Thread: BLS Ambulance staffing
09-24-2008, 12:35 PM #1
- Join Date
- Sep 2008
BLS Ambulance staffing
I am looking to see how fire departments staff a BLS ambulance. Is there currently 2 EMTís assigned to it or is it staffed with one EMT and receives a rider from an engine company once transport is determined? The system my department is taking a toll on the firefighters and the equipment.
How our system works:
In the early 1990ís our department began a first responder program with EMTís. Over the years the system got busier and busier. The first responder engine companies began sitting on scene for extended periods waiting for the volunteer transport or outside agencies. In early 2001, the department decided to purchase it first ambulance. The staffing on the ambulance was and is currently 1 F.F./EMT . We are currently a ďback upĒ to the day time per diem staff and to the volunteers at night; however, we are just as busy as they are. When a call comes in for a medical, the ambulance and an engine company are dispatched. Once on scene, if a transport is determined the rider of the engine transfers his gear over and transports to the hospital with the ambulance. The engine in most cases is out of service until it gets a truck rider at headquarters leaving it short staffed.
If some other department runs a system like this please post a response. If you think this is crazy and a safety and accountability issue, please post a response. The Union says this is a staffing issue and is up to the chief, I respect that, but the union also needs to look at the safety issue this is creating.
10-23-2008, 07:56 PM #2
Up until recently, we ran one BLS rescue (what we call ambulances) per battalion, and there are 5 battalions with either 5 or 6 stations each. The basic rescues at first were static, meaning, for instance, that rescue 19 was always basic. The basic rescues were used for a range of calls. They might be sent instead of an ALS rescue if the call was of a lower priority. They might be sent with an ALS engine, truck, or squad. They might be called to transport a patient with minor complaints at a call where an ALS engine or rescue had already assessed and/or treated the pt at the BLS level only. The purpose of all of this was to keep as many ALS rescues in service as possible by having basic rescues transport all the lower-priority patients. Naturally, 90% of our call volume is medical, and of that, probably 80% are BLS calls. This KILLED our EMT's. Ran them into the ground. The "box," as the rescue has become known, has become looked at as a punishment. Morale dropped significantly over the years.
Then we started rotating which rescue in each battalion was basic. This did help some, as it gave some crews a break. Not all, but some. Some rescues had to stay basic with no rotation due to the needs of the county.
Very recently, it was decided that there would be NO basic rescues operated by the county. All rescues would be ALS. In addition, new EMD protocols mandate that the two closest ALS units respond to priority calls (difficulty breathing, chest pain, bad traumas, arrests, strokes, etc.). Because a number of medics have been moved from fire apparatus back to rescues, those apparatus are now BLS. Those ALS rescues are now sometimes the closest ALS unit to another ALS rescue. So, you might have an engine or truck and two ALS rescues going to the same call. How that's supposed to free up ALS resources, I don't know. What I do know is that it's increased the call volume for the rescues, since they're now responding to calls that would've previously been answered by a fire apparatus with a medic. They're responding farther away. They're having to pick up more of the BLS calls that used to be handled primarily by basic rescues. They're getting hammered now. We've got a problem just getting medics to come here, much less stay. We've got Nationally Registered medics who have not turned in their numbers to the state because it's not worth it to be a medic in this county right now.
What we DO have in place is a private service that contracts with the county to pick up BLS calls and transports, in the same manner that our basic rescues used to. We've used a private service in this capacity for years now, to good effect. Up until recently, the service (which is only contracted to supply 5 units) had up to 8 units on duty at any given time. They were all always busy. Since the county is experiencing the same budget crunch as most governments across the nation, they asked the private service to step it down a bit, down to 5 units total, with one of them being daytime-only. This allows our rescues to pick up more calls, more patients, and more billing. That billing equals more money to the county, but it also equals a hell of a lot more call volume for our rescues.
10-23-2008, 08:21 PM #3
- Join Date
- Aug 2003
Our combination department is quite busy with EMS. Currently we operate with 1 Captain, 1 Lieutenant, 1 Firefighter/Paramedic and 4 Firefighter/EMT's. We staff 1 Engine, 1 Tower Ladder, 1 Heavy Rescue, 1 BLS Ambulance, 1 ALS Response Vehicle, 1 Command Vehicle. The Captain is assigned to the Command Vehicle, the Firefighter/Paramedic is assigned to the ALS Response Vehicle, 2 Firefighter/EMT's assigned to the BLS Ambulance and the Tower Ladder and 2 Firefighter/EMT's and the Lieutenant assigned to the Engine and the Heavy Rescue. This system works OK for us. There is a good possibility (and it does happen) that if a fire call comes in when the ambulance is out that there is no ladder truck. In this case mutual aid is an option. Our BLS Ambulances carry 2 SCBA's and have space for our turnout gear so that ambulances can respond directly to fire calls if needed. More often than not the ladder is needed for manpower rather than tools or equipment.
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