#HM12Doc 11 BLS Calls

On the eleventh Day of Christmas Happy Medic gave to me…

11 BLS Calls

10mgs of Morphine

9 Homeless Psychs

8 Asthma Attacks

7 OBs Crownin’

6 Priapisms

5 Golden hours

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green
I was driving to work the other day and had an epiphany.  I do that often, no surprise there, but this time it was in relation to EMS.

On the side of the busy freeway, clogged because of all the stimulus spending construction to widen it, I passed a car getting a flat changed by a small pick up truck labeled as a tow truck from a local service noted for their easy to recognize trucks.

But it was not a tow truck.  It was a small pick up truck likely equipped to change flats, jump start cars and deal with basic problems encountered on the roadside that don’t need an actual vehicle equipped to remove the vehicle from the roadway.

Farther down another highway, also being repaired using stimulus money, a two vehicle accident was slowing us down.  This incident brought the CHP and an engine, but what I noticed was the two different kinds of tow trucks that had arrived on the scene.  One was the typical truck type, with the little arms that come down and scoop up the front wheels of a car, while the other was a flat bed and able to load up a car that could not roll with the first type.

Later, while crossing the By Bridge into the City, a vehicle had stalled and was being pushed over the bridge by a beast of a tow truck.  This rig had a reinforced front end to push cars, heavy duty tow arm and ran red lights and sirens, not to mention carrying 100 gallons of water, a pump and a hose reel for vehicle fires.

When I realized that each area I passed through had the basic tow trucks available, some areas had more specialized units for specialized situations.  The companies did not automatically send the giant tow truck from the bridge for a reported flat tire, but scaled their response to fit the reported problem.

Why doesn’t EMS do that?

Some may claim that a BLS tier with an ALS fly car is the solution, but what happens when that little pick up truck arrives on the scene on the bridge and needs to push a car and can’t?  Now we have 2 resources tied up instead of one.  And the opposite, sending the giant truck to deal with the mundane that doesn’t require their specialty is a waste of money and equipment.

BLS calls need BLS intervention, but not always BLS transport.  A successful system will incorporate all aspects of the towing company’s versatility, while allowing the situations that were overstated initially to get a downgraded response.

A trained mechanic who can evaluate what the vehicle needs and guide the company’s fleet appropriately, puts the power in the hands of the company, not the caller, to act in the best interest of all persons involved.

Imagine how long the driver with a flat would have had to wait if all the tow trucks were on other hauls and no other resource existed?

Too long indeed.  Now imagine that flat tire is an aepnic child.  Do we really have our patient’s best interests in mind when we default to transport no matter what, just to get paid?  Perhaps the answer EMS is looking for is not in reimbursements, but in providing the service your community needs when they need it.

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12 thoughts on “#HM12Doc 11 BLS Calls”

  1. One agency I know of is sending a BLS SUV to low acuity calls. Some cities don’t automatically send an ambulance but wait for BLS to request one.

    Personally I would send an ALS ambulance to every call, BLS first response on select calls, and a higher trained medic to certain critical calls (Wake County).

  2. One agency I know of is sending a BLS SUV to low acuity calls. Some cities don’t automatically send an ambulance but wait for BLS to request one.

    Personally I would send an ALS ambulance to every call, BLS first response on select calls, and a higher trained medic to certain critical calls (Wake County).

  3. Here in Lubbock, TX, a 911 call for medical emergency involves a fast responder SUV, a FD engine, and an ambulance… even for a slight fall, headache, whatever. And these are all city services, mind you, supported by my taxes, not private services. I hate to think of the maintenance costs involved in sending an engine to each and every call, but that’s what the city poobahs have declared necessary.

  4. Here in Lubbock, TX, a 911 call for medical emergency involves a fast responder SUV, a FD engine, and an ambulance… even for a slight fall, headache, whatever. And these are all city services, mind you, supported by my taxes, not private services. I hate to think of the maintenance costs involved in sending an engine to each and every call, but that’s what the city poobahs have declared necessary.

  5. HM, you are personally responsible for extending my career. I don’t have a lot of hope that we can fix this debacle we call EMS, but with enough passionate people such as yourself, the beginning may just happen sometime during my career, which I honestly don’t think has much more time at all.

    Merry Christmas, Brother!

  6. HM, you are personally responsible for extending my career. I don’t have a lot of hope that we can fix this debacle we call EMS, but with enough passionate people such as yourself, the beginning may just happen sometime during my career, which I honestly don’t think has much more time at all.

    Merry Christmas, Brother!

  7. Sending an ALS ambulance to EVERY call is the problem. Not every call needs a paramedic on scene. Yes, you can play the “what if” game, but the truth is that it’s just not necessary. Most calls can be treated and transported (as needed) on the BLS or ILS level. Save the ALS care for whom ever needs it, and not every patient.

    1. Happy would probably tell you basics and intermediates aren’t educated enough to decide when a patient needs and doesn’t need ALS.

      What’s your criteria for determining if a patient needs ALS?

      How are you supposed to implement refusal and other community paramedicine programs using EMTs with only 110 hours of training?

      Are you aware of how difficult ensuring ALL critical patients receive ALS in a tiered setting?

      If you really need RSI and other advanced skills simply send a higher trained medic to those calls.

  8. Sending an ALS ambulance to EVERY call is the problem. Not every call needs a paramedic on scene. Yes, you can play the “what if” game, but the truth is that it’s just not necessary. Most calls can be treated and transported (as needed) on the BLS or ILS level. Save the ALS care for whom ever needs it, and not every patient.

    1. Happy would probably tell you basics and intermediates aren’t educated enough to decide when a patient needs and doesn’t need ALS.

      What’s your criteria for determining if a patient needs ALS?

      How are you supposed to implement refusal and other community paramedicine programs using EMTs with only 110 hours of training?

      Are you aware of how difficult ensuring ALL critical patients receive ALS is in a tiered setting?

      If you really need RSI and other advanced skills simply send a higher trained medic to those calls.

  9. So what do we do- send the heavy-duty super wrecker to everything, then sit around and wait for the pickup truck if it’s just a flat?

    Seems like a lot of systems do that now, and it’s not working for anybody- especially the patie… I mean, motorists served by the heavy-duty super-wrecker after a few years of running on 90% flat tire calls. And god help the pickup truck operators if they’re employed by a different agency….

  10. So what do we do- send the heavy-duty super wrecker to everything, then sit around and wait for the pickup truck if it’s just a flat?

    Seems like a lot of systems do that now, and it’s not working for anybody- especially the patie… I mean, motorists served by the heavy-duty super-wrecker after a few years of running on 90% flat tire calls. And god help the pickup truck operators if they’re employed by a different agency….

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