ALS and BLS Team Approach


  1. The EMS provider with the highest level of certification is responsible for the initial assessment of all patients unless the number of patients or the severity of injuries makes this impossible.

  3. In the event of a non-transport (refusal or non-viability), the EMS provider with the highest level of certification is responsible for the assessment and documentation unless the number of patients and the severity of injuries make this impossible.

  5. In situations where a BLS crew has requested a paramedic for assistance and the paramedic feels BLS transport is indicated, the paramedic will continue to assist the BLS crew throughout the transport.

  7. Patient care may be delegated from the Paramedic to the EMT under the following conditions:

    1. The patient is stable and does not meet any of the criteria for ALS transport listed below.

    3. The Paramedic fully informs the EMT of assessment findings and anticipated patient needs.

    5. The EMT is comfortable with accepting responsibility for treatment and transport.

    7. The patient has not received any ALS treatment (i.e. – IV therapy, intubation, etc.)

    9. The Paramedic fully documents assessment findings and treatment up to the point of delegation of patient care to the EMT.


ALS treatment and transport is indicated if the patient has one or more of the following conditions. If the BLS crew is able to deliver the patient to an emergency department in less time than it would take for the ALS crew to make contact, the BLS crew should complete transport. Waiting for ALS to arrive should not cause delays in transporting the patient.

    Shortness of breath or acute dyspnea
    Chest pain or anginal equivalent
    New onset altered level of consciousness
    Uncontrollable bleeding
    Patient meets Trauma Alert Criteria
    Patient meets Medical Alert Criteria
    Shock signs/symptoms (unstable patient)
    OB at >20 weeks with contractions and:
              - Evidence of meconium staining or
              - Vaginal Bleeding
    Childbirth prior to 38 weeks gestation
    Syncope or near-syncope
    Symptomatic with abnormal vital signs
    Any uncertainty about the patient’s status

Any time the EMS provider believes the patient’s condition warrants ALS treatment and care.