Effective: 03-14-22
Supersedes: 06-22-20
Purpose: To define Policy and Procedure for Basic Life Support Providers to request or cancel Advanced Life Support Services.
Policy: The patient’s need for potential ALS intervention shall be the ONLY factor that is utilized by on-scene Brewster and EasCare Ambulance Service EMS personnel in determining whether or not to request ALS services.
Definition(s):
Advanced Life Support (ALS) refers to the pre-hospital use of medical techniques and skills by qualified personnel who are specially trained and shall include such functions as advanced airway and circulatory maintenance and the management of cardiac disorders.
Basic Life Support (BLS) refers to the pre-hospital use of those techniques and skills included in an EMT-Basic training course which meets the minimum training requirements defined in 105 CMR 170.000.
Requesting ALS:
Upon assessment of a patient, the BLS crew shall determine whether or not the patient may benefit from ALS intervention.
Once a determination is made that the patient may benefit from ALS, a request for ALS response shall be made by the most expedient means available. The request should usually be made via company radio; however, telephone or through the police or fire department is acceptable. The following information shall be included in the request for ALS:
· Age and sex of the patient
· Patient’s chief complaint or presenting sign or symptom that may require ALS evaluation.
· Requested hospital destination.
· If there will be an extended extrication.
· Any other pertinent information; please be brief.
Chief Complaints and presenting signs and/or symptoms that typically require ALS evaluation and intervention include but are not limited to the following:
· Active seizure
· Airway compromise or obstruction
· Anaphylaxis
· Cardiac Arrest
· Chest pain
· Entrapped patients
· Heat exhaustion and heat stroke
· Hypoglycemia (low blood sugar or insulin shock)
· Impending childbirth / Out of hospital births
· Multi-system trauma
· Respiratory arrest
· Respiratory distress
· Shock/hypotension
· Significant burns
· Unconsciousness or altered mental status
BLS crews shall not delay transport to await the arrival of ALS. Appropriate patient assessment, interventions and packaging shall be completed, and transport initiated if the ALS unit has not yet arrived.
It is the responsibility of the dispatcher to determine whether or not ALS resources are available and to allocate those resources. On the scene, EMS providers are not to determine whether ALS resources are available or not.
Cancellation of ALS by BLS
BLS must:
· Complete an appropriate patient assessment and provide treatment in accordance with the Statewide Treatment protocols;
· Having determined there is no foreseeable need for ALS based on the written guidelines (above), or determining that the patient can be transported to an appropriate health care facility in less time than it would take for ALS to arrive on scene, or intercept BLS during transport, BLS may cancel ALS;
· Document their assessment and treatment of the patient on their trip record; and
· Document the cancellation and reason(s) for cancellation of ALS on their trip record.
Licensed Health Care Facilities: Cancellation of ALS or BLS
A facility licensed to provide health care services may, on the authority of its license, cancel ALS or BLS that is responding or has established direct patient contact when the licensed health care facility assumes full responsibility for the cancellation decision. ALS or BLS so cancelled would have no further obligation to respond, assess, treat or transport. EMTs must document the cancellation by the licensed facility on their trip (or dispatch) record.
Reference: MA OEMS Administrative Requirement A/R 5-615
https://www.mass.gov/doc/ar-5-615-cancellation-of-als-0/download