ALS versus BLS

[DFIB]

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.....

Why do you say that your rural basics are more advanced than the rural basics in the states? Have you ever been privy to the operational in's and out's of service in rural states. This is not an attack but an honest question.

[Kiwiology]

Why do you say that your rural basics are more advanced than the rural basics in the states? Have you ever been privy to the operational in's and out's of service in rural states. This is not an attack but an honest question.

Australia only have two levels; Paramedic and Intensive Care Paramedic so "Paramedic" is the equivalent to their "basic" level because they do not have a lower level.

A Paramedic in Australia will have a very broad scope of autonomous practice that includes things like LMA, IV cannulation and fluid administration, adrenaline, parenteral analgesia, salbutamol +/- ipatropium, midazolam for seizures, ceftriaxone (most states), aspirin, GTN, glucagon/glucose IV/glucose oral and some other variants depending on your state ambulance service; e.g. box jellyfish venom in Queensland

There are moves-a foot to standardise the scope of practice but it's slow going

In New Zealand

Paramedic

OPA, NPA, LMA, PEEP, tourniquet, 12 lead ECG interpretation, defibrillation, cardioversion, NaCl 0.9%, aspirin, GTN, salbutamol, ipatropium, glucagon, 10% glucose, ondansetron, loratadine, entonox, methoxyflurane (where used), paracetamol, adrenaline, amiodarone (cardiac arrest), ceftriaxone, morphine, fentanyl, midazolam (seizures), naloxone

Intensive Care Paramedic

Paramedic + intubation, intraosseous access, cricothyrotomy, chest decompression, pacing, atropine, adenosine, amiodarone (fast AF or VT), ketamine, midazolam (sedation), vecuronium*, RSI (selected Officers only)

* All Intensive Care Paramedics can sedate and paralyse an already intubated patient (i.e. dead person) but only selected RSI trained ICPs can anaesthetise and paralyse to intubate, the difference is subtle but important.

[craig]

thanks for posting the reply kiwi, saves me doing it

I say what i did dfib, because of the differing level that ou guys have in the states, the 'basic' ambo has very little to go with.

the basic qualified level we have here in nsw is what kiwi has put up, give or take....

the only level lower than paramedic (P1) here is trainee/intern and they can not work without a qualified officer

hope that helps a little to understand

very similar here to kiwiland though

only there are more of us...........lol

[systemet]

I'm going to start from the assumption that anyone becoming an EMT is planning on one day becoming a paramedic. I know this isn't always true. The way I see it, you've got two major goals as an EMT in preparation for medic school:

(1) Gain exposure to the largest possible number of patients, so that you have seen many conditions as an EMT before you encounter them as a paramedic, and develop your physical examination / assessment skills.

(2) Get lots of experience managing calls.

An all-BLS system, or a tiered system that has infrequently available ALS, is optimal for (2), and even better if you see a lot of patients, meeting (1). This would be ideal, in my opinion. I think the benefits of having worked with an ALS partner prior to going to paramedic school are understated, although a decent paramedic can provide a mentoring role. Your history taking / physical examination skills will (hopefully) improve during paramedic school, but if you begin with them already well-developed, you're ahead of the game.

Unfortunately (or, I guess, fortunately, depending on your perspective), most of the busier services that meet (1), tend to have an ALS tier or are all ALS, either reducing your exposure to sicker patients, or limiting your opportunities to develop leadership skills on critical calls, as you'll likely be deferring to a medic. Typically these jobs also pay better, and are closer to major population centers.

It's nice, for example, if you've got to run at least a couple of cardiac arrests BLS before you end up on an ALS practicum. It's nice to have run a couple of MCIs, before being thrust into a situation where not only are you the senior provider, you may be the only ALS provider, and you may have to make some very difficult decisions while balancing multiple factors.

[Kiwiology]

very similar here to kiwiland though

only there are more of us...........lol

Fur Suvun Nine hundheld calls Sudnee ... I still don't like my partner, when is my new one coming? Hang on, hey Craig why are you driving off without me? Poo, not again!

The question is sort of redundant here really since both Officers alternate driving and attending unless the patient is critically unwell (if the patient is stable it doesn't matter if they've been loaded up on morphine (for example) the lower qualified Officer e.g. Technician can attend to them) and there really is not a whole hell of a lot of difference between our levels; there is some obviously

[craig]

Fur Suvun Nine hundheld calls Sudnee ... I still don't like my partner, when is my new one coming? Hang on, hey Craig why are you driving off without me? Poo, not again!

The question is sort of redundant here really since both Officers alternate driving and attending unless the patient is critically unwell (if the patient is stable it doesn't matter if they've been loaded up on morphine (for example) the lower qualified Officer e.g. Technician can attend to them) and there really is not a whole hell of a lot of difference between our levels; there is some obviously

sounds the same as it is here kiwi, except we dont say it with a funny accent,..........

[craig]

Just to clarify,

Paramedics (our basics) can give

- Adrenaline 1:10 000 in cardiac arrest IV

- Adrenaline 1: 1 000 in Anaphylaxis IV/IM/ Neb

- Atropine Auto injector for CBR/NBC incidents

- Glucose gel for Hypoglycemics

- Glucogon for the same

- Glyceryl Trinitrate for ACS

- Hartmann's Soln. (ringers lactate)

- Lignocaine 1% (local anaesthesia)

- Metaclopramide

- Morphine for pain

- Naloxone

- salbutamol (Neb) adult and paed.

- Aspirin (ACS)

- Midazolam (fitting) IM / IV/ IN

- Methoxyflurane

- oxygen

- Paracetamol

- Ipratropium bromide (adult & paed.)

- fentyanl IN

- Benzyl Penicillian

- Influenza vaccine

- Ibruprofen

- Tenecteplase (selected officers currently, rolled out as standard by end of 2012)

- Enoxaparin Sodium (selected officers currently, rolled out as standard by end of 2012)

- Clopidogrel (selected officers currently, rolled out as standard by end of 2012)

- glucose 10%

- Ondansetron

- fexofenadine

- Obidoxime (CBR/NBC)

and skills are 12 lead egc, LMA, OPA, NPA, IVI,IN, IMI, SCI, BGL, Laryngascope & magill forceps

just to name a few.

the ICP can do more and give a few things more as well..

Edited April 3, 2012 by craig

[Kiwiology]

- Tenecteplase (selected officers currently, rolled out as standard by end of 2012)

- Enoxaparin Sodium (selected officers currently, rolled out as standard by end of 2012)

- Clopidogrel (selected officers currently, rolled out as standard by end of 2012)

I see that thrombolysis for Paramedic (ie non ALS) is being introduced here too (probably not until 2013)

I am not sure if I agree with it to be honest, whats your structure/guideline around that look like?

Edited April 3, 2012 by Kiwiology

[Steve Whitehead]

I've worked both dual paramedic and EMT/Paramedic systems and my personal preference has always been divided EMT/Paramedic units. I do like working with another paramedic, but overall, I just think the EMT/Paramedic system provides a stronger platform for EMT skill development and it supports the long term development of personnel as they enter the EMS field.

A few years back at my organization, the ALS/BLS tiered system vs. ALS/BLS mixed resources debate got so heated that I made a video cartoon joking about it. The overly intellectual arguments for each side just started getting ridiculous, so I basically mocked the whole process. It was very successful and got everyone to lighten up a bit. You can still find the video on YouTube here:

Edited April 3, 2012 by Steve Whitehead

[DFIB]

Just to clarify,

Paramedics (our basics) can give

- Adrenaline 1:10 000 in cardiac arrest IV

- Adrenaline 1: 1 000 in Anaphylaxis IV/IM/ Neb

............

I see your point. It is an extensive protocol. It sounds more like comparing apples to oranges in levels of care and a semantic difference in the job titles. Your "paramedics" would not be considered "basics" anywhere on the American continent.

Maybe that is why you call them paramedics.

Edited April 3, 2012 by DFIB