This will begin an occasional reminder that ALS is not simply BLS with extras. Advanced Life Support addresses elements an 8 week EMT class barely covers.

I am not an “EMT Hater,” I am not looking to pick a fight with the “Basic for lifers” out there who take their duties seriously. This is geared towards those who think ALS belongs on an ambulance only.

All good Paramedics must be accomplished EMTs. I know that. But on a call the other day, an EMT with clearly no understanding of the situation told me I was in the wrong for checking a blood sugar before a blood pressure. (Altered mental status with bounding radial pulse.) He told me later that I need to “…put that ALS shit aside. BLS before ALS saves lives.”

It took me a minute to see what he meant to say, that BLS is better than nothing and ALS without BLS is clearly silly, but the underlying current is anti-ALS. Mainly because the ALS units here run more than their BLS counterparts.

Advanced Life Support begins when the bells ring and I combine my education and the information coming from radio. From that I can rule in and rule out possible beneficial treatments to conditions I may find. This way I’m not flying in the dark when we arrive.

I learned this business from an instructor who stressed “why.” Your patient’s pulse is 50 and irregular. You can treat it right away or you can find out “why” it is that way and treat the cause, not the symptom. Sure your patient is hypotensive, but “why.” It is often the “why” that can steer ALS in one direction or the other.

BLS treats the what, ALS treats the why.

When I asked my co-worker why he thought a blood pressure was warranted right that moment, he replied that was what they do, he didn’t have to care why. He asked if I knew the blood pressure by magic just by checking a pulse. I smiled.

Some communities are ditching Advanced Life Support in favor of a less expensive, but less effective, Basic Life Support system.

If you have ALS, fight to keep it. If you’ve lost ALS first response in your area, remember that the only rhythm BLS can treat is V-fib. By then it’s too late.

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