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

[flight-lp]

OKay wow!!!!!! First of all EMT-B's are able to think critically.....DUH! Or we wouldnt be able to this job!!!!!!

Actually, that is predominately not the case. As previously stated, a trained monkey could do the job of an EMT-B, but an educated person can utilize a thought process that combines knowledge and skills to provide the best care possible for each individual patient. That does not equate to putting a C-collar on everyone who tests Newton theories or a NRB on everyone who believes that the 21% oxygen content in the environment is insufficient. Please take a moment to read over some threads, you will find a wealth of knowledge concerning this very subject.

You are lashing out at emtb's because of one thing said about paragod.

Nope, had nothing to do with it. I have absolutely nothing against EMT's. I work with some of the best on a daily basis. There role in the care of our patients is invaluable. But it is not equal. A quality EMT can identify the difference.

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.

Do you think there is a reason why? Could it be perhaps that administrators and medical directors recognize the need for advanced life support? Perhaps a level of care that cannot be feasibly performed by an EMT-B?

It is not a personal attack, it is about what constitutes the best for our patients. These are my beliefs, I respect that you do not agree with them. That is fine, but perceptive assumptions are never a way to introduce yourselves to a new online family. On that note, welcome to the family.........

[flight-lp]

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.

I'm confused by this statement, wouldn't the MVA be the one that you would "load 'n go"??? What about ACS patients? They would definately benefit from ALS therapies...............

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.

Your dedication and pride is admirable, but volunteerism is a dying breed in this country. Come on, your community deserves a higher level of care. You have an agency that is willing to provide it, many communities would kill to have it. Sometimes you have to consider the best needs of everyone, not just the volunteers in your service. Besides, this could open new doors for your volunteers (paid positions, advanced educational opportunities, etc.) Please expand on how this would "hurt" you (other than putting your organization out of business).

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.

Can you provide your cardiac arrest survival statistics? Does your "discharged neurologically intact" percentage exceed 5%? What are your mortality rates on your urgent / critical medical patients (i.e. how many COPD'rs and CHF'rs died within 24 hours of arriving at the hospital or passed while in your care)? How many of your 75% falls resulted in a fracture? I am interested in hearing your response..........................Thanks!

[JakeEMTP]

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

After re-reading the post, I apoligise to the original poster. However, the fact still remains, that a BLS provider was going to cancel ALS when in fact his pt. was having an MI.

Again, my humblest apologies to the original poster.

[PRPGfirerescuetech]

Wow.

This, like many posts here, has turned into a measuring contest.

Heres the deal.

None of us have enough education to be doing what were doing.

This is why the medical field laughs at us, doctors dont trust us with 4x4's, let alone much more, and our education system has fallen wayside to a curriculum similar to a "how to" first aid manual.

Basics call medics too much, because thats what they are trained to do. They call the ALS providers with a whole bunch of "monkey see monkey do" training on ALS interventions they shouldnt be allowed within 10 feet of.

So, what have we learned?

Basics shouldnt be allowed within ten feet of primary care without an incredible amount of additional education.

Medics shouldnt be allowed within ten feet of many of their ALS skills without an incredible amount of additional education.

So trash the basics, feel free. However, in the grand scheme of things, were all just overcompensating for being trained technician monkeys.

Discuss.

[katbemeEMT-B]

flight-lp here is the info you wanted

We are 6 minutes or less from the hospital. The ALS chase car would be at least 30 minutes away. The only patient that would benefit from them would be the MVA most likely because of extrication and the length of time it takes. I all other cases we are paged, have the pt assessed, loaded and at the hospital within 20 minutes which is less time than it would take for the ALS car to reach us. If the call is to our south we are to the hospital in 30 to 40 minutes. The chase car wouldn't even be on seen yet. Unless of course we sat there and waited for them which would delay patient care. Clear now. As a service we do recognize when ALS is needed and thats when we call for ALS Air Care because they are able to get to the scene in 7 minutes or less. Ex: long extrication, fall over 20 ft, or in one case to transport a victim of a mva that was an organ donor.

First you have to understand the economics of this area. It is a mostly agricultural area with a large elderly and immigrant population. The household income on average is extremely low and many people do not have insurance. Our rates just went up to $475 a run plus supplies. Make this an ALS service and it would be unaffordable for most of these people and they would no longer call for the help they need(the chase car would tack on another $500 plus thier supplies). Yeah you can argue yes they would but I know the people in my community and I see how the change in our rates have affected our run volume just this year. The worst part is that these people in the community suffer because of it. Aside from that, the service that is trying to move in to our territory has done this in many other communities and they are fast becoming a monopoly. There is nothing to govern what they can charge or to cap these charges. They also carry with them much controversy as being a service that cares more about their egos than the patients.

I don't know what the numbers are from previous years but for the last fifteen months we have only had four patient deaths of those patients we cared for regardless of what the call was. One was a sixteen year old mva who's injuries killed her instantly. ALS was called as she was an organ donor and CPR was performed until they were able to intercept about half way to the hospital. Another was a sixteen year old with burns on 95% of his body as he decided to make himself into a human torch. He survived for 8 weeks and our service was given a distinguished service award by a Metro Trauma Center for the care we gave him. Another was a cardiac pt who may have benefitted from ALS but was pronounced by an on-scene medic employed through the local hospital. The last was a female in her early 70s who suffered a TSI. She was at the hospital within 6 minutes and on her way to a specialty hospital an hour later. It was found out three days later she had pancreatic cancer but it was the blood clots in her body that killed her. Rochester/Mayo is the best hospital in the Midwest, she died in their care. Would ALS have saved her? By the way, she was a family friend so that one was a pretty hard call for me. We have been called for unresponsive, possible heart attack but when arrived on scene the patient was already gone, rigor had already set in.

If you would have read what I actually wrote it stated that 75% are elderly falls, sob, and diabetic reactions. As I stated above a large portion of our population is elderly. I do not have exact numbers but I know that I personally have had three broken legs, a broken arm, dislocated shoulder, three broken hips, and a broken nose. One patient broke his hip and two weeks later fractured two vertebra in his lower back. We transport many patients for sob. Sometimes it is related to something very serious like my wonderful COPD pt that still smokes 3 packs a day and sometimes it's just a bad anxiety attack. Regardless, they still get top-notch care. At least by us. As far as the "Discharged neurologically intact", that's a little harder to answer because when you are dealing with the elderly many of them are not neurologically intact when you transport them. Are they any worse? Very few. There have been a two that have suffered massive strokes and had their lives altered but that would be it.

I hope that I have answered your questions and given you the information you are looking for. Let me just say a couple more things. I am proud not just of myself as an EMT-B but of our service as a whole. The job I recently acquired with an ALS service has only reinforced this. Not only have the medics that I have trained with been completely impressed with not just my skills but my knowledge, but they have worked with our service many times and have nothing but good to say. While I agree there are some crappy BLS services out there, I know of one close by, ours is not.

[EMT4455]

Last time I checked a TRAINED MONKEY COULD NOT do the job of an EMT-B. If it wasn't for EMT-B's you would be screwed around here. I think that I have enough brain cells to decide wether I need medics. I also know I don't need a medic to tell me it's a BLS run. When you run out here in the middle of no where land you let me know how it works. And yes protocols are in place for that reason. But there are many times that we as educated EMT's know that we do or don't need medics. I am a newbie here and very insulted by your attitude toward EMT-B's. It would be like me bad mouthing First responders. Out here they are a great asset to us and do there jobs well. But then I guess cause were not medics they could pay monkeys alot less.

[JPINFV]

Last time I checked a TRAINED MONKEY COULD NOT do the job of an EMT-B. If it wasn't for EMT-B's you would be screwed around here. I think that I have enough brain cells to decide wether I need medics. I also know I don't need a medic to tell me it's a BLS run. When you run out here in the middle of no where land you let me know how it works. And yes protocols are in place for that reason. But there are many times that we as educated EMT's know that we do or don't need medics. I am a newbie here and very insulted by your attitude toward EMT-B's. It would be like me bad mouthing First responders. Out here they are a great asset to us and do there jobs well. But then I guess cause were not medics they could pay monkeys alot less.

1. Welcome to reality. It isn't always nice, pretty, or fair.

2. How would you rate your fellow EMTs? Not you, them. Would you trust your life in every one of your fellow EMT's hands? Now I'm a suburbs boy, born and raised. The only way you can even tell you moved into a new city is by the little plastic sign in the median. The EMTs around here range from slightly dumber than dog vomit to people destined for great things. There are some people whom I'd rather let me sit and die in a taxi than have them transport me. So, exactly how much do you trust your squad's/unit's/company's/department's worst EMT? When developing protocols and the like, you have to gear it towards the dumbest one with a card because you can not give each person their own individual set of protocols.

[PRPGfirerescuetech]

Last time I checked a TRAINED MONKEY COULD NOT do the job of an EMT-B. If it wasn't for EMT-B's you would be screwed around here. I think that I have enough brain cells to decide wether I need medics. I also know I don't need a medic to tell me it's a BLS run. When you run out here in the middle of no where land you let me know how it works. And yes protocols are in place for that reason. But there are many times that we as educated EMT's know that we do or don't need medics. I am a newbie here and very insulted by your attitude toward EMT-B's. It would be like me bad mouthing First responders. Out here they are a great asset to us and do there jobs well. But then I guess cause were not medics they could pay monkeys alot less.

Be insulted. Thats a good thing, and means you show promise. Your recognition of this means your smart enough to have formed your own opinion, regardless of how wrong it is.

We are all trained monkeys, just some of us realize it in the hope of a real education system and a brighter future.

In the mean time, I wish you luck in your employment.

Side note, I've worked both extremely rural, as well as extremely urban systems. Regardless of length or distance, I was a well trained monkey. Your only variant is how long you have to utilize that training.

Regards,

Mr. PRPGfirerescuetech, well trained monkey EMT-B

[EMT4455]

okay I agree. I look at the schedule to know if someone should call an ambulance or not. There are some ahhh lets say non-aggresive EMT's. I just don't agree with the stand that flight lp took. I am nor is the guy who started this topic a dumbass. It was a general knowledge question from a BLS service and in the process we got slammed into the ground for doing our jobs. I think that flight lp could have used a little more tact thats all. And yes we are becoming advanced. Well those of us that can pass the class.

[BEorP]

But there are many times that we as educated EMT's know that we do or don't need medics. I am a newbie here and very insulted by your attitude toward EMT-B's.

1. How many hours was your EMT-B course that you call yourself "educated"?

2. Welcome to EMT City. The attitude that is prevalent here is not one of hating EMT-Bs but rather one of wanting to advance the profession by increasing education of all providers. Please do not take any of this personally.

3. Can you please tell me about a time when you made a critical decision and what specific education (e.g. patho knowledge) helped you to make this decision.