Dispatch systems are designed to get the right resources to the scene based on limited information, but the dispatch determinant is only the beginning of the patient assessment. Because dispatch decisions must be made before EMS arrives, some patients receive ALS resources that ultimately are not needed, while others may require a higher level of care than initially recognized. As a result, determining the appropriate level of transport depends on the assessment performed at the patient's side—not the dispatch determinant alone. In this episode, Maia Dorsett is joined by Roger Stone, Ben Kaufman, and Jeremy Cushman to discuss how EMS clinicians and systems can determine whether a patient requires ALS transport or can be safely transported by a BLS crew. Drawing on Montgomery County's pioneering work in developing and validating an ALS downgrade process, the panel explores common pitfalls, the importance of thorough assessment, strategies to avoid missed diagnoses, and the role of structured decision-making in improving patient safety while making the best use of limited ALS resources. Whether you are an EMT, paramedic, educator, quality leader, or medical director, this conversation offers practical insights into building systems that support consistent, patient-centered transport decisions.

Resources:

Montgomery County Resources: Checklist, posters, presentations

Monroe-Livingston policy on Determining the Appropriate Level of EMS Clinician for Patient Transport

CAPCE accredited CME available @ Prodigy EMS: https://frontend.prodigyems.com/class/CDB94B9A-6A2F-4DFD-A91F-C6F270700826?tab=overview