Does BLS call for ALS intercept when not needed....

[paramedicmike]

Ah yes. I love it when Dust gets on a roll. I love it even more when he's right.

:salute:

-be safe

[JCicco345]

I agree with Dust 100% on this one. I have to be honest though. After just finishing my year and a half medic class, which I went into with a year and a half of experience as a basic, when I started and I though I knew a lot about medical and trauma calls and I thought I knew what I was doing but actually going through the medic program you quickly learn how much you don't know. It's not a bad thing, education is the biggest downfall of modern ems. Even medic school is pretty basic when it gets right down to it, but its something to start a career off with but you still need the con-ed classes and you still need to study and read articles and learn as much as you can. But to think as a basic you can save the world is ridiculous. In EMT school the treatment for every call, that is remotely emergent, is call ALS and place the patient on high flow oxygen. Not much of a treatment. Again this isn't meant to demean BLS, I still work BLS, but it is just that basic life support, immediate stabilization until the patient can receieve a higher level of care. BLS is great for first response, but ALS should be the standard of care.

[Laura Anne]

Of course we need EMT-B personnel!!!!! To think that I'd have to carry my ALS equipment up and down the steps all by myself, lift that darn heavy litter up and down, in and out of my truck, and lets not forget those darn fender-bender refusals we ALS providers love so much. Why heck! You-all EMT-B's are great for alotta things!! My personal favorite though is the gomer-mobiles aka BLS transport rigs....why if it weren't for you guys, the medics would have to do so much more work and quite frankly, I am too busy thinking up other sarcastic things to say....WOW!!!! How about just holding my clip board on scene and looking pretty??? No???? NOT what you expected?????? Well golly-gee wilakers.....I reckon I'll have to find a better reason for having my partner then....... notice I didn't say drive....lol :shock:

WHEW....*stepping out of the pile of smelly shi...ugh I mean oozing sarcasm......*:roll: :wink: :wink: :wink:

KIDDING SHEESH... I know someone will take this the wrong way and all I can say to playful sarcasm is...well, get over it.

I work on a truck with an EMT-B partner and I have never had a problem with the EDUCATED EMT-B's. For the most part, I allow the EMT I am working with run the call until/unless severe ALS intervention is required. I also try to have an EMT-B grasp the basic concept of assessment along with A&P when working with me. In doing so, I challenge their skills and drive them to think a bit more critically. This allows them to question, comprehend, and interpret cases later on down the line. This is how I was taught. I think it worked fairly well. It was from this approach that I became passionate about furthering my education to the level of EMT-P. Not only educating, but assisting in the descent of EMT-B's that seem to tunnel vision on certain injury/illnesses.....aka...... attempt to arrest the ignorant mind. 8)

It's the EMT-B's that don't want to further themselves in the educational aspect of EMS that I cannot stand. Mind you, there are PLENTY of medics who are the same way and we all have run into them from time to time. I just don't understand why someone who gets into this field feels that they are educated enough. EDUCATED ENOUGH?! :evil: There's no such thing, and if one is to portray themselves to be educated enough, well quite frankly, I don't want you anywhere near me, my family or friends, or even my patients because you are in my eyes dangerous. This I feel is the passion that drives this forum and the people on it; all here want to better, not only themselves, but the field as a whole.

Uhhh, so to answer your question? Yes, I do feel EMT-B providers are needed, but I would hope that they'd further their education and use EMT-B as a stepping stone towards becoming a paramedic.

[Just Plain Ruff]

laura - +5 for the first part, I'm dang near almost up off the floor from laughing

+20 for the rest of the post. Incredible

You can take care of me anytime as can your emt-b's who have worked under you.

[katbemeEMT-B]

First I would like to respond to JPINVF.

A broken bone can very well be an emergency. A femur fracture for instance, hip fracture, fracture of the vertebra, or a fracture with gross deformity. Common sense would tell you that you shouldn't move the patient until the fracture is stabilized. Critical thinking tells us how to go about that. While a textbook may have given us guidelines to follow it doesn't cover every situation so it takes critical thinking to best care for that particular patient.

Yes we can start IVs. We are certified through our Medical Director and have to be recertified every year to ensure proper skills. We are allowed two attempts on any one patient. If after two attempts we are unable to obtain IV access we are to contact Medical Control at which time he more than likely tells us to forget about it. There have only been rare occassions when he has given us the go ahead to attempt a third.

Although we carry oral glucose on our rig we rarely use it as most of our diabetic reactions are unconscious. You don't admin. oral to an unconscious patient. We carry glucagon and are able to give IM. Again, we are certified through our Medical Director.

If a patient is having an allergic reaction and it has been verified, we are able to admin. an Epi-pen that we carry on our rig. We must contact MC first. We are also able to admin Albuterol via Neb. no MC for it.

FALLS: Here is where critical thinking comes into play. This is where you have to assess the scene and the patient.

Why a medic for a stroke patient? Have you ever had one crash en-route before. A medic would be able to intubate the patient and place on a cardiac monitor. Something we are not able to do. There is some talk about changing that though.

As for a unstable patients, I work for an ALS unit also and we very rarely do any interfacility transfers with more than a medic and one or two emt-b's. Recently we had a cancer patient that needed to be transferred to a Metro hospital. His BP was bottoming out, his heart rate would fluctuate, and he was having periods of apnea. When we took him there was no RN with us. It was one medic and two emts (one of which drove).

TRAINING: While some emts may decide to quit learning once they are done with their initial class, I think most continue to learn as they do their job. This learning consists of not only textbook materials but also on the job experience. A book can not possibly teach you everything. It can only give you basics. You learn more by getting out there and experiencing it. If your mind is open to experience it is open to learning. You have to be willing to listen to what others are telling you (doctors, medics, more experienced emts). Also, CE plays a vital role in ems as guidelines change constantly and you should always be aware.

Now in response to Dust

Let's see.....we've been compared to monkeys, called first responders, and now told we can't drive either. Out training is no more than that of a boy scout who took 120 hours of first aid. Just to clarify, I went to school for six months, had six months of ride alongs, and twelve months of probation after that. I have also had countless hours of CE and attended a three day ems conference for seven hours per day worth of training and information sessions. That doesn't include my training to be a driver. That was a class I had to attend, three months of ride alongs, and six months probation.

I too have had a patient or two that have left me wondering what was going on and if I was doing the right thing for him. I never said that I don't have more to learn. But I also am confident in the fact that my schooling and experience has prepared me for many of the situations that I have and will have to deal with. If I don't know what to do I ask some one who will. I was taught taught how to assess a patient and determine his needs. It was actually something that was part of our state practical exam. In all seriousness, if we weren't able to properly assess a patient, how would we know when we should call for ALS. Maybe where your from they don't properly educate emt's (don't know where that is), but around my area depending on how much the student is willing to put into it, they can come out with a hell of an education and they can continue that education.

So you don't feel ALS is needed for issues with the heart, stroke, or major trauma? Where's your patient assessment and critical thinking skills. Read above for my response which does illustrate my ability not only to determine when ALS is appropriate but also that I can think critically.

I'm not puffing my chest or patting myself on the back. I don't because I know that I still have a lot to learn. I don't need a pat on the back to make myself feel good, I feel good everyday because I wake up healthy, have a job, and inspire my kids to exceed at all that they think they can be and do. While I may only be an emt, my plans are to continue my education. Where it will take me from here I'm not sure, but it will be in the medical field. So you can say what you want but in all honesty they are just words, and while some are pretty sharp, I know who I am and what I've been through and where I am right now and that's what matters. The most important thing to me is that you can ask any of my six kids if they are proud of me and they will say yes because they know it wasn't easy for me to start all over beginning with school. I have set a challenge for each of them now and I am sure they will succeed as will I. They will continue to learn as I am and they will be better people for it.

[JPINFV]

First I would like to respond to JPINVF.

A broken bone can very well be an emergency. A femur fracture for instance, hip fracture, fracture of the vertebra, or a fracture with gross deformity. Common sense would tell you that you shouldn't move the patient until the fracture is stabilized. Critical thinking tells us how to go about that. While a textbook may have given us guidelines to follow it doesn't cover every situation so it takes critical thinking to best care for that particular patient.

/me scratches his head. /me looks at post where it says "normally aren't." /me sighs. Shouldn't using critical thinking be a reason FOR a medic and not a reason AGAINST a medic?

Yes we can start IVs. We are certified through our Medical Director and have to be recertified every year to ensure proper skills. We are allowed two attempts on any one patient. If after two attempts we are unable to obtain IV access we are to contact Medical Control at which time he more than likely tells us to forget about it. There have only been rare occassions when he has given us the go ahead to attempt a third.

Ok, so you've got an IV. Can Basics use their new found access to give anything besides fluids?

Although we carry oral glucose on our rig we rarely use it as most of our diabetic reactions are unconscious. You don't admin. oral to an unconscious patient. We carry glucagon and are able to give IM. Again, we are certified through our Medical Director.

Well, D50 is vastly superior to glucagon for hypoglycemia. Shouldn't we be focusing on giving our patient's the best treatments possible instead of settling on something that is just good enough, at least sometimes?

If a patient is having an allergic reaction and it has been verified, we are able to admin. an Epi-pen that we carry on our rig. We must contact MC first. We are also able to admin Albuterol via Neb. no MC for it.

Interesting, but it'd still be better to have a medic on scene.

FALLS: Here is where critical thinking comes into play. This is where you have to assess the scene and the patient.

BLS assessments is limited by education and tools. Not every disorder is visible, hence the invention of assessment tools [monitor, d-stick, etc]. Education is important to interrupt those tools. While the old saying is "treat the monitor, not the patient," doesn't mean you throw the monitor, and by connection the education needed to properly use the monitor, out with the bathwater.

Why a medic for a stroke patient? Have you ever had one crash en-route before. A medic would be able to intubate the patient and place on a cardiac monitor. Something we are not able to do. There is some talk about changing that though.

Wouldn't that be an argument to support medics on ANY life threatening emergency? What happens if that allergic reaction crashes? "Opps, sorry, we can only handle some things, could you please hold 20 minutes till someone else gets here?"

As for a unstable patients, I work for an ALS unit also and we very rarely do any interfacility transfers with more than a medic and one or two emt-b's. Recently we had a cancer patient that needed to be transferred to a Metro hospital. His BP was bottoming out, his heart rate would fluctuate, and he was having periods of apnea. When we took him there was no RN with us. It was one medic and two emts (one of which drove).

It is quite common for me to run RN-CCT calls. It's a pleasant call taking patients down the ambulance ramp at one hospital to their MRI with an RN. 2 minute transport, 20 minute minimum wait at the MRI, RN/monitor does all the work. Isn't it also strange how RN's don't need to contact a base hospital to complete their orders? [/rhetorical questions] That said, RT or RT/RN transports seem to have sicker patients on average than just plain RN transports.

TRAINING: While some emts may decide to quit learning once they are done with their initial class, I think most continue to learn as they do their job. This learning consists of not only textbook materials but also on the job experience. A book can not possibly teach you everything. It can only give you basics. You learn more by getting out there and experiencing it. If your mind is open to experience it is open to learning. You have to be willing to listen to what others are telling you (doctors, medics, more experienced emts). Also, CE plays a vital role in ems as guidelines change constantly and you should always be aware.

Books can teach you a damn lot though and give you a much better base for making decisions in unique situations than working in the field. I'll take a bio lecture over "ACLS for the EMT-Basic" any day of the week. As far as guideline changes, let's take the 2005 CPR guidelines for example. There numerous ways that AHA made those available for people to learn outside of a CE course. Want to know why the change took place? It's on their website. Want to just know the change? It's listed without explanation. Hate reading? They have a webcast, including a section specific to EMS. CE's play a role, but a real education is "vital."

Now in response to Dust

Let's see.....we've been compared to monkeys, called first responders, and now told we can't drive either. Out training is no more than that of a boy scout who took 120 hours of first aid. Just to clarify, I went to school for six months, had six months of ride alongs, and twelve months of probation after that. I have also had countless hours of CE and attended a three day ems conference for seven hours per day worth of training and information sessions. That doesn't include my training to be a driver. That was a class I had to attend, three months of ride alongs, and six months probation.

For the record, I made the boy scout comment. Also, for the record, I'm a 4th year biology undergraduate [4 weeks left!] with a poli sci minor and a boy scout. Yes, the trauma training rivals that in boy scouts. Training to be a driver? Honestly, driving isn't that hard. The trick is to not drive like a jackass, regardless of the amount of lights the ambulance has running. Unfortunately, there is way too many people who drive like jackasses.

[AnthonyM83]

So, what are they good for? First responders. That is exactly and completely what they are good for. That is all their training is appropriate for. Immediate stabilisation of life threatening conditions. They aren't educated to thoroughly assess and diagnose medical conditions and/or determine appropriate intervention. And because of that, they are not qualified to even determine when a higher level of care is or is not indicated.

That's pretty much how I see myself...a first responder.

I'm there to identify any life-threatening problems, treat at EMTB level, and prep patient for the paramedics' assessment when they arrive in the FD ALS Squad. That way medic can worry about doing his investigation and interventions without having to worry about basic things things like O2 by NRB or chest compressions or getting VS.

If we're first on-scene long enough, I'll try to do as thorough assessment as I can with the goal of being able to give the medics the best report possible. The value of doing this (for me) is that each call I become more comfortable and natural at extracting the appropriate information for each call type, so that during my paramedic internship I can concentrate more on analyzing the information, putting together the puzzle, and seeing the big picture and deciding on the best course of action, instead of worrying on getting the information out of the patient and stumbling on what questions to ask.

At least that's how *I* view my job and get value from going to work each day. I'm fortunate to have a partner who cares about medicine enough to have a similar outlook. We're by no means experts and there's always the rush to do it all and have patient packaged (if we think it's going to be a transport) before the medics arrive, but I think it's a worthwhile outlook.

[katbemeEMT-B]

You know, at 21 years old you really have no idea what the world is about. You have lived a sheltered life of school, school, school. From what I can tell (with the help of almost three years toward a psychology degree) you also have some deep issues to work through. I have a son the same age as you are who had the same attitude you have until one day reality smacked him right in the face. When it happens to you I hope and pray it isn't as devastating and life altering as it was for my son all because he chose to take his little sister to school one day, thought he could beat the traffic and got t-boned. She was almost killed. So you know what don't preach to me about how medics are the only ones who can save lives. It was the crew that was on (all emt-bs) that saved her life. Had they not acted quickly, and used the skills that they were taught in school and on the job, I wouldn't have my little girl today. So get your head out of the clouds, come back to Earth, finish your schooling, and join us in the real world where you will truly get to use these 'Critical thinking" skills you brag so much about. And to reiterate what I have said previously, apparently our education here is much better than that else where in the country or even closer to home as we are taught some things that are normally taught to medics. We are taught outside the scope of an EMT-B as our instructor knows that in small rural communities with ALS more than 30 miles away, these are valuable tools for us to learn and take with us.

A quote to ponder

""Whether you are an EMT-B, EMT-I, or EMT-P; you are only as good as your education and experience" With that being said, as your instructor I intend to give you the best education you can get using my knowledge and 40 years in EMS." As stated by my instructor when I took my "boy scout first aid class" aka EMT-B class.

[EMS49393]

I've been biting my tongue for a while on this post, but I really can't hold back any longer. Khanek, did you learn about "projecting" in your psychology course work? I'm not sure JPFINFV is the one with the problems here. Did your nearly three years of education towards your psychology degree include any reading comprehension course work? Seeing as how you either misinterpret what you read or are unable to put your actual thoughts on paper, it's apparent to me that you were able to skip right over English 101 and 102 at your local community college in pursuit of your degree.

That 21 year old young man understands the complications with training basics to use Epi-pens, start IV's, give glucagon, etc. As a paramedic, I understand education behind those "random" skills your medical director foolishly lets you engage in. I'll tell you what, you tell me what the drugs you are using are classified as, how they work, how they are metabolized, the contratindications, the complications, and what you would do in the event of an untoward effect, and I'll be glad to call you a over educated basic. Epinephrine and glucagon are not benign as many basics like to think.

It's a real shame you went through the tragedy of a bad car wreck with a child. I'd really like to know how the basics saved her life. Did they throw her in the back of the ambulance and drive like hell? That's about all they can do in a trauma, and honestly, outside of control and airway invasively, decompress a chest, start IV's and defibrillate, there isn't much more I can do as a paramedic in a trauma. You can let go of the pompous notion that a basic is the only reason your little girl survived. I'm wagering the reason your girl survived has more to do with God and a good surgeon. I'd even let the firemonkeys have some credit if there happened to be an extrication involved.

Regarding the topic at hand. Luckily I work in a service that is an ALS charter, meaning a paramedic attends every emergency call. However, if I were on a chase car system, I would rather a BLS crew call me than not. I don't mind running calls and dealing with patients. Golly gee, that happens to be the reason I became a paramedic. Any paramedic that shows up and berates a basic for calling is an uncaring moron, and it's a safe bet they have a pint of Ben & Jerry's waiting for them at a cozy station somewhere. If you feel you or the patient happened to be treated inappropriately, it is your right to report that to one of their supervisors. You are an adult, you should be able to string enough words together to complain.

I'll now return my soapbox to the closet.

[Yummymedic05]

I'm wagering the reason your girl survived has more to do with God and a good surgeon.

:cheers: :cheers: :cheers: