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

[Laura Anne]

::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.

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:violent1:

THANK YOU! People want to be referred to as 'professional' in this forum, yet the majority of people lack the basic grammar skills of a second grader!!! Just push the wee little button called SpellCheck for the love of GAWD..... :roll: Also, throw in a few tid-bits of punctuation here and there, followed up by some capitalization and HEY....YOU TOO CAN BE ON THE NEW T.V. SHOW Are You Smarter Than a Fifth Grader?

OK *whew*, now that I am done my pointless rant, I'll toss in my two cents worth of an opinion....

I'd rather be safe than sorry with a basic crew calling for a rendezvous rather than have the BLS crew miss an important sign/symptom and cause further harm. I don't work in an area where there isn't an ALS squad on every corner. We/I am fortunate in that aspect because I know if there ever was a problem with a local BLS crew's patient crashing, they'd have some help around the corner, whether it be another crew or the ER itself. If I did get called to assess a potential ALS patient who is initially in the care of the BLS crew and found the Pt to be deemed stable for the continuation of BLS intervention, I'd be OK with it. The point I think being missed here is the need for ALS in a region that seems to call them frequently for back-up. Perhaps getting your county to provide ALS to it's people would be better for all involved? I am assuming you're squad is volunteer and doesn't feel the need for ALS, either volley or career?

Another point is the lack of knowledge and continuing education of the basic and medic providers is what chokes this entire field as a whole. Everyday I learn something new and I am happy/willing to do so. It's when the mind becomes stagnant and education lacks that we hurt not only ourselves, but the profession we all worked so hard to promote with sites such as this. Also, regardless of status (volley/career, basic/medic), there's always going to be a few bad apples that will ruin the bunch. Name calling only stoops you to their level of incompetence. Lord knows we all at one time or another have been there, just some of us learned from our mistakes........ :wink:

P.S. It is summertime now...is it ok to wear flip-flops yet? J/K!! sheesh.....

[jon_ems_boi]

You can't help people who don't think they need help. If somebody is really convinced that their 3 week first aid course (EMT- makes them an educated critical thinker, capable of medically assessing people's illnesses and determining their medical needs, then that person needs a lot more than any professional guidance we can give them. They need a reality check.

The first step towards recovery is admitting you have a problem.

Funny thing is, I have never heard somebody with an advanced education make these same silly assertions. Not once have I ever heard a medic say, "Wow, that was a waste of time. I already knew all this from EMT school!" And I never heard a nurse say, "wow that was a waste of time. I already knew all that from paramedic school!"

I am not arguing the fact that a medic is more highly trained. However I do not know where you live, but i do not =know that where i live the above mentioned course is a 1st responder course for our fire departments. i know that is some areas an EMT-B can do no more that put 02 on someone and wish them the best of luck. but where i live we take a Year long course, or at least that is what most EMT's I know had to do. WE do preform some skills that in other areas of the country are considered to be advanced skills.

I will give you that there are those people out there who think after being an EMT they are a doctor and can save the world. I am very aware of the fact that i am limited in what i can do for my pt's. and if i could go be a medic tomorrow I would. I am often fustrated that i know , in some cases, what my pt needs and i know that the only person in the field that can do that is a medic. so there in lies my point, that i know when a medic is needed. I am not saying, mind you, that I am god and I have a wonderful education in ems behind me. I am saying that i have been in this career field long enough to know a thing or two about a thing or two that I am not an idiot. thats all I want medics to admit that not all emt's are complete morons.

[dahlio]

:shock: Exactly why, as Dustdevil stated, medic's should be on every ambulance. If the ALS ambulance hadn't been on scene you would have cancelled them and your pt. would have possibly coded on you. Nice assessment there.

I'm not knocking you specifically, it's just that BLS doesn't have the equipment or education to deal with sick pt's such as the one you stated.

Absolutely that was a mistake. I was new back then, and luckily wasn't making that kind of decision.

[BEorP]

Absolutely that was a mistake. I was new back then, and luckily wasn't making that kind of decision.

I'm sure many people are wondering what exactly happened. Someone forget to ask about chest pain? :wink:

[jon_ems_boi]

So i pose a new question for this tread.. based on what everyone is saying.. what is the point of an emt-b.. and it please do not say "drive". I believe that on all 911 ambulances there should be a medic, but that is just not possible. There is not enough man power and money in some areas for that.

[katbemeEMT-B]

I have to agree with Jon. If EMT-B's are so ignorant that all they are good for is driving why do we have them? I try very hard not to take any of this personally but sometimes it gets a little tough when all you do is say that the only one who can save a patient is a medic. Granted, the advanced skills would come in handy sometimes, but how many times is a medic using the same skills as an EMT-B? Do you need to be a medic to splint a broken bone? Stop bleeding? Start an IV? Help a diabetic? Help an allergic reaction? Transport a child or adult that fell? No. These are EMT-B skills. A medic comes in to play when there are issues with the heart, wish we had one then; stroke, definitely wishing; and major traumas. Even with some unstable patients it would be an asset. So the way I see it, EMS needs EMT-Bs and medics. Lets quit picking on each other, putting each other down and just agree that there are good emts and bad ones; good medics and bad ones; and the world needs the good ones.

[JPINFV]

Do you need to be a medic to splint a broken bone?

Nope, but broken bones normally aren't an emergency either.

Stop bleeding?

They come in handy when the person starts to bleed out. Saline might dump the patients hemocrit, but there is a point where you become damned if you do, damned if you don't.

Start an IV?

Huh? Basics can start IVs? Where is this again?

Help a diabetic?

Basics can give D50, where, again? D50 is much more helpful than oral glucose.

Help an allergic reaction?

Only if the person has an epi-pen prescribed for them and with them.

Transport a child or adult that fell? No.

Again, this greatly depends on the situation. Why did the person fall? Seziure? Shock? Just because a patient's chief complaint is BLS doesn't mean that the cause of the complaint is.

These are EMT-B skills. A medic comes in to play when there are issues with the heart, wish we had one then; stroke, definitely wishing;

Why are you wishing for a medic with a stroke? Unless ALS can give thrombolytics, there is not much you can do prehospital besides ruling out hypoglycemia. Sure. a medic would be nice in case something else happens, but a stroke by itself is BLS purely for a lack of prehospital options in most areas.

and major traumas. Even with some unstable patients it would be an asset.

I would imagine that ALS would be most appropriate FOR unstable patients. Why else do even mildly unstable patients get transported interfacility with an RN?

So the way I see it, EMS needs EMT-Bs and medics. Lets quit picking on each other, putting each other down and just agree that there are good emts and bad ones; good medics and bad ones; and the world needs the good ones.

To add on to that final statement, let's work so that we increase the good ones. That's going to require more education than 120 hours of boy scout training.

[Dustdevil]

So i pose a new question for this tread.. based on what everyone is saying.. what is the point of an emt-b.. and it please do not say "drive".

I definitely agree there! They are not qualified to drive. Not sure where in all that bandaging and splinting training they acquired the belief that they were qualfied to take my life in their hands behind the wheel, but that is another delusion. Even if they had a whole weekend [sarcasm] of EVOC thrown in there to boot, you've got to show me a lot more than a 120 hour first aid course before you are going to chauffeur me around the city streets with lights and sirens and adrenaline pumping through your veins. So yeah, EMT-Bs definitely are not driver material.

So, what are they good for? First responders. That is exactly and completely what they are good for. That is all their training is appropriate for. Immediate stabilisation of life threatening conditions. They aren't educated to thoroughly assess and diagnose medical conditions and/or determine appropriate intervention. And because of that, they are not qualified to even determine when a higher level of care is or is not indicated. Consequently, first responding is the only appropriate function for a person of EMT-B level training. Is that a bad thing? No. Is it demeaning? Of course not. First responders are an extremely important element of the EMS system. It is the very core of the military medical system, from which modern EMS was developed. No military medics or corpsmen take offense at being utilised at an appropriate level. You don't ever hear them blowharding about how they are qualified to perform a nurse, PA, or physician's job. Take a clue from them. Accept your lot in life, be proud of it, and do it to the very best of your ability, or move up. Those are your choices. Whining is not an option. It's a cop out. And an annoying one at that.

I have to agree with Jon. If EMT-B's are so ignorant that all they are good for is driving why do we have them? I try very hard not to take any of this personally but sometimes it gets a little tough when all you do is say that the only one who can save a patient is a medic.

Please find me one single quote from here where anybody said anything even remotely approaching that silly statement. It hasn't happened. And your failure to see and think this through rationally does nothing to make anybody feel more comfortable that you are a critical thinker, qualfied to assume responsibility for the lives of our most vulnerable citizens.

Granted, the advanced skills would come in handy sometimes, but how many times is a medic using the same skills as an EMT-B? Do you need to be a medic to splint a broken bone? Stop bleeding? Start an IV? Help a diabetic? Help an allergic reaction? Transport a child or adult that fell? No. These are EMT-B skills.

Right there is the very crux of your failure to understand the issue. You do not yet have the education or experience in EMS to understand that THIS IS NOT ABOUT SKILLS! All our silly little skills -- yours AND mine -- are absolutely worthless without the educational foundation necessary to intelligently and competently assess your patient's condition and needs. Physicians come out of their fourth year of medical school still scared to death that they cannot competently do this. I came out of medic and nursing school scared to death that I couldn't competently do it. And after thirty years of practice, I STILL see about one patient a week that leaves me wondering WTF is going on, and if I am doing the right thing for him. You're only fooling yourself if you are honestly asserting that your EMT-B training prepared you to competently assess the condition and needs of your patients. I can assure you, no matter WHAT EMT school you went to, it did not. In fact, it was never intended to. Look at your curriculum. It very clearly was designed to teach you only one thing: to recognise and stabilise immediately life threatening conditions until definitive care can be obtained. Period. I don't care if your silly little school taught you how to do CABGs and heart transplants, those skills are worthless to you when you don't have the education necessary to diagnose the conditions you are treating. And, take away the skills training from EMT school and what is left? About 40 hours of theory, tops, of which about 8 hours is anatomy and physiology. Puhleeze. The guy who puts freon in my air conditioner every summer has two years of college education. And you want to call yourself a qualified medical professional?

A medic comes in to play when there are issues with the heart, wish we had one then; stroke, definitely wishing; and major traumas.

As has already been pointed out, this statement only serves to illustrate just how unable you really are to determine the appropriate use of ALS resources, which was the point of this thread.

So the way I see it, EMS needs EMT-Bs and medics.

You see it wrong. EMS only needs EMT-Bs if the ambulance resources are stretched so thin that first responders are necessary. But EMT-Bs are never needed on an ambulance crew.

Lets quit picking on each other, putting each other down and just agree that there are good emts and bad ones; good medics and bad ones; and the world needs the good ones.

Let's quit puffing our chests and patting ourselves on the back for completing a three week first aid course and acting like we are something of indisposable value to society. It's a joke, and since we have all been through it, you aren't fooling anybody except those who choose to be fooled.

[flight-lp]

:cheers: :hello1: :cheers: Best post in a while! Well spoken!

[BushyFromOz]

My mentor once said to me "Josh, you cant teach or discuss anything unless you really bvelieve in what your saying"

I think dusty just showed that first hand :wink: