Paramedic Response Unit/Rapid Response Vehicles/Fly Cars

[Eng542ine]

CBEMT... I agree to an extent. Only in a truly Utopian society could one be guaranteed the availability of a transport capable BLS unit. Your most advanced providers should have the most basic tools of the profession at their disposal, i.e. a rolling ambulance cot and an ambulance to put it in!!

Mediccjh... Agreed... But now who do we hold accountable and press for change?? We are all intimately familiar with the problem, the system is broken, there's no two ways about it. Where do we go from here? I don't know. I do know one thing though, if WE, as EMS professionals, don't have input in this, we're just going to get another system doomed for failure. Any ideas?

All in all, I still think ALS Intercept could be improved upon by adding the fail-safe of putting your Paramedics into something as cheap and readily available as a non-custom mini-mod ambulance. That would be an excellent safety-net for the system. Don't throw the "it's too expensive" argument at me... the gas-powered SUVs common here can and do EASILY meet or exceed the cost of a diesel mini-mod. The costs draw very close, especially when one factors in maintenance costs, longer PM intervals for a diesel engine, etc.

[mediccjh]

CBEMT... I agree to an extent. Only in a truly Utopian society could one be guaranteed the availability of a transport capable BLS unit. Your most advanced providers should have the most basic tools of the profession at their disposal, i.e. a rolling ambulance cot and an ambulance to put it in!!

Mediccjh... Agreed... But now who do we hold accountable and press for change?? We are all intimately familiar with the problem, the system is broken, there's no two ways about it. Where do we go from here? I don't know. I do know one thing though, if WE, as EMS professionals, don't have input in this, we're just going to get another system doomed for failure. Any ideas?

All in all, I still think ALS Intercept could be improved upon by adding the fail-safe of putting your Paramedics into something as cheap and readily available as a non-custom mini-mod ambulance. That would be an excellent safety-net for the system. Don't throw the "it's too expensive" argument at me... the gas-powered SUVs common here can and do EASILY meet or exceed the cost of a diesel mini-mod. The costs draw very close, especially when one factors in maintenance costs, longer PM intervals for a diesel engine, etc.

However, once you put your Paramedics in your cheap ambulance, and they are dispatched with BLS for an ALS assigment that ends up being BLS, with no BLS responding, your medics now must dispatched the stubbed toe while the AMI 2 miles away has to wait an extra 20 minutes for the paramedics.

This debate can go around and round. My Utopian society is professional BLS providers in a transport-capable ambulance w/ ALS chase fly cars, this way ALS is kept for more serious emergencies, which is what the original concept was.

[CBEMT]

This debate can go around and round. My Utopian society is professional BLS providers in a transport-capable ambulance w/ ALS chase fly cars, this way ALS is kept for more serious emergencies, which is what the original concept was.

Mine too, but I will say I'm attracted to the idea of the ALS providers being able to scoop and screw on a run that needs to be scooped and screwed, if necessary.

[medic001918]

And I'm in favor of having providers that are capable of managing the scenario they're placed into for the extra time it takes for a transporting ambulance to show up when needed. No system is perfect. Is it better to have a BLS take an ALS call w/no medic available since that medic is riding a stubbed toe to the hospital? Or is it better to have an ALS provider on the scene with an ALS patient while waiting for a BLS transport unit? I would prefer to see the ALS provider with the ALS patient, that way at least some of the needed care might be able to be provided. No system is perfect. But some are better than others. When executed well, the intercept system is the least of the evils. And that's being said having experience in an intercept system, and one where the ALS provider is in the ambulance doing every assigned call that comes their way. It's about best use of resources...and the best use in this case is having the ALS provider with the ALS patient. Not the ALS provider with the BLS patient.

Shane

NREMT-P

[FormerEMSLT297]

ALS Intercept vehicles are one of those concepts that looks GREAT on paper but, TOTALLY SUCK in reality!!!

First and foremost this falls on the State of New Jersey for failing to require municipalities to provide EMS. This is what happens when you let the people at the helm of the failing volunteer system dictate policy... fools...

I don't know whether i think that you are qualified to give an opinion since you have only been a medic for 1 month.

I noted your reasons and deleted them for brevities sake..... But let me ask you this... I know NJ has its own problems with volly F.A. Squads and such, but..... if you had a dedicated paid BLS unit that could show if the F.A. Squad didnt get out in say 10 minutes ... would that change your mind about being in a fly car.??????... What about being able to clear 1 call and turn the patient over to the bls and then go assist another BLS unit that had a critical patient ?????... instead of being tied up transporting a broken arm to the hospital ????????

Just curious.

[Just Plain Ruff]

ALS Intercept vehicles are one of those concepts that looks GREAT on paper but, TOTALLY SUCK in reality!!!

Granted I've been a medic a whopping month now... I have had AMPLE opportunity to form this opinion and cite three instances off the top of my head where the wait for a transport unit seriously compromised patient care...

1) CVA... after BLS took the better part of an hour to grace us with their presence and the transport time to the Stroke Center he was out of the 3 hour window

2) Status Ep... 20 minute wait for BLS... that was 15 minutes after we completed the RSI...

3) Rapid A-fib... non-responsive to diltiazem (or any other damn thing we tried)... we had plenty of time to play in the FIFTY minute wait for a BLS ambulance that ended up coming from 7 towns away... in the next county!!

Every unit ALS and BLS should have transport capability. There's no feeling I have ever experienced that can compare with the absolute helplessness that comes with having to wait almost an hour on a scene with a critical or unstable patient and have no way to get them to definitive care...

WELL... except when you hear an ALS job go out somewhere (with no other unit available) and you're on a scene waiting for BLS to arrive so you can release an INFINITELY stable patient to them...

First and foremost this falls on the State of New Jersey for failing to require municipalities to provide EMS. This is what happens when you let the people at the helm of the failing volunteer system dictate policy... fools...

WHOA Wait a minute

clarify for me a little bit cause I'm in on this a little late.

Were those instances cited above intercept units that were on scene or was it a als unit with transport capabilities.

Why did you wait so long on scene if you are a als unit?

Why were there no ALS units available to come back you up?

This sounds like a broken system and needs to be fixed.

If this was a ALS unit with transport capability then why did that crew wait for BLS?

Your post left a bit to be desired in clarification for those of us just getting into the thread.

[Eng542ine]

FormerEMSLT297... I believe I am quite qualified to comment on this topic... in addition to my month as a medic... you can add 6 years as a career EMT... 10 years as a firefighter/first responder in a fire-based EMS system... good enough???

Ruffems... definately a broken system that is nowhere NEAR being fixed... and God-forbid a paramedic had to drive something besides an SUV... we can't control what the rest of the state does or doesn't do but we sure as hell can control what we do!!

[Just Plain Ruff]

I agree on the SUV part but you didn't answer my question as to why those three incidents were on scene for so long.

Were they a non-transporting unit or could they have transported the patients involved? Were they a SUB or a Ambulance?

just curious

[FormerEMSLT297]

Eng542,, you didnt answer my question about having dedicated bls units to ride with you ?

Would that change your mind about ALS SUV's ?

I just think that if properly supported with the correct number of BLS units the system could work well... I understand NJ has it's own problems,, not to mention that stupid law about ALS being only hospital based...

[Eng542ine]

Ruff... Ford Expeditions... no ambulances here... on the rare occasion an ALS unit is assigned an ambulance it's referred to as a "penalty box"...

FormerEMS... Honestly, no... it wouldn't change my opinion... having an ALS unit in a transport capable vehicle only serves to benefit the patient... I may be having difficulty answering your question as I simply see no advantage to a "fly car" or an intercept vehicle that is not transport capable... The simple fact of the matter is that transport-capable BLS should be there, in the event they aren't... SOMEONE has to transport... In all honesty, had myself and my partner on any of the jobs I mentioned been in a transport capable vehicle, we could have been at the hospital LONG before a first aid squad decided to grace us with their presence... and therefor it could also be accurately stated that even if the patient's truely were BLS patients and we would have been able to release, we could have transported the patient to the hospital and been available for another dispatch quicker had we had an ambulance... quicker than we WERE available after waiting for the squad to show... BTW... I could NOT agree with you more than I do with the whole hospital-based BS... this is what keeps us from getting REAL pay/benefits/pension... we're stuck working for the money-hungry private industry... not a municipal/county/state entity providing a government service as it should be...