Boston EMS

[fenwayfrankee]

1) Nebulized Albuterol was started in Boston as a "Special Project Waiver" with the state several years ago. It was successful enough that the state adopted it as a BLS intervention. Intranasal Narcan started the same way.

 

2) For the most part, Boston operates as a non-transporting ALS service, just in ambulances. There has been talk over the years about putting the medics in SUVs, etc, but there has been concern that they may end up on a scene and a BLS truck would either be delayed or unavailable and the medics would be stuck there. There is only one medic supervisor per shift. With rare exception they do not actually "work" as medics and transport in BLS trucks.

 

3) Except when extremely busy, a BLS truck is always sent with and ALS truck. Typically, if the ALS crew is going to work the patient, they will go in the ALS truck. Sometimes, for a variety of reasons they may end up in the BLS truck. In this case everything in the ALS truck is duplicated in a portable form. For critical patients, both medics will ride in back and the BLS will drive. In less acute cases, if in the ALS truck, the medics will transport by themselves, leaving one medic in back and the other driving.

 

4) I guess this depends on your definition of "needs". Without getting into a philosophical discussion about what ALS can and should do, I would say that its fairly rare for someone who "needs" ALS intervention not to get it. That being said, Boston is unique in the fact that 90% of the transports go BLS. There are other systems, one just on the other side of the river that ALS' 90% of their transports. Plus, there a numerous private ambulance companies around town that are used for mutual aid when needed and available.

 

 

 

 

Ed,

 

After watching some of the Boston EMS episodes, I have a few questions if you don't mind.

 

1. I noticed in a couple of instances the BLS units administered nebulizer treatments, which in my state is reserved for the Paramedic level.  Do the EMTs have an expanded scope of practice to allow for that stuff or are they actually EMT-I?

 

2. Given the heavy reliance on BLS transport units vs ALS transport units, does Boston utilize any sort of paramedic response vehicles (other than field supervisor units) to meet up with the BLS units?

 

3. When an ALS & BLS unit go to the same call, it seemed like both paramedics rode in with the patient (regardless of the actual need for multiple providers).  In some cases, it appeared that they did so in the BLS unit rather than their unit and I assume one EMT drove and the other brought the 2nd unit to the hospital.  Is this the normal practice?  Are the BLS units stocked with ALS equipment to some extent for that or do the paramedics need to bring whatever ALS gear they need with them from their truck?

 

4. How often do you encounter situations where a patient needs ALS, but it's not available due to having such a small number of ALS units on duty?

 

 

Just curious since your system is a lot different than what's in my area, including a city a little smaller that Boston.

 

Thanks.