Chase Car VS. MICU Ambulance | Which is BETTER?

[@sedolect]

Here in Germany we only have one type of ambulance, all ambulances are outfitted as a intensive care transporter. The difference are in the crew how mounted that truck. The common German ambulance is staffed by a paramedic (Rettungssanitäter) and an advanced paramedic (Notfallsanitäter). If needed or the call implied a serious accident a NEF, similar to a chase car is called, mounted by a advanced paramedic and an emergency doctor, who studied medicine and has a advanced emergency training. On the scene are 3 trained paramedics and one doctor and during the transport to the hospital a advanced paramedic and the doctor are monitoring the patient. For really serious situations an ambulance and a helicopter, staffed by a pilot, an advanced paramedic and emergency doctor are called to an emergency, the helicopter transports the patient to the hospital, if needed. Germany also provides specialist ambulances, for cardiac things and so on.

[@Sweetw4ter]

Wrong...

[@TheParamedicCoach]

Congrats on 15k subs! Keep it coming my friends #ems

[@michaelborrello9944]

Thank you we appreciate the support !

[@zpppeswag]

Interesting how different things are state to state. In Ohio a MICU is a critical care unit and has a minimum staffing of an EMT, medic and an RN. Typically operated by the flight services. Around here 911 is all fire-based ALS, most suppression apparatus is ALS with at least one medic, BLS is strictly IFT.

[@HeroesNextDoor]

Yeah it’s very interesting! Hopefully one day it will all be more standard across the nation

[@chicken_banana6881]

It's interesting how different things like MICU's are just in the US. Here in europe / austria a MICU is always staffed by an ALS crew with a physician and our fly cars / chase cars always have a physician onboard with one medic. While BLS does mostly IFT they sometimes also take low tier calls.

[@Elmacheto]

Neat. Here in Austria we mainly run BLS Ambulances. If it's in ALS call they get a chase Car (or Air Ambualnce) staffed with an emergency physician+Medic/EMT to support.

[@Marburg3]

Sind nicht alle RTWs ALS da jeweils mindestens ein NFS drauf ist ?

[@vollelektrolysierer5773]

@@Marburg3 Den österreichischen NFS (ohne Notkompetenz-Weiterbildungen) als Advanced Life Support zu bezeichnen, ist ein bischen weit hergeholt. Es brauch nicht nur die Ausbildung, sondern auch die Erfahrung und die gesetzliche Grundlage/SOPs.

[@nicholasdiehl7368]

ALS IS Advanced life support and BLS is BASIC LIFE SUPPORT

[@HeroesNextDoor]

Correct

[@BranDone-qv6qv]

All great info but you left out a major thing.. CLOCK STOPPING! City or counties that contract out EMS require calls be responded to in a specific time frame. That clock stops the second a provider arrives so companies use sprint vehicles/supervisor cars to stop the clock keeping their times in check. It’s a way to cheat the system that you guys don’t like to talk about.

[@binbin6878]

Isn't it like a... good thing?

[@unknown1238157]

I like the chase car with 2 medics because it’s frees them up to take more life threatening calls where their needed. That way you don’t have medics doing BLS transports, when their skills are better used on a cardiac arrest.

[@HeroesNextDoor]

Yeah, that’s definitely one of the big upsides to a chase car

[@wademolzahn8870]

In Loveland Colorado they have a chase car/ support unit

[@sotosl5772]

Closest hospital is 45 minutes to an hour...

[@davidshippee715]

Ambulance, can't transport in a chase car.

[@wademolzahn8870]

Also a BLS can turn into a ALS will in transport.

[@gunnyzimm4983]

In a few of your videos I have Fire Police units in Fire Stations, I'm in Virginia and a Volunteer Firefighter, we don't have Fire Police, what are they and what is their job? We have Fire Marshals in the county and the State Police have them, our Law Enforcement is provided by the county and / or state. Thanks.

[@HeroesNextDoor]

Check out the Bloomsberg video on their fire police that might answer some questions. If it does not feel free to message us on fb and we will answer them.

[@dillonlexington]

So, great video first. My thoughts on this is that all "BLS" trucks should have the AEMT on board as one of the techs (our service calls an AEMT a BLS provider even though they do start the IV and a couple more meds). As far as the QRV/chase car, that I am a huge fan of. For the very reasons you mentioned, the misdispatch where it comes out as ALS and should be BLS. On the flip side of that our chase cars are smaller and quicker so if a call is dispatched BLS and should be ALS, the chase car can get there quicker. So many times have I seen medics take in BLS runs, as the medic was always in the back, and I am in agreement with that sometimes because I believe medics loose their Basic skills and could just use the practical run 'refresher" but this does not apply on all the calls. Over all again, great video, keep them up. But to clarify my answer and my opinion only is that Medic chase cars are the way to go in the future.

[@HeroesNextDoor]

For sure! AEMTs are new for Pennsylvania, but hopefully that start being more common on ambulances

[@Jtuz96]

Ontario has all "ALS/paramedics) in every truck out there. Our services only hire primary care paramedics and advnced care paramedics.

[@kylewick46]

Great info!!

[@HeroesNextDoor]

Thanks for watching. Keep spreading the word.

[@erikjohnson7221]

It’s interesting to watch your videos, because where I live in NW Washington State EMS is some a little different. Here in my county, all EMS is fire department based. All departments in the county run on every medical call and provide BLS transport, and then we have 2 departments that also staff medic units with 2 paramedics to respond to ALS calls in addition to a BLS crew. As far as number of personnel on scene, BLS calls will usually have 3-4 people, and ALS calls will usually have 5-6 people on scene. Cardiac arrests are even more, where they dispatch 2 engine/aid unit crews with 3 people each, a medic unit with 2 paramedics, a battalion chief and an EMS supervisor. So very interesting to see how some services might only have 2-3 people on scene for some potentially serious calls. Definitely have to trust your partner on those!

[@joshuafurze3395]

In England we have ambulances which contain either 2 paramedics or an EMT and a Paramedic, also ambulance cars which contain a paramedic and also we do have Ambo bikes but we do have doctor cars but it is very rarely seen as they are only used in direr situations

[@GeorgeThoughts]

Yep! The NHS Ambulance Services in the UK have a very well oiled and efficient set-up which ensures there's never not a fully qualified paramedic on-scene, as you mentioned. I suppose using the lingo from this video, our ambulances attend to all BLS and ALS calls because they're either crewed as 2 paramedics or a paramedic and an EMT, whilst our solo Advanced-Paramedic crewed RRV "chase cars" and motorbikes attend primarily ALS calls as priority. And then yes in some areas the most serious patients may also have a "Critical Care Team" attend made up of a Doctor and an Advanced Paramedic usually arriving by helicopter. Local areas are also more often serviced by volunteers as well who respond only to "ALS" cardiac arrest and breathing difficulty calls in their personal vehicles without emergency lighting. Because, especially in rural areas, an Ambulance can be 40 minutes away but your Volunteer First Responder lives or works 2 minutes away!

[@timneji]

We also have enough EMT and below Ambulances and Cars run by EMT‘s. Of course our system works much better than the US one but far from perfect.

[@redwhitebluepatriot6174]

I know a lot of departments staff their ambulances with a paramedic and an emt

[@michaelborrello9944]

Very true and I work at one of those departments. Sometimes I have another paramedic partner too

[@patrickvennard838]

This is so different in the UK 🇬🇧 I work for the second-largest service in the UK where we have a Paramedic on every vehicle. We had Rapid Response Cars with Paramedics on but the Chief decided that he wanted every truck to have a Paramedic on. Most trucks in my station are double Para Crews and 90% of the time they are transporting none critically injured, patients we train EMT anymore!

[@Postma_hemzelf]

In the Netherlands all ambulances are ALS with an extra trained nurse on board. All nurses have a background in Trauma, or ICU, or cardiac care. If the patient is critical there are two ambulances dispatched. If they need extra help the Mobile Medical Team with a doctor (Surgeon or anesthesiologist) and an extra nurse is called and they come most of the times by helicopter or otherwise by car. In the Netherlands we don't have BLS in regular ambulance services. In the Netherlands we have also a MICU, but a Dutch MICU is only used to transport a patient who is already on an ICU from one hospital to another.

[@galaxyloki]

So confusing 🤦🏼‍♂️ why not just have one to do everything?

[@zerodarkthirty7171]

one thing i will say about my hometown we have 3 different ambulance services 1 ALS from the fire house 2 ALS from private and 2 MICU from private ambulance company

[@ahodson2500]

That’s crazy. Our MICU are staffed with two paramedics one being a certified critical care medic. Our ALS cars are staffed with one medic and AEMT. We have basic cars that are staffed with two basics.

[@HeroesNextDoor]

Sounds like a good system to have. Bet there is less burnout of your medics

[@coover65]

Wow! That sounds rather complex. Do your dispatchers use an MPDS type of system? Whee I am we run either 2x Advanced Care Paramedics in a truck, or a critical care paramedic in an SUV "chase car", or a trauma paramedic (like the British HEMS crews) also in an SUV. Resources sent is dependant on the initial call or upon sitrep. To ease the burden of non urgent patients being sent to hospital we also have low acuity paramedics. They run around in vans as a 1 person operation. Patients with minor medical illnesses or injuries who can be treated at home, are. They suture, can give a tetabus injection or prescribe ABs. I think the crewing of ambulances only by vlunteers is somewhat archaic. We use them as first responders and like ll volunteers do a magnificent job. In our neck of the woods there's an expectation that when you call for an ambulance that you'll be treated by highly trained professionals, just as you would in a hospital setting.

[@wicky201]

GUYS's is not a word! Guys is already plural, otherwise a good video.

[@CHITOWN8072]

MICU is truly CCT as in Mobile ICU that's just an ALS ambulance.

[@hihfty]

There's a pretty unique situation that exist in Rhode Island. They have an ALS level called cardiac which is unique to there state. They have almost all of the meds and skills as a paramedic. The cardiac is the backbone of the entire state because the saturation of hospitals and the density of the state. The entire state is fire based EMS and it is extremely unlikely to see a BLS ambulance. Some volunteer Dept may roll a BLS ambulance initially but Cardiacs are in an abundance in Rhode Island and the entire state truly has 100% ALS coverage so the fly car is non existent there.

[@HeroesNextDoor]

We would love to come do a Station Cribs and other videos. Send contact information to [e-mail] and we will schedule something soon !

[@gocoastgaurd721]

Yep. Look how amazing the EMT-Cardiac intubation skills are! *sarcasm*

[@hihfty]

​@@gocoastgaurd721 The study that was done at the time was a political hit piece. The Dr that did the study was on the ambulance board and is a strong proponent of Hospital based EMS and Private EMS. He has been on the record multiple times attacking fire based EMS .At the time they tried to essentially null and void the cardiac level as ALS and that would immediately make all Fire based EMS BLS. They offered 0 training measures and then instead went after intubation in the protocols. The Dr ended up losing the fight and then all of a sudden all of the misplaced tubes suddenly stopped happening. If you peel back the numbers in any state there are going to be plenty of missed placed Tubes. 11 tubes in 3 years, if true is not a number that calls for immediately de licensing the cardiac level.

[@AmboAdz]

Should see what it's like over here in 🇬🇧 it can get quite complicated especially between the NHS and Private companies on skill sets and what can and can't do

[@HeroesNextDoor]

What is NHS ?

[@AmboAdz]

@@HeroesNextDoor it is the National Health Service as we don't get charged for health care unless you decide to go private for procedures, however alot of the ambulance work here mixed and do have private company's likes of Ambulnz (others are available also) who work on 999 emergency calls, none-emergency patient transport and event cover

[@duckdevilproductions3996]

My Department Ambulance is ALS Certified bug we don't always have a Paramedic Available so we sometimes have to call a different Department

[@rebvilla1]

In our country if ALS is needed the BLS requests them, but if the time to take the victim to the hospital is shorter than the ALS responding time, we rather transport the victim to the hospital instead of wasting time for the ALS to arrive. We can also start the transport until we meet the ALS. If it takes less time to take the victim to hospital we don't request ALSs support.

[@kinghill500]

Love ❤️

[@thescottishgiant855]

Right ok In Scotland we have one ambo service that’s separate from everyone else apart from the NHS obviously we have doctor cars which are basically repainted police cars with green lights and sirens that has a doctor in it but all our ambulances have 2 paramedics in them

[@AmboscottUK]

And that's the best way to do it. No one gets less than paramedic level of care

[@thescottishgiant855]

@@AmboscottUK exactly, no matter what happens your always treated by the best

[@dasarge84]

all the ambulances in my area are all MICU ambulances 3 man crew

[@Marburg3]

In 🇩🇪 every ambulance is ALS staffed with at least one paramedic and an EMT. We also have chasecars staffed with a physician and a parmedic. These are called if the ambulance crew wants to do more invasive procedures such as advanced airways or giving advanced meds. Our Helicopters are also staffed with a paramedic and a physician acting as a „flying chasecar“.

[@vollelektrolysierer5773]

Doing advanced airways and advanced drugs is literally what ALS stands for. If you need the physician unit for that, the ambulance is by definition not an ALS unit.

[@cameronallan5624]

@@vollelektrolysierer5773 maybe Marburg3 meant even more advanced than that, like roadside surgery. Not sure.

[@ltmongoose1594]

Who drives the chase car when the medic rides in the ambulance to the hospital?

[@HeroesNextDoor]

Most of the time the other EMT from the ambulance service or just leave it behind and pick it up after

[@johah2454]

Neat here in ohio I think it’s bit different specifically in my county the difference of a ambulance is BLC or ALC is the crew. Most depts in my county are volly with part time staff but that could be two EMTS or EMT and medic or any combo but if there one medic it’s ALS. We have CareFlight and Medflight which in addition to helicopters we call they both services MICUs and Medflight services Chase cars. There are two depts I know are full time. One is full time Fire/EMS and other is full time contract EMS which serve the town they reside in with the towns FD being Volly, and they serve my FD which is also volly cause we don’t have a ambo, my dept is to small for one right now plus almost no funding. Running with like one 1984 engine 80s brush and 2003 tanker. Sorry besides point. But the contracted EMS isn’t always ALS cause sometimes there’s a medic on duty sometimes there is. The one full time dept in my county has full time Fire and paramedics. There’s one more idk but for what I do. That’s it lol

[@johah2454]

But my county is too rural for chase cars to

[@tsell8957]

What would you do with the chase car if you rode with the ambulance to assist in als intervention during transport

[@HeroesNextDoor]

You either leave it at the scene or have an EMT follow you to the hospital

[@andrewplayzgetthebestvideo7700]

Great video

[@ronroberts8593]

Whats the difference in billing with Medicaid and medicare ? In new jersey a paramedic unit comes with 2 paramedics in either a chase truck or a ambulance, even though if you are in an ambulance according to state law MICU can not transport. Unless your BLS is more thna 30 mintues away and it is life threatening emergency.

[@HeroesNextDoor]

Billing changes but all reimbursement go to the transporting unit and the “chase” must have a contract or bill the transporting unit. Example BLS transport runs $600-$800 plus mileage where ALS is broken down into ALS 1 or ALS 2. ALS 1 normally charges $1100-$1300. This is the basic IV,02,monitor and one medication. ALS 2 would be $1300-$2400 this is 3 medications or intubation or defibrillator etc. Hope this helps explain. Each service can request what ever they want but Medicare and medicaid pays usual and customary.

[@nicholasdiehl7368]

I always wanted to know what the other little ems car coming with a ambulance

[@HeroesNextDoor]

Chase car. We talk about that in another video

[@kjazure]

After noticing the "heroes next door" decal on the side of your ambulance, that makes me wonder if you 1) have fire/EMS agency that you own or 2) collect and keep up emergency vehicles. Very cool

[@HeroesNextDoor]

Neither haha, we photoshop our logo on the side for the video

[@kjazure]

@@HeroesNextDoor awesome

[@kjazure]

@@HeroesNextDoor well you sure fooled me. Good work to whoever did that

[@coreydark8795]

Why not just have all ambulances as paramedic ALS you call them? Would make it easier and more simple than having what 4-5 types of ambulance. Your chase cars would move to advanced/critical care paramedics whom are almost as qualified as doctors and even have doctors? It works here in Australia. We even have doctors on our rescue helicopters.

[@OfficerYeknom]

Here in Western SD we run all ALS ambulances. Every station runs 1 ALS ambulance and station 1 (central main hub station) has multiple ambulance. But we also have chase cars. Station 1 & 2 have what we call mobile medics. That are used for major incident support and used for minor calls where transportation won't be needed. Also all of our engines, trucks, and rescues have atleast 1 paramedic on board. Most of the time though it is 1-2 paramedics and 1-2 EMTs. On the volunteer side the city is surrounded by volunteer departments which for the most part only run first responder/EMT level services with no transportation due to low call volume. My department only runs ~200 call a year.

[@brandondefend5442]

I see a lot of you're calling a Chase car video in Austin Texas

[@Duckyou555]

How would you get stuck on a BLS unit. If you have to ride in with a patient then you are on a ALS run so you would be tied up till your done with that call anyways, unavailable for any other call’s until you have turned patient over. So know you are back in service in your chase car. Because I’m assuming that one of the EMT’s of the BLS unit drove your chase car back to the hospital for you. So I’m not sure how you would be stuck on a BLS UNIT. However say the EMT for what ever reason did not make it back as fast with your chase car they could meet you on scene of the next BLS call and swap out then. I understand the idea of the chase car. But in the long run it truly seems like a lot of waste. I know that when service’s first started doing this it was largely to do with lack of qualified personnel. But now Paramedic and EMT’s are a dime a dozen. That’s why we see pay not going up again. Where I live 911 service providers are required to staff all 911 units as ALS no BLS unit can run a 911 call. The fire department responds on all calls and depending on if it’s a BLS or ALS call you will have at bare minimum one 3 to 4 man/ women staffed unit normally an Engine and if ALS Normally ENGINE and a RESCUE the rescue is ALS some Engines are now ALS this is due to fire has more stations and closer, as well as man power and they can send riders in with you for help on Trauma or severe calls. So no matter what you have extra hands.

[@Duckyou555]

And the public is never left wondering as well as the 911 provider as to weather or not you will be able to send ALS to a call. Just makes since to me. However I am lucky to live in an area that modeled its EMS structure very early on when the are was still rural back in the 50’s and 60’d and especially after Vietnam with all the experience the men and women brought back with rapid transport of the wounded via Helicopter and M.A.S.H. Units the survival rate of the wounded dramatically increased.

[@masterofmetal85]

You forgot phrn

[@HeroesNextDoor]

You are correct however the PHRN is mainly used as transport or flight and not the 911 service. Since the protocols are the same for medic vs PHRN many service employ the cheaper option.

[@michaelnoe3907]

I'm confused... I'm a Pa Paramedic, CCEMTP Certified. My ambulance is not a MICU until the Nurse is a board. MICU = Paramedic and RN or PHRN; transport (level similar to helicopter crew) ALS = Paramedic, AEMT; transport BLS = EMT/EMR; transport QRS = EMR/ EMT/Medic; Non-transport Chase-Car = make BLS transport ALS Is it that different on the east side of Pa verses the west side?

[@HeroesNextDoor]

Yes, there is different terminology used. We hardly ever see PHRN being used on the 911 service side any more. They are being transitioned to the critical care transport side. Don’t get me wrong there are a few out there but they are now the minority. So we use MICU to state its an ALS vs a BLS for the same company.

[@lolokbr]

So basically just a fancy way of saving money. How about we just fund EMS the way we do Fire (since 80 to 90, even 95+ % of calls at most services are EMS), then we can afford to buy enough ambulances and staff them all with at least one paramedic?

[@HeroesNextDoor]

Time to lobby the government cause I agree with you 100%. But don’t take away from the hard work of the fire or police services