Would you ALS or BLS this patient and why?

[Dustdevil]

Gotcha-- I suppose as long as both are simultaneously dispatched and scene time isn't delayed to wait for the BLS, this isn't too bad. Especially since some of those on the BLS bus may actually be medics acting in a BLS capacity, correct?

I would agree with that, for the most part. The important factors are assessment and time. So long as each patient gets a competent (being the key term here) ALS assessment before transfer to BLS, and it costs no time to do so, especially when many of the BLS providers are indeed medics, I don't see a major issue coming up frequently.

What throws a monkey (pun intended) wrench into the scenario is when any of the following factors exist:

• 1. The ALS assessment is not competent.

2. It costs time on scene to await the arrival of BLS.

3. The ALS provider has ulterior motivation to outsource the patient.

• When dumping the patient means you get to go back to an air conditioned recliner chair or a warm bed, the potential for mismanagement is simply too great to risk. I don't believe that Boston has any of those problems. Even if their medics dump the patient, they're still going to have to do a written report on it and almost immediately get dispatched to another patient.

[JakeEMTP]

Gotcha-- I suppose as long as both are simultaneously dispatched and scene time isn't delayed to wait for the BLS, this isn't too bad. Especially since some of those on the BLS bus may actually be medics acting in a BLS capacity, correct?

Except sending 2 ambulances to the same location is a duplication of service. Considering the fuel cost alone would make one consider the merits of this response. As always, if all ambulances were ALS and staffed by medics, there wouldn't be any discussion about this. Anyway, there isn't (or shouldn't) be BLS and ALS, only pre-hospital medical care, which encompasses both.

[Dustdevil]

Except sending 2 ambulances to the same location is a duplication of service. Considering the fuel cost alone would make one consider the merits of this response. As always, if all ambulances were ALS and staffed by medics, there wouldn't be any discussion about this. Anyway, there isn't (or shouldn't) be BLS and ALS, only pre-hospital medical care, which encompasses both.

Agreed. And that is really the fallacy of fire-based "first responders". Somehow, the IAFC and IAFF have managed to propagate and perpetuate the lie that they save the city (or county, etc...) money on EMS by allowing for fewer ambulances. Of course, that's shell-game nonsense. Is it cheaper to run fewer ambulances than more ambulances? Sure. But if you add the cost of fire first responders to that equation, you realise that you are actually spending a lot more for a lot less, as well as significantly delaying transportation. And transportation is really the only job of EMS that holds consistently and significantly valid as a necessary component of an EMS system.

Once you get past the smoke and mirror show put out by Paul Pepe and his ilk, it becomes blatantly obvious that fire involvement does not decrease the cost of EMS in the least. It increases the cost of EMS. But not only do city managers lack the sophistication or ability to see the proposition clearly, many of those that do still go with fire-EMS because it gets more productivity out of the under-worked and overpaid firemen, who are already on the payroll.

[CBEMT]

Except sending 2 ambulances to the same location is a duplication of service. Considering the fuel cost alone would make one consider the merits of this response. As always, if all ambulances were ALS and staffed by medics, there wouldn't be any discussion about this. Anyway, there isn't (or shouldn't) be BLS and ALS, only pre-hospital medical care, which encompasses both.

In a typical ALS/BLS system I'd agree, but it's hard to argue with results- and Boston has them.

[Dustdevil]

What kind of results? Financial statistics proving a savings with fire first response?

Can you post them for us to consider?

[JakeEMTP]

In a typical ALS/BLS system I'd agree, but it's hard to argue with results- and Boston has them.

As compared to what? How good would the numbers be if the number of ambulances responding to calls was cut in half? Would the cost savings in fuel alone be enough to have medic only response? it's the same old same old. This is the way we've always done it so it must be right.

[CBEMT]

What kind of results? Financial statistics proving a savings with fire first response?

Can you post them for us to consider?

Where did I say anything about fire first response?

I'm talking outcomes with a reduced number of ALS providers in the system.

[Dustdevil]

Where did I say anything about fire first response?

You didn't. In fact, you didn't say anything that gave us a clue what you were referring to. That's why we asked.

I'm talking outcomes with a reduced number of ALS providers in the system.

You still haven't said anything that gives us a clue as to what you are talking about.

[CBEMT]

I'm talking about having ALS and BLS transporting in the same system. "Results" being the most highly regarded EMS system probably anywhere in New England and certainly in Mass. CPR save rates in the 40's isn't anything to sneeze at either.

But they use BLS, so they exist somewhere between volunteers and fire departments on the EMTCity Scale.

[Dustdevil]

There are full ALS systems that achieve the sane numbers, so what makes you think it has anything to do with having BLS ambulances?

That's sort of like assuming that medics who cannot pronounce their R's are somehow more competent than others.