14 replies to this topic

[Richard B the EMT]

I forgot to indicate that my protocols might be different than anyone else's, if they are not FDNY EMS. Whatever your local protocols are, follow them.

[HellsBells]

Just call ALS back up and move on with your assessment. In scenarioland they amost always need advanced care. I'd say you're overthinking this one.

[WolfmanHarris]

Agreed with HellsBells. It's just a check-box on a scenario.
In reality, make sure you're building your clinical judgment to the extent you can justify the request for ALS. I don't mean justify in terms of being held to account my anyone else, but in making sure you understand why you've requested it and if the request makes sense. If you're not already, become familiar with the scope and interventions available to ALS in your area and in general the indication/contraindications. That way when you're requesting back-up you're doing it smartly and can do what you can to prep the patient for ALS. (i.e. if you're not able to acquire an ECG, then atleast expose the chest and towel them off prior to ALS. Roll up sleeves to expose sites for IV's. Have a recent set of vitals ready to go. Don't delay packaging unless required.) Remember, especially in the case of trauma, ALS interventions will be unlikely to have a significant impact on outcome. Get them packaged and ready to go so that ALS can start their lines, intubate or decompress on route.

[nattlebattle]

Proctors a lot of the time want to see that you are thinking ahead. Rapid transport is the major decision and calling for ALS show that you understand the significance of the particular scenario.

[Kiwiology]

In reality, make sure you're building your clinical judgment to the extent you can justify the request for ALS. I don't mean justify in terms of being held to account my anyone else, but in making sure you understand why you've requested it and if the request makes sense. If you're not already,

Excellent point mate and one I forgot to mention before.

Ringing up on the belt mounted little talking box that your patient required some Advanced or Intensive Caring is all well and good but it's a good idea to say why your patient requires back up e.g. for pain relief, for antibiotics, for cardioversion etc.

Typically all that is said here is "so and so calls Ambulance, status 1 / 2 patient, require R50" well that doesn't actually tell us a whole lot, it says your patient is either critically or seriously ill and that you want some back up but doesn't say a whole lot as to what is wrong with them; we know how inaccurate ProQA/MPDS is, for people who are super crook^TM I'm sure your back up wants to have a ponder about what he or she is going to do when they get there.

It is also an important consideration because most often back up is dispatched on a 1 with lights and siren at faster than normal road speed so it helps to determine if ALS should be on a 1 or a 2.