Would you ALS or BLS this patient and why?

[p3medic]

Don't be stupid, everyone knows that R's are silent.

I think the system here works for us for a few reasons. One, our BLS recieve 600 plus hours in the Academy, above the 120-140 in the EMT program which in my opinion makes them much more capable of taking care of patients than the average EMT grad. Two, having fewer medics allows the medics to see a high number of very sick/injured patients, resulting in more experience in skills such as intubation which has come under scrutiny in many systems. The most identifiable reason for poor intubation/airway management skills is lack of experience. On that subject, we have our own airway registry wich allows us to track success rates and other data points. All RSI cases are reviewed by a panel of physicians for appropriateness. Three, having BLS ambulances available to transport lower acuity patients frees up ALS resources without having to resort to nonsense like ALS engine companies.

As for the financial aspect, it is cheaper for the taxpayer to fund 19 BLS trucks and 5 ALS as opposed to 24 ALS trucks. Every patient doesn't require an ALS transport. Tying up an ALS truck to transport a minor illness does not make financial sense. In a large urban area, the vast majority of calls barely need an ambulance, never mind ALS. Anyone working in a city setting knows of the widespread abuse of the EMS system by people without access, or more accurately can't be bothered with transporting themselves to see their PCP.

[JakeEMTP]

P3,

Regardless if the BLS providers have any additional 600 hrs at the Academy is irrelevant. They still don't have your education.

You say that having BLS ambulances (is that an oxymoron?) relieves the ALS to respond to more serious calls. But, if BLS is dispatched originally and they deem the call ALS, or vise versa, isn't there now 2 ambulances out of 24 at the same call? Please explain how that is an efficient use of resourses.If all Boston EMS ambulances were ALS, there wouldn't be the need to send 2 units to the same call. I agree not all pt's may require ALS interventions. They do however deserve an ALS assessment.

[p3medic]

Yes, the 600hr EMT doesn't have the same education as I do, and I don't have the same education as ERDOC. I think the average EMT here is capable of doing a focused assessment and know when they don't know. Tying up two ambulances may not always sound efficient on paper, but the patient comes first. If myself and my paramedic partner can tend to a critically ill patient as a team, the patient, in my opinion is better served than the one treated by the single medic, with his parter driving. Is it cheaper to run single medic? Absolutely. Is it better for the patient? I don't think it is.

[Richard B the EMT]

If there is a difference with Paramedics who cannot pronounce their "R"s, then Elmer Fudd just got pwomoted to being a pawamedic.

And the issue of Single Paramedic, or "Mensa-Medic" as I know of them, versus a 2 Paramedic Team is somewhere on this site, I know as I started at least one of them.

The "Search" feature is our friend.

[JakeEMTP]

Yes, the 600hr EMT doesn't have the same education as I do, and I don't have the same education as ERDOC. I think the average EMT here is capable of doing a focused assessment and know when they don't know. Tying up two ambulances may not always sound efficient on paper, but the patient comes first. If myself and my paramedic partner can tend to a critically ill patient as a team, the patient, in my opinion is better served than the one treated by the single medic, with his partner driving.

I Totally agree with you here. No question, 2 medics are better than 1 and if I need a driver, a FF will suffice. I think we are in agreement here.

Is it cheaper to run single medic? Absolutely. Is it better for the patient? I don't think it is.

I also agree with this statement. That's not what I was saying. All ambulances should be dual medic is.

[Dustdevil]

I dunno. I have a hard time reconciling these two beliefs:

• * EMTs on ambulance with Paramedic = Bad

* EMTs alone together on ambulance without Paramedic = Good

• The two theories seem contradictory. It's kinda like saying, "Well, EMTs are okay, so long as I don't have to put up with them."

Hey, I don't want to put up with them either. But neither should our patients, who have the bad luck to be dying of something that doesn't interest paramedics, have to put up with them.

[p3medic]

I understand what you are saying, and in a sense I agree. The education for EMS providers at all levels in the U.S. is piss poor, no doubt about it. The problem as I see it is skill retention, intubation being the big one. IF we could provide continued clinical hospital rotations for intubation and other skills that would be much less frequently needed in a system that is all ALS, and we could prove that our ability to perform at a high level could be maintained then I would agree. The problem as I see it, from my little slice of the World is a high call volume with a small number (relatively) of critically ill/injured patients, spread over a small number of medics allows for frequent management of these most difficult patients, as opposed to the all ALS system which in my particular area would be treating and transporting a high number of non-acute patients, with much less experience with the most critical. Example, we run 5 ALS and 19 BLS on the average day shift. So, if in the average 8hr shift we have 20 very sick patients, that is 4 per ALS truck. If we were all ALS with the same 20 sick patients we would have less than 1 per medic truck per shift (2 medics per truck).

I don't have all the answers, but as it is now, this particular tiered system seems to work well for us. Fire provides first responders on certain call types, they function at the FR level and don't have a transport role.

[p3medic]

I dunno. I have a hard time reconciling these two beliefs:

• * EMTs on ambulance with Paramedic = Bad

* EMTs alone together on ambulance without Paramedic = Good

• The two theories seem contradictory. It's kinda like saying, "Well, EMTs are okay, so long as I don't have to put up with them."

Hey, I don't want to put up with them either. But neither should our patients, who have the bad luck to be dying of something that doesn't interest paramedics, have to put up with them.

I'm not sure I follow. What particular pathology would these patients be dying from that would be not of interest to the paramedics? Granted, the interventions at the BLS level are fewer, however in our experience patients triaged by ALS for BLS transport haven't had poor outcomes secondary to a ride in a BLS truck vs ALS.

As for 2 EMT's working together without medics, it seems to work well for us, the EMT's are provided an additional 600hrs of training, not medic school by any stretch, but significantly more than most other BLS providers in the U.S. and they seem to do a good job. Are there gaps in their knowledge? Absolutuely, their are gaps in mine too.

[Dustdevil]

Just on a parenthetical note, has anyone ever heard anyone speaking of their system say, "it doesn't work well for us"?

If it's all you know, it's hard to really be objective about how well it works.

[ccmedoc]

As for 2 EMT's working together without medics, it seems to work well for us, the EMT's are provided an additional 600hrs of training, not medic school by any stretch, but significantly more than most other BLS providers in the U.S. and they seem to do a good job.

Just on a parenthetical note, has anyone ever heard anyone speaking of their system say, "it doesn't work well for us"?

If it's all you know, it's hard to really be objective about how well it works.

Kinda serves your monkey reference well, don't ya think.. :thumbleft:

OK, thats enough.............back to your regularly scheduled[/font:3dd8abddde]