Level of ALS on first response vehicles

[efr5569]

I am looking for any system or department that has a different level of ALS on first response vehicles vs transport vehicles. By this I mean, they perform ALS procedures and give ALS meds, but not as many procedures or ALS meds as the transport vehicle or EMS vehicle perform. I know there are systems that are BLS first response and ALS transport and others that are ALS first response and BLS transport with the PM jumping on the transport unit if the call is ALS. I am looking for a tiered ALS system. Thanks

[ATFDFF]

You may want to check with your state's Department of Public Health (or whoever oversees EMS on the state level). I know in some states tiered ALS response is okay...but others it is now. For instance, in Illinois, it's an all-or-nothing system. Either your unit is BLS or you're ALS with a monitor, all your drugs, etc. On an engine/truck/SUV you obviously don't need to carry the same number of supplies as you have on an ambulance, but you need to have a monitor, all your drugs, a certain number of IV bags/supplies, etc.

[tree68]

In NY, if you're ALS, you're ALS. About the only thing you don't have as an ALS first responder is a stretcher.

Some agencies (usually those which are totally volunteer) don't carry narcs due to the custody and accountability requirements.

[efr5569]

Thanks for your replies. I know that states have minimum requirements for a department to be an ALS provider. I was curious to see if there were any systems that medical direction had set up where the first responders were ALS either at the state minimum or higher, yet the transport unit was even higher than that. My goal is to combine two ALS beliefs. The first that it is important to strive to have ALS on all units that respond to medical calls and second that too many medics trying to perform the same skills can cause paramedic degradation. By having first line meds, equipment and procedures for nontransport first response vehicles, it provides a top level of service to the community and also allows the responders to by highly proficient within their protocols. I understand this only works if the transport component arrives within an acceptable time after first response if not at the same time. This might be the first anyone has thought about trying this. Thanks

[ATFDFF]

Thanks for your replies. I know that states have minimum requirements for a department to be an ALS provider. I was curious to see if there were any systems that medical direction had set up where the first responders were ALS either at the state minimum or higher, yet the transport unit was even higher than that. My goal is to combine two ALS beliefs. The first that it is important to strive to have ALS on all units that respond to medical calls and second that too many medics trying to perform the same skills can cause paramedic degradation. By having first line meds, equipment and procedures for nontransport first response vehicles, it provides a top level of service to the community and also allows the responders to by highly proficient within their protocols. I understand this only works if the transport component arrives within an acceptable time after first response if not at the same time. This might be the first anyone has thought about trying this. Thanks

It seems like you're basically describing the job of an EMT-I or Advanced EMT. Some ALS capabilities. However, if you want to go more than that, you're just getting into Paramedic territory. And, again, in every state I've heard of, you're either BLS, ILS, or ALS...no in between.

And as far as 'minimum' standards...again those minimum standards are everything you need to be ALS. I don't know of any states or systems in states that I've worked in that allow you to pick and choose what level care you give.

[tree68]

New York has four levels (five if you count CFR, but EMT-B is the minimum level to staff an ambulance). Ambulance services can be certified at any of those levels and must carry the appropriate equipment:

BLS - Basic skills and tools
Intermediate - "trauma tech" - IV and defib, but no meds
Critical Care - pretty much all ALS skills and meds, but must get orders for some procedures and meds
Paramedic - Everything in the book

Basics are allowed a few advanced skills, like blood glucose testing and epi on a case-by-case basis, as are the BLS services.

Statewide there is a wide range of arrangements. Some counties have no ALS ambulances, with all ALS being provided by "fly cars" (or whatever they're called). Our county has services at just about every level.

The "intermediate" is a dying breed here, except as a stepping stone to "critical care," which is also in decline. Educational opportunities for paramedic are improving statewide, so most folks who want to go advanced are now working straight through to paramedic.

[edpmedic]

In Fairfax, all of our engines are ALS. We have 37 medic units, and four BLS units. The engines are lacking CPAP, Jet Insufflation, Vacuum splints, 12 lead capability and ETCO2 monitoring on the Phillips, and carry less meds, such as no Zofran, no Dopamine, three Adenosine, one D50, one Glucagon, and only three epi 1:10000. Txp units are expected in a timely fashion, and we have EMS Captains that carry a full complement of meds and 12 lead capable monitor. The engine medic has everythine else the medic unit has otherwise save txp equipment (we do have a long board, collars, spider straps, and towel rolls).

[DanielsSFD]

Shreveport Fire Department is Fire & EMS.

All firefighters are emt-b.
All paramedics are firefighters.

ENGINE - Firefighter/EMT-B
AMBULANCE - Firefighter/EMT-P

When an MVA or Medical Emergency happens Engine and Medic both respond so its basically all ALS responses here.

[Firemedic 61]

The State of Florida dictates what equipment qualifies for a DOH ALS vehicle certification. Anything extra is up to the AHJ.

[backsteprescue123]

At work we have a tiered system county wide. County EMS provides and staffs 10 Life Squads (ALS Ambulances) throughout the county. Fire Departments provide the First Responder (usually BLS but in some cases ALS).

At my particular department, we are all ALS. There is at least one paramedic on every rig, every day. All of our engines and trucks have a full ALS compliment. Also, all of our ambulances are ALS equipped. So on every call in our jurisdiction, ALS will be dispatched. But if it is truely an ALS call, then the County sends a Life Squad along as well.