BLS refusing handoffs from ALS?

[AnthonyM83]

I hadn't considered this much before, because I took my EMT class where every rig had a medic & EMT, so we didn't review it in class and I don't have a point of reference.

But my partner expressed concern about FD handing off certain calls to us. I later walked in on a conversation with another EMT who was telling him the old ambulance company with 911 contract used to refuse handoffs from FD all the time when they didn't feel it was BLS. That we should be too b/c our certifications and careers were at stake.

The call that upset my partner was:

Female, 40s,

Severe RUQ pain x30 min,

Neg masses, regular menstrual, no vag. bleed

Has 7 children, states not pregnant

Found in crouched position

Pain becomes excrutiating every 2 -3 min ("feel like contractions")

Recovering from stomach flu (with antibiotics)

FD did history before we arrived, so that's from the FD runsheet...so sorry it's limited

We were told to transport her no lights/sirens in heavy traffic, BLS.

During transport, pain started radiating to her back.

Partner said in EMT school he was told abd. pain should be taken extremely seriously. He felt FD just kind of did a quick history and passed it on to us just out of laziness/casualness (we weren't there for the history taking though).

So, what do you guys think of the issue of refusing to transport BLS when firemedic tells you? Obviously, they'd never tell you to transport a hypotensive ALOC sucking chest wound, but wabout the others.

I'd be hesitant to question them more than just, "So, you think ____ is okay for BLS? I just want to be sure."

My reasons:

1) Partner & I only have 3mo combined experience

2) We're EMTs, they're medics (would it come back on them if it were a borderline & something did happen? medicolegal-wise?)

3) To upkeep relations with fire dept.

Obviously, if I feel we really need a medic on board for the good of the patient, I'm going to be more assertive about it...but what about borderlines, do others out there refuse to transport BLS? Someone gave the idea of just moving to the next jurisdiction and then calling for ALS assitance from that fire squad.

P.S. For the example given that was my partner's issue. While I was surprised they didn't come with us, I wasn't upset, since I assumed they thought it wasn't AAA/ectopic or something of the sort and there wasn't more they could do enroute. But I might be wrong in not having gotten upset?

[csr]

Wow. Can't say I've ever heard of a problem like that. Here the FDs run First Responder level non transport response. The Transport agency is a private service, Acadian Ambulance Service Inc., Which staffs a Medic and a Basic on each rig.

[AnthonyM83]

PPS

In this specific call the FFs were ready to clear the call and told the family they could private transport or take the ambulance.

We routinely get handed off calls (extremity minor wounds, bleeding under control, some falls, etc). Problem isn't handoffs, problem is knowing if they're appropriate handoffs and how to approach inappropriate ones. If there is a problem that is...my partner is the one who felt there was an issue. I'm still undecided at this point.

[JCicco345]

We don't have that around here to that degree, our medics will turf a call to BLS if it's appropriate and going a distance. As far as your call, the severe RUQ pain should be ALS. If the medics deem BLS appropriate then you should assess the situation and if you are comfortable with it, then transport the patient. If not, than tell the medics your not comfortable with it, do so tactfully though, like you said you don't want to jeapordize your relationship with them. As for the situation of you and your partner having 3 mo's combined experience that is a problem that your service needs to deal with. That's unsafe.

[medic001918]

From the sounds of the call, I can't say for sure that I would have ALS'd the call. I work in a service where I regularly can downgrade a call to my BLS partner (with one service) or where I can downgrade the call to the volunteer (my full time spot) BLS transport unit. If you're not comfortable with a call, you should say so. I know that I've gotten in the habit when I turf a call that the last thing I say is "are you guy's good with this?" This gives them the chance to speak up if they have any other questions or comments or simply want me to ride with them.

As for your call, what about this call "should be ALS?" It's a 40ish year old female with abdominal pain who's recovering from the flu. Has she been taking her antibiotics as prescribed? Or did she "feel better" and quit taking them? Is there any assocated nausea and/or vomitting? any pain anywhere else? Is there any chance that she may have been pregnant? Birth control? If it's isolated RUQ abdominal pain with normal vital signs, I would probably turf the call to BLS as well. I guess I would have to know more about the patient to make a decision, but based on what I've read I am thinking BLS transport would be fine.

The fact that you have three months of experience between the two of you is an issue, but not one that can't be worked around. If you approach the medics and tell them that you're new and not really comfortable with the call then chances are that they'll ride with you on the call or explain to you why it's BLS and not ALS. Don't be afraid to ask questions or voice a concern. It's the only way you're going to learn.

Shane

NREMT-P

[ERDoc]

Playing Monday morning quarterback, this call reeks of chole, not really an ALS issue. It is situations like this where better education (or any education for that matter) might be helpful. I've seen 3 of the 4 Fs so far (female, 40, fertile). Be cautious making generalizations such as the one that your instructor made. Most abd pain needs not to be taken serious. ABd pain is one of the most common ER complaints and we fail to find a cause in about 80% of the cases. I have seen serious pathology present as just a vague, mild discomfort. One of the most painful causes of abd pain believe it or not is gas (not exactly an ALS call). Looking at the two concerns you had AAA and ectopic, what is ALS going to do anyway? Both cases need a surgeon (not even an ER doc). The best treatment in the field for both would be diesel. Even in the ER, treatment is going to be quick bedside US and a call to the appropriate surgeon. I am also assuming in this case that the pt's vitals were wnl.

One way to address the medics in this case is to ask them what they think is going on. Find out what their presumptive diagnosis is. Then ask them if they are OK with it going by BLS. Obviously is there is some sort of abnl vital or something going on, push a little harder. You need to be an advocate for the pt to make sure that they get what they need.

[itku2er]

Here we dont pass patients on.....if you are als and you take a call requardless of whether your patient has a stumped toe or is coding you dont transfer care to a lower level EMT. ..... but its a rural area so we have no first responders or FD personnell that triage the patient first.......here the AIC on the squad that arrives does it all.......If you pass patient care to a BLS and you are an ALS provider you are negligent.....

[AnthonyM83]

If you pass patient care to a BLS and you are an ALS provider you are negligent.....

Yeah, that part I don't got. I asked my FTO about it and he seemed kinda confused and said, "you're right...we're only supposed to pass to those of equal or higher training." I guess it's written into caselaw or something? Not sure how it works...but I don't mind it. We'd get little patient time otherwise.

[medic001918]

.......If you pass patient care to a BLS and you are an ALS provider you are negligent.....

Not quite true. You are only negligent if you hand off an ALS level patient to a BLS crew. If you hand off a patient that is a BLS patient to a BLS crew it is an appropriate transfer of care. However, if you end up missing something and the patient ends up having something going on that you missed, then you are negligent. And let's not forget the other key to the puzzle, you have to have a protocol for downgrading a call to BLS. There are services that can't afford to have their paramedic riding in on every stubbed toe when they have a transport crew capable of handling the call. It's not always the best use of resources in a town that has limtied resources available.

Shane

NREMT-P

[itku2er]

Not quite true. You are only negligent if you hand off an ALS level patient to a BLS crew. If you hand off a patient that is a BLS patient to a BLS crew it is an appropriate transfer of care. However, if you end up missing something and the patient ends up having something going on that you missed, then you are negligent. And let's not forget the other key to the puzzle, you have to have a protocol for downgrading a call to BLS. There are services that can't afford to have their paramedic riding in on every stubbed toe when they have a transport crew capable of handling the call. It's not always the best use of resources in a town that has limtied resources available.

Shane

NREMT-P

LIKE I said ......Where I AM FROM we dont hand off a patient.....to a BLS crew no matter what .....if we are als and we have touched that patient or rendered care in anyway WE DO NOT HAND OFF THE PATEINT....reguardless of what the call is...