DFIB]

This question is directed primarily toward EMT-B's because it is directly related to their scope of practice.

In a rural setting, if you were given the opportunity to choose between riding with a Paramedic on an ALS unit or working straight BLS; Which would be more appealing?

What would be the pros and cons of either decision?

What is your rationale behind the choice you would prefer?

Now from a Paramedics perspective; What do you think would be the advantages of an EMT-B working in either of the capacities mentioned in the questions above?

[ATFDFF]

I'm a medic now but worked for about 6 years as EMT. I'm writing this assuming that the call types are the same no matter if a truck is ALS or BLS. Now, if you're saying that the only BLS truck would just do renal roundup and the ALS would do the majority of 9-1-1 calls, that would make a difference, obviously.

As an EMT, I would much rather work on a BLS ambo than an ALS. Even though there are many, many good medics who on less-than critical calls let their EMTs run the show....in the end the EMT is still "under" the medic. Also, on anything "good" obviously the EMT would end up driving on an ALS rig. Personally, being able to be completely "in charge" of the call on a BLS truck is more appealing than working on an ALS truck.

Now as a medic, I would rather have an ALS partner, for a few reasons. First, for the obvious help with skills and procedures on runs. Also, I like having the ability to switch off with my partner on calls....where as if there was a 1 Medic and 1 EMT ambulance, me (the medic) would get stuck with all the ALS calls and associated paperwork. Also, as a newer medic, I know I would be apprehensive and nervous about having an EMT (who possibly has years more experience than myself) work under me. Not sure why....but I know it'd make me nervous.

[runswithneedles]

Having worked a year as a emt. My answer depends on whos my partner. Does he have the superiority paragod/firefighter complex that treats me worse than the grime on his boot. Or does he treat me with respect as a fellow healthcare colleague. Personally I prefer having an ALS just because it allows room for error if a transferring facility lies to dispatch about a patients condition and they need the medic or the patients condition deteriorates while enroute to pick him up.

[DwayneEMTP]

I would think that in the first instance it would depend on your goals.

Do 'you' intend to move onto paramedic? Is your goal only to volunteer at your local fire station? What is the level of care provided at the basic/basic service that you're looking at?

I can't really give an unbiased answer as I found the City as soon as I began considering becoming a basic, so I can't imagine making a decision that would lead me down a path that contained less chances for increasing my education.

The downside to a basic/basic in my opinion is that you would have a built in intellectual glass ceiling. You would learn from, and your behavior/decisions scrutinized by those at more or less the same level as yourself, and there is much less room for growth there than if you were in the same situation with a more advanced provider.

Also the opportunity to learn and possibly practice above your scope of practice would be eliminated.

The only reason I could see to choose a basic/basic system is if 'you' were a whacker that just wanted to strut instead of advance, or if there were no other options available.

Of course this assumes the opportunity to choose to gain experience in a progressive, professional organization, as there are many services that allow little more for their medics than some services do for their basics.

I'm curious as to the catalyst for the question, though of course it may be personal and that's more than fine...

[Just Plain Ruff]

I prefer the Emt/Medic role

I have almost always worked in this sort of role and it suits me just fine.

I no longer work in the field, worked my last shift a couple of weeks ago. Hung up my stethoscope.

But having a dual medic is nice but I always have preferred the emt medic

Don't really have a reason behind that preference.

Oh yeah, let's not make this thread into a medic versus basic thread and I swear if I hear that mantra "EMT's save medics crap" well I don't know what I'm gonna do.

Edited April 2, 2012 by Captain Kickass

[CPhT]

Coming from the Detroit area, I like the idea of what we call "DEMCA" rigs; which is one EMT-Basic with either an EMT-Specialist or Paramedic. Basically, this expands your workforce by allowing you to send out an ALS truck, where in the systems that require at least 2 paramedics, you wouldn't be able to send out that truck due to understaffing.

As a Basic, I would personally love to go out on a DEMCA unit, because that would allow me to see a wider variety of calls. However, I know that when the time came, I would be relegated to driving. Unless the call was specifically able to be treated as BLS, every intervention that was to be done would be under the license of the medic, so I imagine they would want to "CYA" and do it themselves. I personally like to rotate driving and teching, so I would probably go nuts if that was my permanent role.

[DFIB]

I'm curious as to the catalyst for the question, though of course it may be personal and that's more than fine...

I am looking at a service that has both types of units. I was running the possibilities over in my mind and considering learning more by working with a medic as opposed to being able to prove competency and therefore advance in esteem in the company, I am not sure why.

It seems that there is an obvious trade-off in working EMT/MEDIC versus EMT/EMT. On the first the opportunity for learning is much greater while in the second I think an EMT would have the opportunity to work his entire scope of practice.

I also think that the experience of being "in charge" on an EMT rig would be important and productive learning as opposed to spending days spiking IV bags, carrying bags and driving the truck for a medic.

This makes me wonder if value of the skills learned watching the medic will outweigh the experience of having to "cowboy up" and make the correct critical decisions for my patient. I love responsibility and guess I would like the opportunity to prove myself in the more competitive US working environment. I also love learning from higher providers. Where I work now there is only one guy that can really teach me new medical skills but he is a real passive EMT and prefers for me to take the lead. I guess that is why I hang out with Drs.

There is learning in both environments although I would suppose that the basic/basic unit would be inherently self limiting in the level.

Hopefully I will get to do both.

Thank you everyone for you comments.

[DwayneEMTP]

I've little experience with partners, only having had a half dozen basic partners or so, but I think the stereotypical "Spike my fluids and carry my bags" ideal of a basic/medic partnership is most often not accurate.

For instance my last basic ran almost all of our arrest where IV access and meds were concerned because he was really good at it and we often had a dozen or so vollies on scene that needed to be monitored and utilized as well. After I had time to get to know him and his work it was common that he would begin more advanced assessments (lung sounds, pupils, abd palp, etc) and interventions (push drugs, apply CPAP, etc) while I did the "lesser" jobs of starting an IV because I could easily do that while gathering a history which I felt was the more important goal for these patients.

Sometimes he was given these duties because I was confident that information from others was really important for the diagnosis and I wanted to gather it in my own way, in my own order. Other times because I knew he was to become an medic student and it was good for him to use those tools. But always because I became confident that he would do everything to the best of his ability every single time. Very often better than me.

He was, and continues to be, the only provider that I've ever known that goes into every call with gloves on his hands, safety glasses on his face, and an N95 in his pocket, yet not have a whackerish bone in his body.

I've heard of teams where the basic was nothing more than a helper and a driver, but I've never personally known any medic that would stay long with a partner that s/he viewed that way. That type of partnership has to be ego driven, as most of what we do can be done by many, and not allowing people to explore the boundaries of their abilities is just contrary to what most of the decent providers that I know consider kind and/or interesting.

Not sure if that helps.

[DFIB]

Dwayne,

Your comments do help. I think that I am leaning toward the EMT/Medic team for all of those reasons that you mention. My experiences with Medics have been very positive for the most part. I am just a little apprehensive about ending up with one of those guys that just want a helper as opposed to an extender.

Thanks Brother

[craig]

guys

from my experience of a rural community it really dont matter

I am the only ICP on my station and therefore work with everyone else, however our "basics" are a little more advanced than basics in most areas of the states.

we take turn about each day as to who drives and who treats, If the patient requires paramedical interventions then i will step in and do what is required, but other than that I am happy to drive whilst the other guy treats.....