ALS in a BLS service?

[Scaramedic]

No Fiz I see what you are saying. A Med Control (Online) is not to be confused with your Medical Director. Your Med Director is the one who decides your scope of practice. He is the one that decides what drugs are or are not (within state regs) on your truck. He is the one who says what procedures you can perform.

If you look closely you should see your protocol book by the radio at every hospital, some MD's use it as a reference. In most systems protocols are county wide so it is easy for the Doc to know what you can and can't do. Many systems require online med control to take the same protocol test that you do, so they know what you can do. Having said that there is a little wiggle room as far as dosing and other interventions, just like we have a little wiggle room in the field.

It does not matter what the NREMT, the feds or in most cases even your state says you can do. It is up to your Medical Director to decide your scope of practice via your protocols. The protocols say that you are a representative of your M.D. and in his absence you shall do the following when a S/S presents. Example the state of Washington allows Paramedics to perform pericardiocentesis, yet not all systems in the state provide this intervention. Why? Not all Medical Directors believe it is necessary in the field.

The problem is the OP is there is no Medical Direction outside of Online Med Control which is insane. The online Docs are either confused on the situation or insane, they have no basis to issue these orders, at least in my experience. Of course you never know what happens in the boonies, personally I have only worked in cities with more than 1 stoplight.

Peace,

Marty

[Ridryder 911]

If your service isn't licensed as an ALS service, you cannot perform any ALS intervention.

Shane

NREMT-P

Actually, not all states are created equal. In Oklahoma, we have a regulation of individual protocols, that allow a BLS service to employ and use the Paramedic at their current license. There are many that are operating that way. This allows services in rural area that may not have enough Paramedics for full time 24 hr coverage to still provide ALS care.

There are specific guidelines, and must be under protocols of the medical director.

Personally, I think it is a stupid allowable guideline. Many have enough to go Paramedic level, but never will since this will "fix" them into having to employ and have Paramedics on each responding unit.

R/r 911

[CBEMT]

If you look closely you should see your protocol book by the radio at every hospital, some MD's use it as a reference.

LOL. I wish.

[fiznat]

^^ Yeah haha me too. To be honest I doubt most of or docs really have any idea about how our protocols work. There are a set few of them who are very involved, but 90% have no idea what we are/aren't allowed to do. Recently a doc at one of the two major hospitals we frequent was absolutely shocked to find out that we cannot RSI patients. I seriously doubt they are in tune enough to know what drugs we carry, what we don't, what is standing order and what is not.

[Scaramedic]

^^ Yeah haha me too. To be honest I doubt most of or docs really have any idea about how our protocols work. There are a set few of them who are very involved, but 90% have no idea what we are/aren't allowed to do. Recently a doc at one of the two major hospitals we frequent was absolutely shocked to find out that we cannot RSI patients. I seriously doubt they are in tune enough to know what drugs we carry, what we don't, what is standing order and what is not.

That's sad, that is the reason I think that you should have a centralized online med control. One group of MD's trained in the EMS system.

Peace,

Marty

[1EMT-P]

The first thing that I would do if I were you would be to write to the local and/or state office of EMS and ask them. The second thing that I would do would be to ask your agency if their insurance covers ALS providers. The third thing that I would do would be to ask your Medical Director for written authorization to perform advanced skills in an emergency.

PS: Remember to dot all your I's & cross all your T's.

[akroeze]

That's sad, that is the reason I think that you should have a centralized online med control. One group of MD's trained in the EMS system.

Peace,

Marty

Or eliminate the need for on-line control except in the most extreme of cases.

[katbemeEMT-B]

What has to be remembered is that it's not only the staff that is licensed at a certain level, but your service is licensed to perform services at a specific level, (BLS or ALS). In the OP, the service is licensed at the BLS level. This means that regardless of the level of training of staff on the truck, they can only perform at a BLS level. When state issued the license, the service registered their protocols. If it is reported to the state that you have practiced outside of those established protocols, your service could be shut down. The other thing to consider, and I would assume it's standard across the U.S., the state does inspections of your service. They actually come in and look at all the equipment and supplies that you carry and stock. If it is found that you have ALS drugs on a BLS truck, they again can shut you down.

It is possible to have a service that runs as part-time ALS. This means that when a paramedic is present, the truck is considered ALS, otherwise it is BLS. It has to be licensed with the state that way. Also, the ALS equipment and drugs can not be stored on the truck. They must be locked up where only the medics can get to them and place them on the truck themselves. We have a service about 30 miles away that is part-time ALS, that's why I know how this works. Our service was also looking at an ALS chase car, unfortunately, things didn't work out. The medic didn't want to carry everything with him.

I realize it may not be the same across the board, but I also feel that if your service is licensed as BLS, regardless of what online doc is telling you, you should practice as BLS. I wouldn't take the risk. If the patient is in dire need of ALS, then call for intercept.

I wish you luck in making the switch from BLS to ALS. I hope you have better luck than we have. If you succeed, let me know how you did it.

Just my two cents.

[iMac]

Out here the service I worked for would have not allowed that. It has to be written down and known that yes if this situation presents itself as an ALS service and registered paramedic you are allowed to do this or that.

I have been put into situations where I was given certain medications or was told to do a certain procedure if the patient were to crash during transport, BIG NO NO. Against ALL protocols, laws and regulations. Easy for them to hand out unwritten info, meds and treatments to save themselves some staff.

Your medical director and your ALS supervisor need to sit down and figure things out before the "situation" presents itself.

[KSEMT122]

Sounds a little like Clay County EMS to me. In Kansas EMS ground services can be licensed in two main ways. Type I (ALS) and Type II (BLS). If you choose to register yourself as an ALS agency that means you have to have Paramedics available on 100% of the calls you respond to. By the way there are only 30-35 Type I services in Kansas due to the requirement of having a Paramedic on EVERY call. However, what most services in Kansas do is register as a Type II (BLS). Even if they have Paramedics on every call, just in case they can't fufill that requirement. It is very typical in Rural EMS systems. The agency I used to work for was a BLS agency. I had a Paramedic Partner and our shifts were set up that way. They registered as BLS because we didn't have many Part-Time Medics to cover Medic shifts. So that way every once in awhile they could run a BLS only truck. That is how it is in Kansas. The BLS Trucks can operate either way as long as protocols are in place to do so and there is a Medic available. The ALS trucks in KS MUST ALWAYS have a Paramedic on board. Personally I wouldn't work for a service that didn't have ALS protocols in place.