Respect for BLS?

[calhobs 110]

After seeing some of the post in the other discussions, there does not seem to be much respect for BLS from ALS. It seems ALS thinks BLS is a taxi service by the way they talk about them. Why is that? There is such a big differnece in respect from here to the city. was wondering if any other BLS felt the same.

[WAS967 97]

I can't speak for other ALS providers on the board, but I personally respect each and every EMT I work with regardless of clue level or other factors. I looks at those without a clue as an opportunity to train someone and make them a better EMT. Those who DO have a clue are invaluable in times of crisis and for trying calls. Problem up here (compared the city since you mention it) is call volume. EMTs just don't get the exposure to critical calls that they might in the city. Techs in the city more often get to a call before the medics and have been in the hot seat more than EMTs in this area.

The problem falls back on ALS reliance. EMTs up here in the burbs are too heavily reliant on ALS to provide care. The EMTs just don't have experience. Case in point. I did a call recently for a seizure patient. BLS called for an expedite in rainy weather. (There's that word again Tom). I get there and find out the reason they called for the step-up is because the patient was "vomiting blood". In the end it was a run of the mill seizure call. Patient had biten thier tongue (a common occurance in grand mal seizures) and that was causing the "vomiting of blood". An experienced BLS crew would have known better and in the end, should have been able to handle the call without ALS intervention. I'll forgive them a little since the patient only spoke broken english, but you can do better than telling me the patient just has good PMSx4 yet you have no vitals. You don't need to speak spanish to get vitals folks.

I'll end my rant here.

[Guest EMSwhitecloud]

Being an EMT, I have to say that i dont think I have ever had a Problem with anyone higher then me. Maybe things are different where i am, but they pull me in not push me away, maybe im different bc i like to jump in and maybe because I really dont depend on ALS. I do what i know I can do and what Im supposed to do and if i have any questions I ask, but I dont really think they look down on me....ALS Correct me if Im wrong.....

[LCFD994 8]

Speaking for myself as a ALS provider both in Westchester and in Putnam, I have all the respect for the EMTS and other members of the EMS crews that come out day in and day out.

What I dont like is the same as WAS said, that some of them are ALS reliant, god knows I have been trying to help them not be ALS reliant. But I think th only way that will happen is when MEdics are stopped being dispatched on every single call no matter what it is for.

[Guest WCDES636]

WAS,

You have respect for EMT's beacuse we came up in a BLS system. Unlike today where BLS crews will continue in ALS so the medic can tell them it's OK to transport BLS.

[calhobs 110]

very well said WAS967, I do agree with you that BLS is very dependent on ALS here. I have been here for two years now and still find it hard to work with a medic, for the simple reason in the city it was a luxery to have one. This is how it went in the city. 11 David -central, central go 11 david we need a medic here any avaible for an MI, with out pause 11d no medic avaible will advise when one free well needless to say i am still waiting to know if one is free LOL. this would happen time and time agian for od's, arrests, etc. and trauma forget about it in the city it was standerd BLS, my first car accident here was a fatal and when i saw the medic pull up i was like wow who called you. He asked me what we got (now keept his in mind i was still in shock in seeing a medic on this call) and i said a traumatic arrest, he then says how bad, and as i am reaching for strecher out of the rig i stop and say well its traumatic so it must be pretty bad. LOL. I later told the medic i was sorry i did not mean to be harsh i just didnt think at the moment was so surprised just to see him there.

[Guest alsfirefighter]

Most of the posts that I have read I never got the impression that there was any lack of respect of BLS, but some issues many of us have with some of the things we see and go on. I generally get along with most of the EMT's I work with, and many of them will tell you I'm probably one of the most demanding Medics they will work with in regard to doing their job and function on a call. Good clinical care is like a complex dance, everyone must know their role and someone must take the lead. There are cases where the dance is BLS and as a good ALS provider you allow BLS to take the lead and use their skill. Unfortunately what I am also noticing is that I generally have to observe more because there are some with bad skills. EMSWhiteCloud can back me up on how I operate and I do have to give it to her, she is aggressive and wants to always know more and even better she has common sense. There is a severe overdependency on ALS and its partly the system and how some ALS agencies operate or are forced to operate by the agencies they respond with. Not only is experience a problem, but clinical judgement also seems to be a problem at times. Here is my cases in point, with some info left out so those involved don't get all snitty and those around know the jobs. If I recall while WAS was on his seizure, I got a call for a stroke upgraded to cardiac arrest by 60 Control. While responding, BLSFR confirmed cardiac arrest, then BLS again said it with those words "expedite the medic", you know because I was sunday driving and stopped for gas. Arrived on scene and again was told by bls member CPR in progress which I was then asked if we were going to "scoop and run.." ummm, no. Get inside BLSFR delivered 2nd shock, 2nd BLS member doing well bagging, however said it was hard to bag. Advised to use head tilt chin lift and to use a oropharyngeal cause that might help. The expediter bls member standing in corner, watching, needed 2nd O2 tank and reeves, the ones she should have grabbed instead of telling me to expedite. Basic stuff not getting done, so I did ACLS and choreography in the midst. Instead of worrying where the medic is, get your job done.

Second, and this seems to be a vast problem I've noticed from working several areas with BLS albuterol admin. Arrive at job location, walk in and BLS reports patient having an Asthma attack and is in distress and is on her 2nd treatment. (I got a bit lost due to a whacky numbering system) The BLS provider who looked more in distress was asked what were the patients lung sounds..."ummm, I really couldn't hear them well." Ummm, how did you come up with asthma then? Asked twice nicely for BLS provider to "excuse me" so I could assess, but just had to get the pulse ox on because "she is really struggling." I didn't realize that pulse oximetry had such therapuetic treatment value for shortness of breath. Third time, she got the get out of my way so I can assess and treat this patient properly. Listen to lunch sounds...crystal clear, while listening looked at hands....cramped. Removed nebulizer handed it to BLS provider, talked to patient with cool demeanor, explained that her anxiety attack will cease when she controls her breathing, calms down and when the alpha effects of albuterol (needless at that) wears off. Patient breathing normally and RMA'd 5 mins. later. Lack of respect? No, I explained what she did wrong and what to do next time. Shake of the head of due to poor clinical treatment...yup.

3rd and final point. Arrived at PIAA ahead of bus. Decent MOI, BLSFR on scene also, one patient sitting, shook up, upset and c/o neck and left shoulder pain (she was T-boned in her door). Left her with BLSFR to check on other patient. BLS bus arrives, advised they need to immoblize sitting patient. I come back over from evaluating other patient and BLS provider off bus, says stand her up and we will do a take down. Unfortunately for this provider I've had another run in with his immobilization skills, so he didn't get the educational voice, he got the your judgement is wrong voice. She is sitting down, put the board under her but or lay her down, getting a patient dirty isn't a contraindication of sound immoblization. Which in general that skill is going down the toilet. What ever happened to the KED? Unless you can clear C-spine and in my area we can if the MOI allows, use proper technique. Even when your opinion is they want insurance money. Even a 5 mph crash can be significant from the rear. If anyone has done SP's little mock up crash at 5 mph knows this.

Everyone gets the benefit of doubt. Respect is gained or earned.

[Guest EMSwhitecloud]

I agree with everything said by ALS :hug: . Im not the kind where I need ALS for a BLS call. If someone trips by accident, falls and hurts their arm and there is no medical reason behind it...why wait for ALS, the person tripped. Splint it, give them ice and go. I dont understand why we have to sit and wait for a medic on that. It's dumb. Anyway, the reason I think for ALS dependency is that some people may not have enough confidence in themselves to properly treat a patient without ALS. Well in that case you shouldnt be doing BLS if you have to depend on someone else to do your job. Sorry Im done ranting.

[Guest mediconpatrol]

Speaking for myself, I highly respect the BLS system. As a medic I have needed to rely on the help and assistance of all the BLS crews that I respond with. I think the respect is two fold...The crews I deal with know when to cancel me and they also know when I would want to evaluate the situation. We keep an open line of communication. I have also made it very clear to them that I dont expedite...use their judgement and if it is that important for me to "step it up", then they can load and I will meet them.

True respect is earned but that goes both ways, I have seen a lot of medics who have belittled BLS and those are the ones that make a working relationship so much harder to obtain.

Just remember when all else fails....it is BLS that gets us through.

[x635 4,066]

I agree with many of the above points, but I'd like to pose a new question/rant of my own....

What about BLS providers that have no respect for ALS??

As much as it's hard for some people to stomach the following comment, there is a certain "pecking order" in this field, just like in a hospital.

Just like in the hospital, you have the pecking order of ( from lowest to highest) medical student, housekeeper, support aide, tech, resident, nurse, NP/PA, and Doctor. This order is generally based on training and job duties, and commonly accepted. Well, the medic has considerbaly more and more intesnse training than the EMT, which should warrant a certain level of respect for the medic.

And just because you have an ambulance does not make you BLS. Being BLS means you have been trained in skills and apply them properly during every call. Poor BLS skills are not the fault of medics on calls, nor are they always the fault of the EMT's themselves. They are often a sign of poor leadership,trainig and oversight, and often lack of interest in the field or the wrong reason for getting into the profession. Lack of experience, although experience is extremly helpful, should not be an excuse either. Your basic skills sets should be standard and muscle memory. If you're not going to function as part of the team and use your training, then you are not shwoing respect for other members.

And being nice to people during calls in progress should not be an issue, just get the job done. Treat people nicely, but people should not have to be coddled.

Again, there is a difference between an ambulance and BLS. BLS provides professional quality basic prehospital emergency care, while an ambulance provides a very loosely organzied and delviered service where the main priority is getting the bus out, not the care delivered. Which one are you?

BLS is a neccesity, ALS is just a luxury, as I was taught by my Tac coworkers when I was a newbie.

WAS and ALS made good points, and I'm not going to repeat or get into those..

Overall, respect is earned, and given by me on a case-by case basis.

[Guest alsfirefighter]

I don't think I can spell coddle. Is that a word WAS? lol.

Great post brother.

[WAS967 97]

You have respect for EMT's beacuse we came up in a BLS system. Unlike today where BLS crews will continue in ALS so the medic can tell them it's OK to transport BLS.

True. Long gone are the days of doing it all ourselves as EMTs and if we had a code or bad accident we called in Drs. McGurty, Burns or Hickey. 8)

[WAS967 97]

While responding, BLSFR confirmed cardiac arrest, then BLS again said it with those words "expedite the medic", you know because I was sunday driving and stopped for gas. Arrived on scene and again was told by bls member CPR in progress which I was then asked if we were going to "scoop and run.." ummm, no. Get inside BLSFR delivered 2nd shock, 2nd BLS member doing well bagging, however said it was hard to bag. Advised to use head tilt chin lift and to use a oropharyngeal cause that might help. The expediter bls member standing in corner, watching, needed 2nd O2 tank and reeves, the ones she should have grabbed instead of telling me to expedite.

Here's a tip to all you providers out there (regardless of level) when it comes to cardiac arrests. Take a deep breath and RELAX. The patient is more stable now than they ever will be as ironic as that sounds. They can't get worse. You can help make them BETTER, but you need to step back and use your head. Let your body do what you were trained to do (blowing and pushing) and then let your mind step back and THINK about the big picture. Are you doing compressions on a water bed? Move em to the floor. Are you up three stories? Get a reeves. Did you run in without your suction? Go get it, cause you are gonna need it eventually. The more experienced you are the better you will get. But we all have to start somewhere. Have patience with those who have less experience than yourself, and learn from those who have been around the block a few times. But for those of you who have lapped the course a few times, don't let it go to your heads and start treating those below you like lesser beings.</soapbox>

[WAS967 97]

Listen to lunch sounds...crystal clear, while listening looked at hands....cramped. Removed nebulizer handed it to BLS provider, talked to patient with cool demeanor, explained that her anxiety attack will cease when she controls her breathing, calms down and when the alpha effects of albuterol (needless at that) wears off. Patient breathing normally and RMA'd 5 mins. later. Lack of respect? No, I explained what she did wrong and what to do next time. Shake of the head of due to poor clinical treatment...yup.

Well thankfully they didn't have the epi pen ready to jab the patient in the leg with. Had similar but the BLS crew said they were going to give the patient an epipen but wanted to wait until I got there. (Thank God) Needless to say the patient was just anxious and needed a good talking to. Epi pen would have mad it worse. Not to put the fear of god into people, but if you are gonna give a medication, be DAMN sure you know what it is that you are doing. If you need to, call the medic or medical control. Ask for advice. Thats what we/they are there for.

[WAS967 97]

I don't think I can spell coddle. Is that a word WAS? lol.

From dictionary.com (I know, I'm a geek): :mrhappy:

cod·dle  Audio pronunciation of "coddle" ( P )  Pronunciation Key  (kdl)

tr.v. cod·dled, cod·dling, cod·dles

  1. To cook in water just below the boiling point: coddle eggs.

  2. To treat indulgently; baby. See Synonyms at pamper.

[Guest paramedico987]

Any medic that shows disrespect for BLS is a putz!

Most times the only thing that we do ALS-wise is put an extra hole in your arm and take you to the hospital anyway!

BLS is where you'll ease the pain of a fracture with good splinting.

I think mostly providers complain about BLS patients who's complaints often seem to waste our time (especially at 3:00 am) rather than EMT's who provide the care.

:roll:

[Guest NYTruckie]

I don't respect, and/or disrespect people on calls because of there level of training (ALS/BLS?First Responder). I try to put people on scene into two categories.

1) Competent & Helpful

Or

2) Incompetent

[Guest]

I would have to agree, it does not matter what level of training you have, if you know what your doing, I rather take a CFR with me on the ambulance that knows what they are doing rather than a EMT that has no clue (which I have some EMT's that are that way).