Basics Doing Advanced Patient Care - Good Or Bad?

[Linuss]

The advanced first responders and healthcare officers carry Methoxyflurance, Salbutamol, GTN, Adrenaline, Glucagon, AED, OPAs (talk of LMAs and 3 leads being implemented, already being carried in some areas). To become an advanced first responder it's over 200 hours of training spread over a year and a half to practise at that level.

Wait wait wait.

Your advanced first responders are "more equipped and trained", yet have almost the exact same drugs, and only, on average, 80 more hours of education in 4 times the time frame? Hell, I had 210 hours in my EMT in 4 months. So I had 10 more hours in a quarter of the time of your advanced responders who are apparently better at emergencies than I was as an EMT?

[Kiwiology]

Until the US accepts that a hundred hours of training and how ever many fancy add on skill packages you want to get is grossly inadequate to render any form of patient care we are just going to round and round and round.

It is disturbing that almost all other developed nations are light years ahead of the US and that we in New Zealand have achieved more in five years than you have since publishing the EMS Agenda for the Future in 1996.

[BushyFromOz]

Until the US accepts that a hundred hours of training and how ever many fancy add on skill packages you want to get is grossly inadequate to render any form of patient care we are just going to round and round and round.

It is disturbing that almost all other developed nations are light years ahead of the US and that we in New Zealand have achieved more in five years than you have since publishing the EMS Agenda for the Future in 1996.

Kiwi, is NZ part of ACAP as well, or did they just hold the conference in auckland?

[Kiwiology]

Not sure, I think we just had the conference here.

Probably to warm us up to the idea that we'll become the next state of Australia at some point :D

[BushyFromOz]

Not sure, I think we just had the conference here.

Probably to warm us up to the idea that we'll become the next state of Australia at some point :D

its inevitable...........

[daedalus]

I hardly think giving Morphine is a menial task! There's a lot to take into consideration when giving it, as I'm sure your well aware its a very dangerous medication...

I don't think you understood my post. A medical assistant can give almost any medication in the IM route if they are told to, but they have almost no training in pharmacology whatsoever. Why is this possible? Because no knowledge of pharmacology is required for their job description, the physician is present during the procedure. This is exactly what medical assistants are for. While prescribing morphine as a physician, or deciding to use morphine using independent clinical judgment is not menial task, giving an IM injection is. The physician can spend her time educating the patient or writing the chart while the assistant gives the injection.

"In every instance, prior to administration of medicine by a medical assistant, a licensed physician or podiatrist, or another appropriate licensed person shall verify the correct medication and dosage. The supervising physician or podiatrist must authorize any technical supportive services performed by the medical assistant and that supervising physician or podiatrist must be physically present in the treatment facility when procedures are performed, except as provided in section 2069(a) of the code."

Are medical assistants allowed to administer injections of scheduled drugs?

If after receiving the appropriate training as indicated in Item 1, medical assistants are allowed to administer injections of scheduled drugs only if the dosage is verified and the injection is intramuscular, intradermal or subcutaneous. The supervising physician or podiatrist must be on the premises as required in section 2069 of the Business and Professions Code, except as provided in subdivision (a) of that section. However, this does not include the administration of any anesthetic agent.

[uglyEMT]

If you only have two ALS units for 75 miles, there is a simple solution... MORE PARAMEDICS!!

Usually the EMTs who complain about Paramedics not respecting them are the ones who are either too lazy or scared to go to Paramedic school, or have tried several times and failed. I'm sorry, 120 hours does NOT qualify you to perform invasive procedures. Sure, you can start that IV, but what do you do if you suspect you've caused an air embolism? For a CHFer, would you attach saline or just a lock? What happens if you give too much Narcan to an unconscious overdose patient? Your patient is having a Right Ventricular Infarction... would you give them nitro? Can you give Bicarb and Calcium through the same IV? How does Bicarb work? What does it do? How does Calcium work?

I'm sorry, but 120 hours with a few 16 hour "extra cert" courses should not qualify you to administer ANY medication. You have less education than a hairdresser and you want to inject substances into somebody that will alter their body chemistry? Substances that alter how their body is working at the cellular level? Substances that could kill them?

When I finished my EMT class, I had training. Now that I am finishing my Paramedic schooling, I have an education, and I am going to be continuing on to higher education. Yes, there is a difference between training and education... for example, would you want your daughter to get sex education or sex training? Think about it.

Please read my posts I NEVER said an EMT should be doing anything ALS. I have stated repedatly that EMTs need more education then 120hrs. I have always said EMTs should have more training but NEVER,NEVER go beyond their SOP.

Also I never complained about Medics what-so-ever. In fact I respect them (check my posts) and hold them in high regard.

My quoted post was in response to another poster saying EMTs dont have the knowlege to make a decision to call ALS. Thats all. As Aeromedic stated some EMTs have many many years experience under the belts and can make informed decisions. On my squad alone we have 4 memebers that recently celebrated 25 years with the squad, several members at 10 years, and a few with 2 to 5 years. Now I am not saying the 2 to 5 year guys should be making judgment calls but surely the 10 and 25 year members sure can.

As for more medics... concidering NJ is a hospital based ALS state talk with the hiring hospitals, some dont want ALS units and the ones that do keep the amount to a minimum so unfortunatly its not the medics that are in short supply its the jobs.

Edited June 26, 2010 by UGLyEMT

[Linuss]

Until the US accepts that a hundred hours of training and how ever many fancy add on skill packages you want to get is grossly inadequate to render any form of patient care we are just going to round and round and round.

It is disturbing that almost all other developed nations are light years ahead of the US and that we in New Zealand have achieved more in five years than you have since publishing the EMS Agenda for the Future in 1996.

Have any proof AT ALL to back up your claims? Or is it as anecdotal as it seems?

Honestly, for people who claims they like evidenced based medicine, some of you totally fail at proving things beyond "It just makes sense". I haven't seen any meaningful research into survival rates in different countries different EMS systems.

Don't get me wrong (because I know someone will) I'm a proponent of education. But don't bash something and then not back up your accusations.

[JakeEMTP]

Kiwimedic has provided facts, many times in fact. Do you have any facts and figures to dispute his post?

[Kiwiology]

Its not always about survival rates, the impact of morbidity and mortality is a much more important consideration.

I know of nowhere in the developed world where the entry to practice standard is as low in EMS as it is in the United States.

After 14 years of developing the "EMS Agenda for the Future" it is dissapointing that 200 hours of education and the ability to basically do nothing is acceptable.

The National Scope of Practice model says a basic EMT can administer oxygen, oral glucose and aspirin.

The National Scope of Practice model says an Advanced EMT can cannulate and administer GTN, salbutamol, entonox, IM adrenaline (anaphylaxis), glucagon, glucose and naloxone.

... and this is somehow not neglegently inadequate and the best you could come up with after fourteen years when Australia, Ireland and New Zealand could achieve more in less than ten?

Sorry guys I don't mean to bust your balls and I have some appreciation of various issues such as the size of the country and variation of systems you have to work with but OMFG!

And before we get carried away into a skills pissing match, you can teach any idiot to slip in a drip and pop an amp of something but it takes a true clinican to do it properly.