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ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY Colleen Chawla, HCSA Director
Emergency Medical Services District
1000 San Leandro Blvd, Suite 200
Travis Kusman, MPH, EMS Director
Karl Sporer, MD, Medical Director
Date: February 21, 2018
To: All 911 EMS Field Providers
From: Karl Sporer, EMS Medical Director
Re: Transfer of care to BLS Ambulances
Next month, Paramedics Plus will expand its use of Basic Life Support (BLS) ambulances in its delivery of 911
service to Alameda County. The use of BLS ambulances for Alpha and Bravo medical responses as determined in
accordance with the Medical Priority Dispatch System (MPDS) has always been permissible under the Paramedics Plus
contract with the County.
Analysis of several years of clinical outcome data has identified several Bravo determinants within our EMS
system with consistently low clinical severity and corresponding very low rates of ALS intervention. Beginning in March of
2018, Paramedics Plus will expand its use of BLS ambulances in responding to these Bravo determinants.
The expanded use of BLS ambulances in the 911 system will create increased opportunity for first responder unit
based Paramedics to transfer the care of a patient to BLS ambulance based EMT’s. Transfer of care of patients from
Paramedics to EMT’s working together on an ALS ambulance has been common and safely occurred in our system for
many years. It is equally permissible for a first responder unit based Paramedic to transfer care to a BLS provider in our
system when the patient’s clinical condition makes it appropriate to do so. The use of an ALS assessment and/or
intervention does not preclude the transfer of care to a BLS provider. The severity of the medical issue and Paramedic
judgement should dictate when this transfer of care is appropriate.
All patient care decisions in our EMS system should be made with the best interests of the patient in mind. If the
patient requires ongoing, time-sensitive ALS level care that could make a meaningful difference in terms of patient
outcome, the patient should be transported without delay via the provided BLS unit with the first responder unit based
Paramedic retaining care as the primary patient care provider.
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In the event a first responder unit arrives on scene for one of the selected determinants to which a BLS
ambulance has been assigned and subsequently assesses a patient as “in extremis” or otherwise having an acutely time-
sensitive disease process threatening loss of life or limb, the first responder unit may still request a Code 3 non-divertible
ambulance response. In this circumstance, the closest ambulance (either BLS or ALS) will respond.
I highly encourage all of our 911 providers to review the current scope of practice of our EMT’s as defined in the
Alameda County EMS Protocol Manual. For 911 system BLS ambulance-based EMT’s in Alameda County, this includes:
• Use of Pulse Oximetry and Glucometry
• Administration of Aspirin and Naloxone
• Administration of Epinephrine via Auto Injector
• Assisting patients with the administration of physician prescribed devices, including but not limited to,
patient operated medication pumps, sublingual nitroglycerin, and self-administered emergency
medications, including epinephrine devices
• Monitoring intravenous lines delivering glucose solutions or isotonic balanced salt solutions including
Ringer’s lactate for volume replacement;
• Monitoring, maintaining, and adjusting if necessary in order to maintain, a preset rate of flow and turn off
the flow of intravenous fluid;
• Transferring a patient, who is deemed appropriate for transfer by the transferring physician, and who has
nasogastric (NG) tubes, gastrostomy tubes, heparin locks, foley catheters, tracheostomy tubes and/or
indwelling vascular access lines, excluding arterial lines
• Monitoring preexisting vascular access devices and intravenous lines delivering fluids with additional
medications pre-approved by the Director of the EMS Authority
Thank you for your prompt attention to this matter and your continued hard work and dedication to the residents and
visitors of this County.