ALS or BLS? Help me decide...

[benanzo]

I think that we've misunderstood my intentions on this. I was not bashing the medics here. They are excellent and probably the best trained in the country but that alone is not making the system here great or even good. Medic One is terrific once they get a chance to do what they do. The problem is simply that the system is overwhelmingly BLS. The fact that the ALS/BLS decision is being made by EMT-Bs (Seattle Fire) who never see a call all the way through to the ER makes their scope of experience to decide that minimal at best. It seems that the private AMB company here, AMR has more experience with pt care than fire does. Every patient they see is one on one up close and personal gathering info and exam and then transfer to ER. That kind of experience is not part what the ffs are getting because when they see a pt they're in groups of 3,4,5???? very few of them have any good experience with report writing and exams and interpreting the results because they're not always the ones doing it. If I have to tell one more FF that hmc doesn't deliver babies I'm going to scream. they never see the end result of not taking someone into the ER on a board even though the mechanism warranted it...the nurse/doc doesn't call their station, no they grill whoever brought them in. There is very little accountability involved. I usually know if I did something wrong or if there was more I should have done when the ER tells me so. FF never get that criticism. But I'm not saying that AMR should take over as primary BLS response like some people here think they shoud....I think MEDIC ONE should do all transports. The city needs to divert funding from running ALS/BLS/BS calls with engines/ladders to buying more medic rigs and training more medics.

[dors]

I agree with most of that but a BLS crew should be able to make a sick/not sick decision from BLS education.

[benanzo]

it's not a matter of just being able to decide sick/not sick. There are way more factors than just knowing when to call medics. I am talking about knowing and understanding the specifics of transport and destination. They only ever see the first half of a call...nothing more, whether the pt went with medics or AMR, that is all they see. There is no transfer of care which is a huge part of field experience.

Personally I think seattle has begun a slow transfer from BLS fire to BLS AMR as primary response. They just started a formal contract about 3 years ago and have had AMR respond to many calls instead of fire which I think is a clear example that the fire engine is being slowly phased out of EMS all together. It's inevitable given the rising operational costs and limited willingness for taxpayers to pay for what they don't use. I think every system will be privatized eventually.

[Just Plain Ruff]

Quoted from Mamam

We do have an agency around here that sounds an awful lot like this Medic One unit. We call them the "God squad" because that is what they think they are. Just recently given the powers for MFI (last year) they have had to had to cric 5 people in the past 7 months alone. Never mind that they should have done this, but SHOULD they have done this? Not being on the scend, I cannot clearly say. But seems to me that you should be able to ascertain if you are going to be able to get a tube before ya'll go and paralyze someone!!

Ok what does MFI mean? and Cric 5 people in the past 7 months. That seems high but since you weren't on the scene you cannot judge what should have or should not have been done.

As for the statement that you should be able to get a tube before you paralyze someone, there are times when RSI is clearly indicated and there have been times when even then you cannot get the tube.

Before you go off blasting people you should walk at least a baby step in their shoes.

But in all defense, even though you clearly say you are a lowly baby EMT-cc don't cut yourself short. Keep learning and never never never stop asking questions.

[flight-lp]

I had the opportunity to meet a couple of King Paramedics last year and they had to be without a doubt the most arrogant medics I have ever met. The only words of substantiation that came out of their mouth was "we don't have to run BS basic calls". Wouldn't their momma's be proud! Honestly I am really not too impressed. Yes they have somewhat liberal protocols and their education standards are set higher than the bar (but I do not agree with the "military medic experience does not count", most military medics or corpsmen could run circles around their civilian counterparts). My problem lies with their response time. Average is over 9 minutes, with only 70% in under 10 minutes and over 10% are OVER 15 MINUTES. Sorry, thats not that great. I also do not agree with a non-certified call taker or even an EMD/EMT deciding over the phone who should go and how stable or critical the patient is. If a Paramedic is available, then the Paramedic should be dispatched. They boast an all "P" staffing, how about putting some of those medics with AMR or the Fire Department's basics to provide better coverage? The way the stats are now, it is grossly insufficient.

[dors]

there are only 7 medic rigs in seattle, each with 2 medics. that city has over a million people during weekday work hours. something's not right about the proportion of that. I talked to a friend of mine who used to work for AMR up there and said that AMR has at least 30 rigs roaming seattle streets during the same time. It says on the webpage that only 35% of 911 calls get a medic dispatched initially. a lot of the time he said that the Fire Dept. first responders would cancel them before they get an eval and just call AMR (BLS) to transport. Other times the medics would actually get there and do the eval but would still call AMR. He said they usually save their resources (yeah, their 7 rigs) for only the most critical people. he said that AMR usually ends up taking patients that they wouldn't even be allowed to touch anywhere else in the country. that seems like a big problem. I don't know what their standing orders are but I can't imagine that they're designed to be that liberal otherwise that's HUGE liability. It looks like benanzo layed out a pretty good case of how that system is slowly failing because of the medics having to cherry-pick their patients. it doesn't even sound like it's their fault, they just have to be mindful of the overall system load and available resources. I agree with benanzo that it sounds like something is about to change. We saw the same shift here in portland, it was slow but very necessary.

[Dustdevil]

Benanzo has definitely recognized a chink in the armour of the almighty Medic One system. Sounds like they get so much smoke blown up their own asses, that their medics believe their own hype. Sounds like a system that coasts by on past glory without really maintaining any of the progressive greatness they were once known for. Reminds me of the paramedic schools that continuously tell their students that they are the best school in the state, and they graduate with attitudes that are unbearable, when the fact is they aren't any better than any other school.

I don't care if Medic One staffs its ambos with board certified trauma surgeons. The system itself appears to have serious operational flaws that render its effectiveness and professionalism extremely dubious.

SPELL CHECKED: No errors found. 8)

[mamamo899]

Okay, the last I am saying on this. I only say "lowly" EMT-CCT certification is because of the fact that on this particular (and several other) threads on this website there are a select few who feel that if you are not a paramedic who was trained for at least 6000 hours then you do not have the skills or know how to be in this field. I have to argue strongly against this. I have yet to go past my "night course certification" due to family constraints at this time, not due to any factors that prohibit me from learning. Sorry, ranting...

As for MFI-medication facilitated intubation- (it is RSI, for some reason they changed the jargon around here for some reason). I stated that I was not on the scene, and God knows, tubes can be missed, just seemed an exaggerated number of surgical crics being done in the field that maybe could have been taken in with the good old OPA (or combi or LMA). Perhaps I am wrong, I have not yet attended the regional advanced airway course for MFI.

Anyhow, this has gotten way off the initial topic about this patient being brought in BLS vs. ALS.

[akflightmedic]

While I can not say the system is ineffective or not working cause I do not work in or around it, what I can say is you can not pick on their education standards. The program is phenomonal and it is something we should all strive for. As for the system itself, if it is so inefective, why do they consistently get high grades? I am asking, not defending. Why is there very little negative press? As with every system, there will be chinks in the armor and flaws with one area or another. But in the education arena and as leaders and innovators of new trials and procedures, they have been leading the pack.