Noloxone...should EMT-I's be able to administer?

[Dustdevil]

His issue, isnt lack of competence, its that his education hasnt brought him to a point of being able to see the bigger picture. When EMS providers are actually taught medicine, as medical practioners, I will give you the personal PRPG guarantee that this discussion wouldnt even come up.

Isn't that what I said?

But yeah, spending a day learning about a drug isn't education. It is training. It is a piece-mail approach to the profession of medicine. It does not adequately prepare you for the provision of advanced life support. It's retarded, as is your medical director.

[PRPGfirerescuetech]

Isn't that what I said?

lol, maybe. Alot to read to catch up.

[medic001918]

all the comments about EMT-I's wanting to get access to 'more drugs' without higher education is the main focus for all the Paramedics on this thread. However, the number of hours right now does not include administration of Narcan. Therefore...if it was allowed, more training would need to be done!! WOW...more education! :shock: That means more hours of training. :roll:

I just found out that a service that neigbors my city allows EMT-i's to administer Narcan with their protocols. This is because the med.director held a training class to 'EDUCATE' the Intermediates.

And with all the problems that Paramedics are having in the news these days...what gives them the right to talk about how EMT-Is actions? How many of you paramedics have given 'paramedic drugs' for an unconcious unresponsive and get to the ER and find out later that a d-stick was 20? i hear about it quite often from ER docs all over. Paramedics treating the monitor, or not utilizing a basic skill...using the glucometer.

So now I ask...after proper additional training by a medical director, what is wrong with Intermediates administering Narcan?

You're kidding, right? A medical directer putting on a a quick training course and allowing someone to give narcan doesn't sufficiently cover anatomy & physiology as well as pharamacology. There's a reason why anatomy & physiology is multiple semesters with a class dedicated to it. Understanding A&P is where you begin to understand pharmacology. So how many hours do you think is appropriate to add in order to administer narcan? A one day, 8 hour course? Think you'll be able to cover it all there? It's not just when to administer the medication, indications and contraindicatinos. It's the potential for side effects and the management of the patient experiencing them. If you want the added interventions, go obtain the appropriate education. An EMT-I course and/or a one day course to "add" the medication is not enough to be safe with it in my opinion, and that of many other experienced providers. A medical director can provide a quick training, true education takes time.

As far as your d-stick comment, I can honestly say that's never happened to me. In an attempt to be rather thorough, nearly every patient gets one done. As far as what gives us "the right to talk about intermediate actions?" That's easy, we're higher educated and have a larger understanding of the big picture. Since we have the education behind us to practice at your level and beyond, we have a solid grasp of our opinions and can explain why we feel that way (reread the thread, there's no need to explain it once again). Paramedics don't have certain procudures because we don't have the education behind us to perform them safely. That's just the way it goes. If we want those additional procedures, take your education to a higher level and obtain the education and licensing to perform them. Don't try to dumb down one aspect of medicine in order to add an intervention that has the potential for great harm when performed on a lower level. A large part of being a paramedic is understanding what could happen, and having the ability to manage it if it does. An intermediate does neither in the case of narcan administration.

Shane

NREMT-P

[craig]

i still find it hard to believe that your "intermediates" cant carry out advanced procedures or drug interventions.

they are "intermediate" to what?

to gain the level of ALS here you have to be in the employment of the service for at least three years.

and you then do the minimum of 240 hours in the class room, then 80 hours in the hospital doing pract followed by 160 hrs "on road" with a paramedic crew as third on car, to do a road pract aspect.

this is after doing the three years in the job as well as the training that goes with it.

Even if you attend a school that gives you a "paramedic degree" doesnt mean that you can treat at this level untill you have done the above within the service (after you have been employed- for three years).

stay safe

[firemedic78]

medic001918 wrote:

So how many hours do you think is appropriate to add in order to administer narcan? A one day, 8 hour course? Think you'll be able to cover it all there? It's not just when to administer the medication, indications and contraindicatinos. It's the potential for side effects and the management of the patient experiencing them. If you want the added interventions, go obtain the appropriate education. An EMT-I course and/or a one day course to "add" the medication is not enough to be safe with it in my opinion, and that of many other experienced providers. A medical director can provide a quick training, true education takes time.

:roll: I don't seem to recall saying that it was only an 8hr class, or that it didn't go over A&P of the systems affected by the drug. That goes back to some paramedics assuming they know it everything! You know exactly what goes on in these training classes, even though you haven't asked anything about it.

Nate wrote:

The fact that they still can't fix any other issues that might arise with the adminstering of Narcan.

As has been mentioned here on this thread, and should have been in all paramedic's pharmacology sections, Narcan administration given properly and in the correct dosage/time frame is more likely to help rather than hurt the patient. Can side effects happen that Intermediate NOT control...yes! However this is a very small majority of patients IF the drug is administered correctly. No paramedic can say that when given the proper amount/time that a majority of these patients have side effects that require immediate paramedic level skills/interventions! AND, as has been stated in various threads on this site, sometimes sarcastically, thats what ALS intercept is available for.

:shock: what i think is really bad is that some paramedics that are fighting this thread and stating that Intermediates are crying for more drugs, skills, or whatever.... are hipocrites. Here's why: At some point, a group of paramedics did question adding skills and/or drug use for themselves. Why would they do this? To learn...and to be more valuable on the street. After a while, the MDs were convinced to give paramedics a bit more education and allow them to practice more skills/drug therapy. We know it wasn't a group of MD's that got together and decided to dump these skills on paramedics! They asked for it and they got it. Now the same principles are being attempted by some Intermediates who want to take another step in education and practice skills to be more valuable on the street. Nothing ever said that they weren't going to move on to paramedic, but not everyone starts at age 18 going to basic and goes straight through paramedic in a few years (like one medic I know on this site). Most people i know want to get some street experience between each cert level so they can use that experience to help learn.

So WHY are paramedics so against a learning process that they have gone through in the past??

[nsmedic393]

So WHY are paramedics so against a learning process that they have gone through in the past??

Perhaps because they have gone through the entire precess and have first hand knowledge of how it sucks?

[chbare]

Firemedic78, I think allot of the resistance regarding EMT-I's and advanced procedures is based on the observation that allot of EMT I programs just do not teach enough background and physiology regarding performing these procedures. I cannot speak for your training, but I know there are several state certified EMT-I programs that are about 100 hours in length and popping out people who are performing very advanced procedures. In New Mexico we have people with under 300 hours of training pushing EPI, Benadryl, Promethazine, Narcan, Dextrose, Monitoring potassium, and giving beta agonist nebs. Even the I-99 NSC only recommends 300-500 hours of training. I do not want to imply that any EMT-I is stupid or not capable of learning these procedures, It's just that from what I have seen and experienced EMT I programs are inadequate at teaching people to be competent ALS providers. I would also bet that many of the paramedics on this site believe that most of the current paramedic programs are inadequate as well. Again, I do not want to imply that anybody is inferior or unable to learn.

Take care,

chbare.

[medic001918]

Firemedic78, I think allot of the resistance regarding EMT-I's and advanced procedures is based on the observation that allot of EMT I programs just do not teach enough background and physiology regarding performing these procedures. I cannot speak for your training, but I know there are several state certified EMT-I programs that are about 100 hours in length and popping out people who are performing very advanced procedures. In New Mexico we have people with under 300 hours of training pushing EPI, Benadryl, Promethazine, Narcan, Dextrose, Monitoring potassium, and giving beta agonist nebs. Even the I-99 NSC only recommends 300-500 hours of training. I do not want to imply that any EMT-I is stupid or not capable of learning these procedures, It's just that from what I have seen and experienced EMT I programs are inadequate at teaching people to be competent ALS providers. I would also bet that many of the paramedics on this site believe that most of the current paramedic programs are inadequate as well. Again, I do not want to imply that anybody is inferior or unable to learn.

Take care,

chbare.

+1. The majority of EMT-I (in my area) are of short duration and insufficient to allow these procedures. As far as what your class involved to allow you to push narcan, I'm confident that it's nowhere near what the average paramedic goes through in order to be allowed to perform these interventions. So if you want the interventions, go obtain all of the proper knowledge behind them. It's part of the paramedic skill set, go to paramedic school and you can give narcan all you want. Otherwise, I still don't feel that it's an intermediate medication. Others seem to agree with me. And as usual, noone has explained any medical reason why an intermediate would be giving it and how it benefits the patient? However, many people have explained the rationale of why intermediates should not be giving the medication. So if your class was so thorough, you should be able to explain how the drug works, potential side effects (and management of the side effects) and when and why to give it. Please include some A&P in your explanation of the how's and why's. This is all part of standard paramedic level education, for a paramedic level drug.

Noone here is against people learning or saying that they can't learn. They can in fact learn. It's just the means in which they go about obtaining the education. A shortcut class does not make up for a thorough education based on a solid foundation. This foundation doesn't appear to be taught in the EMT-B course, and only lightly touched upon in the Intermediate course. To obtain a broader scope of practice, obtain a broader general knowledge of medicine through the proper education. Want to play with paramedic level medications and interventions, go to paramedic school to adequately prepare yourself for the practice.

Shane

NREMT-P

[kevkei]

Even though Narcans half life is shorter then most opiates, it's still pretty long. 45 minutes or so,

I disagree. Narcan doesn't have a specific half life if it is bound. As long as it is competatively binding to a receptor site, it's affinity depends on the affinity and concentration of the drug it is competing with.

For example, if a patient has 10 mg of morphine in his system versus 20 mg, the narcan will wear off faster in the 20 mg scenario due to the plasma concentrations of the morphine.

[Lithium]

Hmmm, interesting way of looking at it ... are you saying then that the harder the narcan has to compete to bind to receptors, the shorter the half life, primarily due to it 'working so hard'? That doesn't make much sense to me, because that would imply narcan is equatable to a living cell using energy exponitiously, when we all know that it's purely a chemical.

Technically however (and I may be wrong here ... but this is how I understand it), serum concentration and half-life refers only to unbound drugs. If the drug is bound to a receptor, depending on the cells activity, it will either be utilized quickly or slowly, and then made available for biotransformation and elimination ... the rest, will simply attempt to find an open receptor and slowly (as I was actually taught narcans half-life is anywhere between 30 and 81 minutes) be eliminated. Therefore, the serum concentration of the narcan is not affected by the serum concentration of the opiate.

peace