ALS or BLS?

[ADyingBreed]

How's everyone doing?


I'm still in basic school, so i wouldn't know, but...

Are most of your calls ALS or BLS? It seems like most would be ALS..

 

[DesertMedic66]

Most 911 calls in my area are BLS. However they still get an ALS response from us.

 

[STXmedic]

Most are definitely BLS.

 

[MMiz]

Most calls would technically be classified as BLS, but in an ideal system would receive providers at the ALS level.

 

[Mariemt]

We are als conditional.

Meaning we have both. Most of the time we run with on call bls crew, but our medics have a hand held radio on them and will respond if the dispatch complaint sounds like they are needed or we request them.

 

[Akulahawk]

Most calls are BLS. A few involve some kind of ALS care. A few of those need full-tilt ALS care.

 

[chaz90]

I'd say the majority should be BLS, many of the rest are "precautionary ALS," and few of the remainder need any kind of ALS intervention beyond a monitor, IV, Zofran, or Fentanyl.

 

[NomadicMedic]

90% of ALS calls are really BLS and 90% of those BLS calls don't need an ambulance.

Okay... Maybe not 90%, but its got to be close.

 

[chaz90]

90% of ALS calls are really BLS and 90% of those BLS calls don't need an ambulance.

Okay... Maybe not 90%, but its got to be close.

Amen to that! Almost every BLS call I hear dispatched makes me wonder if I would have called 911.

 

[STXmedic]

90% of ALS calls are really BLS and 90% of those BLS calls don't need an ambulance.

 

[Fire51]

Like most people have said a lot of calls are just BLS calls but once something like an IV is started then it turns into ALS care.

 

[NomadicMedic]

Like most people have said a lot of calls are just BLS calls but once something like an IV is started then it turns into ALS care.

And my point is, most of that ALS care is unnecessary.

 

[Bullets]

And yet some still advocate for ALS on 100% of calls

ALS was involved in 14% of calls in my town in 2012

 

[Wes]

Are we defining ALS as intervention or assessment?

 

[usalsfyre]

And yet some still advocate for ALS on 100% of calls

It's not that we think the calls require a lot of ALS intervention, it's just that some of us doubt the average EMT-Basic's ability (hell, I doubt a good number of medic's ability) to properly determine ALS vs BLS.

 

[Wes]

On a relatively similar note, isn't there a study that doubts a paramedic's ability to determine whether or not the patient ends up being admitted to the hospital?

 

[rmabrey]

On a relatively similar note, isn't there a study that doubts a paramedic's ability to determine whether or not the patient ends up being admitted to the hospital?

Anymore I doubt an ER doctors ability to determine whether or not they will be admitted.*

* not bashing the doctors, just the politics they deal with


OP a majority of our calls are BLS, but the system dictates ALS care, so we do it.

 

[Carlos Danger]

It's not that we think the calls require a lot of ALS intervention, it's just that some of us doubt the average EMT-Basic's ability (hell, I doubt a good number of medic's ability) to properly determine ALS vs BLS.

And this is exactly why it doesn't really matter who does the assessment.

IMO, most urban EMS systems should be BLS only. By BLS, I mean the ability to administer epi auto-injectors for anaphylaxis, versed auto-injectors for seizures, albuterol nebulizer for asthma, maybe SGA's in arrest. Physicians or a CCT unit can respond in the unusual case of a very sick patient(s) who can't be transported immediately to the nearest ED.

Only rural systems need paramedics, and even then pretty rarely. I would say, 1 paramedic response unit for every 5-10 rural 911 ambulances. Helicopters are of course also available to bring additional ALS and CCT support for select situations in rural areas.

When the only tool you have is a hammer, everything looks like a nail.

 

[medicsb]

On a relatively similar note, isn't there a study that doubts a paramedic's ability to determine whether or not the patient ends up being admitted to the hospital?

Whether a patient is going to be admitted or not should have NO BEARING on the type of prehospital care a patient receives. Those sort of studies are silly to me. There are a lot of patients that legitimately need ALS care who may not be admitted (e.g. many SVTs, asthma, seizures).

Anyhow, for the OP. The overwhelming majority of calls can be handled at the BLS level. You will tend to see more patients be treated ALS in all-ALS systems as many medics will opt for monitor and IV "because the patient will get it anyways" or some far-out "what if..." sort of scenario, and management will not advise against it because it bills at a higher rate. This is not to say that many don't require an ALS level assessment. (Over time, more and more services are going to be audited by medicare or have payments reduced.)

 

[mcdonl]

It depends on what your protocols say.... In Maine, the EMT-B is directed to call for ALS in the majority of calls. The AEMT is allowed to negotiate with OLMC. The medics are medics.

all of that said, the majority of calls we get could be BLS, but with a 35-60 minute transport the patients condition can change and we prefer to have ALS on board.