101 Things the Fire Department wishes you knew



Thursday, July 9

Support ALS in Your Community

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.

7 comments:

The Road Doctor said...

If your BLS'er can't tell you what that BP is at a minimum from a radial pulse, then it is time for some remediation. It is BLS knowledge, afterall...

Jedifire11 said...

I don't think I really understood anything as an EMT beyond what the protocols said until I took my paramedic class. I've been an EMT in MD for 5 years and I'm waiting to take my NR tests. I understand a lot more now about whats going on with a patient and how to treat it and what that treatment is doing to the patient's body. IMHO, a good EMT would've had a BP for you by the time you were done with the finger stick. ;)

RIEMTkevin said...

"BLS treats the what, ALS treats the why."
I love that quote. I wish it was true in my state. Our ALS in RI is the cardiac tech which is a 240 hour addon class. Most of them have no desire to understand the "why" and get caught up in the "what" of ALS procedures. Medics are shunned and ignored, i dont thinks its a matter of ALS versus BLS, but a desire to improve your tradecraft.

medicblog999 said...

Could this be the first time we don't see eye to eye????

I agree with some of what you say, there is and always should be a need for ALS interventions in certain circumstances, but equally, there is a place for BLS.

I'm sure you have seen paramedics fannying (is that a UK only saying?) around on scene waaaaaaayy to long with a critical patient when they should be long away from the scene (going back to stay and play or load and go). Sometimes paramedics sit around trying to gain difficult IV access on a patient who they have no intention of giving anything IV to, the BASIC EMT might just stick some O2 on and get them off to hospital.

The argument over lack of background knowledge is one that I totally agree with though. I always want to know the why of what I am doing. If our guidelines change I want to know why, it's not good enough to be told "just because". I love a patient who has an emergency which really has me thinking about what is going on.
That is the difference between the two skill sets.

Scratch the first line of this comment, I guess I do agree after all, but I think the important thing is for the ALS paramedic to realise when to use ALS skills and when to stick with BLS.

Big Show said...

As an EMT-B myself, the EMT was totally in the wrong. He should have had a BP for you before you arrived onscene. As BLS providers we all know we can vary the order in which we do things based upon our clinical judgment and the situation. For example, dispatched on a hypertension, makes sense to check BP first.

Anonymous said...

There seems to be an overaching cynicism regarding ALS.

Many, even amongst the EMS community are calling into question intubation, ALs skills during trauma, etc

I think you will see a general opinon of "theyd be better off with just EMTs" become quite common.

I also would not be suprised if Paramedics become increasinly restrcited in what role they can play, and towns and cities reduce the number of medics they are willing to employ.

The Happy Medic said...

Anonymous, curious to hear what region you are in. email me? thehappymedic@gmail.com?