The transition from BLS to ALS

[thebigcheese]

Hi! I work for a small EMS service (2 ambulances and squad car) in Texas that serves about 40,000. Typically we run close to 700 calls a year.
Recently they have decided to enact a new ride out program that forces new EMT-I's and P's to work a certain number of shifts under the eyes of somebody of the same rank. I think the magic number is four shifts and 6 calls, and after that you can work on the box at your skill level.
Now this sounds great and is actually probobly a really good idea, but the problem is that we don't really have that many ALS personnel that work often, and even if we do we rarely get a call that involves serious ALS care. This has caused us to have EMT-I's and EMT-P's function as EMT-B's for up to 4 months before the service clears them to their cert level.
My questions are: How is this legal? If you get stuck on the box with a state and nationally certified EMT-P, but the service won't let them act as one, and you get a patient that NEEDS als, isn't it negligence if the EMT-P doesn't provide that care?
How do other services clear up to the next level?

Sorry if this sounds disjointed, but if you need more information I'll be more than happy to provide it.

[medic563]

Precepting is the norm around here. 40,000 people and only 700 calls a year, you have some really healthy and safe people in your town. As for your main question, I personally see it more as a liability not to do the ride along. Fixing the problem with the patient needing ALS and not getting it is an easy one. Until someone is offically cleared to operate at the ALS level, they wear the BLS rocker or patch. If they dont identify themselves as ALS than there is no expectation of care. As for having the BLS patch on when they are riding with the other ALS provider, its easy to explain that someone is new, and that the experienced ALS provider must ride with you for a couple of calls to check your compentence before cutting loose on your own. (Or in whatever politically correct way you wish to say it). In my home state, you must obtain medical control through a hospital prior to being allowed to operate at the level of your license. In the next state over, you have a license, you have control. However, most every service makes you precept some anyway because just because you passed the test doesnt mean your competent. In fact many medics who have been unable to get control in my home state due to incompetence, go to the next state over to one of the few services that wont make them precept.

[Weruj1]

We are a samll POC department, over teh past 3 or so years began to get trained medic moving into town and joining the FD, how ddi dwe knew they were competent ? Ya they may work as EMT/Medic somewhere full time but how do we know what they know before just giving them keys, narc tags, and protocols ? So in conjunction with our Medical Director, came up with the Medical Certification Advancement Orientation. It is essentially 3 parts, must complete a ride along 36 hours with day shift, tell us that they are "ready" to hit the street and an interview with the Medical Director. Until then they are considered BLS provider. If anyone wants a copy it is MS Word....let me know...

[Res343cue]

Precepting is quite popular here in Vermont too. Heck, most departments even "precept" their Basics and First Responders in some way or another.

ALS, or BLS, it doesn't matter, they want to make sure your able to adequately do the job.

[thebigcheese]

Thanks for y'alls responses. I guess my real question is do y'all think that 4 months (which is about how long it takes to get all the requirements done) too long?

Also, how do other services do it? Are there inservices to attend also or is it just ride-alongs?

One last question. Right now if an EMT-P joins our service, after their initial rideouts, our service looks at them as EMT-B's, then they have to rideout again to become EMT-P's. Does anybody else do this, or is everything covered in the inital rideouts? I'm attempting to get a good case together to help overhaul the system so we can get more ALS people in the service.

[Res343cue]

Originally posted by thebigcheese
Thanks for y'alls responses. I guess my real question is do y'all think that 4 months (which is about how long it takes to get all the requirements done) too long?

Also, how do other services do it? Are there inservices to attend also or is it just ride-alongs?

One last question. Right now if an EMT-P joins our service, after their initial rideouts, our service looks at them as EMT-B's, then they have to rideout again to become EMT-P's. Does anybody else do this, or is everything covered in the inital rideouts? I'm attempting to get a good case together to help overhaul the system so we can get more ALS people in the service.

4 Months, that doesn't seem too bad. Ours takes even longer, but we're also a small system running about 5000 calls per year (including about 2750-3000 interfacility runs)

We do it through a three-phase system for ALS providers. During these phases, amounts of ride time, in services, meetings with med control for critiques, have to be done.

During phase one for an ALS provider, they are essentially an Intermediate, but are allowed to function as an ALS provider with a senior medic in the back with them. As a phase 2 provider, they are allowed to provide some ALS skills by themselves, without a senior Medic. As a phase 3 provider, they are "released" into the streets to function as a Medic, with supervision coming form Med Control. This process can take as short as 6 months, with some taking as much as a year from what I have seen.

The system works really well, and it allows the director and med control to get a feel for this provider before fully allowing them into the field. It took a long time to get the first few medics through, and to get the system running, but the benefits have far outweighed the costs of having this system.

For the initial BLS/ILS providers, they go through a period of time where they ride as a "third", or "second tech". They get signed off, and are eligible to come in for coverage when the other units arer on calls, to fill in for providers when they are out sick, or eventually get hired part-time / full time. These providers go through it twice if they want to do ILS or ALS. We like our system, and woudln't change a thing about it.

For a small service, it may be hard to get multiple medics and other ALS/ILS providers through a system like ours.

[medic563]

One place I work, if you are a medic when you get hired you have to ride 3rd for a week worth of shifts, then 90 days of probation working BLS. After that you have to meet with the prehospital care coordinator and med con doc and take a protocol test. You then have to do 5 ALS observation calls, then a minimum of 20-30 ALS calls with a group of preceptors that the hospital selects. Throught those calls you have to meet with the med con doc every 10 calls or so. After 40 calls if you havent been making the grade you are put on probation for 6 months in which you work BLS, then have to start the process all over again but with usually 20 observation calls.

[RyanEMVFD]

For us medics take about 6 months to clear, and this is a pretty busy system here. I'm all for having to get cleared to perform at your level. Everyone had to take a test at the end of class to get their cert, just consider this the same thing. Also how do we know if that person passed with a 70 or a 100.

I've seen some MDs that have it where you have to have made at least an 80 on the state or national test to work at that level.