EMS From a Distance: ALS? BLS? Let skills fall where they may

Basic versus advanced EMS training and care continue to evolve

BLS before ALS!”

I doubt there’s anyone with more than a few months in EMS who hasn’t heard that cliché. It used to make sense to me. As an EMT, I liked the way it prioritized my low-tech contributions over the meds and monitors of my paramedic partners; and as a new medic, it reminded me not to overlook basic care, no matter how cool my tools were. So why does “BLS before ALS” sound so silly to me now?

ALS, BLS: The limits of labels

Prehospital care rarely follows a BLS-to-ALS hierarchy. More often, we combine basic and advanced interventions as cases warrant: the alert cardiac patient with crushing chest pain, for example, who gets aspirin and a 12-lead as her vitals are checked; or the obtunded diabetic with an unremarkable pulse, whose finger stick is more significant than his blood pressure. Now that we’re introducing EMTs to naloxone, CPAP and other measures once reserved for ALS providers, I don’t think categorizing skills as BLS or ALS is as helpful as asking whether EMS needs such a distinction at all.


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