DB 18-2 ALS UpgardeDowngrades

Question 1

When a fire company is dispatched with a Paramedic RA and the fire company members determine the patient does not require ALS intervention, the fire company shall request MFC to cancel the Paramedic RA and request a___.

Answer 1

BLS Ambulance

Question 2

How is a BLS ambulance dispatched when an ALS Rescue is cancelled and BLS rescue requested?

Answer 2

Non-emergency unless otherwise requested by on scene fire company

Question 3

A Paramedic RA on scene of an incident should request that a BLS ambulance be dispatched to provide transport for a patient only requiring BLS transport, when all the following conditions exist: A thorough ___ completed

Answer 3

• A thorough assessment completed

Question 4

A Paramedic RA on scene of an incident should request that a BLS ambulance be dispatched to provide transport for a patient only requiring BLS transport, when all the following conditions exist: Patient is ____

Answer 4

stable and not in immediate need of transport and/or medical intervention

Question 5

A Paramedic RA on scene of an incident should request that a BLS ambulance be dispatched to provide transport for a patient only requiring BLS transport, when all the following conditions exist: The patient’s complaint/symptoms do not meet what part of PDP?

Answer 5

Part 1 of PDP or approval for BLS transport is granted by base station

Question 6

ALS Downgrade to BLS:

If the patient’s condition meets base station contact criteria, the base hospital must approve _____

Answer 6

EMT Transport

Question 7

ALS RA downgrade to BLS RA:
___ Paramedic RA members on scene agree that the patient is stable for BLS transport; if not, the patient shall be transported by Paramedic RA.

Answer 7

Both paramedic members must agree, if not ALS transport is a must

Question 8

ALS RA downgrade to BLS RA:
The patient’s age, chief complaint, and previous medical problems do not merit ALS treatment and transport (i.e., high-risk patients who do not meet the PDP Section __).

Answer 8

1

Question 9

ALS RA downgrade to BLS RA:

The estimated time of arrival (ETA) of the BLS RA does not exceed ___ minutes, non-emergency.

Answer 9

30 minutes non-emergency

Question 10

When does our call load and corresponding “wall time” tend to peak?

Answer 10

On weekdays during the late afternoon and early evening hours

Question 11

What times of the year can dramatically increase call volumes?

Answer 11

• Flu season

- excessive heat waves

Question 12

If the ETA for the BLS ambulance is > ___ minutes non-emergency, or the patient’s condition would be better served by more timely transport (i.e., the patient is on a freeway, etc.), then the ambulance on scene should transport.

Answer 12

30 minutes

Question 13

Paramedic RA members shall remain on scene to ensure a smooth transition of care until BLS members take responsibility for patient care and transport by ensuring the following three things?

Answer 13

• receiving facility agreed upon
• All EPCR info obtained and entered by paramedic RA shared with transporting BLS ambulance
• Paramedic RA documents assessments and treatments on EPCR before sharing

Question 14

If BLS company members on scene determine the patient requires ALS assessment, treatment and/or transport (per the ___ or by ___), an ALS resource shall be requested from MFC.

Answer 14

per the PDP or by Clinical Judgement

Question 15

If the closest ALS resource is a ____, the dispatch will also include the closest Paramedic RA.

Answer 15

Paramedic Assessment Company

Question 16

ALS UPGRADE BY BLS RESOURCE:
What may be done when a BLS members on scene determine the patient is medically stable and not in immediate need of ALS intervention?

Answer 16

Assessment company may be cancelled

Question 17

ALS Upgrade by BLS Resource:
What conditions prevent the cancellation of an assessment company by BLS company on scene when both Assessment Company and RA are dispatched to an upgraded call?

Answer 17

• Non-traumatic chest pain (age over 40 yo)
• Shortness of Breath
• Abnormal vital signs (HR <50 or >120 regardless of age)
• Hypotension (systolic <90 mmHG or > 2 years of age)
• Acute ALOC
• Active seizure
• Signs of shock
• Trauma center criteria
• Combative patient
• Extended response time for ALS RA
• Multiple patients

Question 18

Assessment Company response may be discontinued for patients with any of these conditions when BLS members find a patient in a _____ (doctor’s office, medical clinic, etc.) and the patient is receiving appropriate medical care directly related to the patient’s chief complaint.

Answer 18

Healthcare facility (doctors office, medical clinic, etc)