The first steps are the hardest: 3 lessons learned on a BLS truck

Starting out on a basic life support (BLS) ambulance can be the first step toward a career in the fire service

For the last call of our 12-hour shift, my partner and I were dispatched to the hospital to transport a 96-year-old female back to her home to die – the exact opposite of what I had been trained to do during EMT school.

This was years before I worked for the fire department, back before I had finished my first semester of paramedic school, when I was still the new guy assigned to a basic life support (BLS) truck for a private ambulance company.

Up to that point, my transport experience consisted of taking dialysis patients to and from their appointments. Those patients had been chronically ill, but this patient was actively dying. I had never seen that before.

If you are hoping to land a job with a fire department that also provides EMS, a job on a BLS truck for a private service will definitely get you started in the right direction.
If you are hoping to land a job with a fire department that also provides EMS, a job on a BLS truck for a private service will definitely get you started in the right direction. (Photo/MCT)

The nurse handing over the paperwork sensed my unease. “Just drive fast,” she said. After we loaded the patient into the truck, we got stuck in rush hour traffic.

My partner had taken the wheel, easing us along, one car length at a time. I was in the back with our patient. With a valid do not resuscitate (DNR) order in hand, there was nothing I could do but watch and learn.

I observed the way she was breathing, the short, rapid breaths. And I noticed the thin glistening sweat on her brow. I felt her fading radial pulse beating at a 110 bpm. These were the signs of shock, and now that I knew what they looked like, the next time, I would be ready.

Waiting outside of the patient’s house was her entire family. When we moved her to the bed, her adult daughter touched me on the shoulder and said, “Thank you for your service.”

A rite of passage

The BLS transport unit is the workhorse of the ambulance industry. It’s a tough, grind of a job with very little glory. It’s the place where everyone in the private ambulance services get their start, giving the new folks the opportunity to learn the ins and outs of working on an ambulance in a non-emergency setting.

But since fire-based EMS services typically only respond to emergency calls, many firefighter/EMTs skip this role all together. And honestly, many look down their noses at the job, as if it had nothing to offer outside of a paycheck.

When I reflect on my career, I often think back to when I was assigned to the BLS truck and how I didn’t realize all that I was learning at the time.

If you are hoping to land a job with a fire department that also provides EMS, a job on a BLS truck for a private service will definitely get you started in the right direction.

A few of the opportunities this job provides:

  • Learning how to move patients
  • Learning how to treat the patient, not the numbers
  • Networking with people in the EMS and fire service

Let’s review all three.

1. Learning how to move patients

When I was going through EMT school, I never realized that one of the most frequent challenges I would meet while on the job was physically moving patients.

While I was studying the ABCs – airway, breathing and circulation – I had no idea that I was going to be contending with narrow hallways, steep staircases and houses overflowing with a lifetime’s worth of furniture.

My time on the BLS truck taught me one of the most vital techniques to use when faced with one of these tough situations, that is, to ask the patient or family, “How do you usually exit?” Many families and patients will know of an easier way to go, but they do not feel comfortable speaking up unless they are invited.

More times than not on a BLS truck, you will have limited staffing. You and your partner are it, so you have to work smart. After seeing what you can accomplish between you and one other person, working on a fire-based EMS crew with five or six other responders will be a piece of cake.

[Read next: Lifting assistance: Carrying bariatric patients over the gap in today’s healthcare]

2. Learning to treat the patient, not the numbers

BLS transports can often be routine, transporting the same patients over and over. But this repetition gave me the chance to get to know many people who were living with chronic illnesses. And I learned that not every abnormal vital sign constitutes an emergency. Some patients are constantly in a state of extreme hypertension or hypoxia.

But exacerbation of chronic illnesses like diabetes, end-stage renal disease and congestive heart failure make up a large part of emergency calls. An EMT’s knowledge of these diseases is crucial. However, many times the patient will be the one to tell you when something is not right – and how you can fix it.

3. Networking opportunities

I worked with a wide array of partners during my time on the BLS unit. Many were just starting out like me, but a few were full-time firefighters who had taken on the ambulance job part time.

During my shifts with the firefighters, I was able to ask questions and get honest answers as to what I should do to land my dream job. Just about all of them told me to complete paramedic school, which I did.

But when I went up for my job interview with the fire department, a few of the faces on my panel were familiar, thanks to my job on the BLS truck. Even though I do not believe that this fact alone landed me the job, it never hurts to know a few folks on the other side.

The BLS truck may be your ticket ahead

The fire/EMS service is a small world. With every role we take during our career, in a way, we are auditioning for the next. Like I said before, working on a BLS truck is a grind. But if you do it well, with a great attitude, it may be just the ticket you need to land your dream job.

Editor’s Note: What was surprising or particularly educational for you about working on a BLS truck? Share in the comments below.

[Bonus resource: How to buy patient transport devices (downloadable PDF)]

Next: Watch Chief Goldfeder's take on how to sell fire-based EMS to prospective members.

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