Does BLS call for ALS intercept when not needed....

[flight-lp]

My reason for this post was to draw attention that a lot of bls providers need to train there crews to asses pt's better.... and i can not agree that it takes a medic to decide if a medic is needed i know when i have a pt with non life-threatening complaints i do not need a medic i do not need a "Paragod" or "water walker" as we would call your kind.. to tell me just because i am an emt-b that i can not do my job with out your supervision...... you forget that you started at the same place as the rest of us bls people...... all i have to say is there are some medics not all i must add that just need to get over them selves

~groan~ Here we go again................

No, you do not need to train the BLS crews, you need to educate them. Nowhere in these posts did anyone tell you that you can't do your job nor need supervision. However, it is a FACT, not opinion, not a "paragod" complex, but a FACT, that having a Paramedic on an ambulance is far superior to a BLS unit in the 911 environment, especially in the rural environment where critical thinking abilities rarely possessed by an EMT-B are essential. Call it what you want and I'm sorry that this hits a nerve with you, but reality speaks louder than an impulsive exclamation by a young EMT.

My personal opinion (take it however you wish) is that ALS intercepts are a "barely treading water" level of pre-hospital care. Yes it is a huge step above volunteer BLS units running 911, but it is no where near optimal.................

[JCicco345]

A medic on every ambulance brings up a good point. In my area there are no trucks that are staffed with a medic and a basic, all trucks are either 2 basics or 2 medics. Which seem stupid considering if they split all the crews it would double the number of ALS trucks available. Why do you need to medics on the same truck ? Do you really need a medic to drive ? I can see that occasionally having a second medic might be slightly benificial. You have a really sick patient or you aren't 100 % sure of the diagnosis or the treatment plan and you want someone to bounce the idea off of. But I don't feel that it is worth it to waste having a second medic on the truck for those rare occasions. ALS should be the standard of emergency care.

As for the initial post, the system I work in we only request medics when it's a call that requires immediate ALS interventions en route to the hospital. For the most part we are never more than 5-10 minutes from the hospitals so it is usually quicker to just take the patient to the definitive care.

[Yummymedic05]

When I get extremely irritated with BLS calling for an ALS intercept is when they are 4 blocks from the hospital and the patient decides he's having chest pain/shortness of breath/etc at that moment. Instead of driving the next 2 minutes and coming in, they (meaning BLS ambualnces) stop and call for ALS. That's wasting time and pisses people off!

In the county I work in, one specific BLS unit calls for ALS all the dang time! It could be a stubbed toe and they are calling for ALS. They are insecure with their skills, but refuse to learn or get some confidence. This is also the crew that calls for a helicopter for anything. I agree with having the helicopter on its way and canceling rather than having it there too late, but come on! They don't assess, they "freak out" and then call for any level higher than they are.

Saying all this, if a BLS unit is not comfy with a certian patient, I would rather them call someone who is comfortable. The #1 is the patient, if the pt sees their caregiver isn't comfy, they will begin to get anxious.

EMS should NOT be a damn hobby! If you volunteer you should still keep yourself educated!

[JPINFV]

Ok, honestly, can all the EMS directors get together with the paramedics and hospital staff and work this the f out?

I've been yelled at for not calling medics when the hospital was less than a minute away from the hospital.

I've been yelled at for not calling medics with a stable patient that seized in route [sz happened, ironically, while waiting at a red light just before the hospital].

I've been questioned about calling medics from the medics when the 911 dispatcher gave me a 2 minute ETA and I hadn't even started packaging the patient yet.

While, yea, EMT's need to grow a f'ing backbone and be able to explain their actions, the rest of the medical community needs to get on the same page. You can't please everyone all the time, and you can't please some of the people any of the time, but the situation with prehospital ALS vs ER is just insane.

[JakeEMTP]

i do not need a medic i do not need a "Paragod" or "water walker" as we would call your kind.. to tell me just because i am an emt-b that i can not do my job with out your supervision...... you forget that you started at the same place as the rest of us bls people....

Evidently you do need a medic since the call you stated you were going to cancel ALS, when in fact your pt. was having an AMI.

I can only speak for myself when I say this. I do not forget where I came from. In fact, I'm still there. However, I chose to upgrade my education to the paramedic level so please don't spread that insecure attitude here.

[EMT4455]

OKay wow!!!!!! First of all EMT-B's are able to think critically.....DUH! Or we wouldnt be able to this job!!!!!! That was just an insult to any EMTB.Especially if Medics are 30-40 mins out. That was a line of crap. You are lashing out at emtb's because of one thing said about paragod. Either way we are all here to do the same job. Yeah there are Young EMT's but the one you are refrerring to has been doing this along time and is very good at what he does. Yeah there are crappy EMTb and medics we all know that. But the point of the discussion was wether bls is calling for ALS to much. We have protcols that state we have to call for medics. And there are times that we dont need them and can make that call as an EMT. But we would get in a world of crap if we don't. So there are times as EMTB's that we wonder if we are calling to much jusy because protocols says so. So stop being so uppity about medics and basics. We are all the same breed.

[katbemeEMT-B]

I work on a rural volunteer BLS service. We rarely call for ALS intercept unless it is really necessary. When it is necessary it is never a ground unit but always an air unit as it would take too long for ground to reach us. The local hospital is actually in the process of placing what they call an ALS chase car that will service four separate communities with about an 80 mile radius. They would respond for cardiac arrest, stroke, or major mva. I don't feel it will be of much use because other than the mva we load and go. If we are heading to the hospital to the south they will never catch us as they are coming from the north. If we are going to the hospital to the north we will be within 2 miles of the hospital before they reach us and it makes no sense to stop so they can come aboard. The time that would be wasted could be the difference between life or death.

Don't get me wrong, I'm not saying that we don't have a need for ALS service, I'm just saying that I have confidence in our crew as we have handled many a critical patients in the past and the fact that we didn't have ALS available wouldn't have made the difference in the outcome. When we needed the additional service we called for it. I feel it should be our decision and not theirs. What this comes down to is a major ALS service trying to position themselves into taking over our territory by showing a need for ALS service. I feel that our Medical Director is letting us down. We run an efficient and well educated service and while two of the other communities may benefit from the service ours and our neighbor will only be hurt by it. We have learned to become self-sufficient and we take pride in that.

By the way, we average about 210 runs per year with 75% being elderly falls (emergent and non-emergent), sob, and diabetic reactions. 1% are cardiac, 1% are stroke, 1% are child related, 3% are mva, and the remaining 19% are general illness or injury. A need for ALS? Probably not. Do we call for ALS often? Nope. Are we putting patients lives in danger by not calling ALS? I don't think so. I think we call when we need them but only when we need them.

[JPINFV]

::head hits desk as he starts sobbing quietly to himself::

1. For the sake of all that is good and holy, please proof read your post. While, yes, this is the internet, it is a forum for thoughtful and professional discussion. As with any other interaction, how you present yourself to those that are going to read and respond to your post is important. No one is expecting a post comparable to a graduate thesis, but the proper use of conjunctions [junction] can be expected.

2. A 120 hour basic first aid course that really doesn't even justify us being able to give oxygen is not going to begin to touch on critical thinking. Look around at the basics next time you're at work and ask yourself, "How many of them actually knows why the body needs oxygen?" Would you take a drug that your doctor couldn't explain how it treats your problem? Why should we hold EMS workers to a lower standard since, at best, they can only consult with a physician over the phone?

3. Pointing out that there are crappy Basics and crappy Medics so no one should talk about it is a non-sequitur. Just because there are crappy toilets out there doesn't mean I shun all toilets. Bidets are a different story.

[EMSGeek]

Part of BLS calling for ALS when not necessarily required may be due to the county/region/state. I work in Upstate New York primarily on a BLS transporting ambulance which services a college campus of about 8,500 staff and students. One of our big calls is ETOH abuse (big freaking surprise) but when I get on scene and I get a PT who has simply had too much to drink and needs to sleep it off, if that guy gets 1 single question wrong then he is AOx2 and therefore AMS. For AMS I have to call ALS or the county/region/state CQI committees will rip me a new one. I know that some of the medics are pretty pissed when I get them out of bed so they can talk to the PT for three minutes and then clear the PT for BLS transport. Some of our drunk patients really just need sleep. I will make sure they have a reasonably sober friend who will take care of them the rest of the night but if the PT is maintaining their airway, has no difficulty breathing, no trauma, stating they took no drugs and I have no reason to believe they are lying (other than the fact that they are talking), vitals are WNL, and they haven't been binge drinking then I'm more than happy signing these guys off. Sometimes we will get a PT who initially is AOx2 but after a little talking and maybe some fresh air is now AOx3, why should I bug the medics?

Most of the providers I know up here who operate in more rural areas are very confident about their skills because they need to be. As it has been mentioned some areas have a 30+ minute transport/link up time so you are basically on your own and had better be able to handle the PT.

[BEorP]

Evidently you do need a medic since the call you stated you were going to cancel ALS, when in fact your pt. was having an AMI.

It wasn't the OP who tried to cancel ALS on the AMI.