Redefine "BLS before ALS"

[stcommodore]

We all know its a common phrase when teaching medics. But I think we need to redefine the phrase. No doubt you put on oxygen, bag, etc before you intubate or take a blood pressure before starting an IV but its not as simple as the phrase. A medic starts his assessment BLS but is always thinking at the ALS level. Mabye the phrase is made to be simple but mabye the phrase isn't used right. What do you all think of the topic?

[Ridryder 911]

I think it is a phrase for and by basic levels to sell t-shirts & many other wacker devices such as T-shirts, and other paraphernalia and mainly to inflate ego's of those that don't truly understand total patient care.

One that really knows medicine realizes that BLS and ALS intertwine and can occur simultaneously. Why would I have to wait for a blood pressure to start an I.V. or check a pulse before placing on a ECG on conscious, alert patient ? One can do both simultaneously. There is no separation, it is called patient assessment.. period. If one reads many advance level material it always recommends that one to make sure BLS or ABC's are maintained.

Simple enough, if one really knows how to perform their job and to provide care.....

R/r 911

[emtpsaveu911]

I Agree with Rydryder, Also I think If given a situation where an ALS trained Paramedic cannot go any further in their treatment, or maybe they are "stumped" so to speak on what to do next, or you just don't have the proper diagnostic equipment in the field to do what you need to do ( or really what we are trained for but may know what the pt may need) We can just treat the patient to the furthest ALS care necessary and then back to the basics until transfer of care. (IV fluids/drugs Cardiac/pacing/cardiovert/Airway/Et/or just plain CPR etc..Or provide comfort support/pain meds O2 etc.. I mean not that we would stop giving the ALS care that is already being given but there is no other option in our scope of training -so maybe thats where they get go back to the basics which any Paramedic worth anything would not stop giving BLS care ( Vitals ,O2, etc..) to begin with I think thats what they mean-- I don't know, any other thoughts?

[Dustdevil]

I think the problem is two-fold. First is the disjointed manner in which EMS training occurs in the US establishes this "BLS before ALS" theory where, in reality, it simply does not exist anywhere else in medicine. This causes those in EMS to believe it is somehow the norm, and actually an advisable situation, which it is not.

Second (which is really a by-product of the first) is the pervasive mistaken notion that the practise of medicine is nothing more than a list of skills that you memorise and practise according to a cookbook recipe. Again, nothing could be farther from the truth. As Rid very correctly stated, medical practise is a wholistic process that encompasses the entire human being and all of the knowledge and procedures that contribute to his assessment and care. Anything less is just first aid.

[Timmy]

In aussie land you either get ALS paramedics or mobile intensive care paramedics or nothing lol!

I don’t see how an EMT/BSL would be beneficial when there are paramedics around.

The only BLS teams we have in Australia would be the CERT Team, there volleys who live in very remote communities were the ambulance response time it very long, normally 20 mins +.

There mainly there for an arrest or MVA. There work load is about 3 calls a month, its not worth having a professional station there. They drive around in little 4x4 cars with debif, 02 and first response gear. They wait at the scene until the paramedics arrive. There basically there to kick off the chain of survival.

[craig]

In aussie land you either get ALS paramedics or mobile intensive care paramedics or nothing lol!

I don’t see how an EMT/BSL would be beneficial when there are paramedics around.

The only BLS teams we have in Australia would be the CERT Team, there volleys who live in very remote communities were the ambulance response time it very long, normally 20 mins +.

There mainly there for an arrest or MVA. There work load is about 3 calls a month, its not worth having a professional station there. They drive around in little 4x4 cars with debif, 02 and first response gear. They wait at the scene until the paramedics arrive. There basically there to kick off the chain of survival.

Now timmy that isnot entirely true

in victoria you have paramedics and intensive care mica guys

but thats in victoria

the reason you have 'paramedics' in victoria is because jeff kennett, your ex premier did an election promise of have paramedics on every car

the way he did this was to change the name of the guys from ambulance officers to paramedics and wait for it they kept the same skills

he achieved his aim in the eyes of joe q public as there are now paramedics on each car in victoria

and for saying the only bls team we have in aus, well judging by your photos i would say you were part of the biggest bls team we have.....the jonnies

stay safe

[AZCEP]

This argument is carried by the NREMT testing process. Does it really happen in practice, let's hope not. If you want to focus on one aspect of care, perhaps it would be better directed to think in terms of the invasive nature of the treatment you are wanting to perform. Start simple, less invasive, and work to more complex/invasive modalities.

There's a reason paramedic students become hermits for 2 years of their lives. Hopefully, it is in a pursuit of understanding why this testing station mantra doesn't apply to actual people they will have to treat.

[NREMT-Basic]

I agree completely with Dust and Rid. Many EMTs are taught that we are using BLS to stablize until ALS can be had or until we arrive at the hospital. In my system, with a Basic and Paramedic on each rig, these things are algarhythms are happening simultaneously. I had the good fortune to be taught by a paramedic whose belief was that both Basic and Medic should know their skills well enough to know what is called for and to work as a team. This is where the true practice of pre-hospital emergency medicine takes place. Yes BLS and ALS skills are different, but they also overlap and intertwine. The notion of BLS before ALS is ridiculous. That being said, it is also the way that many new ems students are being taught...that the two are seperate entities and not that they depend and work off each other to off the patient an wholistic level of care. We arent taking BPs and pulses just to have numbers...they inform what other interventions may or may not occur. Yet another reason to keep studying and learning even after you pass your exams. Thanks to Dust and Rid for their experienced comments on this idea.

[JPINFV]

I don’t see how an EMT/BSL would be beneficial when there are paramedics around.

2 reasons.

First, EMT-B's are really an ONIBP machine (Organic Non-Invasive Blood Pressure machine).

Second, Basics save Paramedics from doing manual labor.

That said, BLS does have it's places, just normally not on an ambulance, espacially alone (CCT cars would be a good example of a use).

Oh, and before any noob basics get's their panties in a twist over this, I'm a basic too. You need to realize the limitations of your scope, and more importantly, your education.

[fallout]

As a paramedic student, I have always been told "BLS before ALS." but my educators made it very clear that they meant start with the least invasive/least risky procedure and proceed to the more risky procedures given the patient's response. Some things clearly call for aggressive ALS management e.g. cardiogenic shock. Other things, such as respiratory distress, general practice is to start with oxygen delivery and CPAP or PPV before going to medications and the potential side effects.

Maybe "Initiate solid BLS management as a temporary measure until definitive ALS management can be performed."

Hardly a slogan to inspire the youth of America, but I'm not in marketing, so who cares.