ALS in a BLS service?

[ksemt]

I have a question regarding paramedics providing ALS care in a BLS service.

I'm a new paramedic working in a small rural BLS service. Don't ask why I'm still there - long story plus I'm working to get the service to go ALS, at least ALS assist, but anyway.....

My dilemma - for some reason we carry a few first line ACLS meds (in case a doctor happens to arrive on scene I've been told). My question is; I've been told by our service director that in case of a code blue I can call our hospital and get orders to follow ACLS guidelines - even though we have no written protocols recognizing ACLS.

Am I safe in going above/beyond our protocols with only verbal authorization from our receiving hospital....I been told it's ok by some and a big no-no from others?

[Just Plain Ruff]

Holy Cow, I would want that decision made by the Kansas Board of EMS or whatever the governing board is.

I was always taught that if you don't have the protocols in place and the ALS licensure then you were bls and bls only.

The doctor on scene changes it all just for the doc though.

Call the state board of EMS on this question.

[medic001918]

If your service isn't licensed as an ALS service, you cannot perform any ALS intervention. Otherwise, you're operating without authorization. I wouldn't work for a service that's willing to put you out like that. If things go well, great. But if thing's don't go well, I'm going to guess they'd leave you hanging out to dry.

Shane

NREMT-P

[Just Plain Ruff]

that was the other thing I wanted to say

if you utilized ALS skills even with auth from the hospital you would be operating out of scope of your services licensure so you would be liable if something went wrong.

Heck with this litigious society of ours with people looking to sue anyone and everyone, they get wind of this situation and you performed als on them they'd sue you in a heartbeat.

I gathered from your post that you are settling for working at this particular service in a "Must have to" situation. If I can help you out please let me know but to put yourself out like that and take in all that liability would be a very very bad thing.

Please don't do anything that would jeopardize you or your standards.

please pm me if I can help in any way.

[Dustdevil]

This will be different in every state. Call the state. After they give you an answer, call back and talk to a different person and ask again. I'd do that at least three times, and not settle on an answer unless all three are in agreement.

What you describe would be perfectly legal in many states that aren't all anal about "state protocols" and such nonsense. Certainly not the best of situations, but if you and your MD and your base physicians have a good understanding and working relationship -- assuming the state doesn't prohibiit it -- it's not unheard of. I'd at least get my MDs signature on a standing order to allow it though.

[Scaramedic]

I agree with Dust, first find out what the state law is. Then check with your local EMS agency/county/city. If they have no regs then go to your Medical director and have him write ALS protocols. Having him "say" it's OK is not kosher, you need to have thorough ALS protocols. Otherwise you're an EMT-Basic.

Peace,

Marty

P.S. Most states would not allow the ALS drugs on a strictly BLS service.

[fiznat]

I dont understand that-- if the doc gives you permission via on-line medical control (presumably a recorded line), how does the liability fall on the EMS provider? How is this different from any other ALS provider calling medical control for something above and beyond the standing order protocol? The doc gives you specific permission to perform a specific treatment under his own licence- whats the difference whether you have previously established ALS protocol or not? The point of on-line medical control is to supercede/augment those protocols anyways!

[Scaramedic]

Actually Fiz a Medical Control Doc cannot supersede your protocols. He can only allow you to carry out certain interventions stated within your protocols. Your Medical Director has decided that certain interventions he wants an MD consulted before you carry out that intervention. An online Med Doc cannot tell you to perform an appendectomy for example. You can only work within the level of your protocols no matter what an MD says. No protocols means the online Doc has no clue what your MD allows you to do.

Peace,

Marty

[ksemt]

Thanks all for the replies...many were what I expected but most of you made me nervous enough to spend the afternoon on the phone with the KS board of EMS.

I'll address that issue first. According the board (and the state statutes they referenced - blue text) I can... "Mobile intensive care technicians; authorized activities....

©when voice contact or a telemetered electrocardiogram is monitored by a physician, physician’s assistant where authorized by a physician or licensed professional nurse where authorized by a physician and direct communication is maintained, and upon order of such person may administer such medications or procedures as may be deemed necessary by a person identified in subsection c"...without having written protocols is place. Do they recommend it? No, but it is legal. I can call in and get orders to anything that is covered under my "authorized activities"...I won't list the entire statute here but thats the gist of it.

Keep in mind I'm talking following simple ACLS guidelines and not things like pericardiocentesis (although in theory they fall under "authorized activities" because I've been trained to do it, according to the board).

Also keep in mind protocols are at this time in our medical directors hands awaiting approval, although it's proving to be a waiting game.

Dust,

No we don't have a good working relationship. I guess I should say the medical community and our service doesn't have a wonderful relationship. It stems from a service that has been lax in, well, lots of things. I'm working my butt off to change that but it's a slow process.

Many of you stated you wouldn't work for a service that "hangs you out like that" or some such wording and no it's not a "have to" situation. True, it's not the best situation but it is my hometown/county. I have friends and family here that deserve better than what they are getting. Advancing to ALS is proving to be quite "problematic".

A. The community doesn't know a BLS unit from an ALS unit and have no idea they are currently, and have been for 25 years, receiving the lowest legal limit in pt care allowed.

B. The "politicians" don't want to spend all the extra cash to move up.

C. "Many" of the current staff have no desire to change either...it's hard to argue against "it's been working OK for 25 years".

[fiznat]

An online Med Doc cannot tell you to perform an appendectomy for example.

Right, because that is outside of my scope of practice. Scope of protocols is simply which items within my scope of practice that a MD has pre-approved me to perform based on standing order. Are you sure you aren't confusing these two definitions of scope? I don't see why a doc couldn't order me to perform a procedure that I HAVE been trained on, but simply am not allowed to do daily on a standing order basis.