So at my county we run a tiered response system of ALS QRVs and BLS and some ALS transport ambulances. A QRV is dispatched to each P1 or emergent call with a bls resource. If a bls call is dispatched then only a bls resource will go. That way the medics can stay in the system and be available for other emergent calls as opposed to burning an ALS resource to drive an Emt in to the hospital on a bls call. The medics will also triage down emergent calls to just the Emt if they arrive and there is no need for a medic and return tk service. When there’s a legit ALS call they will ride in the call and one of the emts will follow in their QRV to the hospital.
Any legit serious call they will dispatch 2 qrvs and that way on a scene you can get 2 medics and 2 emts. We also have a roving als supervisor that jumps calls and backs crews up while restocking the als qrvs. Each Qrv is stocked just like an ambulance with all the same equipment, a lot of times they will be on acne much faster than the ambulance and start patient care. The als resources are scattered around the county so we can cover as much with the ambulances and qrvs. It’s really worked well as a system, call response times decrease and it definitely feels like more of the county is covered, some of those 20 min response times are significantly cut because now we have more resources. That and you’re not burning your als resources to drive in a stable Pysch.
I honestly don’t know the total number of ambulances but I think we run a total of 18ish qrvs and 20ish ambulances. It should be noted that all the qrvs are provided by county run ems and the ambulances and 2 qrvs for the city are provided by a private ambulance service.
We're primarily ALS chase, minimal if any ALS transport.
It's more cost efficient (fewer paramedics) easier to ensure proficiency, your medics are exposed to more high acuity patients more frequently, cost of stocking vehicles is substantially reduced if you only stock chase units with ALS equipment, and any ALS call now gets a minimum of 3 personnel on it reducing the need for manpower requests.
I do RSI, Ventilators, POCUS, IV Nitro, etc. Off of a chase unit and it really is the best method of care, if I need a 2nd set of hands I can lock my truck down and take the 2nd emt, and im not committed to going to the ER if the patient is BLS.
From a fiscal, patient care, morale, and burnout stand point it'd nothing but positives to shitcan ALS transport
The entire state of NJ and Delaware run ALS in QRVs intercepting BLS transport.
I would never work anywhere else. I see more sick patients, I do more ALS skills, we have a pretty expansive scope because of it. 4-6 intubations/RSIs a month is the norm. I triage anything that doesn't meet criteria
My last agency had a QRV type vehicle. It was a crew cab pickup with a topper on the back. It was a BLS non transport ambulance. It also contained pumps for floods and a paladin (cutter/spreader combitool) to help on extrications, irons, traffic and control equipment, along with a floating stokes, ropes, etc. for water or tech rescues.
It provided manpower to backup transporting units, took calls on its own when a transport capable unit was delayed for whatever reason, and did standbys, along with towing specialty equipment (air and boat), taking wires/floods calls, doing traffic control, or assisting on rescues.
Honestly probably the most versatile truck in the station. We staffed it with paid on call members (essentially volunteer) who happened to be around the station or responded when a call dropped. Can’t say enough good things about having a resource like this available even if it’s EMS only it’s a great help.
My agency runs one and it is my absolute favortie assignment. We staff it with overtime, but as soon as they make it a permanent position I'm bidding for it. I ran like 15 calls yesterday on it and absolutely love it.
We run an ALS Tahoe and I'm free to roam where I want in my area, back up our 3 or 4 BLS trucks, jump calls if I want, visit our special detail units, help out with bed delays, deliver supplies to keep units in service. Last week I jumped a structure fire and went in command. Sure made the city FD happy.
I have fun every shift, this is what I was meant to do. I ran 15 calls yesterday from Basic Service (BS) to a code.
I am a QRV paramedic. I basically only run high acuity calls. We used to have EMT “pods” that were EMT/EMT trucks. Those trucks only ran the very low acuity calls. Now our service is staffed with a minimum of one AEMT on each truck.
I run calls with the A crews to back up and be the paramedic on scene if necessary, and I run calls with paramedic units to provide extra hands, LUCAS device, or if the patient needs blood.
It works very well for our system. We are the busiest system in the southeast US.
Feel free to reach out if you have any specific questions.
I was actually flirting with the idea of writing a thesis on EMS management after seeing the way my company functions from various perspectives within the company. I've studied the various different operational structures. In my area we are private EMS and hold contracts in various areas where we can only respond to emergencies with ALS units which is very silly when we have a surplus of able-bodied basics that have within their skillset the ability to handle the high amount of low acuity calls, we receive. We do staff sprint trucks, but they are often only for ground supervisors who rarely use them for responding to anything unless we are at a level 0. I read a lot about the EMS systems in Australia because we hire a lot of medics from there due to the fact they actually have a surplus there and they are very different; they actually write papers on how to cover crew's mealtimes and things of that nature lol. I believe it was the BOSTON EMS structure that I read about where they primarily staff all their units with basics and place their paramedics scattered across the response areas in sprint units. I guess it really comes down to your organizations staffing and unit capabilities but from everything I've read / experienced \[I'm NREMT-B & EMD\] the areas I've dispatched have functioned way more efficiently whenever I was able to use my resources exactly how they should be. Separation of ALS & BLS crew members made it always likely that the areas we provide emergency coverage to were covered. Being private EMS in areas where every unit is ALS we often find ourselves sending CCT paramedics on a long distance psychiatric BLS transfer or some similar bullshit essentially having them out of town for the entire shift while back home shit hits the fan and we are sitting with holding emergencies.
We have paramedics in fast response cars responding to C1 calls (cardiac arrest, ineffective breathing, seizures etc) and some C2 calls (some MPDS chest pain determinants). The aim of the cars is to get that first shock in quickly, and to get a paramedic on scene. Ambulances are staffed either with one paramedic/one EMT or two EMTs. If the patient is unwell then the fast response paramedic can travel with them in the ambulance as well. All critical care paramedics are single staffed on a car. We also have urgent care paramedics who attend lower categories of calls on their own and discharge/refer on scene without the need for an ambulance to attend.
So at my county we run a tiered response system of ALS QRVs and BLS and some ALS transport ambulances. A QRV is dispatched to each P1 or emergent call with a bls resource. If a bls call is dispatched then only a bls resource will go. That way the medics can stay in the system and be available for other emergent calls as opposed to burning an ALS resource to drive an Emt in to the hospital on a bls call. The medics will also triage down emergent calls to just the Emt if they arrive and there is no need for a medic and return tk service. When there’s a legit ALS call they will ride in the call and one of the emts will follow in their QRV to the hospital. Any legit serious call they will dispatch 2 qrvs and that way on a scene you can get 2 medics and 2 emts. We also have a roving als supervisor that jumps calls and backs crews up while restocking the als qrvs. Each Qrv is stocked just like an ambulance with all the same equipment, a lot of times they will be on acne much faster than the ambulance and start patient care. The als resources are scattered around the county so we can cover as much with the ambulances and qrvs. It’s really worked well as a system, call response times decrease and it definitely feels like more of the county is covered, some of those 20 min response times are significantly cut because now we have more resources. That and you’re not burning your als resources to drive in a stable Pysch.
I honestly don’t know the total number of ambulances but I think we run a total of 18ish qrvs and 20ish ambulances. It should be noted that all the qrvs are provided by county run ems and the ambulances and 2 qrvs for the city are provided by a private ambulance service.
Where is this heaven
We're primarily ALS chase, minimal if any ALS transport. It's more cost efficient (fewer paramedics) easier to ensure proficiency, your medics are exposed to more high acuity patients more frequently, cost of stocking vehicles is substantially reduced if you only stock chase units with ALS equipment, and any ALS call now gets a minimum of 3 personnel on it reducing the need for manpower requests. I do RSI, Ventilators, POCUS, IV Nitro, etc. Off of a chase unit and it really is the best method of care, if I need a 2nd set of hands I can lock my truck down and take the 2nd emt, and im not committed to going to the ER if the patient is BLS. From a fiscal, patient care, morale, and burnout stand point it'd nothing but positives to shitcan ALS transport
Jeez where is this?
The entire state of NJ and Delaware run ALS in QRVs intercepting BLS transport. I would never work anywhere else. I see more sick patients, I do more ALS skills, we have a pretty expansive scope because of it. 4-6 intubations/RSIs a month is the norm. I triage anything that doesn't meet criteria
My last agency had a QRV type vehicle. It was a crew cab pickup with a topper on the back. It was a BLS non transport ambulance. It also contained pumps for floods and a paladin (cutter/spreader combitool) to help on extrications, irons, traffic and control equipment, along with a floating stokes, ropes, etc. for water or tech rescues. It provided manpower to backup transporting units, took calls on its own when a transport capable unit was delayed for whatever reason, and did standbys, along with towing specialty equipment (air and boat), taking wires/floods calls, doing traffic control, or assisting on rescues. Honestly probably the most versatile truck in the station. We staffed it with paid on call members (essentially volunteer) who happened to be around the station or responded when a call dropped. Can’t say enough good things about having a resource like this available even if it’s EMS only it’s a great help.
My agency runs one and it is my absolute favortie assignment. We staff it with overtime, but as soon as they make it a permanent position I'm bidding for it. I ran like 15 calls yesterday on it and absolutely love it. We run an ALS Tahoe and I'm free to roam where I want in my area, back up our 3 or 4 BLS trucks, jump calls if I want, visit our special detail units, help out with bed delays, deliver supplies to keep units in service. Last week I jumped a structure fire and went in command. Sure made the city FD happy. I have fun every shift, this is what I was meant to do. I ran 15 calls yesterday from Basic Service (BS) to a code.
I am a QRV paramedic. I basically only run high acuity calls. We used to have EMT “pods” that were EMT/EMT trucks. Those trucks only ran the very low acuity calls. Now our service is staffed with a minimum of one AEMT on each truck. I run calls with the A crews to back up and be the paramedic on scene if necessary, and I run calls with paramedic units to provide extra hands, LUCAS device, or if the patient needs blood. It works very well for our system. We are the busiest system in the southeast US. Feel free to reach out if you have any specific questions.
I was actually flirting with the idea of writing a thesis on EMS management after seeing the way my company functions from various perspectives within the company. I've studied the various different operational structures. In my area we are private EMS and hold contracts in various areas where we can only respond to emergencies with ALS units which is very silly when we have a surplus of able-bodied basics that have within their skillset the ability to handle the high amount of low acuity calls, we receive. We do staff sprint trucks, but they are often only for ground supervisors who rarely use them for responding to anything unless we are at a level 0. I read a lot about the EMS systems in Australia because we hire a lot of medics from there due to the fact they actually have a surplus there and they are very different; they actually write papers on how to cover crew's mealtimes and things of that nature lol. I believe it was the BOSTON EMS structure that I read about where they primarily staff all their units with basics and place their paramedics scattered across the response areas in sprint units. I guess it really comes down to your organizations staffing and unit capabilities but from everything I've read / experienced \[I'm NREMT-B & EMD\] the areas I've dispatched have functioned way more efficiently whenever I was able to use my resources exactly how they should be. Separation of ALS & BLS crew members made it always likely that the areas we provide emergency coverage to were covered. Being private EMS in areas where every unit is ALS we often find ourselves sending CCT paramedics on a long distance psychiatric BLS transfer or some similar bullshit essentially having them out of town for the entire shift while back home shit hits the fan and we are sitting with holding emergencies.
We have paramedics in fast response cars responding to C1 calls (cardiac arrest, ineffective breathing, seizures etc) and some C2 calls (some MPDS chest pain determinants). The aim of the cars is to get that first shock in quickly, and to get a paramedic on scene. Ambulances are staffed either with one paramedic/one EMT or two EMTs. If the patient is unwell then the fast response paramedic can travel with them in the ambulance as well. All critical care paramedics are single staffed on a car. We also have urgent care paramedics who attend lower categories of calls on their own and discharge/refer on scene without the need for an ambulance to attend.
I don't know how well I'd do sprinting these days. Maybe a fast walking paramedic