Two Units To Transport 1 PT ALS

[64FFMJK 21]

while we are talking about pet peves today why do so many areas feel that it is neededto transport an ALS PT in a vollie bus with the Medic onboard. I understand if it as an intercept on the way to the hospital but there are several areas in Dutchess that you hear XYZ Fire enrout ALS medic on board.

I have several problems with this.

1. why wait for the medic on the scene if you are going to transport then get moving delay in PT transport for a medic is still a delay in transport

2. If you are waiting on the scene or the medic gets on the scene before you get the PT packaged why take 2 units out of service for 1 PT. not a good idea since the ALS unit is the unit that was probably going to cover your district while the BLS unit was out.

this is also a issue with resources with the trend in fuel cost why are we waisting fuel since fuel is one of the number one issues that fire commisioners complain about since it one of the easiest to control

[Reliance 29]

while we are talking about pet peves today why do so many areas feel that it is neededto transport an ALS PT in a vollie bus with the Medic onboard.  I understand if it as an intercept on the way to the hospital but there are several areas in Dutchess that you hear XYZ Fire enrout ALS medic on board.

I have several problems with this.

1. why wait for the medic on the scene if you are going to transport then get moving delay in PT transport for a medic is still a delay in transport

2. If you are waiting on the scene or the medic gets on the scene before you get the PT packaged why take 2 units out of service for 1 PT. not a good idea  since the ALS unit is the unit that was probably going to cover your district while the BLS unit was out.

this is also a issue with resources with the trend in fuel cost why are we waisting fuel since fuel is one of the number one issues that fire commisioners complain about since it one of the easiest to control

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Up here in Nova Scotia sometimes two ambulances will respond on an emergency call. The first is code 1 and the second is code 2. The reason behind it is for ease of extricating the patient from the residence. It is sometimes easier with 4 Paramedics versuses two. Especially when oxygen and IV's are required.

Most of the 300 fire departments do not do MFR so EHS NS is on it's own unless an agreement is in place with the area fire department.

Plus out of the 300 fire departments only about 10 have paid staff and the rest are volunteer.

[PVFD233 68]

I dont know about you but I dont like the idea of turning over a call when my department can txp. The medic can grab his/her gear and get on, Why go through all that training for somebody else to do the work. PRIDE . As far as I know most of the time the pt is packaged and almost ready for txp just waiting for ALS and yet still will be in route to the Hosp depending on the location of ALS.

Now as for a waste of sources it most certainly can be.

[64FFMJK 21]

I dont know about you but I dont like the idea of turning over a call when my department can txp. The medic can grab his/her gear and get on, Why go through all that training for somebody else to do the work. PRIDE .

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Now how much pride are you going to have left when the second call in the district drops and you go 4 dispatces and 20 minutes before the 2nd bus gets out for the priority 4 BLS call in the district and the PT waits 30 minutes for a bus

[Guest]

Why are you taking 2 units out of service?

In my area of Fairfield County, an ALS intercept will only take one unit out of service. For example, if New Canaan must intercept with a Norwalk Hospital ALS bus, a New Canaan EMT and a Norwalk Hospital Paramedic switch ambulances during the intercept. Now you have a New Canaan bus with a medic and a Norwalk bus with either a medic and emt or two emt's - either way norwalk still has a bus ready to cover the town. only one unit is therefore being used.

[Guest]

Now how much pride are you going to have left when the second call in the district drops and you go 4 dispatces and 20 minutes before the 2nd bus gets out for the priority 4 BLS call in the district and the PT waits 30 minutes for a bus

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Second call? Thats the case 95% of the time on the first call! Unless of course there is potential for someone to be a hero, then you've got everyone and their sister. No offense, but that whole pride thing is a crock, if you cant get out with a full crew just give it up - i cant tell you how many times i've seen and heard people use that argument when they send a driver alone and they borrow an EMT or Medic from the contracted bus.

I'm not really sure what your asking though, i guess your talking about a BLS agency that requests ALS and that resource is a full ambulance? Just like in any system that has ALS as an independent resource, you have to make a judgment call. There are allot of different factors to consider together. Was ALS dispatched simultaneously, were they requested, how far out are they, etc. If ALS is 3 minutes out and the patient's condition permits, there is nothing particularly wrong with packaging the patient and loading him/her up and then killing a few minutes going through the motions. Considering the fact that you should be able to pretty quickly identify if your going to need ALS, and assuming that resource isn't too far away, i've found that early recognition means that there is virtually no wait time, given the fact that while the ALS is enroute i've initiated BLS care and have packaged and moved the patient. Very situation dependent.

[Guest alsfirefighter]

64FF...Perhaps you can explain what you are entailing a little better for some of us. Your post is very difficult to follow and I'm not sure exactly what you are alluding to.

From what I could decipher I believe your saying when you have a volunteer ambulance dispatched and then an ALS ambulance with 1 and 1 on board are dispatched and the medic leaves his ambulance to transport. That is a system issue. Very rarely when I worked in Dutchess did I ever have to do this and when I did it was always an intercept. Which is a seperate issue when you meet up and tell the EMT that you are going in service and they just are sooo sure its ALS warranted.

As far as the "pride" comment. When I start making decisions based on pride...I'll quit. I have pride in my skill and accomplishments. But as far as worrying whom is doing what, transporting what or whom is in control...makes no difference to me.

[64FFMJK 21]

OK sorry for lack of details.

XYZ Volunteer BLS ambulance & comercial EMS ALS are simultanious dispatched to a call. BLS gets on scene and ALS has 10 - 15 min eta. most areas could be at or almost to the hospital in this time frame.

In Dutchess the majority of calls are now simultanious dispatched since there is a lack of volunteers especialy during the day. I do understand that yes there is pride and the volunteers want to be in the back of the bus but now what hapens when the same dept gets a call for a minor BLS call and now a 2nd comercial usualy ALS unit is sent to cover the second call since the BLS bus from that dept. transported an ALS PT and took 2 units out of service.

most volunteer depts in dutchess county have the BLS bus as part of a FD rather then a seperate agency and usualy only have 1bus to a district and more and more districts are doing away with the bus altogeather and going to first responce vehicles (BLS flycars).

[Oswegowind 17]

I believe that this topic has to be discussed in individual vicinities. For instance, in Yonkers, it is not uncommon for 2 units (excl spvr) to be dispatched to the same event due to either a lack of information or an excellent amount of information. There is a policy under true SSM (system status management) however that is not followed and hasn't been for some time, that is 1 unit emergent, other non-emergent. For the most time the closest unit should respond priority and upon arrival immediately brief commo and the other responding crew as to the condition. In some instances, such as known Cardiac Arrest, than the ALS unit shall respond priority, and the BLS (backup crew) non emergent. If needed at any point and at the direction of the person on scene the second crew may be requested to step up their priority and get there ASAP.

In locations where there are extensive response times by both ALS and BLS for whatever the reason may be, this plan may not be as feasible. In that, both units may be required to respond emergent to almost all calls to ensure proper patient care in a timely manner. And as was said, no one should ever wait on scene for the other units arrival if they are able to package and move the patient with the resources provided...that is why someone invented the ALS intercept. Most of the time this should be adhered to. As well, EMT's need to have confidence in making a judgement about the condition of THEIR patient and either cancel the medics if not needed, get moving to the ER, or stabilizing the patient that requires extensive treatment at the scene (extrication, severe bleeding control where moving would jeopardize). We all receive the same basic training, we all just have to use it and not fear it!