I got to sit in on a meeting with our billing company the other day and had a nice little discussion about what constitutes an ALS call.

In their non-clinical world only a call where a person performs an ALS skill is an ALS call.

I couldn’t disagree more.

I see what they’re going for, thinking about justifying our ALS rate for the guy who claimed to be suffering a stroke, but got no treatment.

But WHY did he get no treatment?  Because of a good ALS assessment.  That, to me, makes it an ALS call.  If we get on the scene with a BLS engine and they’re able to determine the transport is BLS, great.  Trouble is I have no BLS cars in my fleet, so even if I stick an EMT in the back I still have a Medic driving.  Plus there’s the stickler that the regulatory agency requires an ALS assessment on all patients.

So there we were, arguing whether or not running an EKG is an automatic ALS transport, him taking the side that it can’t be because it didn’t show anything and me arguing that that’s the entire point.  ALS isn’t the tools we carry or the skills we practice, it is our assessment skills.

I can train a cat how to intubate, but I can’t train him when not to.


Our assessment skills are what make the difference between a BLS and an ALS patient.  Plenty of ALS patients can be treated with BLS in the short term, sure, let’s not get into a BLS vs ALS pissing match, but instead shift our focus from what’s in the toolbox to when and WHY to use what’s in there.


Discussion finished, and me having lost, I wondered about the inefficiency of an all ALS transport system.  Perhaps I can convince the state and County to open their minds to alternate options.  We already transport to a specific alternate facility, perhaps more research is in order?


Just hope I can bill it at the ALS rate.


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