Call for ALS?

[Sasha]

For those of you who ride a Basic/Basic 911 response truck. What kind of calls do you determine to need ALS? How do you make that determination? What parameters are set by your company? Are there complaints that automatically get an ALS response sent with them? Do you not feel that everyone needs an ALS assesment?

 

[EMTinNEPA]

99% of the time, my service and ALS will get a stacked dispatch. Anything that's potentially or definitely life threatening (major trauma, bleeding, ABC threats, altered mental status, cardiac arrest, etc., etc.) will have a stacked dispatch. However, BLS will get dispatched alone if it's something minor such as knee pain or "an ill person". Fire standbys also get BLS only, unless it is a confirmed working structure fire, in which case the incident will get an ALS rig as well.

 

[Buzz]

For those of you who ride a Basic/Basic 911 response truck. What kind of calls do you determine to need ALS? How do you make that determination? What parameters are set by your company? Are there complaints that automatically get an ALS response sent with them? Do you not feel that everyone needs an ALS assesment?

If there's a medic unit available, the ALS crew gets sent out to a rescue call. If one's not available, they send the BLS. Once on scene, the BLS car will rarely request ALS because they could be to an ER by the time the ALS crew would be arriving on scene. (Our average transport time to an ER in this area is 7 minutes) The only time the BLS crew would request ALS is for an MVA where prolonged extrication is probable.

 

[Sapphyre]

I've mentioned before, I work in the land of Johnny and Roy. All calls get an engine/truck/quint, a squad, and and ambulance, at least. The squad is ALS and they are dispatched at the same time we are. The captain can cancel the squad on some calls (don't ask me which).

 

[medic417]

However, BLS will get dispatched alone if it's something minor such as knee pain or "an ill person".

UMMM what to say and how to say it. That is stupid. Sorry but knee pain can be indicative of many things and warrants an ALS response. As to the ill person almost ever code I have worked was dispatched as an ill person but I guess they did not deserve an ACLS attempt to save their lives per your system. :wacko:

Sorry every patient deserves an ALS exam. And again in reality ALS should be the minimum of patient care on every ambulance. Even the stubbed toe call could be masking some other real problem that at the basic level would be missed. I have had more than one patient thats only sign/symptom with BLS exam was big toe pain that turned out to be having an acute MI.

Now if your service chooses not to have the best which would be two Paramedics per ambulance but runs an Basic/Paramedic ambulance then after an ALS exam care could be given by the basic allowing the Paramedic to drive. But an ALS exam is warranted on all calls.

 

[emtfarva]

Calls that I would request als for:
Chest Pain
Diff Breathing
hypotension, hypertension (when comfirmed by me)
active sz
AMS
Back Pn
extended extraction

 

[Sasha]

UMMM what to say and how to say it. That is stupid. Sorry but knee pain can be indicative of many things and warrants an ALS response. As to the ill person almost ever code I have worked was dispatched as an ill person but I guess they did not deserve an ACLS attempt to save their lives per your system. :wacko:

Sorry every patient deserves an ALS exam. And again in reality ALS should be the minimum of patient care on every ambulance. Even the stubbed toe call could be masking some other real problem that at the basic level would be missed. I have had more than one patient thats only sign/symptom with BLS exam was big toe pain that turned out to be having an acute MI.

Now if your service chooses not to have the best which would be two Paramedics per ambulance but runs an Basic/Paramedic ambulance then after an ALS exam care could be given by the basic allowing the Paramedic to drive. But an ALS exam is warranted on all calls.

that was exactly what i was saying in the chat last night.. where were you! jeez! (insert smiley face here... typing from pjone! but some people dont feel als is even warranted. silly us doing the extra education for nothing!

 

[MMiz]

At our service the only calls that would not get a 911 ALS response for 911 calls were calls by the local jail asking for transport or psych calls.

As BLS I've requested ALS for chest pain, difficulty breathing, and wacky vitals (usually hypotensive). Those are just things that I can't effective treat, and the patient deserves ALS.

Our service believed that any BLS that would warrant lights/sitens transport deserved ALS. If I were to get a patient in the truck and radio that I was transporting lights and siren, then it would automatically initiate an ALS intercept. I've cancelled ALS twice due to our close proximity to the hospital (five or less minutes).

 

[medic417]

that was exactly what i was saying in the chat last night.. where were you! jeez! (insert smiley face here... typing from pjone! but some people dont feel als is even warranted. silly us doing the extra education for nothing!

Yes we wasted our time and money as we all know basics save Paramedics.:wacko: That would be like letting a blind person guide a seeing person through traffic.

 

[Shishkabob]

That would be like letting a blind person guide a seeing person through traffic.

Yes, that's the proper attitude!



/sarcasm

 

[Sparky79]

I think I'm just gonna tear up my useless Basic cert and see if McDonalds is hiring

 

[medic417]

I think I'm just gonna tear up my useless Basic cert and see if McDonalds is hiring

Probably make more money and might actually use your basic skills more there doing CPR and helping choking people.

 

[ffemt8978]

I'll post the same scenario that I did in the chat room last night, and you can explain to me how it warrants an ALS assessment.

A few years ago we had to transport a patient who was stung by a non-poisonous scorpion that was smaller than a dime. The stinger did NOT make it through the skin, and there was absolutely no bleeding, swelling, or anything else wrong with this patient. The only reason we transported was that the child's mother absolutely insisted on going to the hospital.

So why does this patient warrant an ALS assessment?

 

[Sparky79]

Probably make more money and might actually use your basic skills more there doing CPR and helping choking people.

You're probably right! Luckily, I'm a full time electrician and an emt part time. I would make about 1/3 of what I make as an electrician if I was a full time basic. I don't know how people survive on that.

I do more first aid on construction sites as an electrician than when I'm doing shifts on the ambulance as an emt.

 

[medic417]

I'll post the same scenario that I did in the chat room last night, and you can explain to me how it warrants an ALS assessment.

A few years ago we had to transport a patient who was stung by a non-poisonous scorpion that was smaller than a dime. The stinger did NOT make it through the skin, and there was absolutely no bleeding, swelling, or anything else wrong with this patient. The only reason we transported was that the child's mother absolutely insisted on going to the hospital.

So why does this patient warrant an ALS assessment?

Prior to EMS arrival you do not know all those facts. Plus who says it was not poisonus are you a scorpion expert? Some scorpions look very similiar to one another one just hurts like heck the other injects some pretty serious poison. So you actually are responding to a possibly serious event so should be ALS responding. Patient is found. And yes a scorpion expert arrives as you do confirms not poisonous. After ALS exam no problem found not even a true sting. So guess what we do not transport regardless of mothers demand.

But ALS was needed to rule out and to be there if it turned out legit. What would a basic crew do if airway closing from the toxins? Call ALS so ALS should have been first response to be safe.

 

[ffemt8978]

There are no poisonous scorpions in my state, unless they're in a zoo.

And if we had waited for ALS to arrive just to assess this patient, it would have been an hour for them to show up. But you mentioned that you would have not transported the patient, regardless of the mother's demands. Legally, we can't refuse to transport a patient. We can do our best to talk them out of it, but if they insist then they get the ride.

But just to make sure that I understand this, you're saying that every patient deserves an ALS assessment to rule out anything because we don't know what we're going to based upon dispatch information. Yet you wouldn't take them to the hospital, so that a definitive diagnosis/rule out can be accomplished using appropriate diagnostic equipment such as labs. I'm curious as to what diagnostic equipment you would have used on this patient that was different than what I had access to at the time.

 

[emtfarva]

Calls that I would request als for:
Chest Pain
Diff Breathing
hypotension, hypertension (when comfirmed by me)
active sz
AMS
Back Pn
extended extraction

drug OD
hypoglycemia

 

[medic417]

There are no poisonous scorpions in my state, unless they're in a zoo.

In todays world we can not say that for sure. With people and packages traveling all over the world we are seeing more and more insects that are not native to the USA. So there is always potential that one could be there. Also even the non poisonous do cause some people to have severe allergic reactions. Again an ALS call.

 

[volff21]

for those of you who ride a basic/basic 911 response truck. What kind of calls do you determine to need als? How do you make that determination? What parameters are set by your company? Are there complaints that automatically get an als response sent with them? Do you not feel that everyone needs an als assesment?

as an emt in the state of pa not to long ago we were able to determine following state protocol on whether or not a pt was als or bls criteria.anymore if we make that determination and cancel als they tend to request an audit of our report.wont be much longer and an emt will just be an abbreviation for drivers.

 

[volff21]

But then again if you let them board and dont feel the need to ride it cover your a**