Is ALS At Fire Scenes Really Neccasary?

[x635 4,066]

Recently, I've been discussing the issue of ALS at fire scenes with many Medics who I know. This seems to be a more conterversial issue than I intially thought.

I personally believe that ALS is absolutely a neccesity at a fire scene standby given the high potential risk of injury. Granted, many injuries are BLS, but the injuries that will need ALS will need ALS ASAP, such as inhalation burns and chest pains. I also feel that a medic should be there to oversee the rehab sector.

I strongly feel that there should be a fire scene and rehab protocol added to the WREMAC protocols. I'm currently researching the issue, and hope to write a letter eventually.

The other part of the issue seems to be liablity with regards to a tiered, flycar type system, and how they intergrate into a system.

I've been told by one regional agency supervisor that he does not think ALS is neccary at fire scenes, and that they should not be doing them because it presents a large liability for the agency. I feel that is ridiculous, and it presents an even bigger liabilty for ALS not to be there. The only part of that issue that I agree to is the taking medics out of service for a fire scene, but that is a system problem.

One last part of this issue.....should FD's add ALS to their line cards?

[afd65 4]

if als is avalible then yes it should be there at a fire scene. the better the care the better the person can be treated. if als is not avalible then they should try to get it but if not then at least bls should be on scene

[Guest]

I agree...if they're available to stand-by at scenes, then why not have them there? In counties like Putnam where ALS is limited, they will usually stand-by at a scene unless there is a call nearby where they are needed. Although most injuries at fire scenes are BLS, its nice to know they are there if a major injury is sustained....

[ja3kfd 34]

YES they should be on line card as soon as a 10-75 is transmitted by unit on location, I unfortunetly in my 1st month as chief had 2 structure fires, a good friend of mine went down on the 2nd. structure fire, THANK GOD ALS and BLS were standing by on scene, he turned out to be fine. But that was a god send to have them there. When you read this have please every one remember it. Also I thank my friends and commrades in my neighboring depts. when i was chief we would get together often and discuss all these ideas I know I pulled a lot of info. from them.

[Guest alsfirefighter]

I have to disagree. The majority of injuries on the fireground are BLS in nature. Even some of the large ones can be begun to be stabilized by BLS with ALS enroute and while they are beginning to leave or are transporting with a intercept.

FF goes down cardiac arrest...they have AED's. Chest pain, you begin BLS and ALS begins when they arrive. Don't delay transport.

Inhalation injury, first I have to say unless its an extreme instance this should not be happening to firefighters. If you activate your FAST or know you have a member in distress, missing or lost the call for ALS to respond should go out right then and there.

We don't post cops at banks because bank robberies could happen. In larger cities or 3rd party systems where there is an influx of ALS ambulances it works better. But in many systems where there is 1 flycar, even 2 it can get your resources tangled quickly and there will always be a few that will park in an area that will get them jammed up.

[Pudge3311 5]

ALS,

Isnt firefighting today very proactive? Arent we always out there trying to educate the public about fire saftey? So when a structure fire does occur, which I believe is not very often, whats wrong with being proactive and preventing things from getting worse? How bout your the one who comes outside and falls to the ground? Wouldnt you like to know that a medic is right there, I sure would.

Fires are few and far between these days, and if you have an ambulance there to standby, you might as well have a medic too. If the BLS unit transports, and there is no other ambulance on scene, you now have some type of EMS.

Its not everyday that someone starts shooting a gun at cops, but every cop still carries a gun just in case. I say bring the medic, just in case.

[x635 4,066]

ALS,

The majority of our calls in general are BLS in nature, lol!!

For the first time I can remember, I cannot really understand your reasoning. First off, you say things "should not" be happening to firefighters. You know no matter what, and no matter how safe you are, things happen. This is in no way a perfect world, and due to the nature of the business, we cannot guarentee a perfect incident every time due to a variety of factors. You say we don't post Cops at banks because of potential robberies, but banks in high risk areas have security guards, cameras, safes, and other PRECAUTIONS. Why do we have FAST teams?

Additionally, you say inhaltion injuries do not happen often and should not. Well, masks can get ripped off and such accidentally, but have you forgotten about one aspect of a fire scene....the RESIDENTS/VICTIMS!!!! I've treated several inhalation injuries from fire scenes, including ones that have needed immediate intubation. Due to the chaotic nature of a fire scene, these vicitims, whatever injuries they may have, may not be immediately found or noticed.

Of course BLS is an essential. But you can use your same logic on every single ALS call we do. Why is there even ALS then? As far as the intercept portion of the call goes, well, why even call the medic? They can be at the hospital before ALS can even intercept. Also, doing immediate defib and proper CPR is more important, but having that resource with the drugs and the abilty to treat those reversible causes is beneficial at times.

In urban systems I work or have worked for, we easily send an ALS and/or a BLS bus. Flycar-wise, where resources are limited, well situations like this IMO are just another reson to add another car, send a supervisor, or an ALS from a transport system. As far as tangling up your resources....simple....park remote from the scene and potential scene and hoof it in, or create a staging area. That's what I have always done for years. I've also kept an eye on the bus or car and moved it as neccasary. And when you cover a large area, sometimes its going to take the medic awhile to get there., which is an essential reason for them to stage.

I guess you don't believe in rehab, either.

WE CAN SEND ALS TO CUT FINGERS, AND OTHER MINOR BLS CALLS IN THIS COUNTY, THEN WE CAN SEND ALS TO FIRE SCENES!!!!!

[LCFD994 8]

In my opinion on every Chiefs line card when he/she confirms a fire they should automatically get a FAST Team, a Ambulance , and A Paramedic.

I could care less about the percentage of fire scene calls that are BLS. or ALS. You should have the best possible care available immediatley to the firefighters or" victims" that are rescued without any type of hesitation.

I would rather see the Medic stand there and be bored and NOT have to do anything, then be stuck in traffic, cant get to the scene because the road is blocked by apparatus, the ambulance cant get out because its blocked by apparatus, or the Medic is coming from a distance becasue they cover such a large area.

As far as limited resources, well thats just too bad. Thats what mutual aid and relocation is used for, or have the Medic Supervisors get there asses out of the office and put more trucks on the road during a large incident.

Yes the majority of times a Medic will not be needed on the scene, and most BLS crews have AED's and can do CPR, and are good at what they do. But do you want to be that firefighter that goes down and needs to be intubated becasue your airway is closing due to smoke inhalation, and there is no medic there becasue the Chief was too stubborn to request one. All the BLS and CPR, and AED's wont help you there.

[Guest JQP442]

Pudge3311, I couldnt agree more!!! =D>

As firefighters, many of us say 'call in mutual aide, you can always turn them back latter'. I think the same holds true for ALS. If you dont need them, you can send them home when things are safe, BUT should someone go down (be it a firefighter or civilian) they are at the scene and can go to work. Hopefully we do not need to call on there services, but I know that IF I get hurt, they are there.

Someone said that should BLS be all that is needed, then you have a medical person at the scene. From experience, its a nice thing to have. The BLS unit can do the transport and when someone else is hurt and a 2nd BLS is not there yet, SOMEONE can start treating and help.

[Guest NYTruckie]

I don't think that Paramedic's should do fire stand-by's. Yes you can move paramedics to cover the medic at the stand-by. But them the Medic will have longer to drive to the call. I have no problem with the medic moving closer to the fire but in service and not near the packed apparatus/Private cars. If a supervisor wants to stand by on fire stand-by's I'm all for that. I don't think a medic can be on scene and in service because at some point he will be busy and his car/ambulance will be blocked in.

[WAS967 97]

I personally believe that ALS is absolutely a neccesity at a fire scene standby given the high potential risk of injury. Granted, many injuries are BLS, but the injuries that will need ALS will need ALS ASAP, such as inhalation burns and chest pains. I also feel that a medic should be there to oversee the rehab sector.

I strongly feel that there should be a fire scene and rehab protocol added to the WREMAC protocols. I'm currently researching the issue, and hope to write a letter eventually.

Frankly, Rehab is neither our job nor our responsibility. It is up to the individual FDs to draw up a rehab sector plan and make it a part of thier SOPs. I know of NOT A SINGLE FD that has a definitive Rehab plan in this area. (And don't try to tell me that having your guys sit out for 10 minutes with a cup of gatorade is definitive rehab). I personally agree that ALS should be on the scene to be ready to assist, but in both flycar systems that I work, where resources are limited and spread out geographically, the ALS should be available for other calls if needed. Most of the times we are dispatched to standby, we are considered committed to the scene and at the will of the Fire Chief (i.e....i keep hearing units asking the chief if it's okay for them to go 10-8 ). It's fine if they want to have a BLS unit there standing by. Great. In fact I say they should be standing next to the FAST team with a Stetcher/Longboard, and gear all ready to go - rapid deployment style. The ALS can be nearby but should remain available for another call - emphasis on not getting yourself blocked in by apparatus. (If siting on the next block is what you have to do, then so be it).

As for Rehab - You want definitive rehab? Get a trailer/RV/whatever that is atmospherically controlled - someplace where your guys/gals can go and cooldown/warmup on an exteme weather day. Have them be evaluated by EMTs (You shouldn't need a medic to do a basic physical). Record vitals. Have preestablished medical cards for each member. If thier vitals are out of preestablished range - they are grounded. (When was the last time you saw a medical provider around here able to tell a FD guy that they can't go back in cause thier pulse is too high? Without SOPs, you CAN'T). Have refreshments IMMEDIATLY available - gatorade/sports drinks, granola bars/nutragrain bars, soups, etc. (HELL, I Say park a bloody ice cream truck outside the damn thing on a hot day). Have MANDATORY rest periods for the crews. (I can't stand seeing these reports of people dropping dead from excertion, etc).

Somewhere there is a good place for medics on the fireground. Committed to the scene is not it. Sitting back at the station watching TV ain't it either.

(Edited for glaring spelling/grammar errors - I'm sure there is more but I'm too lazy to check dictionary.com)

[chazEMT 5]

AMEN WAS!!!!! I can't put it any better than you did there!! =D>

Have SOGs in place regarding rehab that will be ADHERED to & ENFORCED ("I don't care if you wanna play with the pretty orange fire...your pulse & BP are both way up--so you're gonna have to sit out!!")

Have your BLS crews TRAINED to do good, thorough, rapid assessments on the firefighters, and able to make an informed decision on whether a firefighter should sit out, or be transported! (And this all comes back to the basic EMT training they receive in the first place!)

And finally - ALS should be nearby (ideally on scene - NOT COMMITTED) and able to respond in quickly if needed!

I strongly believe we should provide the BEST care possible for our brothers & sisters!! With this in mind, EMT-Bs--TRAIN, DRILL, PRACTICE--keep your skills sharp, so you can provide effective BLS to your brothers & sisters!!! And, most importantly, recognize when ALS is necessary, and call for 'em ASAP!!

[ny10570 745]

WAS, you made some great points. Fire Depts have alot more they could do and need to do to protect their members. But I believe ALS should be at the scene. If nothing else, then standing by free to respond to any call that comes in. Some are concerned about longer response times, but it is no different from ALS responding from a situation to which they were dispatched but not needed. I know a good BLS crew is more than capapble of handling any emergency that may arise at the fire scene, but every minute is crucial and there are things that only ALS can provide.

[Remember585 815]

Send a BLS fly-car!!!

Only kidding. I feel that ALS should always be at any prolonged operation where Firefighters are put under stressful conditions. Just because it isn't a house fire doesn't mean that the guys working a job aren't "wearing themselves down." As a matter of fact, we recently created a new "10-75" and "2nd alarm" policies that are now in the 60 Control CAD system. In addition to our Full Department response, we also have one Croton ambulance, one Mutual Aid ambulance and a Medic unit come to the scene. Having the best possible resources within quick access can possibly have a major impact on the overall outcome of a victim / patient.

At our last "real fire" in September, I requested an ambulance and a medic on arrival to stage at the scene in addition to our ambulance. Luckily we didn't need any transports, but we did have a few "overheats." I like to think we commit one rig for rehab, one for transport and a Medic if conditions warrant.

[WAS967 97]

As a matter of fact, we recently created a new "10-75" and "2nd alarm" policies that are now in the 60 Control CAD system. In addition to our Full Department response, we also have one Croton ambulance, one Mutual Aid ambulance and a Medic unit come to the scene.

But is that medic COMMITTED to that scene? OVAC's ALS setup is no different from WEMS or CRP. Resources are limited. Typically you have two medics - one on the ambulance in the Town and one on the flycar in the Villages. If you are lucky and have a third medic around they can stop by and grab the second truck (do they still have the spare flycar or does that get used as an officer car now?). OVAC is busy and it's not uncommon for that medic in the flycar who is now sitting committed on your scene to be needed for something else. LET HIM GO and have another medic shuffle down/up/sideways to fill in the gap.

[Remember585 815]

I have no clue what OVAC does with their 2nd medic car anymore.

And I also won't make any comments about that Fly-Car covering additional calls vs. being committed, because a BULK of the Fly-Car calls are becoming BLS cover assignments.

As far as committing it - if another Medic is needed somewhere, Mutual Aid can cover or we can send the Fly-Car if we can use an ALS rig from OVAC. It's all a judgement call.

[CFD320 35]

All I know is if I (or any other firefighter) am operating at the scene of a fire, ALS on scene is an absolute necessity. It is owed to us; we are putting our lives at risk. When the inevitable occurs, the highest level of care that is available should be on scene. I think I read some rural FD's in the Midwest request medivac helos to working fires.