Boston EMS

[JPINFV]

I'll remember that you don't need a paramedic next time I get a SOB patient, or a hypotensive patient, or a patient that has had an obvious increase in ectopy over baseline (given by the chart). My last shift, I had 3 ER calls (out of a total of 6). A patient complaining of increased SOB, a dialysis patient that was hypertensive (200/100) and a SNF patient who pulled out her PVAD and was hypotensive (80/50). All of those were full code. All should have been ALS based on CC. Yes, that day was unusual.

There are plenty of ER or 911 calls that can go BLS. There are also plenty that should have ALS from the start, and don't. I would rather have a system where a BLS call gets an ALS assessment and monitoring, then an ALS call gets a BLS response.

So get off your high horse and learn how to use the enter key (remember, paragraphs are your friend).

[JPINFV]

If you think that you need to be a paramedic to provide quality care you belong on the private ambulance that you most likely work on. As I am sure you know being a "pro-medic", 90% of EMS calls require no care at all. Just a ride to the hospital. Not even the Oxygen, which is all you feel the EMTs can provide. I am sure that in your system it is the OK thing to do to "just transport and keep an eye on the patient". That really seems like a good use of your "pro-medic" skills. How does it feel to be working as a paramedic doing BLS calls? Especially when you are getting paid less the EMTs that work for Boston? As far as decision making skills go. The six month academy that the EMTs go through on top of the state required training is what makes Boston EMS EMTs good decision makers. Unlike where you probably work where all you had to show you medic ticket and they let you on the truck regardless on your skill or lack of then for that matter. Not to mention that a large quantity of Boston EMS EMTs are paramedics working as EMTs waiting for the opportunity to get internally promoted to the position of paramedic. So they know what it is like to work as an actual paramedic. Opposed to doing the BLS calls and transfers that I am sure you are used to. And the best part is, still making more money then most of the paramedic systems out there, all while working as an EMT. And if we still want to talk about the patient care that is being provided think about this. The paramedics that are working as EMTs have probably seen more "real" calls this month than you did all of last year. With all that exposure, and knowing what paramedics are capable of, and when paramedic skills would or would not benefit the patient. So when the patient can go BLS, they do, and when they go ALS they are getting a very select group of highly trained paramedics with more training and experience. Which ultimately provides better care. Ultimately it works like this. Small group of highly trained and experienced EMTs, and and even smaller group of highly trained and experienced paramedics. Rather than a system of all paramedics. Or a system where the EMTs are just "paramedic helpers". Where when you a working as a paramedic you are just "keeping an eye on the patient and giving a ride to the hospital", opposed to being a Boston EMS paramedic, where you know when you get in the back of the truck you will be providing ALS care that is actually needed and not just "plugging the patient in for the hell of it."

I'll remember that you don't need a paramedic next time I get a SOB patient, or a hypotensive patient, or a patient that has had an obvious increase in ectopy over baseline (given by the chart). My last shift, I had 3 ER calls (out of a total of 6). A patient complaining of increased SOB, a dialysis patient that was hypertensive (200/100) and a SNF patient who pulled out her PVAD and was hypotensive (80/50). All of those were full code. All should have been ALS based on CC. Yes, that day was unusual.

There are plenty of ER or 911 calls that can go BLS. There are also plenty that should have ALS from the start, and don't. I would rather have a system where a BLS call gets an ALS assessment and monitoring, then an ALS call gets a BLS response.

So get off your high horse and learn how to use the enter key (remember, paragraphs are your friend).

[whit72]

well hasnt this gotten interesting.

[fenwayfrankee]

If all starts with triaging the 911 calls when they come in. According to APCO standards, calls that are deemed ALS worthy are dispatched both ALS and BLS. So those situations which listed would get an ALS repsonse according to certain criteria. So when you are 50 years old and call saying you have SOB, you get a ALS response. When you call and say I am 50 years old and I have a headache, it gets a BLS response. The calls are evaluated before an ambulance is ever sent.

[fenwayfrankee]

Just out of curiosity, was your Dialysis patient with hypertension symptomatic? Such as with CP/SOB? Or was HTN the complaint?

[Ace844]

If all starts with triaging the 911 calls when they come in. According to APCO standards, calls that are deemed ALS worthy are dispatched both ALS and BLS. So those situations which listed would get an ALS repsonse according to certain criteria. So when you are 50 years old and call saying you have SOB, you get a ALS response. When you call and say I am 50 years old and I have a headache, it gets a BLS response. The calls are evaluated before an ambulance is ever sent.

"fenway,"

This may be the standardbut it doesn't always happen, and even in your system. Matter of fact the 'Turret' & Boston EMS have been in the press for increasing response times, and have a long history of send 'BLS' only to calls. I even posted an example instance here on this board. So get off your high horse as your

Best system on the East Coast

makes the same mistakes everyone else does. Matter fo fact I know of more than 1 instance in just the last week where the 'turret' has 'held' calls for 8-10+mins before calling 'one of the privates'. Nice try though.

Out here,

ACE844

[Ace844]

Just out of curiosity, was your Dialysis patient with hypertension symptomatic? Such as with CP/SOB? Or was HTN the complaint?

The C/C shouldn't matter. The mere fact that they are a dialysis pt dictates that they should get a full ALS-MD P/E, and workup, because of all the pathophys and adverse process going on. A dialysis pt is one of the sickest you will ever treat in medicine. But it being that you graduated 'the sacademy' you knew that already...RIGHT??!!!

OUT HERE,

ACE844

[fenwayfrankee]

Calls are held because the system is stretched so thin. Its hard to send an ambulance to a call when you don't have one. Imagine how much thinner the system would be stretched if we were tying up additional ambulances on calls. Such as sending an ALS truck to a call that is only worthy of a BLS response, but because they are on dialysis, an ALS truck is sent for no reason other than the patients history. I am sure that the paramedics will be able to provide stellar care to the stubbed toe of the dialysis patient. And when a BLS is sent solo to a call, it is either because the call only warrants BLS care. Or there is no ALS to send. There would be a lot more "solo" responses if everyone that has some type of medical history is getting an ALS response based solely on their history and not the complaint.

[Arachne]

To address a couple things mentioned in the last 4 pages of commentary:

- In MA, for an ALS truck to do 911 requires 2 paramedics. A P-B truck can only do 911 at the intermediate level, and transfers at a paramedic level.* In my region, the difference between a basic and an intermediate is IV (normal saline only), intubation for cardiac/respiratory arrest patients, and glucometers.

- Trinity in Lowell & Chelmsford and Patriot in Lawrence run all BLS trucks. ALS is provided by hospital-based paramedics (out of Saints Memorial in Lowell and Lawrence General in Lawrence). I personally like the system - BLS goes to and transports all calls, but ALS is available for anyone who needs it. ALS is dispatched to anything that "sounds" ALS. If the call sounds ALS but turns out to be BLS, it's a simple matter to cancel ALS so as not to "waste" them as a resource.

- Higher education doesn't go far in BLS. I have a B.Sc. in Physiology. It's very pretty on my wall, but it's not what makes me a decent EMT-B. It helps me to understand what is happening to my patients, and I can better explain to patients what is going on and why we treat them as we do, but understanding what a cardiomyocyte is doing during an MI really doesn't change my treatment of chest pain patients. Familiarity with osteocytes doesn't change treatment of a broken bone, nor does knowing the name of every bump, dent and angle of the bone.

- Most of us who don't know how to use proper punctuation, capitalization and spelling don't brag about being able to write above the 7th grade level. The spell check button is located below the the window you type your replies in.

*In certain areas/emergency circumstances there are waivers to this, but for most private services in higher volume areas this will be the case.

[Ace844]

To address a couple things mentioned in the last 4 pages of commentary:

- In MA, for an ALS truck to do 911 requires 2 paramedics. A P-B truck can only do 911 at the intermediate level, and transfers at a paramedic level.* In my region, the difference between a basic and an intermediate is IV (normal saline only), intubation for cardiac/respiratory arrest patients, and glucometers.

- Trinity in Lowell & Chelmsford and Patriot in Lawrence run all BLS trucks. ALS is provided by hospital-based paramedics (out of Saints Memorial in Lowell and Lawrence General in Lawrence). I personally like the system - BLS goes to and transports all calls, but ALS is available for anyone who needs it. ALS is dispatched to anything that "sounds" ALS. If the call sounds ALS but turns out to be BLS, it's a simple matter to cancel ALS so as not to "waste" them as a resource.

- Higher education doesn't go far in BLS. I have a B.Sc. in Physiology. It's very pretty on my wall, but it's not what makes me a decent EMT-B. It helps me to understand what is happening to my patients, and I can better explain to patients what is going on and why we treat them as we do, but understanding what a cardiomyocyte is doing during an MI really doesn't change my treatment of chest pain patients. Familiarity with osteocytes doesn't change treatment of a broken bone, nor does knowing the name of every bump, dent and angle of the bone.

- Most of us who don't know how to use proper punctuation, capitalization and spelling don't brag about being able to write above the 7th grade level. The spell check button is located below the the window you type your replies in.

*In certain areas/emergency circumstances there are waivers to this, but for most private services in higher volume areas this will be the case.

"Arachne,"

One addition to 'the facts of your post', if I may?!?! Trinity and Patriot both also have staffed ALS (Paramedic) trucks in Lowell, Haverhill, and Lawrence.

Out here,

ACE844