BLS refusing handoffs from ALS?

[Dustdevil]

...could an EMT EVER hand down to a First Responder for transport? I'd say no because it's not a BLS versus ALS, it's now title of provider issue (but then again that logic isn't based on any rules I know of), but I'm just bringing it up for kicks as a theoretical.

I would say that the abilities and legalities of the FRs to transport would be the only prohibiting factors here. After all, it is not uncommon to suggest that people go to the ER by POV.

Back to the original question, I don't think it is "inappropriate" to refuse an ALS to BLS hand-off if you are not comfortable with the patient, theoretically speaking. But there are many potential pitfalls to the situation. First and foremost is the probability of the medic being a nimrod and handing off ALS worthy patients either because he was too stupid to know what was wrong with them, or because he was a lazy tosser who wanted to get back to watch Turd Watch. Sooner or later, one of those two situations will come back to bite the average "trained" medic.

As for your specific situation, I think your options will be dependant upon your relationship with the ALS provider. In other words, are you both employed by the same agency? Or is this one of those retarded FD-ALS-dumping-on-private-providers systems where you are separate agencies? In the former situation, you have some comfortable standing to contest inappropriate dumping. In the latter, your employer is going to fire you for refusing a paying customer and pissing off the fire department, regardless of medical propriety.

In an urban or suburban system, where transport times are relatively short (and where most of these tiered systems exist), I just don't see much benefit or intelligence to the system at all. You'll spend as much time waiting for the non-emergency responding BLS unit to arrive and complete the hand-off than you would have spent just transporting the damn patient yourself. So that begs the question; what is the point or benefit of this system?

[AnthonyM83]

Or is this one of those retarded FD-ALS-dumping-on-private-providers systems where you are separate agencies? In the former situation, you have some comfortable standing to contest inappropriate dumping. In the latter, your employer is going to fire you for refusing a paying customer and pissing off the fire department, regardless of medical propriety.

In an urban or suburban system, where transport times are relatively short (and where most of these tiered systems exist), I just don't see much benefit or intelligence to the system at all. You'll spend as much time waiting for the non-emergency responding BLS unit to arrive and complete the hand-off than you would have spent just transporting the damn patient yourself. So that begs the question; what is the point or benefit of this system?

Yes, it is one of those systems. FD sends a fire engine and truck to every EMS call and we get dispatched a few seconds later. Our arrival times are pretty much the same, though...very often we're first on scene and FD is few seconds to a minute behind...or vice versa.

So, no waiting for BLS to arrive. There is no actual ALS ambulance...it just becomes one when the medic hops in the back with his kit (and the fire captain's truck follows behind to drive medic back).

And I think you nailed with our employer wanting us to keep FD happy. They have a big say in whether we get to renew our contract with the county for 911 calls.

[p3medic]

I work in a tiered, 3rd service system, we send an ALS and BLS unit to every ALS call, as a rule....if the pt turns out to warrant ALS workup, they go ALS, if not, we send them BLS and clear, making ourselves avail for the next case....we cover a single city, with relatively short transport times, small number of ALS trucks compared to BLS, and our ALS stays busy enough doing sick pts, without transporting every 911 call....just how it works here....Our BLS are comfortable tx and transporting a wide variety of patients, it is very rare that a BLS crew here would have issue with doing the transport, and if they did, I certainly would either take the patient, or more likely explain why the patient didn't need an ALS truck....fwi....

[Dustdevil]

...we send an ALS and BLS unit to every ALS call, as a rule....if the pt turns out to warrant ALS workup, they go ALS, if not, we send them BLS and clear, making ourselves avail for the next case....

Ah, okay. Well, that certainly covers the issue of time being wasted on a hand-off. It does, however, seem to be a mismanagement of resources though, nontheless. The costs compounded by staffing and responding that many units surely adds up to enough to simply hire more medics so that hand-offs are not necessary in the first place.

I know that if I were a physician, I would not put my licence on the line by allowing my medics to hand-off 911 patients to BLS. Not with the state of U.S. paramedic education being what it is today. No way.

Anyhow, I forgot that this was LA County that was being discussed. Quite possibly among the most horrible systems in the country. Weird.

[Lone Star]

Wasn't LA County where the Paramedic program first began?