BLS pushing ALS drugs in a "pinch"

[Thunderchild145]

Here, the scope says that a basic can administer nitro if there is medical direction to do so. Since a medic can give that direction, the previous case was totally fine here.

[Lone Star]

What planet are you on? I said I'm an ALS provider, and if I decide the patient needs a nitro I'm going to give him one.

Reading comprehension- it does a poster good!

Actually I'm not, I'm more worried about the fact that you can't pull yourself out of the textbook long enough to work in the real world, where sometimes I can only do 5 things at once and need my partner to be an extension of my hands.

I'm not even asking you to do something you don't know how to do! (IE push Morphine, which is what this topic was originally about.)

I can't wait for your 500 what-ifs that would somehow lead to you losing your license.

My only question is this:

How can you attempt to (trash, bash, flame, isult, degrade, razz, 'snap'...insert favorite word here) me for following MY protocols? Your protocols do NOT apply to Me, just as mine do not affect your job.

I personally don't care if you're Dr. Kildare and Marcus Welby, MD reincarnate....if My protocols say a Basic can't do something, then THIS Basic isn't going to risk everything he's worked for!

This whole post asked if anyone had any experience with Basics pushing meds 'in a pinch'. If I were able to pick and choose the protocols I wanted to follow, then Med Control wouldn't have included it in that big ol' book of 'em! I don't have to like the limits of My protocols, I don't have to agree with them, but I DO have to follow them!

I realize that you can only do so many things at once, and I've never disputed the fact that as a higher licensure than mine, I really should be helping you with those things. But administering drugs outside of the scope of my protocols ISN'T one of the things I should be or am willing to do!

As far as 'working in the real world', I've worked in metro Detroit, that's about as 'real world' as you're gonna get!

There isn't going to be any '500 what-ifs'...I've stated once again that I'm following protocol, and like Paul Harvey would say 'Now you know ....the rest of the story'

[Savoy6]

Here, the scope says that a basic can administer nitro if there is medical direction to do so. Since a medic can give that direction, the previous case was totally fine here.

A medic giving medical direction? HMM? Usually a doc, or base station nurse. Of course in my corner of the world EMT-B's can give epi pens(first aid skill under law) assist with nitro, and can do blood glucose analysis. IF the protocols allow it. Paramedics cannot allow an EMT-B to do skills above the scope unless they are in clinicals, see below.

PUSHING DRUGS? Unless they are a medic student in a clinical setting with a preceptor, a no-no. As Joe Friday said, "that's when I go to work". In the vernacular, a medic is a paramedic. I know from personal experience a medic in the military is a generic term, but not here.

I know there are those emotionally charged times that the defense is, "the patient needed it". My counter is, "yes, from a licensed provider".

That's why we have levels! DUH!

[Lone Star]

A medic giving medical direction? HMM? Usually a doc, or base station nurse. Of course in my corner of the world EMT-B's can give epi pens(first aid skill under law) assist with nitro, and can do blood glucose analysis. IF the protocols allow it. Paramedics cannot allow an EMT-B to do skills above the scope unless they are in clinicals, see below.

PUSHING DRUGS? Unless they are a medic student in a clinical setting with a preceptor, a no-no. As Joe Friday said, "that's when I go to work". In the vernacular, a medic is a paramedic. I know from personal experience a medic in the military is a generic term, but not here.

I know there are those emotionally charged times that the defense is, "the patient needed it". My counter is, "yes, from a licensed provider".

That's why we have levels! DUH!

BRAVO!!!!

Nicely put!

[NREMT-Basic]

And, just for the record, that is a matter of valid debate and local policy.

Your personal protocols do not apply to the whole world.

+5 and a hearty Bravo Zulu to you Dust. And would someone please shoot this thread? It has lived much longer than I intended.

[FireMedic65]

Ok, different scenario. Not to be an @$$, I'm genuinely curious given the responses so far.

Nitro. Allowed for our Basics, of the patient's own med and with medical control. ASA. Allowed for our Basics with the usual precautions, other than that it's completely theirs.

Basic Bob is my partner. I'm an ALS provider. We get a chest pain call. I'm, say, setting up for a 12-lead, and I ask Bob to administer ASA. He does, and I think everybody would agree that this is no problem (unless you're the type threatened by Basics with asprin, in which case feel free to stop reading).

Now I'm looking for an IV, and I want the patient to get a nitro. Patient does not have a script. Can I tell Bob to give the patient a Nitro without incurring the wrath of the board?

Ok, i see your point.... but really... administrating a med is not that hard to do.... you can stop putting on the 12 lead that takes 10 seconds to put on and use another 3 seconds to tell the pt to chew on the tablets or open wide, lift up your tongue. Have we really become that lazy? Yea, giving a pt a med is not hard at all by any means.... the doses are easy. but i wont let anyone but myself or someone equally trained/higher to give a med. its my ass on the line, not yours. what if the person get all excited and gives the pt 4 nitros to chew on by accident? i have been on several calls... as a student... and the emt on the ALS ambulance was asked to get a med from the bag.. JUST get the med... that was all.. not draw it from the vile/ampule or anything.... and i was handed the wrong med. so yea... If you want to allow someone to give the pt a med, and they are allowed to do so per protocol/medical direction... go for it.... but remember... its all about pt care... ill take the extra seconds to give the pt the RIGHT med at the RIGHT dose.

[CBEMT]

what if the person get all excited and gives the pt 4 nitros to chew on by accident?

Only 499 what-ifs to go... :roll:

I feel really sorry for your fellow providers that they have to work someone with thinks so little of them.

Now that I say that, maybe I am expecting too much... I mean, I haven't met an EMT yet who couldn't tell the difference between a Nitro tab and Asprin. I never thought EMS education here was above-average, but after seeing some of the paranoia in this thread I can only assume that there's some truly horrible EMT schools out there.

The secondary problem is, they clearly don't have partners willing to help educate them on what they need to know to work in the street.

[scratrat]

Boy what a heated topic

Almost as bad as my post...good greif!

I haven't noticed this thread till now, so I'll reply to the original poster.

I have had experiences where I have allowed a basic to administer NTG or ASA under my direction. If I'm doing something at the time, and I've already deemed that I would be giving it anyway, I will SOMETIMES allow them to do so. I have to know that EMT well, and trust that they will follow my directions to the t. There are others that I would never allow it. Is it wrong? Yes. I probably shouldn't do it, but I have.

However, I would never allow a basic to push ANY IV medication. Granted NTG and ASA can easily be screwed up I guess. But pushing a drug is a little more dangerous in my eyes. And before everyone screams at me, yes, I know what if... But like someone else said, it's fairly easy to figure out one NTG. And again, I would have to know that they can handle that. I have never and will never allow a basic to administer IV medications, I don't care if it's a caridac arrest. I personally believe there is a much larger margain of error in IV medications. I'm sure everyone will have their feelings on that.

[paramedicmike]

Isn't this thread dead yet????????????? :roll: :roll: :roll:

-be safe

[scratrat]

I just wanted to see how many pages we could get it up to