DB 19-21 - ALS and BLS Resources and Upgrades

Question 1

ALS RAs should be replaced by an EMT rescue ambulance (BLS RA) for transport whenever the following actions have been performed by the first arriving resource to confirm BLS transport is appropriate:

Answer 1

1. A thorough patient assessment including chief complaint, vital signs, mechanism of injury (when indicated) and any necessary ALS diagnostics that may influence the mode of transport.
2. Patient is determined to not meet Section “A” of the Patient Disposition Policy (PDP), or a patient meeting Section “A” has been approved for BLS transport by the base hospital.
3. A “RISK ASSESSMENT” is performed to determine if a patient’s inherent risk factors (age, complaint, medical history, etc.) may contribute to a higher risk potential than otherwise indicated by the nature of their complaint alone.
4. ALL MEMBERS on scene CONCUR that the patient is stable for BLS transport.
5. The estimated time of arrival (ETA) of the BLS RA does not exceed 30 minutes, NONEMERGENCY.

Question 2

Anytime on scene resources disagree on the level of care needed for a patient transport, an EMS Captain shall be requested through MFC and the EMS Captain will make the FINAL DETERMINATION.

Should an EMS Captain have an extended response greater than ____ minutes, the patient shall be transported by the ALS RA

Answer 2

15 mins

Question 3

Factors to consider when downgrading to BLS:

During the hours of ____ to _____, call load and wall times tend to be at their lowest.

During these “off-peak” periods, members should consider the time it would take for an ALS RA to transport and transfer care compared to the time waiting for a BLS RA to arrive on scene, give report and share ePCRs.

Answer 3

2200 to 0600 hours

Question 4

Other factors to consider when opting to request a BLS ambulance for transport when a Paramedic RA is on scene include the following:

Answer 4

-Time of day
-Time of year
-Expected turnaround times at hospitals
-If ETA for BLS ambulance is greater than 30 mins NON-EMERGENCY or patient would be better served by a more timely transport

Question 5

If on scene BLS members determine the patient is medically stable and not in immediate need of ALS intervention, the responding Assessment Company may be canceled and the Paramedic RA continued alone, if the pt DOES NOT meet the following exceptions:

Answer 5

Question 6

When does “wall time” tend to peak?

Answer 6

on weekdays during the late afternoon and early evening hours

Question 7

Assessment Company response may be discontinued for ALS patients when BLS members find a patient in a ___________.

Answer 7

HEALTHCARE FACILITY (doctor’s office, medical clinic, etc.)

AND the patient is receiving appropriate medical care directly related to the patient’s chief complaint.

(In all cases, a Department resource shall remain on scene with the patient until the transfer of care to an appropriate LAFD resource is completed.)