Does your BLS unit carry an AED?

[MMiz]

So do they? What's their reasoning behind it?

I've seen both units with and without them in my county, usually depending on the company. While chances of an EMT-B using an AED are rare, I feel it is a great tool to have available.

How is it where you are?

[lastcode]

You should not make assumptions that the chance of BLS using AEDs is rare. It is extremely common in rural areas. In my area even the cops use AEDs. The closest ALS takes 20 minutes after we call them and usually they are not available. My agency has been carrying AED for around 10 years. They are so simple I think that every city and town should have them placed strategicly for the public to use in emergencys.

[MMiz]

Originally posted by lastcode@Feb 18 2004, 11:26 AM
You should not make assumptions that the chance of BLS using AEDs is rare. It is extremely common in rural areas. In my area even the cops use AEDs. The closest ALS takes 20 minutes after we call them and usually they are not available. My agency has been carrying AED for around 10 years. They are so simple I think that every city and town should have them placed strategicly for the public to use in emergencys.
The private company I work for also has AEDs. The one or two (out of 20 or so) BLS fire/EMT-B stations also have AEDs. In my city where there is a 5-8 minute response time for ALS, cops also carry AEDs.

It was just my experience that private companies did not carry AEDs. It is true that many private BLS trucks don't carry them, as it is another way to save money.

Good to know they're becoming more popular now though.

[SafetyPro]

We have them on both ambulances and use them frequently (worked 2 full arrests in the last 2-3 weeks). We're a BLS department, and the way our system is structured, we don't call for ALS (would take longer to get an ALS unit from another city than to scoop and go...hospital's only about 2 miles away).

[MMiz]

Originally posted by SafetyPro@Mar 10 2004, 01:31 AM
We have them on both ambulances and use them frequently (worked 2 full arrests in the last 2-3 weeks). We're a BLS department, and the way our system is structured, we don't call for ALS (would take longer to get an ALS unit from another city than to scoop and go...hospital's only about 2 miles away).
That's really interesting. All of my partners have used the AEDs multiple times, and the more and more people I ask, Im finding BLS units with AED units are a lot more valuable that I originally thought.

Two arrests in the past month? What kind of area do you work? From the sound of things you're in a pretty populated area, especially with hospitals so close. If a call even comes in with a possibility of a code, our company dispatches a PFR (Paramedic First Responder in a Tahoe, a single medic without the drug box), a BLS unit with an AED, and an ALS unit. Usually the BLS unit has a 2-3 minute response time. The PFR also has a 2-3, and the ALS is required to be there under 5.

It's interesting to see how other companies / departments respond though.

[SafetyPro]

Around here, fire departments are the primary EMS agency. Probably 2/3 of the departments run rescue ambulances (RAs), while the rest run non-transport squads with a private company providing the transport. The private companies primarily do inter-facility transports or provide transport for the FDs, but don't respond as a primary provider (and most are BLS as well).

We support about 11,000 residents, and a large percentage are elderly. We really don't get that many full arrests outside of the skilled nursing facility (where many are DNR anyway), but this past month we did.

As I said, most departments are ALS...we're the only BLS department in the county (we're also the only volunteer department). Arcadia, our neighbor to the south and east, has three stations and runs two ALS RAs. Pasadena, to the west, runs 4 ALS RAs and two ALS engines. Their EMS call volume is high enough that it's impractical for them to respond outside their own jurisdiction, especially coupled with the current hospital crisis in L.A. County. It's not uncommon for an ALS unit to be out of service at the hospital for over an hour waiting for a bed for their patient...recently, 3 RA crews from two departments were out of service for close to three hours at the same hospital...a BC finally had to come in and have one crew take all three patients to put the other two RAs back in service.

[lastcode]

AEDs are great. Our community of about 7000 is really pushing for them. We 2 of them in our small school, each of our ambulances has them, our cops have them, and we have them in a few places around town. The newest auto ones are so easy there really is no excuse for the avg person not being able to use them. They talk and tell you exactly what to do. They can be such lifesavers, but even in cities, it can take to long to get one to the scene.

[SafetyPro]

Aside from my FD activity, I'm a big supporter of workplace and public access AEDs as well. We had them at my last two jobs (newspaper and oil company), and I was the program coordinator for the oil company. I'm also a Red Cross instructor and have been planning on writing an article on workplace AEDs for Professional Safety journal (when I can find the time).

[AngryGeek]

Early defib really is important. AEDs are great things and should be everywhere. Further, I don't think a vehicle should be able to be called an ambulance without an AED (or better). That includes BLS trucks that do nothing but transports. Any patient could potentially arrest into VF or VT.

Even if the station is a block from the scene, and the scene is only a block from the hospital, it will still take a few minutes to get them into the ER. That's more than enough time for a saveable patient to become nonviable.

Now, I know the pertcentage of arrests that go into VF or a VT rhythm that an AED can shock isn't that high. However, the survival rate of patients in those rhythmes that get early defib IS high.

As far as my department goes, we use the same trucks for BLS and ALS. We have Physio-Control LifePak 12s. When you turn them on they start in AED mode but if an Intermediate or Medic is on scene they flip to manual mode easily. Unfortunately even the base model of the LifePak 12 is VERY expensive. I believe fully equiped (pacer, NIBP, Sp02, EtC02, 12-lead, etc.) is around $16,000 (ouch!).

Interesting side note: One of the largest EMS/Fire departments in the state uses LifePak 12s and recently got rid of all their hard paddles because even the paramedics prefer the quick-combo pads (for many reasons). Being able to stand far away from the patient while shocking is a good thing!

[Chimpie]

I agree. We have two AEDs for our community, one with us in the squad, one inside the main building. I take it with me on ALL medical calls (sick calls, requests for BP checks, fallen out of bed, pendant presses, etc.) cause with the elderly you never know when things are going to go south.

We use the LifePak CR Plus. It's a pretty basic unit and serves our needs well.

http://www.numed.co.uk/crplus6.jpg

Chimp

[Alpha752]

I dont work on a squad (yet), but I do work for a major sporting venue, and we even have 4 AED's through out the building. During events we have paramedics and nurses on site with Lifepack 12's, but non event times, I take care of that. We have several officers (security) that are trained in AED use, but I am the only EMT on staff, so my boss put me in charge of making sure that they are ready to go at any time. I am also the first responder if I am on shift. Havnt had to use the AED yet, but I know that they are there, and its a comforting thought. EMS responce can be anywhere from 5 to 10 minutes depending on how busy they are (I work in Downtown Cleveland). Its good to know that I can take care of things for at least that long.

I strongly support AED's on all BLS trucks, in all public buildings, and in any building that holds over 100 people. As long as someone is trained to use it, it is an invaluable lifesaving tool.

Russ

[MMiz]

AEDs are great. Our trucks carry the Medtronic Physio-Control LifePak 500 (http://www.aedsuperstore.com/index.asp?PageAction=VIEWPROD&ProdID=276&HS=1). They're a basic unit that really works well in an EMS setting.

My personal favorite as a device for a community setting would be the ZOLL AED Plus (http://www.aedsuperstore.com/index.asp?PageAction=VIEWPROD&ProdID=278&HS=1). It's a single pad unit, walks you through each step out loud, has a CPR marker telling someone where to do CPR (it's on the single pad), and best of all, tells someone how to do CPR. It will tell you to speed up, slow down, push harder, and so on. It also records all the information for later analysis.

I don't see the Zoll being popular in EMS, but I think it's a great choice for those who haven't operated an AED before.

[ResTech]

I agree with the majority of the above posts. AED's are critical when determining outcome and giving a patient the best chance of survival from cardiac arrest due to the nature of the illness making treatment so time dependent. In my area, we have a two-tiered response system where all FD/EMS station's are equipped as BLS ambulance providers and ALS comes from the two hospitals, one fire station that serves as a satellite station for the one hospital ALS unit, and another FD that just started their own ALS service.

So in my area AED's are onboard all ambulances and QRS (Quick Response Service) units and are usually first onscene prior to the ALS unit and EMT-B's start the initial treatment of all arrest patients. My department uses the LP500 as does most other stations. I do know of a few that use LP12's as AED's and also for the vital signs monitor capability.

The weird thing is that the Pennsylvania Department of Health does not mandate AED's for licensure. We have seperate AED program requirements for "AED provider services" and find it kinda weird that there is no mandate for AED.

I think the most important issue is the national standard of care for treatment of cardiac arrest patients. A BLS provider service that does not have the equipment to deliver the standard of care within their scope of practice is opening themselves up to potential litigation for not delivering the standard of care. I know I would be quite upset if an ambulance arrived at my home without the ability to defibrillate.

The majority of the police departments and three area shopping malls all have AED's which is awesome.

[SafetyPro]

On a related note, they're becoming more and more prevalent in industry. The conference I was just at was the American Society of Safety Engineers, which is primarily industrial occupational safety and health professionals. I counted at least a half-dozen or more AED vendors in the exhibit hall: ZOLL, MedTronic, Heartstream and several others.

[TKO]

I have worked both rural and urban areas in Sask here and it all depends on the private operator if he wants to shell out the cash for them or not. If there is ALS, manual defibrillators are available in all the units but AED's are by choice. I personally don't agree with this especially if we are running a BLS car and ALS isn't available, my god, lay rescuer's have them in the mall and casinos. If I was the ambulance operator running that service I personally would be embarrassed having my crews show up on seen of a code and can't do a dam thing just because I didnt want to buy one. Too bad.

[Chimpie]

I agree TKO. At around $2,000 (US$) you simply can't afford not to have one. Or two or three....

Chimp

[cbdemt]

In my area (central IL) ALL ambulances carry the LIFEPAC 12. The majority of ambulances in this region run out of fire departments (many of which are volunteer). We are all trainied on the basic AED functions as well as 12 lead ECG. There is only one ALS service in the county, so having access to this is vital to our patients. I cant imagine not having access to one. Its quite expensive (starting at $4995.00), but well worth the price.



Take a look...
http://www.dixiemed.com/defibs/lifepak-12.html

[MMiz]

Originally posted by cbdemt@Jun 16 2004, 02:45 PM
In my area (central IL) ALL ambulances carry the LIFEPAC 12. The majority of ambulances in this region run out of fire departments (many of which are volunteer). We are all trainied on the basic AED functions as well as 12 lead ECG. There is only one ALS service in the county, so having access to this is vital to our patients. I cant imagine not having access to one. Its quite expensive (starting at $4995.00), but well worth the price.



Take a look...
http://www.dixiemed.com/defibs/lifepak-12.html
Very interesting.

Our ALS and Paramedic First Responder (One medic in a Tahoe) carry the LifePak12. ALS is no more than 5 minutes away, and the farthest hospital would probably be 10-15 minutes coding.

I really think it all comes down to cost. As a private company, I dont think they can rationalize spending so much on a unit when ALS is so close. I also know the units we carry have the PulseOx, BP system, Vent monitor, and a few more add-ons.

As a basic are you trained to do EKGs? Do you have ACLS too?

very interesting, thanks for sharing.

[citizencain20]

[/B]In rural northern wisconsin, we also carry S-AED's (LifePac) with built in 4 lead ECG. Although not every EMT-B is trained on how to read an ECG (everything treated as if AMI) It is very useful to the hospitol staff upon arrival. Also, with the recent homeland security grant funding now most polic vehicles even carry AED's.

[ffemt8978]

No AED's, but we do carry biphasic defibrillators. (Way Cool!) B)

I was corrected today about this. All of our engines carry the Heartstream Biphasic AED's, in addition to the biphasic defibrillators carried on our ambulances.

[cbdemt]

Originally posted by MMiz@Jun 16 2004, 04:53 PM

Very interesting.

Our ALS and Paramedic First Responder (One medic in a Tahoe) carry the LifePak12. ALS is no more than 5 minutes away, and the farthest hospital would probably be 10-15 minutes coding.

I really think it all comes down to cost. As a private company, I dont think they can rationalize spending so much on a unit when ALS is so close. I also know the units we carry have the PulseOx, BP system, Vent monitor, and a few more add-ons.

As a basic are you trained to do EKGs? Do you have ACLS too?

very interesting, thanks for sharing.
That’s a good point. I guess if the majority of our departments were not in rural areas it wouldn’t be such an issue.

We are trained to recognize basic rhythms (vfib, vtach, brady, etc.) It also is handy when we intercept with ALS in route to the hospital (which happens on most of our ALS calls) because we can already have the patient on the monitor and be running tape when the Medic boards.

We aren’t ACLS - I don’t see that happening in the near future either. I'd be happy if they'd give us advanced airways!

[rescuecpt]

Wow - it blows my mind that not all BLS units have AED's! They are required in New York State. My volunteer fire department is 20 minutes from the hospital and would not survive without the AED. I also ride with an ambulance corps 2 towns over - we run about 10 calls a day - we have an AED and a manual defibrilator on each rig (we have 4 plus a first responder and two fully stocked chiefs cars).

There's no point in showing up on an arrest call unless you have an AED - and since I've become an AEMT, I'm starting to believe there's little value in showing up if you don't have a manual defibrillator and at least a 6 lead ECG.

[MMiz]

Originally posted by rescuelt@Jun 24 2004, 01:02 PM
Wow - it blows my mind that not all BLS units have AED's! They are required in New York State. My volunteer fire department is 20 minutes from the hospital and would not survive without the AED. I also ride with an ambulance corps 2 towns over - we run about 10 calls a day - we have an AED and a manual defibrilator on each rig (we have 4 plus a first responder and two fully stocked chiefs cars).

There's no point in showing up on an arrest call unless you have an AED - and since I've become an AEMT, I'm starting to believe there's little value in showing up if you don't have a manual defibrillator and at least a 6 lead ECG.
EMT-Basics / BLS units in our county mainly have one function, transports. 75% of our calls are transports. BLS units also have another use, ALS transport with a FF/Medic on board. Usually the FD will respond with their engine and ambulance. They'll initiate care and do almost all the work. BLS will arrive only to transport. Literally, they just sit there while the medic does everything, and the medics all have LifePak 12s.

Our company is different though, we're provided the best and newest equipment. We have AEDs, PulseOxs, Electric Suction, 800 MHzs, and all that good stuff. We're a non-profit though, so all the extra money we make goes back into the company. BLS units are also allowed to work as first-responders with the contracts we have. We might get there first, and initiate care. Once ALS arrives, no more than 1 minute later, we step back and assist them. Usually we're cancelled before ALS clears.

Our ALS units have 12 leads, once again the only private service in the county.

The saying goes, in our county there are two levels of EMS: Paramedics and ambulance drivers.

[ma2va92]

every squad in our county has AED .. also every fire truck. and every police car.. or deputy car

[MMiz]

Originally posted by GVRS672@Jul 20 2004, 12:03 PM
every squad in our county has AED .. also every fire truck. and every police car.. or deputy car
That's impressive. How large is your county?

[ma2va92]

Originally posted by MMiz+Jul 21 2004, 08:58 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MMiz @ Jul 21 2004, 08:58 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-GVRS672@Jul 20 2004, 12:03 PM
every squad in our county has AED .. also every fire truck. and every police car.. or deputy car
That's impressive. How large is your county? [/b][/quote]
Our County is comprised of 764 square miles in the west-central portion of Virginia's central plateau. The area has a rolling to hilly terrain with elevations from 800 feet to 4,200 feet above sea level.

wow that sounds good.. not my wording.... direct copy paste from the couty office.. lol well it answered your question

[rescuecpt]

Originally posted by MMiz@Jun 16 2004, 04:53 PM
ALS is no more than 5 minutes away, and the farthest hospital would probably be 10-15 minutes coding.
A LOT of heart muscle can die in no more than 5 minutes...

[ffemt8978]

Right now, there is a big discussion being tossed around the ASHI mailing lists about AED's being made available over-the-counter. Given the current costs of approximately $2000 per unit, should you also be required to obtain a prescription from a doctor to possess one, say, in your own home?

I don't even want to get into a discussion about the training requirements to use one, if they are made available over the counter. I would rather hear if you think this is a good idea in the first place, and why.

[SafetyPro]

Some manufacturers are actually, well, not circumventing, but expediting the whole prescription process by selling the units with a pre-packaged prescription/medical oversight program and training package where they schedule a trainer in your area to come train you. You can actually buy one manufacturer's AEDs at Costco (think it's mail-order only). We actually used a similar program when we got ours at my last job...a subsidiary of the manufacturer provided the prescription and medical oversight. We scheduled the training on our own through our first aid/CPR provider.

I personnally would love to see the prescription requirement go away, so long as there's a system to ensure that the training and medical oversight are handled properly. I don't see the need for a prescription because of the simple fact that there's no reason NOT to prescribe them. A prescription only makes sense if the doctor is making some determination whether or not its a good idea. Currently though, the prescription process' only real purpose is to ensure the training is done and that there's medical oversight. I think there's a better way to handle that though.

I also think everyone should be trained in first aid/CPR. I'd almost go so far as to suggest it be a requirement for graduation from HS. That's not to say that everyone's cut out to do it, or that I think everyone should be required to maintain certification, but I think everyone should at least learn it once.

[rescuecpt]

We had to learn first aid and CPR in highschool - it was part of health class and if you didn't pass health class, you didnt graduate.

[MariaCatEMT]

The vollie fire department I joined has two AED's (so two of three rigs have them on board).

In my community, the police also carry AED's (some not all, usually shift supervisors) last I heard, despite the fact that ALS response time is swift.

Much of the city fire department also is geared with AED's. Some of our schools have them as well.

All the near-by rural services have them as well.

AED's everywhere!

[MCSOMED54]

We have six AEDs, soon to add a seventh. The are made available to our BLS members to checkout when they go on duty. The Paramedics have ALS gear to carry.

[Ray1129]

:blink: This topic of discussion really has my jaw dropped. I never knew that there were places that *didn't* carry at *least* an AED. In Maryland, we're not technically considered a BLS unit unless we have one. There are rural companies that can't afford them, but even then that's something top on the list of things to get. It's in the BLS protocol to use an AED....

I understand that not every state has the same BLS protocols, but I honestly thought that that was a universal thing.

In Maryland, all first responder ambulance are fire department based. There are private ambulance services that do facility to facility transports....90% of their calls are non-emergency. In the fire department, most units carry the lifepak12 or some equivilent. In private companies, it depends on if you're an ALS unit or BLS. Most BLS units carry an AED, and the ALS get the lifepak12's(or equivilent).

It's also becoming standard in Maryland that police departments carry them, and they are even being prescribed to cardiac patients. They've started going up in malls, airports, churches, etc. I thought it was just standard for them to be on ambulances first....

Pardon my ignorance....I'm really kept sheltered, aparently. *impish grin*

[croaker260]

In our state, if you are a liscensed aBLS ambulance, OR a liscenced first responder agency, your rig must have an AED.
This does not apply to wildland fire fighting crews though.

[MMiz]

Originally posted by MCSOMED54@Jul 28 2004, 07:24 PM
We have six AEDs, soon to add a seventh. The are made available to our BLS members to checkout when they go on duty. The Paramedics have ALS gear to carry.
First, Welcome to the forum!

I agree, it's something that should be made available to BLS. My company agrees also, all of our BLS units carry AEDs.

I see you're from Maricopa County. As soon as I read that, I tried to think of where I remember that name from. Then I went to the county web site. I don't think I could disagree with your Sheriff's ideology and practices, but you people sure do seem to like him.

Welcome to the forum though, and I hope you continue to post!

[rescuecpt]

As an officer I have O2 and a BLS bag in my POV, but I am not technically a "first responder" because I don't have an AED. If the department bites the bullet and buys me one, I will be a certified NYS first responder. Right now, I just tend to accidentally "show up" on scene before the ambulance on BLS calls. If the call comes over as ALS, I always go to the Firehouse because that's where my sharp things and druggy things live. :rolleyes: