Zofran

[tcripp]

It is an ALS skill to push Zofran here, but Intermediates are considered to be ALS providers so there is no issue with giving the med.

EMT-B's arent allowed to push any meds through an IV at all. They are limited to oxygen, oral nitro, IM epi, activated charcoal, oral glucose, and assisting the patient with their own inhaler.

So, your intermediates can push any drug that a paramedic can? I'm not following you...

[2Rude4MyOwnGood]

So, your intermediates can push any drug that a paramedic can? I'm not following you...

Yes ma'am.

Our Intermediates follow the same protocols as Paramedics when it comes to drugs. There is very little distinction between I's and P's around here.

[tcripp]

Yes ma'am.

Our Intermediates follow the same protocols as Paramedics when it comes to drugs. There is very little distinction between I's and P's around here.

Wow. So what's the incentive for getting the paramedic patch?

[2Rude4MyOwnGood]

Wow. So what's the incentive for getting the paramedic patch?

Having that patch is your best (read: only) way to get a job with any of the nearby counties. The competition is pretty out of control.

When counties lift their hiring freezes and put a group through the fire academy (fire and EMS arent separate here), there are thousands of applicants for ~20 positions. The best thing you can do to get to the top of that list is have your Paramedic, they are given priority during the selection process.

P's also earn a higher salary than I's, that extra schooling counts for something after all!

[Bieber]

To be honest, guys, I don't think EMTs should be pushing medications. I know there's a lot of socioeconomic factors at work here, and that a lot of places only have EMTs, but it comes down to quality. Making us into skill monkeys doesn't help the profession, and I think that if we want to elevate the profession, these new changes for EMTs and AEMTs are going to hurt more than help.

Like I've said before, we require a degree in my state to become a paramedic, and I still don't feel like I have the kind of knowledge to do the things I'm allowed to do. So how can I agree in good faith to letting providers less educated than I do these things?

[tcripp]

To be honest, guys, I don't think EMTs should be pushing medications.

I appreciate what you are saying and want to clarify that I don't think that EMT-Basic's should be pushing this med. They don't have IV skills so IV meds should not be a part of their sill set.

However, with that being said, EMT-Intermediates or the new national registry Advanced EMTs, already have the capability of pushing a number of meds in a number of routes. What I am trying to ascertain is this. Are there other services out there who currently allow this particular position to push this particular drug?

Thanks to one of our posters, Utah has some very aggressive protocols (http://health.utah.gov/ems/emsc/ems_provider_reference.pdf) that could scare you where Zofran can be delivered by a lower level.

(Also, I firmly believe that instead of allowing lower levels to do skills "just because there aren't enough upper level" is not the right way. We should be figuring out how to get more upper level...)

[DwayneEMTP]

Yes ma'am.

Our Intermediates follow the same protocols as Paramedics when it comes to drugs. There is very little distinction between I's and P's around here.

Where is 'here?'

Also in CO I's have access to the same meds as a medic, but a large part of that can't be given autonomously, but must have online MedCon consent.

Dwayne

[Bieber]

Yes ma'am.

Our Intermediates follow the same protocols as Paramedics when it comes to drugs. There is very little distinction between I's and P's around here.

Wow. With all due respect, it is rare that I hear something so audacious and offensive to my sensibilities that my jaw drops the way it did when I read this. What else can intermediates do in your area? Can they push narcotics as well? ET intubation? NG tube placement? Manual defibrillation? EKG and 12-lead interpretation? Why are they even hiring paramedics? If they can get away with just letting an EMT-Intermediate with two semesters of coursework take the place of a paramedic, where's the incentive to hire the higher educated provider?

This is exactly the kind of backwards thinking that is dragging EMS down. Instead of providing higher education opportunities for paramedics, we're catering to EMTs and just tacking on skill after skill until what you have is a cheap paramedic substitute with not even half of the education but all the power to do harm. It's no wonder people don't take us seriously, we're not even taking ourselves seriously when we allow this kind of shit to pass. Can you imagine what our colleagues in the hospital must be thinking? That we're seriously allowing people with only two semesters of education to give all the same drugs everyone else in the healthcare industry must spend YEARS of education to earn the right to push? It's madness.

And no, this isn't personal. I'm not attacking you, sir, but the system you're working in. Unless you're an advocate for this kind of crap, in which case, with all due respect, you're out of your freakin' mind. Paramedics as they currently are probably shouldn't be doing a lot of the things we are, yet we're letting EMTs grow ever closer to paramedic level care?

[usmc_chris]

I completely understand. NYS follows both the NREMT I/85 and I/99 standard, calling the 85's EMT-Intermediates and the 99's EMT-Critical Care. Up until our latest protocol revision in our region, there was extremely little difference between the CC's and the P's, except that the CC's had to call for orders for a lot of medications that the P's could give on standing orders. I don't think there was anything that P's could do that CC's couldn't except maybe surgical airways. Then the I's could do IV, NS, and ET intubation, but no IV medications - just what we call "BLS" medications here - Epi-Pens, Oral Glucose, ASA, Albuterol, Activated Charcoal, and assisting with pre-prescribed NTG. I put "BLS" in quotes because, as a thread I read a while back on here said, some of the things we allow EMT-B's to do are, technically, advanced procedures, that is, beyond the scope of a layperson.

Fortunately, we've started to curtail this. Our I's can no longer intubate at all, can start peripheral IV's and use alternative advanced airways.

The changes that were put in place for CC's were much broader. They can no longer intubate pediatric patients. Any medication that require a medical control order for a Paramedic is now prohibited for the CC's, they can't even request an order for it. And they are required to call for orders in more cases as well. I think the next time around, they will take intubation away from CC's altogether, so they will no longer be recognized as an ALS provider in their own right.

But that's my region. There's other regions that they've given the I/85's some IV medications, and there is no difference in protocol between a CC and Paramedic. There's no incentive whatsoever to become a Paramedic, especially when there is no difference in protocol and they pay difference is something like 50 cents an hour. Of course, these are very rural areas of the state.

And knowing some of the mistakes I've made, and knowing that I would certainly have liked longer and more in-depth education in Paramedic school ... the thought of some of these people practicing at the level they are permitted to... SCARES me.

As for Zofran, we don't carry it at all. Only Phenergan. Wish we had the option though.

[tcripp]

As for Zofran, we don't carry it at all. Only Phenergan. Wish we had the option though.

And we only have the Zofran. I wish we still carried the Phenergan and had the option. Especially for the patient who is allergic to one of the two...and we are on a long haul (1.5 hour drive).