ALS = Medic/Medic, Medic/Basic, Medic/Intermediate?

[MMiz]

The county I live in requires Medic/Medic for an ALS unit. Do you believe that a Paramedic/Paramedic unit provides higher level of patient care?

Personally I like the idea of Paramedic/Basic. The Paramedic provides ALS services while the EMT does the BLS. I can't think of a single ALS-only call. The Medic/Basic also provies the EMT the ability to learn from the medic, which leads to a more competent crew, and the possibility of an EMT that is more prepared to transition to the ALS role.

What's your take on it?

 

[divinewind_007]

i have always run medic/emt trucks myself. Like you said...the emt does their stuf while the medic does the als. And yes you do learn alot wokring with a medic. However, i can see how a double medic truck could benefit too. It gives both medics the ability to do ALS skills. If one can't get a tube...maybe the other can. Or maybe one is tubing while the other is starting a IO. i could see the benefit from it.

 

[MariaCatEMT]

The county I live in requires Medic/Medic for an ALS unit. Do you believe that a Paramedic/Paramedic unit provides higher level of patient care?

Personally I like the idea of Paramedic/Basic. The Paramedic provides ALS services while the EMT does the BLS. I can't think of a single ALS-only call. The Medic/Basic also provies the EMT the ability to learn from the medic, which leads to a more competent crew, and the possibility of an EMT that is more prepared to transition to the ALS role.

What's your take on it?

I agree with you.

 

[ffmedic]

I have had it both ways. My first 7 years I almost never had another medic. I learned to make do and really became better for it. Our EMT’s learned a lot too. Most of our best medics had been drivers for us. They just sort of “soaked” it up. Most of the new guys will have trouble matching my numbers of calls because of my working “alone” those years. Still when the stuff hits the fan I love having a partner that can do as I do and not have to be limited in their skills.

Our county rigs have two medics now because the union negotiated that hard and won. Lots of miles and long transports with sometimes questionable help from certain VFD’s made it possible. I enjoy my later years having a medic partner to sort things out with.

Not sure what you mean by “all ALS” call but I can think of many were any BLS stuff was minor compared to the thrash ALS needed. When I need an IV or two and a tube I don’t need them minutes apart. Throw in a chest tube or two and it can get tense. Sure one medic can do it all but two do it better.

Also it’s not good for the powers to hear ”we only need one medic”. Two medics are better and the system grows. The more of us there are the better we get due to our numbers. Of course in some systems this isn’t practical I realize and there are considerations on numbers of calls. The balance between enough calls to stay competent and so many you burn out is a fine line.

 

[Jon]

Around here, we run either BLS/ALS tiered or EMT/Medic "MICUs."

 

[Firechic]

We have and hopefully will always continue to run a 2 paramedic MICU.

 

[Guardian]

We run P/B trucks here and it's actually worked out well for the most part. I personally think the more paramedics, the better. Around here however, we don't have enough paramedics to run double ALS.

 

[doc5242]

no matter how trucks are run remember the phrase :

Paramedics save lives..EMT's Save Paramedics

 

[fyrdog]

2 Paramedics provide better patient care. I'll grant you on 80% of my calls it is routine 1 medic is just fine. But the other 20% - one can do Airway whille the other is starting an IV, giving meds, EKG monitor, Pacing. Also 2 heads are better than one.




If Paramedics save lives and EMTs save Paramedics what do medical first responders do?

 

[gradygirl]

If Paramedics save lives and EMTs save Paramedics what do medical first responders do?

Save the EMTs?

 

[doc5242]

If Paramedics save lives and EMTs save Paramedics what do medical first responders do?

Drive the ambulance....

just kidding

 

[Jon]

2 Paramedics provide better patient care. I'll grant you on 80% of my calls it is routine 1 medic is just fine. But the other 20% - one can do Airway whille the other is starting an IV, giving meds, EKG monitor, Pacing. Also 2 heads are better than one.




If Paramedics save lives and EMTs save Paramedics what do medical first responders do?

There was an article on JEMS last year that debunked that theroy - the arguement was that services like Boston EMS (80 medics) and Medic One in Seattle have better arrest save rates than LA city, where every fire truck is ALS-equipped.

 

[Hightoweruk]

But who saves the First responders ???

 

[gradygirl]

Certainly not the canaries.

 

[MedicPrincess]

2 Paramedics provide better patient care. I'll grant you on 80% of my calls it is routine 1 medic is just fine. But the other 20% - one can do Airway whille the other is starting an IV, giving meds, EKG monitor, Pacing. Also 2 heads are better than one.

If Paramedics save lives and EMTs save Paramedics what do medical first responders do?

I disagree. An P/B team works great here. We also have fire as first response, and some of those FD's are ALS here. But if we get a BLS department....

A FF is all over the airway, bagging another is on compressions. If FD isn't there, PD or SO is and they can do it too. In the time it takes me to get the Cardiac Monitor 4 leads on and the Combo pads on she has the IV. Quick look at the monitor tells us if we're shocking. If its shockable, she does that while I set her up for intubation. If its not, I still set her up while she gets her first round of drugs in. Once she is set up, takes none to long to intubate - I hear a monkey can do it - and she is onto her drugs while I get the second line, and then I am driving down the road.

Sounds simple right....does anything ever really go that smoothly??

As a matter of fact when we get ALS fire on scene, us, and our shift commander is dispatched to all codes...well sometimes there are to many medics...

Point is, our protocols allow for the EMT to start IV's, apply the monitor, run 12 leads, glucose checks, administer albuterol, strap on CPAP....lots of stuff a lot of systems dont (Heck, our neighboring county only lets EMTs drive. its what they are hired to do. The medic does all patient care, ALS or BLS). So for our system a P/B crew works fine.....so long as they both can pull their weight.

 

[ffemt8978]

Also, if all you run is a P/P rig, how do -B's or -I's get the patient contact experience they need to become -P's?

Jon, the article that you were referring to, is that the one that stated systems with fewer ALS units do better because they get more practice in their ALS skills?

 

[Jon]

Also, if all you run is a P/P rig, how do -B's or -I's get the patient contact experience they need to become -P's?

Jon, the article that you were referring to, is that the one that stated systems with fewer ALS units do better because they get more practice in their ALS skills?

Yeah... I think that was part of it... something about LA City's medics not even getting 2 tubes a year, on average.

 

[Ridryder911]

no matter how trucks are run remember the phrase :

Paramedics save lives..EMT's Save Paramedics

One of my most hated quotes.. Only developed to sell T-shirts, belt buckles, and caps. Sorry, never seen an EMT save me, or another medic in my career of 30 yrs as a Paramedic. This is a team approach, and I can assure you I have seen many times medics have saved the arses of some basics, of their misinterpretation or lack of medical knowledge.

Two paramedics should be the 'gold standard" this allows each other to trade off, and decreases the demand of the single Paramedic provider. The old saying "two heads are better than one" is true, where one might had missed part of the history, exam, etc.. as well as less stress on the sole Paramedic.

Although, this would be nice to have, realistically and cost effective it is not going to happen soon. I personally would like to see all EMS have the capability of having Paramedic level at the least.....

R/r 911

 

[Guardian]

I agree with rid. If emts in your area are saving paramedics, then your paramedic classes suck and there needs to be higher education standards. On the flip side, many times basics hurt pt care because they are programmed to think critical pt = faster ride to the hospital. My response is, "we are not a taxi service, we are ems. When a pt is turning blue, I need to do what they would do at the hospital only 15 mins faster to prevent brain damage" If I had my druthers, I would do away with emts and only teach at the paramedic level. Paramedics should be the gold standard.

 

[ffemt8978]

Rid and Guardian,

I agree with you that Paramedic should be the gold standard of care, but I'm curious as to how you would implement it in rural areas with volunteer services and almost no funding.