The other day I was reading the JEMS article about BLS being an afterthought. I can't agree more with it. I have been in this field for almost 18 years now, and I have seen alot of changes. For one, they way the state that I am from [PA] is teaching EMT's is horrible.. this is no joke, for a stubbed toe, call ALS. WTH ???? New EMT's that I see are horrible, they have no skills. When I took my EMT, we were shown the proper way to do stuff and we had to observe in the Emergency Room at a hospital for so many hours. Yet, to be a paramedic in this state you need only be an EMT for 6 monts. How can one be a good paramedic when one is a lousy EMT? Heck, when I stared in working for a paid service in 95, I had to do so much ride along time and prove that I had the skills, same held true for my volunteer service. The county that I reside in is messed up, too. They dispatch ALS for about everything. Since when is a high temp in adults ALS ? I can understand why for Peds for the risk of seziures. Since when has a hop FX become ALS ? I can go on and on about it... The EMT can't get no skills because when they get there [the BLS rig] all they are doing is getiing a stretcher and that is it. The county that I am from ALS is ran by three private services, and there have been times where there is no ALS. Or there has been one ALS unit that was available and got sent to the middle of nowhere for a High Temp or Nose Bleed. What if someone called 911 and needed ALS for a true critical call and died beacuse of it ??? Most hospitals in the county where I am from are in the 10 to 15 min range, unless you are in the rural sections. It truly amazes me that the hospital ER staff will :censored::censored::censored::censored::censored: if you come in BLS with a fracture... "oh, why didn't you start an IV ?" well they are too dam lazy to do it themselves. They only way EMT's get any skills is if you work or volunteer in a rural area where ALS is 20 to 30 min away. Hell, I say why do we need fancy BLS ambulances with all that equipment that we are required to carry that we don't use ? I say BLS should go back to the days of the caddie ambulances and all you needed was FA/CPR. Sorry about the rambling, but this article makes sense and it makes me angry that no one has faith in EMT's or want's to give any time or effort to make them work on thier skills !