hammerpcp Posted May 4, 2006 Posted May 4, 2006 Would I like to see more education? And a longer curriculum? Yes, I would. But like Dust said, this is the best we've got and it's the system in place. So if you're questioning if as a paramedic I'm educated enough to perform the procedures and administer medications, then how could you begin to think an Intermediate would be qualified to do so? I'm all for making the paramedic program a bachelor's level program. I see no drawbacks to the concept, and only positives. The paramedic program that I completed was an associate degree level program, which is better than some of the certificate programs that exist. Shane NREMT-P Like I said, what the hell is an intermediate? The point I'm trying to get at, is that level of training and procedures, and scope of practice is all relative, and it is also progressive. So there are no absolutes. At some point, some one decided that you had enough training as a paramedic to do whatever you are allowed to do. And at the time this was a fairly arbitrary decision and i am sure many people argued about the education levels of paramedics and if they knew enough to safely administer the next drug, or use the next airway adjunct. The potential benefits of each new procedure are weighed against the potential risks by the powers that be. And both are constantly being reevaluated, as they should be, when new research is done.
FireGirl911 Posted May 4, 2006 Posted May 4, 2006 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.
firemedic78 Posted May 5, 2006 Author Posted May 5, 2006 firemedic78 wrote: On the other hand several very good reasons have been given supporting appropriate administration of this drug. i'd appreciate putting the correct person in your quotes. I did not make this comment!
Dustdevil Posted May 5, 2006 Posted May 5, 2006 Our EMS curriculums include extensive training on the use, contraindications, adverse effect, desired effects, etc of Nalaxone use. I could write a curriculum that gave your basics "extensive training" on the performance of appendectomies in a week. In a week, we could teach any basic to perform an appy just as well most any surgical resident. After all, it's just a skill. Only a few small muscles and vessels involved. Anybody can learn it. And nothing usually goes wrong anyhow. If it does, they can just call for ALS intercept! How about we do that?
Just Plain Ruff Posted May 5, 2006 Posted May 5, 2006 I am sure that this has been covered but for the original poster, you ever seen narcan given to someone and after they come awake they kick the crap out of the medic for taking away the high they just spent their last 5 bucks to get. I've been that medic and boy did I hurt after the beating I got. I vowed from then on out that I would only bring the patient to a less than verbal response Plus why give Narcan when all they are is out of it. If they stop breathing tube em, if they sieze, valium them if they get violent while overdosed restrain them. Why take on the added headache, back ache, rib pain and stomach pain from getting your teeth knocked in just to wake them up.
craig Posted May 5, 2006 Posted May 5, 2006 I could write a curriculum that gave your basics "extensive training" on the performance of appendectomies in a week. In a week, we could teach any basic to perform an appy just as well most any surgical resident. After all, it's just a skill. Only a few small muscles and vessels involved. Anybody can learn it. And nothing usually goes wrong anyhow. If it does, they can just call for ALS intercept! How about we do that? G'day dust yeah lets do it i 'd like more of a challange........lol both arguments are flawed.....from my perspective anyway.........like i said before and will say again, i feel better beig here and being treated by ANY level of training than those that have been protrayed on these pages. basics in the states or even intermediates must be pretty bad NOT to have the backing of higher skill levels on advancing medications and skill levels. goes to show that education is NOT everything....lol stay safe
craig Posted May 5, 2006 Posted May 5, 2006 I am sure that this has been covered but for the original poster, you ever seen narcan given to someone and after they come awake they kick the crap out of the medic for taking away the high they just spent their last 5 bucks to get. I've been that medic and boy did I hurt after the beating I got. I vowed from then on out that I would only bring the patient to a less than verbal response Plus why give Narcan when all they are is out of it. If they stop breathing tube em, if they sieze, valium them if they get violent while overdosed restrain them. Why take on the added headache, back ache, rib pain and stomach pain from getting your teeth knocked in just to wake them up. you must be a really mean looking guy to be bashed when you give a person the narcan. In 18yrs in ems and working in one of the biggest narcotic using areas in australia i can not remember when i have been majorly assulted by a druggie when they have been awakened by the narcan. yes verbally abused, spat at, hit thrown at (with little power) but i have never been bashed etc for doing it. most times after the narcan administration all the smackie wants to do is roll over and spew......gawd, there were times that we even tried to make them spew......makes it easier to look after them as they dont want to cuss at you and spit on you then. most times the shitbag will not want you to transport them to hospital anyway, so tubing them, restraining them etc can only be detremental anyway as you will be backout the next night doing the same things to them with the same result........... Neca eos omnes. Deus sous Agnoset[/font:fb8f0a4c51] stay safe
JPINFV Posted May 5, 2006 Posted May 5, 2006 basics in the states or even intermediates must be pretty bad NOT to have the backing of higher skill levels on advancing medications and skill levels. goes to show that education is NOT everything....lol stay safe Yes, 120 hours of advanced first aid training is not everything. This is why we need more education, especially at the basic level. Truth be told, any EMT shouldn't even be allowed to give oxygen without even a basic notion of cellular respiration. Does anyone else find it a little scary that basics give a "drug" and not understand how that "drug" works? Anyone else find it scary when an EMT-Basic text book covers the use of cellular phones enough to warrant a note in the index, but not enough about cells to warrant a note in the index?
Sassafras Posted May 5, 2006 Posted May 5, 2006 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. How many times have I done this? Absolutely never. I don't know where you're from, but the fact that you say you "hear about it quite often from ER docs" tells me you work with some sh!tty paramedics. However, don't lump us all into the same group just because you work with a handful of idiots. :wink:
FireGirl911 Posted May 5, 2006 Posted May 5, 2006 I could write a curriculum that gave your basics "extensive training" on the performance of appendectomies in a week. In a week, we could teach any basic to perform an appy just as well most any surgical resident. After all, it's just a skill. Only a few small muscles and vessels involved. Anybody can learn it. And nothing usually goes wrong anyhow. If it does, they can just call for ALS intercept! How about we do that? :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.
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