WTEngel

The Houston Fire Department has primarily BLS ambulances with ALS squads (Suburbans, Excursions, etc.) Basically in the urban downtown area where the most calls come in, the cluster the ALS squads and BLS ambulances, and outside the downtown area where lower call volumes are encountered, they have ALS ambulances. It seems to work pretty well for them... They have two paramedics in the squad, and an EMT and a driver on the ambulance. The only downside is that the squads get the crap run out of them. Some have volumes around 25 or 30 per 24 hour shift. They may only do 2 or 3 transports, but they run all day and all night...

I work for Critical Care Transport at Children's in Dallas. Unfortunately conditions like encephalitis and myocarditis and other illnesses that can result from recent or latent infections hit these kids like a ton of bricks. Particularly because in many cases the parents assume the child is either still suffering from the previously diagnosed infection or has had a recurrence of the previous infection, so they sometimes wait longer than they typically would for the same symptoms. Don't Monday morning quarterback yourself on this call...the treatment even in the ICU will be primarily in response to symptoms, and in some rare cases anti virals can be used. Basically EMS is not going to do anything but supportive and symptomatic care for this kiddo...and maybe say a little prayer that it was caught early enough so that the child may have a chance at recovering.

My old medical director used to say "There is no higher calling than to save another man's life, or to TAKE AWAY HIS PAIN' I believe this is true. Now, taking into account that a doctor normally does want to assess a patient's pain, I would advise against snowing your patient. You typically aren't going to administer so much medication as to mask the pain entirely. I for one can't stand to see someone in pain, and approach it from the perspective of "If that was my mother...." In addition to that...pain meds may be a long time coming after you drop the patient off at the ER, considering Nurse Ratchet has to receive her physician's order, get said narcotic, find a co signer, etc etc... I say take the edge away, and let the patient thank you. As long as you don't snow them and you stick to the protocol, then no one can fault you... Treat the treatable, take away the pain, and above all else, do no harm.