When First Responders Don't Respond

[SanDiegoEmt7]

It's an interesting situation. On top level priority calls, our system requires two units respond (only if it's originally dispatched as top priority, not if it upgrades en route, weird... I know), anyhow, if our fire department (BLS FR's) is occupied with a large fire or incident, they suspend all medical aid responses. This requires two ambulances to respond.

The first responder can be a BLS unit or two ALS will handle the call. Also, our system does not allow for BLS to transport to the ED only IFT, transports to EDs by BLS must be requested individually with BH (with evidence provided as to necessity).

All of this can lead to a pretty crazy backup of calls in our system which is incredibly busy.

Note: I no longer work in SD

How does your system work in this regard? Does it work or what issues do you face?

 

[jjesusfreak01]

It's an interesting situation. On top level priority calls, our system requires two units respond (only if it's originally dispatched as top priority, not if it upgrades en route, weird... I know), anyhow, if our fire department (BLS FR's) is occupied with a large fire or incident, they suspend all medical aid responses. This requires two ambulances to respond.

The first responder can be a BLS unit or two ALS will handle the call. Also, our system does not allow for BLS to transport to the ED only IFT, transports to EDs by BLS must be requested individually with BH (with evidence provided as to necessity).

All of this can lead to a pretty crazy backup of calls in our system which is incredibly busy.

Note: I no longer work in SD

How does your system work in this regard? Does it work or what issues do you face?

I work IFT in probably 8 counties regularly, and EMS in one large county.

IFT is totally separate from EMS here. The IFT companies tend to stay fairly busy most of the time, as does EMS, so there's no reason to have them linked. All ambulances are ALS, so all can transport. The number of units we dispatch is dependent on the type of call. Fire is only dispatched if the incident is such that the patient will benefit if they arrive before us (Code, Resp Dist, Diabetic, MVC, etc) or if we will need them onscene for assistance (Code, Lift Assist, MVC, etc). They are not dispatched to calls we wouldn't run code-3 to. We have the benefit of being a large enough county though that anything short of disaster will not tie up all the fire resources.

That said, FR response doesn't figure into our EMS resource management. We don't have to have a fire truck onscene unless we need them for an extrication. If a call needs two units, it gets two EMS units regardless of how many fire trucks show up. Most calls only require one ambulance however.

 

[TransportJockey]

I work in a county that has 13 Fire districts (maybe 14, I can't remember). 2 are paid, 9 of them have rescues (but very few are transport capable due to staffing). We just generally head to the scene with the anticipation that we will be the only people on the scene. We tend not to rely on the hosemonkey's for much out here.
EDIT: All of our trucks are ILS minimum, but we can have a basic attend on a call if the I/P on the truck deems it BLS.

 

[Epi-do]

The entire county I work in is paid, and all EMS ambulances are 911. The IFT ambulances can vary from anything to one EMT and a driver to a B/P combination.

All EMS responses are with lights and sirens, while ITS responses vary. EMS can respond with fire apparatus, or without, depending upon the information dispatch is able to gather. Personally, I think they send the fire apparatus out with us way to often, but what can you do? I end up disregarding them quite a bit.

 

[SanDiegoEmt7]

I just find it peculiar that we are required to send two ambulances to calls to "recreate" the FR. What's the point. Obviously certain calls (non-breathers/codes) would need the extra hands if Fire is unavailable, but I'm hard pressed to think of much else.

Any call with multiple patients will always get multiple ambulances, but I'm speaking about the single-patient calls. Just don't see the point.

Also, I should mention, this situation happens pretty rarely, but it does happen.

Last thought, our system does not have any third party IFT services, so all EMTs on BLS cars have some ALS shifts and are working for the same providers that serve in the 911 capacity. Both BLS and ALS provide IFT services to our area hospitals, yet BLS cannot run any low priority 911 calls. That is to say, a 911 ALS unit might be dispatched to run a BLS IFT call (regardless of system levels), while on the other hand our system could have zero ALS units available and they wouldn't send a BLS unit to even the most basic of calls (psych, stable abd pain). While it might sound risky, San Diego lets BLS run low acuity "emergency" calls quite effectively and safely. What are your thoughts on this?

 

[SanDiegoEmt7]

The entire county I work in is paid, and all EMS ambulances are 911. The IFT ambulances can vary from anything to one EMT and a driver to a B/P combination.

All EMS responses are with lights and sirens, while ITS responses vary. EMS can respond with fire apparatus, or without, depending upon the information dispatch is able to gather. Personally, I think they send the fire apparatus out with us way to often, but what can you do? I end up disregarding them quite a bit.

You respond to psych calls, ill persons, etc. all L/S?

You and I are on the same page, with the amount of calls we turn fire away on, why obligate two ambulances for one patient.

 

[Epi-do]

You respond to psych calls, ill persons, etc. all L/S?

You and I are on the same page, with the amount of calls we turn fire away on, why obligate two ambulances for one patient.

Yes. The only things we do not go to lights and sirens are runs that come in as an "assist a person" - i.e. someone who has fallen/slipped to the floor & needs assistance getting back to their feet, but has no injuries, or fie runs where there is no entrapment or suspected entrapment. Sometimes, if we are going to assist the police, they will request we respond "on the quiet", like for standby on a SWAT call out.

I don't really agree with it, but don't see it changing any time soon.

 

[johnrsemt]

we respond fire, PD and EMS on every medical or fire run. of course we run 80 EMS runs a year, and maybe 150 fire runs, with false alarms.

 

[adamjh3]

While it might sound risky, San Diego lets BLS run low acuity "emergency" calls quite effectively and safely. What are your thoughts on this?

Out of curiosity, who did you work for in San Diego, if you don't mind my asking?


On low acuity "emergencies:"
I work for a private BLS company in San Diego and regularly run "emergency calls" (defined here as the patient going to the ER). A large percentage of my "emergency" runs consist of leaking, plugged, or removed g-tubes. The rest are made up of "medical clearance" after the patient is placed on a psych hold and has possible injuries that the receiving psych facility wants evaluated before accepting the patient (this can consist of anything from complaining of pain after being handcuffed, restrained, etc, to the patient or witnesses stating the pt swallowed odd objects like staples, shampoo, etc), falls, mildly abnormal vitals, etc, etc.

However, when you have private BLS (with no 911 training/experience whatsoever) dispatched to emergencies there can be issues; Between facilities cleverly wording the patient's chief to appear non-emergent to the dispatcher so they don't have to call 911 and the crews getting in over their heads without realizing it. I've gotten called out for "mild hypertension" to get on scene and find a patient with a history of CAD, and a series of other cardiac issues with a systolic BP over 200 having crushing chest pain radiating to the left arm with shortness of breath (upgraded to ALS for that one, later found out the patient coded en-route to the ER). I've also been toned for "weakness" to find a textbook suspected CVA <3hrs since onset. I was working with a fairly in-experienced, not-exactly-observant fellow that day who would not have called a stroke code if I weren't there.

I guess I'm rambling now, so I'll try to wrap this all up and make a point out of it :rofl:

As long as the system isn't "cheated" by the folks calling private BLS for Tx to the ED when the patient is in need of services that can and will be provided by an ALS unit, I have no qualms with BLS running these "non emergent emergency runs" (quite the paradox, ain't it?). I think the problem stems from facilities not understanding the differences in treatment that different levels of out of hospital care can provide or the facilities being well aware of the differences and using BLS when ALS is clearly warranted for fear of being audited.

 

[SanDiegoEmt7]

we respond fire, PD and EMS on every medical or fire run. of course we run 80 EMS runs a year, and maybe 150 fire runs, with false alarms.

1 call every 4-5 days? Really are earning money to sleep haha

My system runs anywhere from 500-700 ems calls a day.

 

[SanDiegoEmt7]

Out of curiosity, who did you work for in San Diego, if you don't mind my asking?


As long as the system isn't "cheated" by the folks calling private BLS for Tx to the ED when the patient is in need of services that can and will be provided by an ALS unit, I have no qualms with BLS running these "non emergent emergency runs" (quite the paradox, ain't it?). I think the problem stems from facilities not understanding the differences in treatment that different levels of out of hospital care can provide or the facilities being well aware of the differences and using BLS when ALS is clearly warranted for fear of being audited.

I worked for a private BLS as well when I was there, so everything you have just spoken of I understand from experience and agree with completely.

In my current system there is no such thing as private ambulance companies, just an exclusive operating contract for one company which operates ALS ambulances and BLS IFT ambulances. So all those psych calls and pulled g-tubes require an ALS amublance response. Can you imagine what would happen in SD if Rural Metro had transport every patient that went to and ED in the entire city.

My only other point regarding your mention of poorly trained emts not knowing whats above their heads. In our system, every working EMT also works 911 shifts. This doesn't mean that they are better trained than BLS only company EMTs, but they do have more insight into our 911 services and the ability to upgrade is more seamless. Also all calls would go through our dispatchers. A lot of times private BLS dispatchers in San Diego take calls that they shouldn't, seen it many times.

 

[Bullets]

we dont have "first responders" here in NJ. My town runs about 5k EMS calls a year, the large majority of them run by 4 volunteer first aid squads, 2 of which also provide ocean rescue services. our first responders are the local PD who get sent on every call. If the volleys dont get out between 6-1800, they are supplemented by a paid FD engine, or township employees with EMT certs.

Otherwise, the 4 volly FD companies only go to fires or requested for lifts by the EMS agency.

PD does 99% of psych transports without EMS unless its a OD or other similar thing. All calls get a code 3 response. ALS is a 2nd tier, not always available or nearby.

 

[SeanEddy]

My service is a private-based ambulance that runs single-medic in about 90% of the county. The fire department (BLS FR) responds with us on everything greater than an "Alpha" response. Our fire departments around here are also all paid and full-time staffed.

Personally, I think it's a giant waste to have them on EVERY SINGLE CALL. Ideally, we would only have them (or a second unit for that matter) on calls where A) We are responding from a long distance B) We needed their assistance lifting or extricating, or C) We needed them for CPR / bagging.

We currently staff ALS (1 medic / 1 basic) and BLS (2 basics) units. The BLS units respond to IFT and 911 calls if they are an "Alpha" response, or the ALS ambulance is coming from a long distance.

.....On a side note: I really like the ideas of the EMT-B being allowed to attend if the I/P deems it appropriate.