ALS Intercepts

[Kiwiology]

Doing a lot right actually, but those interventions would be considered ALS procedures (even if it's a non-ALS unit), no? Oh, if only Dust where here, he'd go off about that.

Poor old Rob I hope he is OK and being treated well by his live in 20 something veluptious blonde nurse miad he sucked in with his broken down old useless sack of crap in a wheelchair scam \

To answer your question, no. Here "advanced" procedures are those avaliable only to Intensive Care Paramedics, currently they are

- Endotracheal intubation

- Cricothyrotomy

- Ketamine

- Atropine

- Amiodarone

- Midazolam (that may be changing)

- Intraosseous

- Frusemide (probably being withdrawn next year)

- Pacing

- Rapid sequence intubation

- Thrombolysis

Everything else here including things like 12 lead ECG interpretation, adrenaline, naloxone, GTN, cardioversion, laryngeal masks etc is either a Technician (BLS) or Paramedic (ILS) procedure.

And yes Bushman is right, we selectively began upskilling people in 2003 ... and it'll have taken almost a decade by the time everybody is upskilled but hey, good things take time right?

I might moan a wee bit that they should have just upskilled everybody to begin with but I won't be complaining when we finally see the end of calling up for Intensive Care for a bit of morphine or some adrenaline!

[p3medic]

P3medic, I feel I have to disagree with you here. Obviously you have never broken anything before. If a service has the ability to control pain, then it needs to be done. Who are we to say whether a pt. needs pain control or not? If they hurt, they get relief.

Not if every ambulance had the ability to perform ALS interventions. Other major cities in the rest of the modern world do provide all ALS services. Why can't it be done here?

Nonsense. See above. Other major urban centres World wide can do it. It is the responsibility of the provider and the service he works with to maintain their skills. Here we have to perform BLS/ALS skills annually in a clinical setting to be able to continue as a provider. Sure it's a pain in the a$$, but a necessary one at that. Intubation is falling to the wayside BTW. Basic airway interventions will do in most cases. I have only had to intubate 3 times this year but still manage to do it in under 10 seconds. Again, it is up to the individual to keep up to date and proficient.

[mobey]

Everything else here including things like 12 lead ECG interpretation, adrenaline, naloxone, GTN, cardioversion, laryngeal masks etc is either a Technician (BLS) or Paramedic (ILS) procedure.

The procedures mentioned are indeed ALS, just because a country/state/province/regulatory body assigns these procedures to what they label BLS, does not make them any less ALS.

This is a huge problem I see with the mentality of BLS/ILS providers, they just think of these things as "Simple BLS" stuff.... and do not take it serious enough. I challenge you to ask an IV certified BLS provider to name 6 complications of IV therapy, bet it will stump him/her for a few min.

Remember that BLS is pretty well internationally defined as CPR and basic 1st aid. Cardioversion is a far cry from BASIC life support.

[spenac]

Poor old Rob I hope he is OK and being treated well by his live in 20 something veluptious blonde nurse miad he sucked in with his broken down old useless sack of crap in a wheelchair scam \

Guess he only has time to post on the other site, he posted there yesterday. You guys really must have mad him mad.

[Richard B the EMT]

Remember that BLS is pretty well internationally defined as CPR and basic 1st aid. Cardioversion is a far cry from BASIC life support.

By that line, you just promoted Certified First Responder-Defibrillator (CFR-D) Fire Fighters. When the system works, as they get the dispatch first, they arrive first and, if needed, start CPR and apply the FR3 Defib unit to zap the patient. Still within the NYC 9-1-1 system, BLS (the EMTs) can administer aspirin, albuterol, and Oxygen (which is a prescription item, still surprising many), and assist the patient in taking their own Nitro pills. ALS (Paramedics) go from there, with a big list of drugs and narcotics they are authorized, standing orders, to administer, or with a "Mother/Father, May I" authorization from OLMC with certain items, or in addition to dosages already administered.

On a slight rant here, I note that most "overwhelmed" 9-1-1 EMS systems are used by the public as a taxi to the hospitals, and the legislators won't change the rules to prevent this. Also, with visions of instant service by being brought into an ER by ambulance "guaranteeing" being seen sooner, they will tell the 9-1-1 calltakers almost a rehearsed routine with "flag" words ("heart attack", can't breath") that get the higher priorities assigned the "job".

Then the Triage nurse, or Doctor in charge, puts a pin into their bubble by having them wait in the waiting room, and not get an ER exam bed immediately.

My final rant of this posting, repeated often, is, 9-1-1 has become a victim of it's own success, as everyone calls 9-1-1 for almost anything.

[Kiwiology]

In labling these as BLS or ILS procedures you must remember our education requirements far excceds anything, er, everything avaliable in the US and rival that of many other nations eg Canada, South Africa, the UK.

While cardioversion may not be an "intermediate" procedure technically here our intermediate level (Paramedic) can perform syncronised cardioversion.

Does that mean they had a couple hundred hours of education and are now able to zap people? No, they had several years of education and experience before they got up to Paramedic level.

[AnthonyM83]

Everything else here including things like 12 lead ECG interpretation, adrenaline, naloxone, GTN, cardioversion, laryngeal masks etc is either a Technician (BLS) or Paramedic (ILS) procedure.

The distinction I was trying to make is that those procedures might be Technician level, but skill itself is an ALS skill just by the nature of its invasiveness. I fully support them having those skills with proper education, but for conversation purposes realize that those are considered ALS by many (even though they're at the Basic level).

Guess he only has time to post on the other site, he posted there yesterday. You guys really must have mad him mad.

Does that site have more hawt chicks or something?

[Kiwiology]

For the last ten years Australia and NZ have had upskilling programs going on which increase the scope of practice and education of base and intermediate level Ambulance Officers. This has bought interventions that were once the domain of ALS into the non ALS arena and allowed us to make greater use of resources and improve clinical outcomes.

As time has gone on more and more has been added to the non-ALS scope of practice along with increasing education; nearly every state in Australia and NZ now require a Bachelors Degree as base level entry-to-practice qualification with ALS (Intensive Care) Paramedics requiring Graduate Degrees.

Over the next two years ever Paramedic (intermediate) level Ambulance Officer here will be educated in and equipped with 12 lead ECG interpretation, adrenaline, IV analgesia, naloxone, ondansetron and probably midazolam and amiodarone for cardiac arrest too.

To say "oh lets simply move towards an all ALS model" is a wee bit of overkill and really does not cure the problem, its just a quick fix - but that is what Western Medicine has become good at; treat the symptom not the problem.

It all goes back to the old argument, what the US needs to do follow the rest of the world and increase education and scope of practice for its non ALS providers in particular (but them just as much) and come out of the dark ages.

[AnthonyM83]

I think the communication problem is at my end.

Guess I'm just saying starting an IV will always be ALS, no matter who is allowed to do it or in what part of the world. Even if all EMTB learn that from day one EMT school, it's still ALS to many because of it's invasiveness. So, the move is to recognize that many ALS skills can be moved to the Basic provider level. It's more of a semantics thing...but it really doesn't matter. I think we agree on everything.

[Kiwiology]

I certianly agree that procedures like IV cannulation, medication administration and cardioversion are more invasive than say taking a blood pressure and therefore require a higher amount of education and skill.

That does not mean that they should only be "top tier" procedures, or, by that logic, in tje non EMS setting a Consultant Physician would be the only one allowed to cannulate and the Registrars, House Officers and Nurses get lots of practice at keeping thier blood pressure taking up to snuff or something.