FireGirl911

Well let's see if we can push it to 14 then............................................................................ ........................................... Yup, New Mexico has an amazing scope, which I have attached just to fuel the fire... :twisted: F. EMS First Responders (EMSFR): (1) The following allowed skills, procedures, and drugs may be performed without medical direction: (a) Basic airway management. ( Use of basic adjunctive airway equipment. © Suctioning (d) Cardiopulmonary resuscitation (e) Obstructed airway management (f) Bleeding control via direct pressure (g) Spine immobilization; basic splinting. (h) Scene assessment, triage, scene safety. (i) Use of statewide EMS communications system. (j) Emergency childbirth. (k) Glucometry (l) Oxygen (2) Medical direction is required for the following items : (a) Allowable Skills: (1) Mechanical positive pressure ventilation. ( Allowable Drugs and Routes: (1) Oral glucose preparations. (2) Aspirin PO for adults with suspected cardiac chest pain. © Service Medical Director Approved: (1) Semi-automatic defibrillation (including rhythm documentation of cardiac activity). (2) Insertion of the laryngeal mask airway (3) IM drug administration by auto-injection device (4) IM auto-injection of the following agents for treatment of chemical and/or nerve agent exposure (i) atropine (ii) pralidoxime (5) Albuterol via inhaled administration (d) Wilderness Protocols: The following skills shall only be used by providers who have a current wilderness certification, from a Bureau approved Wilderness First Responder Course, who are functioning in a wilderness environment as a wilderness provider (an environment in which transport time to a hospital exceeds two (2) hours, except in the case of an anaphylactic reaction, in which no minimum transport time is required.), and are authorized by their Medical Director to provide the treatment. (1) administration of epinephrine (2) minor wound cleaning and management (3) cessation of CPR (4) field clearance of the Cervical-spine (5) reduction of dislocations resulting from indirect force of the patella, digit, and anterior shoulder G. EMT-BASIC (EMT-: (1) All items in the EMS First Responder scope of practice (2) The following allowed skills, procedures, and drugs may be performed without medical direction: (a) Emergency procedures as taught in standard EMT-B courses. ( Splinting. © Wound management. (3) Medical direction is required for the following items: (a) Allowable Skills: (1) Use of multi-lumen airways (examples: PTLA and Combi-tube) (2) Pneumatic anti-shock garment. * ( Allowable Drugs and Routes: (1) Activated charcoal PO. (2) Acetaminophen PO in pediatric patients with fever © Service Medical Director Approved: (1) Transport of patients with nasogastric tubes, urinary catheters, heparin/saline locks, PEG tubes, or vascular access devices intended for outpatient use. (2) Administration of naloxone by SQ, IM, or IN route (3) Administer the following drugs under on-line medical control. When on-line medical control is unavailable, administration is allowed under off-line medical control if the licensed provider is working under medical direction using approved written medical protocols. (i) Epinephrine, 1:1000, no single dose greater than 0.3ml, subcutaneous injection with pre-measured syringe or 0.3ml TB syringe for anaphylaxis or status asthmaticus refractory to other treatments (ii) Administer a patient’s own sublingual nitroglycerine for unrelieved chest pain, with on line medical control only. H. EMT-INTERMEDIATE (EMT-I): (1) All items in the EMT-Basic scope of practice (2) Medical direction is required for all items in the EMT-Intermediates scope of practice (3) Allowable Skills: (a) Peripheral venous puncture/access. ( Blood drawing. © Pediatric intraosseous tibial access - May be used only after two peripheral intravenous attempts have failed or if there is no reasonable possibility of securing peripheral intravenous access. Limited to one attempt, unless second attempt authorized by online medical control at the receiving institution. (4) Allowable Drugs and Routes: (a) Administration of approved medications via the following routes: (1) Intravenous. (2) Nebulized inhalation. (3) Sublingual. (4) Intradermal (5) Intraosseous tibial infusions in pediatric patients. (6) Endotracheal (for administration of epinephrine only, under the direct supervision of an EMT-Paramedic, or if the EMS service has an approved special skill for endotracheal intubation). ( I.V. fluid therapy (except blood or blood products). © 50% Dextrose - intravenous (d) Epinephrine (1:1000), subcutaneous for anaphylaxis and known asthmatics in severe respiratory distress (no single dose greater than 0.3 cc). (e) Epinephrine (1:10,000) in pulseless cardiac arrest for both adult and pediatric patients. In pediatric patients may be given IO in 1:1000 concentration per PALS protocols. Epinephrine may be administered via the endotracheal tube in accordance with ACLS and PALS guidelines. (f) Nitroglycerin (sublingual) for chest pain associated with suspected acute coronary syndromes. Must have intravenous access established prior to administration. (g) Morphine, for use in pain control with approval of on-line medical control. (h) Diphenhydramine for allergic reactions. (i) Glucagon, to treat hypoglycemia in diabetic patients when intravenous access is not obtainable. (j) Promethazine (5) Drugs Allowed for Monitoring During Transport: (a) Monitoring I.V. solutions during transport that contain potassium (not to exceed 20 mEq/1000cc or more than 10 mEq/hour). (6) Immunizations and Biologicals: Administration of Immunizations, Vaccines, Biologicals, and TB skin testing is authorized under the following circumstances: (a) To the general public as part of a Department of Health initiative or emergency response, utilizing Department of Health protocols. The administration of immunizations is to be under the supervision of a public health physician, nurse, or other authorized public health provider. ( Administer vaccines to EMS and public safety personnel © TB skin tests may be applied and interpreted if the licensed provider has successfully completed required Department of Health training. (d) In the event of disaster or emergency, the State EMS Medical Director or Chief Medical Officer for the Department of Health may temporarily authorize the administration of other immunizations, vaccines, biologicals, or tests not listed above. I. EMT-PARAMEDIC: (1) All items in the EMT-Intermediate scope of practice (2) Medical direction is required for all items in the EMT-Paramedic scope of practice (3) Allowable Skills: (a) Direct laryngoscopy. ( Endotracheal intubation. © Thoracic decompression (needle thoracostomy) (d) Surgical cricothyroidotomy. (e) Insertion of nasogastric tubes. (f) Cardioversion and defibrillation. (g) External cardiac pacing. (h) Cardiac monitoring. (i) Use of Infusion Pumps. (j) Initiation of blood and blood products with on-line medical control. (4) Allowable Drugs and Routes: (a) Administration of approved medications via the following routes: (1) Intraosseous (2) Topical. (3) Endotracheal. (4) Rectal. ( Adenosine © Amioderone (d) Atropine Sulfate. (e) Benzodiazepines (f) Bretylium Tosylate . (g) Calcium preparations. (h) Diphenhydramine (i) Dopamine Hydrochloride (j) Epinephrine (k) Furosemide (l) Glucagon (m) Lidocaine. (n) Magnesium Sulfate. (o) Narcotic analgesics. (p) Oxytocin. (q) Phenylephrine nasal spray. ® Sodium Bicarbonate. (s) Thiamine. (t) Topical anesthetic ophthalmic solutions. (u) Vasopressin. (v) ipratropium (5) Drugs Allowed for Monitoring in Transport: Requires an infusion pump when given by continuous infusion unless otherwise specified. (a) Potassium (no infusion pump needed if concentration not greater than 20mEq/1000cc) ( Fibrolytic Drugs (i.e., tPA, streptokinase, etc.). © Procainamide. (d) Heparin. (e) Mannitol. (f) Blood and blood products. (no pump required) (g) Aminophylline. (h) Antibiotics. (i) Dobutamine (j) Sodium Nitroprusside (k) Insulin. (l) Terbutaline. (m) Norepinephrine (n) Glycoprotein IIb-IIIa inhibitors/antagonists (o) Octreotide (p) TPN (q) Beta blockers ® diltiazem (6) Skills Approved for Monitoring in Transport. (a) Internal cardiac pacing. ( chest tubes (7) Medications For Administration During Patient Transfer. (a) Retavase (second dose only). ( Protamine Sulfate. © Non-depolarizing neuromuscular blocking agents in patients that are intubated prior to transport (8) Patient’s Own Medication that May be Administered (a) epoprostenol sodium Pretty amazing huh? **did we do it? did we make 14?** Marty, thanks for the kindness.

I totally agree. It's too bad that some people are not cool with sucession management. It is not a challenge to the seasoned providers, rather, it is an opportunity to shape the future of EMS. Unfortunately, this mentality is a byproduct of a lack of stress management that leads to cynicism and job burnout. I also think there needs to be a reasonable period of time between B and P to allow for time on the street. Some services and schools will take a newly licensed Basic with minimal experience into a medic class. This does the student a huge disservice. They struggle with understanding concepts that were explained to them in class, but that they have never had to deal with themselves.

I suppose I am just used to having converstations with people that actully lead to something productive. But I guess it would be productive if you did develop that curriculum on field appendectomies. Why don't you share it with us when you have it finished? :roll: back at ya :roll: Our Nalaxone curriculum and protocols have already been implemented.

This is a great topic! Here's my take on it: I too believe that we have a huge effect on how the event will play out, based on our ability to interact with everyone involved. By presenting one's self as approachable, confident, and trustworthy, we facilitate a more tranquil environment, which allows us to focus on the care of the patient. By creating a sense of trust with the patient and their family, they trust us with information and access that we would not have otherwise. This is why EMS/Fire are usually welcomed into someone's home with open arms. This is why mothers hand us their babies. This is why we are asked to attend funerals. It is a bond we create with the community we serve, and by doing this we make our own jobs easier and more meaningful. I agree that this is not a skill that comes easy for everyone. I also agree that as a provider's skill set becomes stronger, they find it easier to focus on rapport. I think that for many, they have the potential to interact at this level, but at the beginning of their career they are still focused on the mechanics of patient care. They are focused on integrating their learned behavior. Once they assimilate their skills, the performance of those skills comes easier, and they can relax and allow themself to focus on the human side of patient care.

1. I will use the spell check next time. 2. Our providers are not inadequately trained, and I am 99.9% sure you are not familiar with our EMS curriculum, state protocols, or anything else specifically related to our state's EMS system, nor am I familiar with your EMS system which is why I am in no position to judge it either. 3. What is wrong with discussing an issue without being sarcastic and putting people on the defensive? The only thing I got out of your post was that you disagree with my position and you think you could train anyone to perform an appi. and that's MY two cents.

:shock: WOW!!!! :shock: So much anger and synicism. The point I was trying to make is that everywhere you go, the needs of EMS are different. Different regions have different issues. That is why it is important to address those issues in education, training, protocols, ongoing QI, and continuing education. Just because your region does not advocate a particular skill doesn't mean our state has not done a good job of addressing our issues. I thought the point of this forum was to share information and seek/give advice, not to verbally attack someone whose perspective is different from yours.

I was so surprised to read this post. It is interesting how different the scope of practice is depending on your location. Our state has a lot of rural areas, and some areas function under wilderness protocols. Here in New Mexico where we have an epidemic of opiate overdose, narcan (nalaxone) can be administered at ALL levels, (except First Responder); including EMT-Basic, EMT I, and Medic. There has even been some counties that have trained their law enforcement officers to administer it via IN. Our EMS curriculums include extensive training on the use, contraindications, adverse effect, desired effects, etc of Nalaxone use. Basics administer via IN, IM, SQ Intermediates administer via IN, IM, SQ, SIVP Medics, same routes as Intermediate The caviat is that the dose is 0.4mg increments up to 2.0 when delivered IM, IV, SQ to allow for titration to the desired effect which is to allow the patient to have enough of a respiratory effort to survive. Respiratory effort is supported through airway positioning and supplemental O2 via BVM or mask. When administered via IN, it is the standard 1.0mg per nare. If 2.0 doesn't have enough of an effect, one is able to contact the recieving hospital for MD permission to administer a repeat dose in the case of a potential poly overdose. It is also state scope that no invasive airway device be placed if there is a potential for a return of a gag reflex, as usually happens after 0.4mg. After dealing with potentially hundreds of opiate overdoses during my time in the field, I have never encountered a patient with an adverse effect from the administration of Narcan if given judiciously and carefully. The problems arise when it is given too quickly and the patient experiences an acute withdrawl. That is when all the bad stuff happens, including them vomiting all over the place and attacking you because you took their expensive high away from them. So far, this scope has worked well for our state.