Inside EMS Podcast: Is There Such A Thing As Too Much ALS?

In this week’s episode of Inside EMS, co-host Chris Cebollero and I discuss his five-year plan to implement a mostly BLS system at his agency.

While there is no “one size, fits all” solution to EMS system design and optimal staffing configurations, my opinion is that we do not have an EMS shortage in this country.

We have too much.

In some areas, we have a shortage of paramedics – not of people available to work – but of people willing to work in shitty conditions for chump change.

EMS is the dilated cardiomyopathy of emergency medical care; bloated, enlarged and inefficient, barely able to meet current system demands, but unable to respond to greater demands without some serious ventricular system remodeling.

We need tiered response systems, with strong BLS providers providing the bulk of care and transports. EMTs who practice patient care, not serve as drivers and equipment sherpas. A small, exquisitely trained cadre of ALS providers, handling only ALS calls. Less skill dilution, less rust-out.

And it’s time to do away with friggin’ ALS intercepts. We need to replace them with BLS intercepts instead.

Instead of clustering all your medics in large urban centers where the benefit of ALS is significantly diminished, put ’em in the rural communities and suburbs with long transport times, where ALS might actually do some good. Have them run calls and man a local community paramedicine program, and triage patients. If BLS transport is needed, call for a BLS intercept from the city. If ALS is necessary, ride in with the patient.

Every few months, rotate that small cadre of medics in the city out to the ‘burbs to get their community paramedic on.

And a dispatch triage system better than the ALS-centric guesswork we have now, that is wrong more than 50% of the time.

That way, you get quality seed corn for the next generation of medics, and the ones you currently have get plenty of practice at actually being paramedics.

That may not actually work for your system, but then again, it just might. The only way to know is to critically examine the paradigm that more paramedics equals better medicine. There is very little proof of that, and we need to stop ignoring that lack of proof.

Think Chris and I are full of shit? Or that we’re making good sense?

Tune into the podcast and let us know.