You BLS guys have got this, right?

You guys got this, right?

I mean, your EMT-Basic ambulance was dispatched as the primary ambulance to a high-level chest pain call in your jurisdiction. Sure you have an ALS ambulance responding to assist, but you can handle it by yourselves, right?

I’m sure you can, because even though the call notes say that the patient is experiencing crushing, sub-sternal chest pain at a 10 out of 10 and is pale, cool, and clammy with shortness of breath according to his wife who called 911, you arrived on scene and cancelled the responding paramedics 3 minutes after you arrived.

I’m sure them paragods weren’t really needed anyway. Even though the guy has a cardiac history and has taken his nitroglycerine tablets with some relief, you’ve got this, right? I mean, you can handle the patient with your wide array of BLS skills, training, and equipment, I’m sure. In the three minutes you’ve been there, I’m sure you completed a detailed physical assessment complete with vital signs, differential diagnoses, and have obtained a quality 12-lead EKG tracing, right? I’m also sure that even though you can’t interpret a 12-lead EKG that you acquired the tracing, transmitted it, and had a physician interpret it within that three-minute window you’ve had to get this all done… Right? Forgive me for pointing out that a 12-lead EKG cannot definitively rule-out myocardial ischemia and for also pointing out that even if the computer interpretation of the EKG printed out by your monitor doesn’t flag the tracing as “***ACUTE MI SUSPECTED***” or “MEETS ST ELEVATION MI CRITERIA***” that something bad could still be going on with the patient that even a physician would need lab work and possibly a consult to accurately assess and diagnose.

Of course, I’m sure you know that. I’m also happy to reassure you that as a paragod myself, my motives really are simply to take your patient away from you so I can bruise your egos, talk down to you, and soak up that sweet, sweet, transport revenue. You’re right that your coverage area is your responsibility and that the people who live there are better off being treated by EMT-Basics who run a handful of calls per month and who learned every single solitary scrap of information presented to them in their initial 8 month training class.

Because all of the above has to be true, right?

Because otherwise, you’re hurting the people you’re supposed to be helping.

And that can’t be true.

Right?

  • lungs

    Preach it brother! :)

  • trixie77

    As a BLS/ ILS provider I run into this constantly with the volunteer FD first responders. To be fair, I also have more than my share of medics who turf syncope, seizure, AMS and 10/10 painful fx off to the BLS crew. When pressured to ride it in said medics typically do NOTHING for the patient except take the history and play on their phones in the captain’s chair. So I think this is an issue of attitude, not provider level.*smh*

    • http://www.lifeunderthelights.com Ckemtp

      Thank you for your comment. I love to see something from a BLS provider on this one because while I was absolutely ranting about something I see from the ALS side of things, the BLS side of things has some legitimate gripes as well that are just as important.
      I’m going to answer your comment in my next post, stay tuned.

      • Christopher Fabulouz Emt Dixon

        Hi all I’m EMT-B in paramedic school. I know my limits as an EMT. I live and work in Chicago as a the third largest city in America we are very lucky to have hospitals EVERYWHERE we 8 level 1 trauma centers in the city. 2 of which are peds only so we have 6 adult trauma centers in the city. If a BLS crew can go to a hospital code-3 faster then a medic can get there go for it! but as trixie said “to be fair, I also have more than my share of medics who turf syncope, seizure, AMS and 10/10 painful fx off to the BLS crew.” the ALS crew NEEDS to be there not an ILS crew. Those are all bond-fide reasons to initiate ALS care. And Trixie77 you may perceive the medic as just playing with the phone and taking Hx in the captains chair. The fact of the matter is there are some patients who NEED ALS care. What are you as an EMT going to do for a seizure?! how about 10/10 pain? Morphine is good but can bottom out the BP along with the shock the patient is probably in if they are in 10/10 pain. And for the syncopal episode are you going to RSI them if they gag on you king LT, LMA or combitube?! Medics “take over” on these calls for a reason!! BECAUSE THEY NEED ALS CARE!!!! an EMT-B or EMT-I IS NOT A MEDIC. if you want these calls BLS people GO TO MEDIC SCHOOL I AM IT’S NOT THAT HARD!!!!

        • trixie77

          Christopher (Fabulous?Really)? Go back and READ my post. I work in a 3 tier system, which should be ideal. The problem is EMT first responders who cancel the medic if the patient is not unconscious or bleeding a river. As far as the medics, some are dispatched by local protocol. The BLS crew cannot cancel a medic on scene against the medic’s advice. ever . I have no issues with a medic riding in on a borderline call. My complaint is when they want to downgrade a call to BLS because as a” life saving fly car medic” they can’t be bothered wasting time on a little old lady’s pain, or a semi conscious alcoholic with multiple co morbidities. They also cannot refuse to take the call if I (BLS/ILS) provider insist I feel they are needed. I also have the option of requesting ALS after I assess a pt that was a BLS dispatch. The problem then becomes the medic’s attitude about taking the call with us when they could be out doing more exciting things . That is where the “playing on the phone comment comes in. To presume that I or any EMT doesn’t know the difference between a medic who is monitoring a pt via “benign neglect” and doing their job, and an arrogant a-hole who won’t even look at the pt or is even rude to the patient, is ridiculous and insulting. As much as I love medics(literally) I have never aspired to be one. And you’re right , it’s not that hard. But I would recommend you work on your reading comprehension and ego control before you continue running your mouth, or you will just be another part of the problem.

  • Pingback: BLS vs ALS – Cold War or Misunderstanding? | Life Under the Lights

  • Ron Maurer

    I too am a lowly BLS provider in a Medic dependent area. Would I call off the Medic on this call….hell no …..do I call medics off damn straight …..when it’s appropriate…..let’s show respect through all levels of care……sorry if I seem defensive but there were many calls that the Almighty ALS providers are not needed and your sarcasm was unnecessary

  • Positive EMT

    So done with sarcasm. You are great and everyone else is stupid.

  • mr618

    To support what Trixie says, there are a few medics in our area who take this kind of “paragod” bs seriously… then they wonder why we won’t put ourselves at their beck and call. We also have Basics who read that “BLS saves more lives than ALS” and interpret that to mean medics are useless. The reality is there are some calls where ALS can — and should — be cancelled en route (fishhook in the ear comes to mind), there are some calls where they’re needed ten minutes ago (CK’s scenario), and there are some where everyone can only say “WTF?”

    It seems to me we’re all in this line of work for the same reasons: money, cool uniforms and driving fast — err, to help our fellow man, yeah, to help.

    Why don’t we just do our damnedest to work together?

  • stickygatch

    All I have to say on this call is you never know what the scene is like until you get there. Dispatch, if using the MPDS, is horrendously inaccurate, and what is said over the air, rarely matches what is actually presented on arrival. So if you are not on scene with the patient, please do not pretend to know what is going on.

    As an intermediate level provider, getting backed up by an ALS unit on a regular basis, I will cancel them as much as I can, if I feel comfortable with the patient. If there is a treatment I can not provide, or I anticipate the patient’s condition deteriorating, then fair enough, a higher level of care is needed. This is all in the best interest of the patient(s) and no just the one you are attending to. For example, if I capture a STEMI with a reasonably short transport time with a hemodynamically stable patient there really is no need for advanced care; ASA is a BLS treatment which really is the only medication we give that has a demonstrated evidenced based positive outcome for these patients. Why would you want to tie up an advanced provider for this sort of thing; yes the patient is very sick, but will ALS care improve their outcome? Probably not. And if the ALS provider was busy with this call and the infant/choking call came in, who would you rather send your ALS crew to?

    Down talking and back stabbing each other this way is doing nothing to advance our profession. We will never progress if we continue to fight each other in this world of EMS. Its time to start getting along and having a bit of respect for our trade.

    So in response to the question, “you got it, right?” My reply is, “yes, we do.”

    Regards,
    Dave

  • Medic406

    Wow… Did each Medic in here forget where they came from??? And for those that didn’t spend time as a basic before becoming a medic… Nice to know you forgot a step ;-) but why dont we take the time to show the respect we EACH deserve. YES BLS is more than capable of running most of the calls. YES ALS can do things that BLS can’t. BOTH do things that WILL SAVE A PT’S LIFE. The moment you stop respecting those around you is the minute you lose the respect you want. We are all here to help people. Get your heads in the game.

    • EMT Student

      As an EMT in training(student), I am more dissapointed in the fact that every EMT or Paramedic I have come in contact with (on clinicals) is a burnout who doesn’t want to be in an ambulance at all. These leads me to belive im going to hate my future career due to all the slacking off I see (waiting at the ED as long as possible to avoid new calls as an example.)

      We dont face the same issue as often regarding ALS and BLS as most ambulances in my state (Texas) have 1 medic and 1 Emt per MICU.

      Even so it can’t be conducive to success- if all mobile health care providers hate/try to prove they are better than another in any/every given situation.

      Regardless of your rank or skill level, the patient comes first.

      Maybe I have no right to talk as my skills arn’t cemented or fully honed, but I really am dissapointed in the mindsets of my peers. Why should I give a crap if you guys don’t? It is depressing to see the apathy in the Emt/paramedics.
      You should be happy that you are making a true difference, in a career field that is relatively safe(medical skill is always useful regardless of location) (not talking safe due to mistakes/lawsuits). I respect all of you for choosing this career field. Just be sure you want it before you step out into “the bone box”. Be safe out there ladies and gentlemen. Hopefully we can stand as equals one day…

      • EMT Student

        Sorry for the misspelled words. I typed this message via phone.

  • JP

    Oh yes Ron! I’m absolutely sure that in your initial 6 months of training they covered every assessment needed and the potential for things to get bad, quickly! I’m sure you do an AWESOME ALS assessment of these patients and call off those medics when they aren’t needed. No need for someone of a higher level to actually take a look at them! You keep it up, you!

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.
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  • Comments
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00
    DiverMedic
    My Blogroll
    One of these days you'll figure out where my blog is... :)
    2014-09-17 22:11:00
    emtterri123
    Six Tricks You Can Use Today to Improve Your EMS Narrative Report
    The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. - Me thinks this should have been restructured as it does not flow and caused me to reread it several times. lol :)
    2014-09-17 08:27:00
    Алексей Рукин
    So You Think You Can EKG?
    78% accuracy... and I'm not even a medical student, only a blog reader...
    2014-07-12 18:12:00
    Another One Bites the Dust (Part 2) | Medic15
    The Five Second Rule – Six Ways you can Reduce Pauses in Compressions and Save More Lives with CPR
    […] 5,7,9 http://www.lifeunderthelights.com/2014/03/24/the-five-second-rule-six-ways-you-can-reduce-pauses-in-… […]
    2014-07-09 18:39:31

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