Are there any systems in the US that utilize BLS as Code 3 responders? Looking to shift some of my ALS workload to BLS units but I'm having a hard time finding MPDS codes and protocols surrounding it.
"Simple" MVA, that is, one with no 2-vehicle head-on or rollover, unknown medical alarm, probable obvious and/or expected death or full arrest w confirmed DNR/MOLST.
If the MVA is speficically a rollover, it's Delta'd out with the BLS bus being in-serviced and an ALS bus, the response districts engine, and Rescue are started. Rescue Co. are also FF-Ps.
There are more but that's a small bit of my system. Ofc with some of these a fly car medic will usually mobile over, especially if the notes look like something else may be going on or if it seems like it's going to turn ALS, but there currently isn't enough to run an ALS bus.
Also for sake of clarification (habit from teaching IRL) when I say ALS I mean Level 4 aka Paramedic, not Level 2 aka Advanced EMT or Level 3 aka AEMT-CC.
I’m not sore I understand your question. Why wouldn’t you want a BLS unit responding hot to someone who is bleeding significantly, for example? Or are you more thinking that most emergencies don’t really need a L&S at all (which is fair)?
From my understanding it looks like a class B call is an emergent response from a BLS unit without any als response at all. If something is emergent enough to warrant l&s isn't is enough to call als as well?
For example, most MVAs should be a hot BLS response only. There’s a high potential for injuries, but there’s not much of anything that requires ALS immediate other than there rare case where you need an immediate advanced airway. Most trauma patients—even serious ones— are best managed with BLS interventions and rapid transport.
Strokes are another great example. They’re time sensitive, sure. So L&S are warranted. But there’s not really anything that a paramedic can do for a stroke patient that a BLS provided couldn’t do. Perform a good assessment, run a stroke scale, acquire and transmit a 12-lead if you can, and transport. The only other thing a paramedic is going to do is start an IV, which can easily be done in 2 mins at the hospital.
In my area, suspected narcotic ODs are almost always a BLS response unless CPR is started. All the police and fire units carry narcan so by the time an ambulance gets to one of these calls the patient is generally already screaming and vomiting from all the narcan they’ve received.
It actually makes sense. When you look at the studies in Philadelphia, victims thrown in the back of the police transport van who were driven to the ER (without intervention) had higher survival rates than those transported by PFD. Its not a Philly only thing. I always was a hook and haul with those patients....I established ALS enroute, but many times we were close to a trauma ER and little more than BLS got done. Long duration transports, including crews who stayed on scene for IV access or intubation, always did worse. To be honest, the only one who can save them will be the trauma surgeon.....
It’s only weird if you aren’t experienced and used to working those calls at a basic level. An EMT is not an ambulance driver. You have an important role to play in providing care.
As a basic EMT, you should be comfortable running any call to the best of your ability at the level of care you’re capable of providing. Strokes, chest pain, GSWs, cardiac arrests, it’s doesn’t matter. Stabilize as best you can, provide the interventions you’re cable of providing, and transport.
It takes some time and experience for any provider to be capable of running a high acuity call comfortably and smoothly. This is just as true for new paramedics as it is for new EMTs. But it’s important for basic EMTs to build their experience level to the point where they can run these calls well.
Old ass study when there were fewer ambulances and medics werent educated on the importance of treating en route. Plus early blood admin improves outcomes by a ridiculous margin. Not challenging to tell your medics to treat it like a trauma code (scoop and treat)
Every system I’ve ever worked in that used MPDS dispatched BLS to all Alpha and Bravo calls. Some dispatched hot to both, some only to Bravo calls. ALS was only dispatched on request, if the call taker later upgraded it, or if there wasn’t another BLS unit within like 10 minutes of them
The AMR system I worked in never figured that out. They would have ALS trucks on BLS IF transfers and then an ALS call would kick out and no one was available.
Boston and Seattle have similar philosophies on ALS- that it should be for life-threatening emergencies where ALS will actually make different the outcome, and that reserving paramedics for those calls ultimately make for better paramedics which leads to better outcomes. Many calls that would be ALS in other systems- and billed as such- go BLS in Boston. If money was the motivation they’d have more ALS trucks, and send ALS trucks to cover BLS calls when available.
Right. They hire paramedics and pay them through a year of their own full-time paramedic school unlike any other in the country because they aren’t interested in making good paramedics. Got it.
I gotcha. I worked for Brewster 10+ years ago and never really got to understand the system that well. The idea of pending calls where I am now just doesn’t fly, they’ll assign an ALS ambulance from miles away for toe pain just to get it off the board.
Oh yea. Me and my partner had no idea what we were doing and were going on BAMA calls pretty regularly. Was cool to work there pre VA contract when there only like six ambulances.
Hopefully someone makes a heads up play and will divert the ambulance to that. But that doesn’t always happen and there might be an engine company on scene for a while doing their best until something frees up.
For years I thought tiered systems were lame, I see the light now.
Ditto- they don’t stack calls here and waste ALS units constantly. They’ll send an ALS unit 30 minutes away for nonsense and only tone out a BLS truck mutual aid if we ask for it.
Almost never unless the person calls back and says a trigger word to upgrade to an ALS call. Calls can sit for an hour sometimes waiting for a BLS truck to get sent if it’s busy as fuck.
Most of Suffolk County (Long Island, NY) is a mix of an ALS provider and BLS provider on a bus if it is a paid crew. However, with the mix of vollies and call volume, crews will mix and often have an ALS bus run with BLS crew with a flycar ALS provider also attending the call to upgrade it if needed or just leave if ALS is not needed. They also follow the ABCD call system but often times the caller misrepresents the situation, so ALS is often accompanying and can leave if not needed.
Similar in many parts of upstate NY. BLS rig is sent on all calls, ALS fly car sent to C, D, E calls. We run quite a few ALS criteria calls BLS due to lack of ALS units or the ED is closer than the closest ALS unit.
For a long time Detroit 911 was like 70% BLS trucks and they always dispatched closest available unit regardless of capability. It's been a minute since I worked in the city though. I know they've got more ALS trucks up these days and they might have changed how they dispatch. Still a lot of basic trucks running and the hospitals are all close so it's probably still pretty similar.
During the bankruptcy period Detroit frequently had a dozen or less trucks on the road of which maybe three or four would be ALS. There was one day I think they got down to eight units. Detroit frequently hits 200+ calls in a day. There's also nowhere in the city that's more than ten minutes from a hospital. I'm not sure if that's where the policy came from but it made sense with the resources they had. Don't know why they kept it after they got more units up though other than habit.
In medium volume areas with limited units it makes sense. BLS takes the patient and moves towards ALS (the ER) and you meet with a Paramedic unit in-between if possible. It's how my area did it for years and it worked well.
That part is fine. The part that isn’t is sending ALS trucks to the toe pain call because they happen to be closest. Part of triaging calls is that lower acuity patients wait.
That part is fine. The part that isn’t is sending ALS trucks to the toe pain call because they happen to be closest. Part of triaging calls is that lower acuity patients wait.
Yes. We use the Alpha-Echo response system here, not code 3 and others. It kind of works like this:
Alpha: everyone no L/S
Bravo: BLS goes L/S, ALS goes cold
Charlie: BLS goes L/S, ALS has discretion
Delta/Echo: everyone goes L/S
It used to be there was a lot more BLS first response here and a shortage of medics. This area is now moving away from that model towards ALS primary response. But, we do still have some agencies around here that utilize BLS providers to their full scope. We also still utilize this system when we have volly FD respond on medical calls. They are the BLS response.
I worked BLS 911 in PA. It was a good system, we could cancel or request ALS on scene or the ALS provider could clear the pt as BLS appropriate and then go back into service. It was either 2 EMTs or an EMT and an ambulance driver on the transport rig.
I’m also in PA. We have this where I live but the reality is the local BLS crews routinely wait for ALS on scene “just to see what we think” so we often end up going.
I worked in an area with longer response times and sometimes a fly car or ALS unit would take longer than just transporting, so we took a lot of critical patients as BLS and called for a rendezvous with ALS (usually didn’t happen). We took STEMIs, strokes, traumas, etc as BLS.
Only if you can give pain meds then downgrade. Where I’m at if you give ANY ALS drug you have to ride in. Which is dumb because what am I the medic going to do that an EMT can’t if too much fentanyl was given?
At least at my org. The proQA codes are categorised specifically. So what may be a 6D for you may be a 6B for me.
The point is what can the basics do? If they can give salbutamol then a SoB Asthma could be BLS appropriate. But if not in their scope it should be a Delta/ALS call.
LA County and Orange County but they always send an ALS engine I believe. AMR Arlington operation in Texas did this for a little while if the levels got low enough.
I don't know about that. Cleveland is all ALS and is the busiest agency in the state of Ohio, with over 100,000 responses a year. They respond lights and sirens to every call. The majority of their calls will have a final disposition of BLS, however there's a medic on every call.
I’m not necessarily discussing just the cities or those with largest run volumes. I’m talking as a whole. Also, cool never would’ve thought Cleveland had so many. Cincinnati I would’ve placed my bets on.
Cleveland is an anomaly due to many factors. It's an issue that is being researched as to why cities like Pittsburgh do far less calls when they're the same size. Cleveland is the second largest city in the state behind Columbus. However Columbus is a combined EMS fire agency but they still don't reach Cleveland's call volume.
This sounds like a great way to burn out medics on BLS work. If I'm not mistaken Philly was a similar system years ago and had a huge turnover problem as a result. How long are people staying in Cleveland in this kind of system?
Sorry, to your question, turnover on average had been about 6 years for medics. However there's been a drastic decrease in attrition over the last 2 years due to the pay increases, administrative changes at the top and progressive moves with protocols.
240 paramedics on staff. Lost 10 this year. 2 were terminations for cause and 2 were retirements. So really only 6 medics plus another 4 EMTs. If you pay, they will stay. Medics start at $31/hr and top at $40. And the cost of living is a fraction of the cost of many other locations.
Detroit is BLS dominate, closest unit gets the call and handles it. ALS will be canceled off hi acuity runs and cardiac arrests for a closer bls unit to handle.
That sounds insane compared to the system I work in. Does BLS run the code on scene with no Epi / advanced airway or do they just transport right away while working the code??
No transporting unless sustained rosc or the scene is unsafe. BLS units here use king tubes, air Q’s, and utilize waveform/numeric capnography. Every truck has a life pack 15 locked in aed mode for 12 lead transmission, ETCO2 monitoring, and cpr qi. We are starting a double blind trial where BLS units will give a single dose of IM epi at the beginning of the code; unfortunately I don’t have an details on that right now.
Milwaukee, WI. Fire Department runs ALS and they contract two Privates, Bell Ambulance and Curtis Ambulance for BLS calls. Some of their ambulances even work out of some Milwaukee Fire houses along side the engine.
Henrico county VA just did a whole study on this … a few years ago it was medic units only the did an internal beta test altered the cad and now its 50% bls fire ambulances surge BLS ambulance and chase medics on the engine.. the medic typically only rides in on 1/4 the calls… its worked so well they are staring a chase car program in 2026
NJ has a tiered system. BLS ambulances with 2 EMTS and ALS flycars with 2 Medics. EMTs respond hot to most calls with medics dispatched as well if the call is screened as ALS by EMD.
Here in Minnesota, due to the spread-out nature of ambulance services and the even more dispersed locations of hospitals, the Twin Cities and Rochester are the only two locations that I know of that have level one and level two trauma care hospitals. So, you'll have private ambulance services run by different towns, where it's either EMT and EMT or EMT and EMR, where the EMR handles the driving. Due to Minnesota laws, they are not able to perform patient care. There are also smaller ambulance services that offer ALS services, but also have a BLS truck with paramedics and EMTs on board. On some days, the truck will provide basic life support, while on other days, it will provide advanced life support, depending on whether a paramedic is on duty.
Additionally, certain ambulance companies, such as Allina North Memorial and Mayo Clinic, exclusively employ EMTs and paramedics. On the same shift, we will have a mix of BLS trucks and ALS trucks. And all of them can do code 3 calls. And if the BLS truck gets there and they realize that they need advance life support they can communicate that to dispatch and either say meet us well in transport or wait on the scene for ALS to arrive it all depends on how far away ALS is and in some cases they may choose to do a Life flight where a helicopter goes to the scene and picks up the patient brings them to the appropriate hospital because it ends up being the quickest option to get best patient care possible within that golden hour.
After all, the appropriate level hospital may be too far away, or advanced life support may be too far away that a helicopter can actually get there quicker than an ambulance. These BLS rigs just have protocols of if this then you need to call for either life flight or advanced life support rig, and if it's this this long for advanced life support rig to show up then you meet them on the way to the hospital or you just transport them to the hospital, providing as much care as you can as a BLS rig.
I know I probably explain this horribly, and someone with more experience than me and a better understanding of the system could probably explain it better than I could. Still, I have a decent understanding of how it would function because I've worked for an ambulance service where I could potentially be scheduled with an EMR, and I'm an EMT; we may have to communicate with dispatch to have an ALS rig respond.
Boston is BLS dominated. NYC has lots of BLS. Delaware and New Jersey are entirely tiered systems. Lots in Pennsylvania as well.
In Colorado where I am now, Colorado Springs sends BLS only to alpha level calls. I believe Aurora does similar.
CSFD also has Community Medicine units that get sent out on lower acuity calls in addition to AMR having dedicated BLS units.
Are there BLS CMED now?
Seattle, and King County generally
Almost everything goes BLS when you don't have any medic units! Such a crazy system.
Boy do they pay though! Living in the region, I’m tempted every time they post jobs.
If you are asking do we have a BLS emergency category that we send BLS units emergency to, the answer is yes. These are MPDS Bravo level calls.
https://preview.redd.it/2wvmz0nyz16g1.jpeg?width=659&format=pjpg&auto=webp&s=9779e0b2ad4730966ccddc1902f367a85119b7e8
Why would there ever be a class B call?
"Simple" MVA, that is, one with no 2-vehicle head-on or rollover, unknown medical alarm, probable obvious and/or expected death or full arrest w confirmed DNR/MOLST.
If the MVA is speficically a rollover, it's Delta'd out with the BLS bus being in-serviced and an ALS bus, the response districts engine, and Rescue are started. Rescue Co. are also FF-Ps.
There are more but that's a small bit of my system. Ofc with some of these a fly car medic will usually mobile over, especially if the notes look like something else may be going on or if it seems like it's going to turn ALS, but there currently isn't enough to run an ALS bus.
Also for sake of clarification (habit from teaching IRL) when I say ALS I mean Level 4 aka Paramedic, not Level 2 aka Advanced EMT or Level 3 aka AEMT-CC.
BLS hot is a BLS unit with a fire response (Ambulance + Rescue). BLS cold is just a BLS unit
I’m not sore I understand your question. Why wouldn’t you want a BLS unit responding hot to someone who is bleeding significantly, for example? Or are you more thinking that most emergencies don’t really need a L&S at all (which is fair)?
From my understanding it looks like a class B call is an emergent response from a BLS unit without any als response at all. If something is emergent enough to warrant l&s isn't is enough to call als as well?
Sometimes yes, but in many cases, no.
For example, most MVAs should be a hot BLS response only. There’s a high potential for injuries, but there’s not much of anything that requires ALS immediate other than there rare case where you need an immediate advanced airway. Most trauma patients—even serious ones— are best managed with BLS interventions and rapid transport.
Strokes are another great example. They’re time sensitive, sure. So L&S are warranted. But there’s not really anything that a paramedic can do for a stroke patient that a BLS provided couldn’t do. Perform a good assessment, run a stroke scale, acquire and transmit a 12-lead if you can, and transport. The only other thing a paramedic is going to do is start an IV, which can easily be done in 2 mins at the hospital.
In my area, suspected narcotic ODs are almost always a BLS response unless CPR is started. All the police and fire units carry narcan so by the time an ambulance gets to one of these calls the patient is generally already screaming and vomiting from all the narcan they’ve received.
Ah that actually seems quite reasonable. Unfortunately our system requires an l&s response to every single call so yeah
What??? What state do you work in? You have to run lights and sirens to foot pain?
Yes. Literally, unironically, I've ran that exact call( toe pain) L&S, yes. Nj
All the calls with a B in the code are Bravos in the link below, starting on page 3.
Caveat 1: I don’t know how old this reference is.
Caveat 2: The system Medical Director can make their own “adjustments” to this.
https://www.angelfire.com/nc/neurosurgery/Priority.pdf
Ah cool that seems mostly reasonable, even if i would probably want medics for a gsw with serious hemorrhage lol
Thats a Bravo some places? How is that anything less than a high delta? Extremely curious and a tad concerned
It actually makes sense. When you look at the studies in Philadelphia, victims thrown in the back of the police transport van who were driven to the ER (without intervention) had higher survival rates than those transported by PFD. Its not a Philly only thing. I always was a hook and haul with those patients....I established ALS enroute, but many times we were close to a trauma ER and little more than BLS got done. Long duration transports, including crews who stayed on scene for IV access or intubation, always did worse. To be honest, the only one who can save them will be the trauma surgeon.....
Even then, not dispatching ALS at all is quite weird
It’s only weird if you aren’t experienced and used to working those calls at a basic level. An EMT is not an ambulance driver. You have an important role to play in providing care.
As a basic EMT, you should be comfortable running any call to the best of your ability at the level of care you’re capable of providing. Strokes, chest pain, GSWs, cardiac arrests, it’s doesn’t matter. Stabilize as best you can, provide the interventions you’re cable of providing, and transport.
It takes some time and experience for any provider to be capable of running a high acuity call comfortably and smoothly. This is just as true for new paramedics as it is for new EMTs. But it’s important for basic EMTs to build their experience level to the point where they can run these calls well.
No I've ran a couple actual ALS calls without ALS because there were no units available, so I absolutely agree with you there
I mean that's fair, it may just be me thinking about it wrong however its also how I was trained to think 🤣
Old ass study when there were fewer ambulances and medics werent educated on the importance of treating en route. Plus early blood admin improves outcomes by a ridiculous margin. Not challenging to tell your medics to treat it like a trauma code (scoop and treat)
Every system I’ve ever worked in that used MPDS dispatched BLS to all Alpha and Bravo calls. Some dispatched hot to both, some only to Bravo calls. ALS was only dispatched on request, if the call taker later upgraded it, or if there wasn’t another BLS unit within like 10 minutes of them
In Boston our BLS to ALS ratio is 5/6 to 1. BLS accounts for 80-100k transports a year while ALS is 7-10k.
Is it common for ALS trucks to go to BLS dispatches if no BLS is available?
no. when you have 5 ALS trucks for the entire city, you don’t waste one on a BLS call
The AMR system I worked in never figured that out. They would have ALS trucks on BLS IF transfers and then an ALS call would kick out and no one was available.
That’s because one system prioritizes maintaining appropriate resources and one system prioritizes revenue.
Both are revenue-focused decisions.
Boston and Seattle have similar philosophies on ALS- that it should be for life-threatening emergencies where ALS will actually make different the outcome, and that reserving paramedics for those calls ultimately make for better paramedics which leads to better outcomes. Many calls that would be ALS in other systems- and billed as such- go BLS in Boston. If money was the motivation they’d have more ALS trucks, and send ALS trucks to cover BLS calls when available.
Seattle is not in the business of “making better paramedics.”
If they had more ALS trucks they’d have to pay for more paramedics. Payroll is the largest cost to an agency by far.
Right. They hire paramedics and pay them through a year of their own full-time paramedic school unlike any other in the country because they aren’t interested in making good paramedics. Got it.
You say that like it’s a good thing. King County isn’t exactly practicing groundbreaking medicine. It’s a mediocre system with good PR.
Nah 911 doesn’t pay. IFT does.
A common misconception. IFT pays better but 911 does generate positive income.
Not that either answer would change a 911 service still benefitting from keeping costs low
I gotcha. I worked for Brewster 10+ years ago and never really got to understand the system that well. The idea of pending calls where I am now just doesn’t fly, they’ll assign an ALS ambulance from miles away for toe pain just to get it off the board.
that’s fucked. what do you do now when a cardiac arrest/trauma/something that actually needs ALS goes out and now you have a delayed response?
Brewster would send two brand new EMT's.
Oh yea. Me and my partner had no idea what we were doing and were going on BAMA calls pretty regularly. Was cool to work there pre VA contract when there only like six ambulances.
Hopefully someone makes a heads up play and will divert the ambulance to that. But that doesn’t always happen and there might be an engine company on scene for a while doing their best until something frees up.
For years I thought tiered systems were lame, I see the light now.
Ditto- they don’t stack calls here and waste ALS units constantly. They’ll send an ALS unit 30 minutes away for nonsense and only tone out a BLS truck mutual aid if we ask for it.
It’s dumb
Almost never unless the person calls back and says a trigger word to upgrade to an ALS call. Calls can sit for an hour sometimes waiting for a BLS truck to get sent if it’s busy as fuck.
Common in some other MA cities too, such as Lowell, Worcester, etc. Not quite the same ratios, but overall system design is similar.
Manatee Co. in FL does. I can't help you with codes, but I know they have a pretty robust BLS 911.
Most of Suffolk County (Long Island, NY) is a mix of an ALS provider and BLS provider on a bus if it is a paid crew. However, with the mix of vollies and call volume, crews will mix and often have an ALS bus run with BLS crew with a flycar ALS provider also attending the call to upgrade it if needed or just leave if ALS is not needed. They also follow the ABCD call system but often times the caller misrepresents the situation, so ALS is often accompanying and can leave if not needed.
Similar in many parts of upstate NY. BLS rig is sent on all calls, ALS fly car sent to C, D, E calls. We run quite a few ALS criteria calls BLS due to lack of ALS units or the ED is closer than the closest ALS unit.
For a long time Detroit 911 was like 70% BLS trucks and they always dispatched closest available unit regardless of capability. It's been a minute since I worked in the city though. I know they've got more ALS trucks up these days and they might have changed how they dispatch. Still a lot of basic trucks running and the hospitals are all close so it's probably still pretty similar.
Closest unit to every call regardless of capability has got to be the single dumbest EMS thing I have ever heard
During the bankruptcy period Detroit frequently had a dozen or less trucks on the road of which maybe three or four would be ALS. There was one day I think they got down to eight units. Detroit frequently hits 200+ calls in a day. There's also nowhere in the city that's more than ten minutes from a hospital. I'm not sure if that's where the policy came from but it made sense with the resources they had. Don't know why they kept it after they got more units up though other than habit.
In medium volume areas with limited units it makes sense. BLS takes the patient and moves towards ALS (the ER) and you meet with a Paramedic unit in-between if possible. It's how my area did it for years and it worked well.
That part is fine. The part that isn’t is sending ALS trucks to the toe pain call because they happen to be closest. Part of triaging calls is that lower acuity patients wait.
That part is fine. The part that isn’t is sending ALS trucks to the toe pain call because they happen to be closest. Part of triaging calls is that lower acuity patients wait.
What is code 3
Plain language is scary mmkay
Agreed
Depends. Some have it where code 3 is priority 1 aka full L&S, others have it as code 3 is priority 3 aka no L&S.
That is why I am asking
Ohhh you meant specifically for him not in general, my bad, I misunderstood.
Yes. We use the Alpha-Echo response system here, not code 3 and others. It kind of works like this:
Alpha: everyone no L/S
Bravo: BLS goes L/S, ALS goes cold
Charlie: BLS goes L/S, ALS has discretion
Delta/Echo: everyone goes L/S
It used to be there was a lot more BLS first response here and a shortage of medics. This area is now moving away from that model towards ALS primary response. But, we do still have some agencies around here that utilize BLS providers to their full scope. We also still utilize this system when we have volly FD respond on medical calls. They are the BLS response.
I worked BLS 911 in PA. It was a good system, we could cancel or request ALS on scene or the ALS provider could clear the pt as BLS appropriate and then go back into service. It was either 2 EMTs or an EMT and an ambulance driver on the transport rig.
I’m also in PA. We have this where I live but the reality is the local BLS crews routinely wait for ALS on scene “just to see what we think” so we often end up going.
I worked in an area with longer response times and sometimes a fly car or ALS unit would take longer than just transporting, so we took a lot of critical patients as BLS and called for a rendezvous with ALS (usually didn’t happen). We took STEMIs, strokes, traumas, etc as BLS.
I can think of many conditions that should be emergent BLS like testicular tortion
Only if you can give pain meds then downgrade. Where I’m at if you give ANY ALS drug you have to ride in. Which is dumb because what am I the medic going to do that an EMT can’t if too much fentanyl was given?
At least at my org. The proQA codes are categorised specifically. So what may be a 6D for you may be a 6B for me.
The point is what can the basics do? If they can give salbutamol then a SoB Asthma could be BLS appropriate. But if not in their scope it should be a Delta/ALS call.
LA County and Orange County but they always send an ALS engine I believe. AMR Arlington operation in Texas did this for a little while if the levels got low enough.
The majority of the Midwest is BLS trucks with ALS chases. I don’t know about codes, but we have extensive protocols.
I don't know about that. Cleveland is all ALS and is the busiest agency in the state of Ohio, with over 100,000 responses a year. They respond lights and sirens to every call. The majority of their calls will have a final disposition of BLS, however there's a medic on every call.
I’m not necessarily discussing just the cities or those with largest run volumes. I’m talking as a whole. Also, cool never would’ve thought Cleveland had so many. Cincinnati I would’ve placed my bets on.
Cleveland is an anomaly due to many factors. It's an issue that is being researched as to why cities like Pittsburgh do far less calls when they're the same size. Cleveland is the second largest city in the state behind Columbus. However Columbus is a combined EMS fire agency but they still don't reach Cleveland's call volume.
Wild. That’s so cool!
This sounds like a great way to burn out medics on BLS work. If I'm not mistaken Philly was a similar system years ago and had a huge turnover problem as a result. How long are people staying in Cleveland in this kind of system?
Sorry, to your question, turnover on average had been about 6 years for medics. However there's been a drastic decrease in attrition over the last 2 years due to the pay increases, administrative changes at the top and progressive moves with protocols.
240 paramedics on staff. Lost 10 this year. 2 were terminations for cause and 2 were retirements. So really only 6 medics plus another 4 EMTs. If you pay, they will stay. Medics start at $31/hr and top at $40. And the cost of living is a fraction of the cost of many other locations.
The Phoenix metro area used to and is still coded for ALS and BLS dispatches but almost all the apparatus have gone ALS.
We have a tiered response system. BLS ambulances with medic fly cars.
Detroit is BLS dominate, closest unit gets the call and handles it. ALS will be canceled off hi acuity runs and cardiac arrests for a closer bls unit to handle.
That sounds insane compared to the system I work in. Does BLS run the code on scene with no Epi / advanced airway or do they just transport right away while working the code??
No transporting unless sustained rosc or the scene is unsafe. BLS units here use king tubes, air Q’s, and utilize waveform/numeric capnography. Every truck has a life pack 15 locked in aed mode for 12 lead transmission, ETCO2 monitoring, and cpr qi. We are starting a double blind trial where BLS units will give a single dose of IM epi at the beginning of the code; unfortunately I don’t have an details on that right now.
Charleston county SC is 50/50 BLS with (usually) ALS fly cars available if it gets dicey.
Milwaukee, WI. Fire Department runs ALS and they contract two Privates, Bell Ambulance and Curtis Ambulance for BLS calls. Some of their ambulances even work out of some Milwaukee Fire houses along side the engine.
All of NJ 911, mostly 2 EMT ambulances (volunteers can still get away with a driver and EMT) then 2 Paramedics in chase cars.
BLS respond to all but confirmed pronouncements, Priority 1, 2, 3, 4, and 5 (5 is no BLS L&S). 6 & 7 are interfacility non-emergent transfers.
ALS responds L&S to all Priority 1, 2, 3 (3 being no ALS L&S), and 8 (pronouncements which can hold for hours)
Priority 1 is choking, arrests, etc
Priority 2 is respiratory, cardiacs, unconscious, etc
Priority 3 is respiratory, cardiacs, unconscious, etc with additional circumstances that allow ALS cold response
Priority 3 is abdominal pain, back pain, falls, etc
Priority 5 is abdominal pain, back pain, falls, etc with additional circumstances that allow BLS cold respone
Henrico county VA just did a whole study on this … a few years ago it was medic units only the did an internal beta test altered the cad and now its 50% bls fire ambulances surge BLS ambulance and chase medics on the engine.. the medic typically only rides in on 1/4 the calls… its worked so well they are staring a chase car program in 2026
Milwaukee, WI. Their ambulances are ALS and a private runs their BLS.
And it definitely works! /s
I take it you’re familiar? I actually know very little about it.
Little Rock, AR
NJ has a tiered system. BLS ambulances with 2 EMTS and ALS flycars with 2 Medics. EMTs respond hot to most calls with medics dispatched as well if the call is screened as ALS by EMD.
Baltimore County MD has BLS units running Code 3.
Detroit. Send whatever unit is closest no matter the licensure. BLS can pronounce TOD. 20 minutes of CPR, no shockable rhythm, call it.
St.Paul minmesita has 6 BLS only 911
Here in Minnesota, due to the spread-out nature of ambulance services and the even more dispersed locations of hospitals, the Twin Cities and Rochester are the only two locations that I know of that have level one and level two trauma care hospitals. So, you'll have private ambulance services run by different towns, where it's either EMT and EMT or EMT and EMR, where the EMR handles the driving. Due to Minnesota laws, they are not able to perform patient care. There are also smaller ambulance services that offer ALS services, but also have a BLS truck with paramedics and EMTs on board. On some days, the truck will provide basic life support, while on other days, it will provide advanced life support, depending on whether a paramedic is on duty.
Additionally, certain ambulance companies, such as Allina North Memorial and Mayo Clinic, exclusively employ EMTs and paramedics. On the same shift, we will have a mix of BLS trucks and ALS trucks. And all of them can do code 3 calls. And if the BLS truck gets there and they realize that they need advance life support they can communicate that to dispatch and either say meet us well in transport or wait on the scene for ALS to arrive it all depends on how far away ALS is and in some cases they may choose to do a Life flight where a helicopter goes to the scene and picks up the patient brings them to the appropriate hospital because it ends up being the quickest option to get best patient care possible within that golden hour.
After all, the appropriate level hospital may be too far away, or advanced life support may be too far away that a helicopter can actually get there quicker than an ambulance. These BLS rigs just have protocols of if this then you need to call for either life flight or advanced life support rig, and if it's this this long for advanced life support rig to show up then you meet them on the way to the hospital or you just transport them to the hospital, providing as much care as you can as a BLS rig.
I know I probably explain this horribly, and someone with more experience than me and a better understanding of the system could probably explain it better than I could. Still, I have a decent understanding of how it would function because I've worked for an ambulance service where I could potentially be scheduled with an EMR, and I'm an EMT; we may have to communicate with dispatch to have an ALS rig respond.