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ALS or BLS? Help me decide...

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48 replies to this topic

#1 benanzo

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Posted 13 February 2006 - 12:08 PM

Hi, I am new to this forum but have been active in other ems forums. I am an EMT-B in (I'll say the Greater Puget Sound Area (Seattle-ish) so as not to be pinned down by the locals I am bashing.) The system is set up so that city bls FD is primary resp on all 911 calls. If needed they request ALS, also city FD. After evals, if pt determined to be BLS tx, they call private AMB. But SNFs call private AMB directly most of the time without using 911. So, pretend you are the private BLS AMB called by SNF to tx pt to ER:

80 y/o male STH decreasing LOC/increasing SOB x 2 hrs. RN @ SNF states pt normally A&O x 3/3, active motor able to support self in wheelchair. Hx NIDDM, A-FIB, HTN, Arthritis, pneumonia 2 mo. ago

Pt presents lying 45 degrees in bed, pale/hot/diaphoretic, barely responsive to px, very congested upper resp., RR 40 very labored, HR 90-120, BP 140/80, sats initially 79% RA, 88% after 5 min highflow NRB. There is no pedal edema, temp 102.0, glucose 160, full code. You call for the FD medics to come but will they take him?

You decide.

What is this guy's underlying problem and what ALS Rx could he benefit from?

I already have my opinion but I want it to be confirmed un-biased first.

Thanks a lot!!
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#2 akflightmedic

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Posted 13 February 2006 - 01:40 PM

Well based on that information, its not hard to figure out who you work for and who the other agencies are. Anyways, this guy sounds septic. Could he use ALS intervention? Sure he could. Would it make an immediate difference..I dont think so. Could BLS run him to the ER which is only a few minutes away? Sure they could. Should BLS do this? I don't think so, since a higher level of care can and should be provided when possible. Should the RNs at the SNF stop skipping the process that is established in order to ensure quality care to all residents regardless of the condition. I think so. They should not be circumventing the system that is in place. That leads to problems and questions such as this one.
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#3 wizchip

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Posted 13 February 2006 - 02:32 PM

I would have to agree that a BLS transport would be appropriate if the ER is with in a short distance. However ALS would be preferable because the patient is a full code. I used to work for one of the major private ambulance services. Many of the facilities in the area had standing orders to call on a private service instead of FD. Granted we we also the primary ems for the city on all levels, but still unless the patient was coding the would call for a non emergent response on everything. Many of these facilities I have been to have less ability to respond to patient needs than any BLS crew would. Many times we would send BLS and ALS to a facility on a call just for that reason, you never got the true story from the staff. In many areas this isn't possible. In my area it was because we always had a minimum of 5 ALS crews and 7 BLS on a shift. But those are my expereiences
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Posted 13 February 2006 - 03:07 PM

Echoing the others, if the transport is short, BLS should begin the transport to the closest receiving facility. Cardiac monitor and vascular access would be nice, but they aren't going to make a huge difference in the end.
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#5 hammerpcp

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Posted 13 February 2006 - 03:51 PM

That sounds like a very difficult system to work within. As if our jobs are not already enough of a gray area, you have interagency/interfacility politics and complicated procedures do deal with. Not knowing the legalities etc. of your system I will just have to go with the common sense answer. This pt does sound septic but he is not decompensating, so a quick trip to the ER with a BLS crew will not be detrimental to him, and ALS could not do any real interventions for him anyway.
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