What Gets ALS?

[RocketMedic]

I know we have a diverse population and set of views here, so I wanted to ask this question: what gets ALS in your system, and why?

Additionally, here are some generic scenario questions- would these receive ALS in your system, and what would generally be done?

Psych?

Isolated, non-life-threatening trauma?

Falls?

General medical sick calls (abdominal pain, pain, fever, weakness etc)?

Respiratory/diabetic/cardiac?

Altered mentation?

Arrests/periarrests?

MVA?

Additionally, in your system, if you request ALS for a non-life-threatening call for symptomatic management, what is their reaction, the reaction of your system, etc?

What are you expected to do?


For ALS providers, what is your general opinion on this?

 

[DesertMedic66]

Everything that gets called in 911 is automatically an ALS call and we are not able to downgrade it to a BLS level. Once a medic makes patient contact that patient now must have a medic during their entire prehospital care.

Calls at an ED, urgent care, private callers who call dispatch directly will either state if it's an ALS or BLS or dispatch will determine what it is.

If a BLS unit is on scene and needs ALS there is no reaction really. The crew will either call or radio dispatch and say "hey we need an ALS unit code 2 or code 3 here" and they will get sent.

 

[NomadicMedic]

Everything. Paramedic on every truck, and then the medic makes the determination if he/she is going to attend the call.

 

[FiremedicSC]

In the system I have worked for I as the medic make the decision, based on what I'm seeing, hearing, and feeling. I know there's people out here that'll be like no protocol says this. But if you can back it up, the psych that's really a call for help and my partner had made a connection while I gathered the who, what, and when's. Then my BLS partener rides it, I'm only 2-3 feet in front of the patient if they start going south. My partner should be up on thier assessment skills and hollar early. But that's my take. Let the butt reaming begin.

Sent from my SAMSUNG-SM-G930A using Tapatalk

 

[StCEMT]

When I was on the BLS truck, the most common to go out to BLS crews were psychs, abdominal pain, and nausea/vomiting. Every now and then they get something different than those three, it turned out to not be nearly as simple as the page said, or they get flagged down.

On my shifts on a P/B truck, it depends. Not all need ALS, but I tech a lot simply because I have already started paperwork on the way. The info we get before arriving on scene is almost nothing, so if it is something that could warrant ALS care I just go ahead and get everything started. I try to get my partners stuff besides basic transfers though, so I will switch up once we get an assessment done.



Additionally, here are some generic scenario questions- would these receive ALS in your system, and what would generally be done?

Psych- Both. Honestly have no idea how they decide what gets ALS vs BLS or what gets urgent vs non-urgent. I think or involuntary psych transfers get ALS. The psych transfers from one hospital are strictly ALS, other hospitals can be BLS. I've never needed to do anything with psychs. Obvious options include physical restraint and chemical sedation.

Isolated, non-life-threatening trauma?- Usually ALS, but I've had it on the BLS level. Get a lot of nursing home fractures, so I usually try to bring some pain control on these. Splinting or position as appropriate depending on the injury.

Falls- Same as above.- Obviously a more severe fall gets ALS from the start, for example a recent ped fall from 10-15 feet.

General medical sick calls (abdominal pain, pain, fever, weakness etc)?- Sick case is really common for both ALS and BLS. Again, no idea how they decide who gets what level and urgent vs non-urgent. Usually they aren't anything too serious, but I have found new onset of things from time to time. They get the fill work up though, sometimes they are surprising. Treat accordingly.

Respiratory/diabetic/cardiac?- I don't think I have ever seen a basic crew get one of these, maybe diabetic. This is pretty much always ALS, the exception being when we have no ALS trucks in service. They get the full assessment and then appropriate treatments depending on the severity of their condition.

Altered mentation?- Possibly has gone out BLS with poor coding, I know crews have gotten strokes etc. These usually all ALS though. Assess, treat.

Arrests/periarrests?- Always ALS.

MVA?: Initially ALS, but I will call a BLS crew for an assist if we have someone who wants transport that isn't needing any ALS care. BLS crews get these a lot though just due to how much we are moving around, I was first on scene for many on the BLS truck just by chance. Usually no treatment needed and frequent AMA's. From time to time some basic pain management and splinting is needed. I've yet to have one in the city that required emergent transport

As far as ALS request, if they request it then it will get sent. It's rare, but it happens. I am more than happy to go out if another crew needs help or have concerns. It depends on the location though, they are good about taking people right away to the hospital if we will be extended. That happens a bit as well.

 

[Eden]

Psych- pt that is imminent threat to himself/others- chemichal control if necessary.
Isolated trauma-no, nothing we can do here.unless serious pain control is required
General sick call- same^, or patient is hemodynamically unstable, Acute stroke- unless AMS it can be BLS. but depends on distance from hospital might be ALS. intiate antihypertensive tx and save some time.
falls- no.
Resp/cardiac/diabetic-yes, because we can actually make a difference in these patients.
AMS- yes, because it usually represent serious underlying pathology.
Arrests/periarrests- of course.
MVA- not necessarily. most of them no.
Symptomatic management-
No problem, if its necessary then you'll get it. Its usually for pain, then we will give the appropriate meds.

 

[agregularguy]

We have a tiered ALS and BLS system, so depending on the call and needs of system, you'll either get an ALS or BLS truck. Generally ALS goes to all OD's, cardiac arrests, diff breathings, chest pain, GSWs, and most MVAs, although I've been seeing more BLS MVAs get dispatched.
BLS will go to most of the non-critical falls, lift assists, decent amount of abdominal pains, nausea/vomiting/general illness, pyschs/drunks.
But, it also depends on the needs of the system. Before we lost the city next to mine's 911 contract, we were down medic trucks frequently, so you'd often see BLS units go to higher priority calls when all the ALS trucks were tied up. And vice versa when we go down BLS trucks.

As for ALS requests, you'll get one as long as one is avaliable and they're closer to you then the hospital. Will both meet you on scene and en route. I'm always ok to help out other providers, especially the newer one's when they feel uncomfortable. However we have several medics here who are less willing, and really dislike being called for pain management to the point of refusing care or yelling at the BLS crew after the call.

 

[RocketMedic]

*Disclosure: my service is entirely MICU-level, so we always have a medic available and organizationally have a fairly sensitive threshold for ALS assessment and care.

With that being said, what is the expectation of assessment for things like falls, nausea/vomiting, abdominal pain, etc? I've found many a sick person who legitimately needed interventions on BLS calls.

 

[DesertMedic66]

In the system I have worked for I as the medic make the decision, based on what I'm seeing, hearing, and feeling. I know there's people out here that'll be like no protocol says this. But if you can back it up, the psych that's really a call for help and my partner had made a connection while I gathered the who, what, and when's. Then my BLS partener rides it, I'm only 2-3 feet in front of the patient if they start going south. My partner should be up on thier assessment skills and hollar early. But that's my take. Let the butt reaming begin.

Sent from my SAMSUNG-SM-G930A using Tapatalk

How dare you!!!!

Kidding of course. I don't think you will find many people on this forum who will ream you for this at all.

 

[agregularguy]

*Disclosure: my service is entirely MICU-level, so we always have a medic available and organizationally have a fairly sensitive threshold for ALS assessment and care.

With that being said, what is the expectation of assessment for things like falls, nausea/vomiting, abdominal pain, etc? I've found many a sick person who legitimately needed interventions on BLS calls.

General N/V will get a BLS truck most days in my system. Falls, really depends on who is dispatching, what other calls are coming in, how many ALS trucks we have etc. Abdominal pain above the navel gets ALS, while generalized/not above navel generally gets BLS. Worse comes to worse, you can call for an ALS intercept though. Also, we're generally almost never more than 20 minutes from the level 1 trauma center at the very furthest.

 

[GMCmedic]

In my system I make the determination.

In most cases, the keywords you learned in medic school that make a run ALS are the ones that I will ALS. However, when I say ALS, that may not mean "vomit" care. I may just ride in with the patient and keep it BLS.

Psych calls will depend on the patient and their behavior.

Usually car wrecks with soft tissue injuries and falls that are your basic "i tripped on the rug" will go BLS with an EMT if the patient doesnt want pain meds.

Minus the obvious calls, if I can do something to make them more comfortable I will.

A majority of ALS patients get IV and monitor. O2 is reserved for RA sat <94%

Sent from my SAMSUNG-SM-G920A using Tapatalk

 

[FLMedic311]

Well the word on the street is that in my system unless you are in the active process of dying or dead AND resuscitatable <--(I think i just created a word..) you are BLS...

But truly we are a tiered response system that operates like most others. Depends on the call, and the Medic, compared to what I had heard prior to arriving here it is not what it may have once been and most calls that should be ALS are.

 

[NomadicMedic]

Well the word on the street is that in my system unless you are in the active process of dying or dead AND resuscitatable <--(I think i just created a word..) you are BLS...

But truly we are a tiered response system that operates like most others. Depends on the call, and the Medic, compared to what I had heard prior to arriving here it is not what it may have once been and most calls that should be ALS are.

That's truly good to hear.

 

[FiremedicSC]

[quote uid=27779 name="FiremedicSC" post=643371]In the system I have worked for I as the medic make the decision, based on what I'm seeing, hearing, and feeling. I know there's people out here that'll be like no protocol says this. But if you can back it up, the psych that's really a call for help and my partner had made a connection while I gathered the who, what, and when's. Then my BLS partener rides it, I'm only 2-3 feet in front of the patient if they start going south. My partner should be up on thier assessment skills and hollar early. But that's my take. Let the butt reaming begin. <br /><br />Sent from my SAMSUNG-SM-G930A using Tapatalk[/QUOTE]<br />How dare you!!!!<br /><br />Kidding of course. I don't think you will find many people on this forum who will ream you for this at all.

Sent from my SAMSUNG-SM-G930A using Tapatalk

 

[TransportJockey]

Almost everything here. All 911 trucks are staffed by at least one paramedic. But sometimes a non-injury (confirmed) fall will get one of the transfer trucks if they're free.

 

[hometownmedic5]

My system waffles on this very issue every day.

All of the dedicated trucks are double medic all the time. We also run a retail base in town with ~6 BLS IFT trucks. Rarely, the company will send a bls truck to an obvious bls call, but usually they will send a town als truck from farther away. Their thinking is the town is paying for the medic trucks, they should be first out the door. By using a transfer truck on a town call, 1) a town call doesn't log a run and 2) a transfer truck might be unavailable for a retail call. So most of the time, the town als trucks do the drunks, psychs, parking lot MVA refusals, and so on.

 

[RocketMedic]

Well the word on the street is that in my system unless you are in the active process of dying or dead AND resuscitatable <--(I think i just created a word..) you are BLS...

But truly we are a tiered response system that operates like most others. Depends on the call, and the Medic, compared to what I had heard prior to arriving here it is not what it may have once been and most calls that should be ALS are.

That's what makes it so challenging to really assess Medic One. Y'all are a fairly secretive group and the best information that we have is typically second-hand information from folks like NomadicMedic or you, and the information that we get from y'all may not be comprehensive or up-to-date.

 

[EMT9396]

Well if you're in Los Angeles County especially around Pomona I can tell you right now the medic there pretty much BLS everyone. I have talked to many of the people on the ambulances there and they have told me that time and time again. I personally was there on a ride along and there was an older patient who had had a stroke before and felt that they were having one again. so the medic did the test on the patient and said patients fine. take the patient and then he was done. mind you the blood pressure was through the roof and other things were happening. once we got to the hospital the nurses there were very worried about the patient and rushed the patient to a room and started getting an iv on going. needless to say the EMT's that were transporting the patient there ended up looking like idiots because the medics didn't want to have to go to the hospital.

 

[Handsome Robb]

Lift assists get a BLS fire engine and no ambulance. All our ambulances are dual medic so everything gets an ALS response.


Sent from my iPhone using Tapatalk

 

[NomadicMedic]

That's what makes it so challenging to really assess Medic One. Y'all are a fairly secretive group and the best information that we have is typically second-hand information from folks like NomadicMedic or you, and the information that we get from y'all may not be comprehensive or up-to-date.

Rocket, I think you should go investigate KCM1. They could probably get you a ride along or two... and a vacation in the PNW would be okay.