Would you ALS or BLS this patient and why?

[ncmedic309]

That's an ALS call and a simple case of the ALS unit being too lazy to actually do their jobs... :roll:

[Dustdevil]

Just a misunderstanding I guess.

You're being to generous.

Sounds more like a FAILURE to understand to me.

[JPINFV]

Where I run, (the frozen tundra that is Northern NY), we don't have the type of response the OP was mentioning, where an ALS ambulance would call a BLS ambulance to transport a patient. I've never heard of such a thing and it souds kind of ridiculous.

I saw something that at least appeared similar to that in Boston last week. (as an aside, what is it with ambulances in Mass going EVERYWHERE code 3? The amount of ambulances I've seen alone going code on the freeway while being passed by traffic has been astounding).

[Richard B the EMT]

Semantics: My system would have entered the call into the system as either a "STAB" or either an "INJ" (Injury) or a "INJMAJ" (Injury Major) calltype.

I saw no mention of guesswork on how much blood was openly lost, and if I didn't see someone mention a lung sound assessment, I apologize. If there's obvious heavy blood loss, or the lungs sound "wet", or if the patient appears to be in extremis, it's an ALS call.

Any way you slice it (pun unintended), it is a call going to the Trauma Center

[Odorono]

It's difficult to really Monday morning QB this entire situation because there is a lot of information we don't know that the monkeys might have, especially the size/ nature of the weapon and circumstances surrounding the actual injury. Perhaps the issue was not so much the possible acuity of the patient (or lack thereof), but the inability of the crew on scene to communicate this to the doc.

But this is not to be construed as a defense of the firemen, because had they just thrown the patient in the back of their rig and gone to the hospital on their own and not asked for a BLS rig, there probably wouldn't have been any issue. Any system that gives transporting ALS the option to turf a pt to a BLS unit that hasn't even been dispatched yet is going to run into stupidity like this.

[defib_wizard]

This is an ALS pt. Especially in southern Az. Where med control can be pretty strict. The only way I could get away with giving this pt to a bls crew is if i had a critical trauma on the same call. I have had this happen almost simular except the pt I had was stabbed in the abdomen with evisceration. pt 2 was stabbed to the scapula. No SC air. I had a basic emt I trust assess the lung sounds and report to me. I would trust this emt with my life as she is my wife. She was an IEMT for 8 years until she had to downgrade or retire. ( long story that still ticks me off!) We got my pt loaded the bls crew left the scene right behind us and followed to the hospital with orders to notify me if the pt status changed. Transport time was <3 min. I agree not the best solution but this is how rural ems sometimes has to be done. The good news is an er nurse was there and hopped on. She rode to the ED with them and kept reassessing him.

In a urban environment with a herd of medics this should not even be a option. IMHO they wanted to go back to bed because they probably moonlight as a construction crew on their days off. And they had a big job the next day.

[katbemeEMT-B]

Due to the fact that this was a penetrating trauma and the area you described, I would say ALS. But then again there really isn't enough information to say. How big was the weapon or knife? Was it serrated? what was the loss of blood? Was he having SOB..? LS? more info about the initial assessment needs to be known before you can make this determination.

I have my own Opinions on "BLSing" Pt's. Esp if there is a ALS truck on scene. In our area this doesn't happen. ALS cannot turn a Pt over to BLS, regardless of Pt status.

According to our instructor and the paramedic book we are using, it is considered abandonment to leave a patient with some one certified at a lower level than you regardless of where you live in the US. That would mean every time these medics assess a a patient then send him/her with a BLS truck, they are abandoning their patient and could be charged accordingly.

[ERDoc]

According to our instructor and the paramedic book we are using, it is considered abandonment to leave a patient with some one certified at a lower level than you regardless of where you live in the US. That would mean every time these medics assess a a patient then send him/her with a BLS truck, they are abandoning their patient and could be charged accordingly.

You need to check the laws in your particular state. In NY, an ALS provider is only an ALS provider if they are on a call that requires ALS. If they are on a BLS call they are considered a BLS provider and can hand over the pt to another BLS provider.

[CBEMT]

This isn't a stab, it barely qualifies as a slash. It's a laceration.

If I can see where it ends, it's absolutely BLS. If I can't see it I'll probably ride in, maybe check lung sounds a few more times, but other than that I'm not doing much.

[CBEMT]

As for the criteria of the Fire guys on the original posters scenario, she'd have gone BLS.

Not to be argumentative, but did ALS care change her outcome?

Sounds like calling 911 instead of bellying up to the bar might've given her a chance at a different ending. Or not.