my agency receives an automatic ALS dispatch, if the call requires ALS care. more often than not, the medic dispatched will clear the patient and send them BLS to the ED. I don’t know what they teach nationally, or in other states, but in NY we are taught to treat pediatric patients, medical or traumatic. as a BLS agency in a relatively rural area (more than 20 minutes to the nearest facility) there are times that we simply take the call in BLS even if ALS is dispatched and will try to intercept if it is possible, but if I have a patient that is critical, I am not going to sit on scene with my thumb up my ass waiting for some self righteous para-god to get there, because they think that I am completely inept at providing care. that’s called delaying care, and is NEVER in the best interest of the patient. I do not care if someone has 50 years of experience as a doctor, if you do not know field protocols, and you are not an emergency provider with your own damn means to get the patient to the hospital, you have absolutely no business assuming care of a patient. the only way to know if that child had a TBI or some kind of bleed or a fractured vertebrae is to get them to a facility with the technology to find out. as a doctor you do not have x-ray vision and you have no business giving a childs family potentially false hope that their baby is going to be okay, because if they aren’t, that family is not going to go after you and your license, they are going to go after the EMS providers who actually provided care and transported.