New Skills for Sask EMT's

[Quakefire]

Howdy.

Acording to the new Sask Health Protocols Sask EMT(PCP) practicioners are now able to use Entonox, King LT's, CPAP, and 12-lead ECG's. There is also the possibility of expanding our Nitro protocols with med control.

Seems like a move in a good direction, especially for rural BLS services.

[mobey]

Quakefire.

No I.V.'s yet?

I am glad about the 12 leads, I hope now they put a cap on using Nitro in inferior events.

[fiznat]

My problem with ALS procedures for BLS providers aside, I agree that IVs are noticeably missing here. You shouldn't be allowed to perform a procedure that can (read: will) cause hypotension without a mechanism to combat it.

[hertzvanrental]

My problem with ALS procedures for BLS providers aside, I agree that IVs are noticeably missing here. You shouldn't be allowed to perform a procedure that can (read: will) cause hypotension without a mechanism to combat it.

I still struggle with the North American concept of EMS with regards to Nitro. In the UK EMTs having been administering nitro S/L and Buccal for years with out having the skill of siting an IV. Never heard of any major problems. After all angina patients regularly self medicate nitro S/L. Just an observation and not a critcism

[Quakefire]

I'm sure IV's are comming, there is word about making us the same with Alberta. I'm looking forward to the kings personally, especially because our service doesn't carry a CPAP machine.

[Siffaliss]

I'm sure IV's are comming, there is word about making us the same with Alberta. I'm looking forward to the kings personally, especially because our service doesn't carry a CPAP machine.

One should not be able to give nitro without the ability to first, initiate and monitor/maintain an IV line, and secondly they need to be able to obtain and interpret a 12 lead and 15 lead ECG. The risk is too great of harm to your patient without being able to do these things. In Alberta us EMT's can give nitro (whether or not the medical director allows this in protocols is individual to the service). My service is urban ALS, so EMT's have a great potential for learning and assisting with these things. When I was still in my rural days and had the chance to admin nitro, I withheld as I could not rule out RVI. This was good, as upon arrival at hospital and completion of 15 lead ECG's it was shown in (from what I can recall) 24/30'ish patients that there was right sided involvement. So I could have potentially harmed or killed a couple dozen people if I would have said "oh, chest pain, cardiac, let's give nitro". IV, O2, ASA (if no contraindications), maybe a little Entonox ... I did my thing and never hurt anyone.

Hopefully most people aren't jumping the gun and giving something "just because they can".

[1EMT-P]

Howdy.

Acording to the new Sask Health Protocols Sask EMT(PCP) practicioners are now able to use Entonox, King LT's, CPAP, and 12-lead ECG's. There is also the possibility of expanding our Nitro protocols with med control.

Seems like a move in a good direction, especially for rural BLS services.

Howdy.

Acording to the new Sask Health Protocols Sask EMT(PCP) practicioners are now able to use Entonox, King LT's, CPAP, and 12-lead ECG's. There is also the possibility of expanding our Nitro protocols with med control.

Seems like a move in a good direction, especially for rural BLS services.

I'm glad that they are adding additional skills to your scope of practice, hopefully they are also adding additional education to go along with your those skills!

[mobey]

I'm glad that they are adding additional skills to your scope of practice, hopefully they are also adding additional education to go along with your those skills!

Depending on where you took your EMT-P, Quakefire may already have more hours in his basic course than you had in your Paramedic course. (not a personal slam, just looking for shock factor).

The BIG problem in Sask has always been too much education, too constricting of protocols.

[Arctickat]

The Saskatchewan College of Paramedics has made it very clear to the practitioners in the province that an education seminar must be submitted to and approved by the education committee before each of these new protocol upgrades can be implemented. The College is extremely focused on all practitioners acquiring the proper education prior to engaging in new treatments and procedures.

Siffaliss States "One should not be able to give nitro without the ability to first, initiate and monitor/maintain an IV line"

The Saskatchewan BLS protocol still requires the provider to call for medical control to provide Nitro to a patient who does not have a prescription. If the patient has a prescription for Nitro, the BLS provider may administer the medication without medical control. Vital signs must be checked after every dose. The reasoning is twofold, if the patient has a prescription for Nitro, he is told to take it when he has chest pain. The patient can not check his BP, nor can he initiate his own IV therapy; therefore, the inability of the BLS provider to initiate an IV is not so relevant. Secondly, the patient is supposed to be in a sitting position when given Nitro, this provides the BLS provider the opportunity to place the patient supine if a drastic drop in blood pressure occurs and the patient loses consciousness. To date, there has been no complication of that severity.

That said, I'd like to see IV initiation become part of the PCP scope and I expect it will become fact within the next 2 years.

[kevkei]

After all angina patients regularly self medicate nitro S/L. Just an observation and not a critcism

The difference with this comment is yes they self medicate for angina (ischemia), but when we get called, it's more commonly for injury or infarction. That, or their self medicating isn't working when they have taken x5 nitro with no relief.

I support the use of nitro for angina, but one should be able to differentiate between exertional angina and unstable angina as well as that of injury or infarct.

IV access should be included, more for other reasons than just that of with nitro administration.