ALS vs. BLS: What’s the Difference?

Many aspiring firefighters are surprised to learn that fire departments handle a lot of EMS calls.  This begs the questions, what is the difference between ALS vs. BLS and why is that important? 

This is why I highly recommend all aspiring firefighters get some form of EMT or Paramedic training. In fact, some departments require you have a certification before you can even take their civil service test or apply. 

You may have seen the abbreviations ALS and BLS for training levels for firefighters. In this guide, I want to explain what these terms mean. I will look at the different roles and training requirements that separate the two. 

ALS vs. BLS: What’s the Difference?

ALS and BLS stand for advanced life support and basic life support.  These terms represent a certain level of care that will be provided by EMS personnel.  Certain skills and treatments are considered ALS while others are considered BLS.  For example, starting an IV or placing an advanced airway (ET tube) is considered an ALS skill while applying and providing oxygen via a nasal cannula is considered a BLS skill.

There are generally two types of EMS support that you’ll find in a fire department – ALS and BLS. 

As far as many citizens are concerned, if they call for an ambulance then they will expect to see a paramedic as soon as possible. This isn’t necessarily the case. 

So, what is the difference between an Advanced Life Support and Basic Life Support crew member? The simple answer here is the level of training and certification achieved by the provider. 

Therefore, one can provide a more advanced life-saving service in extreme cases than the other. They have more training that allows them to do so in a safe, professional manner. Basic life support professionals are only permitted to provide a more restricted list of first aid procedures.

BLS vs. ALS Training

As you would imagine, there are two levels of training here and there are far more professionals with Basic Life Support training than there are with Advanced Life Support training. 

Basic Life Support training is recommended for anyone that works in a profession related to medical care or with people that may be vulnerable to requiring these services. 

It is essential that all EMTs and nurses start with this Basic Life Support training, but the list continues. 

Because Basic Life Support is so focused on traumatic incidents like cardiac arrests, choking, drowning and other threats to life, it is advisable that all those working around pools, in gyms, in care homes and in schools have some form of Basic Life Support training and certification. 

This can be as simple as attending a basic course, learning the skills needed for the most basic assessments and gaining a certificate. 

You don’t get any medical qualifications (although you can) in any traditional sense but you can prove that you have the knowledge to perform CPR and assist with choking or breathing on those struggling in the water. 

Many fire departments will be more likely to hire candidates with these skills, so they are better prepared for medical emergencies. 

This is all essential knowledge that EMTs are required to have in order to get their EMT certification. But, it is not the most advanced level

Advanced Life Support training lets you expand upon your knowledge with new skills to treat medical emergencies. 

EMTs that have Basic Life Support training will find that they lack the certification for more critical incidents. 

They may be able to administer CPR and get patient to hospital, but they don’t have the advanced skills for more complicated cases. Those that wish to gain these skills should become a paramedic

Differences between ALS and BLS

The main difference between the Advanced Life Support and Basic Life Support services is the term “non-invasive”. 

What this means is that Basic Life Support personnel can’t do anything that might be deemed an invasive procedure where they bypass the skin or enter the airways. 

Examples here can include: 

  • Creating any form of incision in the patient for bloodletting or to remove foreign objects
  • Creating any form of artificial aid within the body to help with breathing
  • Using needles to administer drugs and painkillers. This is primarily for the safety of the patient.

Firefighters that only have that basic level of training will not be prepared to handle any further complications that could arise if they were to make a mistake. 

It is better to call in Advanced Life Support as soon as they are needed than to try something, get it wrong, and then get Advanced Life Support to fix a mistake. 

Creating an incision with a sharp implement could be life-threatening if EMTs hit a major blood vessel or nerve. 

Injections could be an issue if the substance doesn’t enter the vein or if the needle tip breaks on a bone. 

No EMT should place an esophageal tube (ET Tube) without training as this could cause serious injury.

However, there is one exception to the rule here is that there are some trainee Basic Life Support personnel that are now trained to administer Naxolone, commonly known as Narcan. 

This drug is an essential tool when dealing with drug overdoses. The rise of opioid overdoses means a greater need for skilled EMTs that can deliver this drug effectively. 

The worst-case situation here is that a Basic Life Support EMT ambulance arrives at a call to find that the patient just needs this one fast-acting drug, but they can’t administer it. 

The patient could die in the time it takes to wait for an Advanced Life Support paramedic on another vehicle. 

This raises a lot of questions about the roles and restrictions of those with Basic Life Support training in advanced cases. 

Dispatch centers for emergency services could get a call that sounds like a Basic Life Support call and find that there are complications at the scene. 

BLS and ALS Skills

EMT’s and other BLS personnel will have skills for non-invasive procedures. The most important of these is CPR. 

To be honest, anyone working in the fire service must be able to handle CPR if needed. It is a skill that should be taught more freely to all citizens. Still, anyone trained in BLS should be proficient in CPR methods to ensure that patients in cardiac arrest have a better chance of survival. 

From there, the BLS ambulance will act as a patient transfer system between the site of an incident and the nearest hospital. It is all about getting the patient to the best possible care. 

This is one of the main roles of a BLS ambulance service. Minor accidents with broken bones, head injuries and incidents of ill-health often require safe transport service to a hospital where they can get the help they need. 

EMT’s can administer basic first aid as needed. 

Where Basic Life Support team members need to stick to non-invasive measures, Advanced Life Support personnel can take more advanced calls and handle these emergencies. 

This means that they can administer the life-saving drugs and procedures needed in certain emergency situations. 

They can use needles to administer the drugs, make incisions as needed for life-saving procedures and also maintain airways by inserting respiratory tubes and other devices. 

Why is this important?

There will be Basic Life Support EMT personnel and Advanced Life Support Paramedics on call in most major fire stations in the US. 

Some smaller stations and volunteer stations may only have access to those with EMT training at the Basic Life Support level. Fire departments need to be sure they are sending firefighters with the proper training on each call. 

Minor incidents that require basic first-aid or CPR and transfer to a medical facility can often fall to those with Basic Life Support training. They can keep the patient alive with that basic life support until they transfer care to the doctors at the hospital. 

Major traumatic accidents and medical incidents where there are complicated cases will require the skills of those with Advanced Life Support. 

Also, it’s important to note that the modern fire service is evolving to be more EMS centric.  Outside of the major cities, the majority of fire departments are looking for individuals with EMT or Paramedic training. 

Having either of these certifications as well as experience will make you stand out during your firefighter interview when compared to other candidates.

Why not have all ALS trained staff?

While there are several reasons for this, I’ll break it down into a couple of the main reasons.  First, is the cost of having an entire crew of paramedics.  

To be honest, paramedics are paid more than EMT’s.  So, for a department to require all personnel are paramedics will force them to pay more for their staff.  

Second, is the availability of qualified medics.  Depending on where you live, paramedics may be in short supply.

While a large percentage of calls to fire stations are medical in nature, they won’t all need Advanced Life Support. Thus, the addition of EMT’s and other BLS personnel.  That is for the life-threatening accidents, vehicle collisions and other complex cases that you don’t see every day. 

ALS and BLS Training for Firefighters

When you join the fire service you will find that there are lots of short CPR courses for firefighters. 

There is the expectation that all crew members will know enough to perform this procedure on patients while advanced help arrives. 

Many smaller departments and volunteer crews won’t ask for much more beyond this CPR certificate or a BLS qualification because it provides the bare minimum needed to work there. 

However, many departments in larger areas and cities place a higher emphasis on EMT training

They see these medical skills as a minimum requirement because of the type of incidents that they come across regularly. 

It really is up to the department what they decide to offer to their firefighters. 

While some departments are still willing to send candidates through EMT and Paramedic school, most now require it prior to applying.

Some may see ALS training as a waste and focus purely on providing a reliable BLS service to residents. Others may see that the need for ALS services is growing in their area and decide to make the switch. 

Whatever the current status of your own department, it is important you get the right training for your role within the department. 

You must understand the expectations of your department when applying to become a firefighter. Are they looking for applicants that already have CPR certification, BLS training or a more advanced EMT or ALS certificate?

If there isn’t a minimum requirement to get on the department, is there a deadline within which you must complete a course?  Many departments will hire untrained personnel but require them to get more training during their probationary period.

Be prepared to take a Basic Life Support course so that you have the basic skills in case they are needed. You will attend many medical calls while you are on duty and many could prove to be life-threatening. 

Your skills with CPR and other non-invasive treatments could keep patients alive as you transfer them to the hospital. 

If you attend an incident like this and feel that your skill-set isn’t enough, or you want to progress into medical care, find a way to add an Advanced Life Support training course to your list. 

We’ve compiled a list of all schools that provide EMT and Paramedic training in the United States (click the link to find a school in your state).

The skills you learn here will give you the chance to make more of an impact during stressful EMS calls, and this can be highly rewarding.

Whichever level of training you achieve – ALS vs BLS – you have an important place in the fire service. 

While Advanced Life Support is clearly the higher level and more desirable qualification in an emergency, we can’t discount the importance of BLS training and those with this skill.  In fact, it’s the foundation required to learn ALS skills.

Fire departments can function effectively when they have staff with both types of qualification. BLS-trained crew members are more than capable to handle the majority of first-aid needs and CPR cases while out on calls. 

They can still handle minor incidents and patient transfers and provide valuable support at the scene. 

But, a few additional firefighter/paramedics with ALS training offer that extra level of support in times of crisis. Train appropriately, take refresher courses and always do what is in the best interest of your patients. 

Other resources you may find useful:

Find EMT Training Near You

Fire Science Degree vs. Paramedic

5 Great Watches for EMT’s and Firefighters