BLS pushing ALS drugs in a "pinch"

[AZCEP]

There are scarce few things that have to be done in a time sensitive manner in medicine. Airway clearance, needle decompression, maybe manual defib, but few others.

The EMT pushed a schedule II narcotic, with an ALS provider available. The ALS provider falsified the patient care report.

Perhaps FFEMT4100 could explain how administration of this medication is of immediate benefit to the survivability of this particular patient. Seems I must have missed that day of pharmacology.

The ALS provider sounds to have been doing BLS things, while he allowed his BLS partner to do an ALS procedure that could have, and probably should have, waited. Then he falsified his documentation to cover his/their a$$es.

Comedy of errors.

[Medic040]

I have just read over this and it does seem that the ALS provider was just doing BLS skills. A EMT-B should never do a ALS skill. I am not aware of any state that allows an EMT-B to push medications of any kind let alone establishing an I.V. Fire Departments and Ambulance Sevices require you to get further training other than an EMT-B to establish an I.V. or push any drug for a reason, you must know the side effects and the use for each of the drugs. Some states allow an EMT-B to maintain a I.V. that has been established by a EMT-I Tech. or higher (RN, PA,EMT-I, EMT-P, and EMT-PS). Minimum level to start a I.V. is an EMT-I or EMT-I Tech in some States.

[akroeze]

I have just read over this and it does seem that the ALS provider was just doing BLS skills. A EMT-B should never do a ALS skill. I am not aware of any state that allows an EMT-B to push medications of any kind let alone establishing an I.V. Fire Departments and Ambulance Sevices require you to get further training other than an EMT-B to establish an I.V. or push any drug for a reason, you must know the side effects and the use for each of the drugs. Some states allow an EMT-B to maintain a I.V. that has been established by a EMT-I Tech. or higher (RN, PA,EMT-I, EMT-P, and EMT-PS). Minimum level to start a I.V. is an EMT-I or EMT-I Tech in some States.

What's the difference between an EMT-I and an EMT-I Tech? :?

[AZCEP]

I have just read over this and it does seem that the ALS provider was just doing BLS skills. A EMT-B should never do a ALS skill. I am not aware of any state that allows an EMT-B to push medications of any kind let alone establishing an I.V. Fire Departments and Ambulance Sevices require you to get further training other than an EMT-B to establish an I.V. or push any drug for a reason, you must know the side effects and the use for each of the drugs. Some states allow an EMT-B to maintain a I.V. that has been established by a EMT-I Tech. or higher (RN, PA,EMT-I, EMT-P, and EMT-PS). Minimum level to start a I.V. is an EMT-I or EMT-I Tech in some States.

A couple problems with this blanket statement:

1. Many places allow BLS providers to either assist the patient with their own, or administer medications. ASA, NTG, albuterol, Epi pens, some even allow glucagon. With your comment, you've effectively hamstrung any credibility you might have had. A quick search of this very site would have told you so.

2. IV's are also allowed by many places to be initiated by BLS providers. You are correct that "some states" require the intermediate as the minimum, but just as many will allow basics to establish vascular access on their own.

[mediccjh]

I still fail to see what the issue is.

A BLS provider pushed an ALS drug, which is an ALS skill.

BAD JUJU!!!

[becksdad]

This post could probably be considered hijacking, but I would like to clarify some things about Florida and accepted BLS skills since this was discussed earlier and misinformation was provided. In particular, I would like to add some things concerning Lee County EMS, which was a specific area brought up previously.

EMT-B's can in fact establish peripheral IV's in that particular system. The medical director decided to offer training, certification, and permission to practice this under his license. However, once that IV is established, that patient becomes an ALS patient. The EMT can collect blood samples through the IV he/she established, and flush with saline, but cannot administer any medication, including any other fluid bolus. The EMT should not be the transport provider of any patient with an IV established - even if it is just a lock.

Lee County does invest well in education and training of its providers - including EMT's. I believe that this is a good thing, but carries some danger with it, as evidenced by some comments made earlier in this thread. I am becoming acutely aware that a little knowledge can be a dangerous thing. We BLS providers are notorious for "wantin' to do more". And that zeal to do more is often misguided through ignorance. We just don't know what we don't know yet. Lack of complete knowledge can lead us to make poor decisions. For instance - that little old lady who was "dehydrated". She may well have been. But was her lethargy really caused by dehydration? That "junk" in her lungs may have been pneumonia as suggested, but could it have been fluid due to CHF? If so, additional fluid is the last thing she would need. Just an example of how often we EMT's do not see the bigger picture in our patient assessments. Not saying that was the actual case. But skills without necessary knowledge can be dangerous things. I do not want to take any action with any patient that I'm unsure of and can't take back once it's done. That's why we have ALS partners. They have more education than we do, and are more equipped to make those decisions. That's why we are limited in our scope of practice as EMT-B's.

I do not believe for a moment that LCEMS's Medical Director gave anyone carte blanche to do whatever they want as long as they can provide evidence that it was in the interest of the patient. That physician (who I have known for several years) has clear cut guidelines for BLS providers. And while that physician has very high expectations of all providers operating under his license, he also expects those providers to remain within those guidelines.

A little friendly advice for Niftymedic: concentrate more on learning physiology of the human body and how interventions can affect it. Concentrate on thorough assessments, becoming more and more efficient in assessments and interpretation of them, then communicating effectively with your ALS partner. Learn from your partner by asking questions. "Why do you give morphine to MI patients?" "what effect does it have to benefit an MI?" "why did you only give that patient 250cc's of NS?" Get into the whys of treatments before you try to get into the hows. Also, communicating effectively with your ALS partner probably doesn't mean saying "get your ass back here and do your job!" I think it would be more along the lines of: "Hey, this patient seems pretty lethargic, her sats aren't too good, and I'm hearing a lot of junk in her lungs. I think you should take a look at this." I bet it works better.

OK, I'm done my ranting. Maybe this rambled on a bit - sorry. It's been a long shift and I'm about ready for some sleep!

[paramedicmike]

+5 for Becksdad. That's a great post!

Thank you for clearing up the confusion surrounding practice in Florida.

-be safe.

[Dustdevil]

+5 for Becksdad. That's a great post!

I'll see your 5 and raise you another 5. :thumbright:

[DwayneEMTP]

-1 for continuing to use the word 'we' when describing people who get erect nipples at the thought of doing the 'sexy' things beyond the scope of their education!

You've been an advocate of education and common sense in all of your posts...Quit saying we when you should say they...Don't make me come over there...

Besides, why should you get all the points, I just posted a dancing elf thingy, and, you guessed it...not a single point awarded! What does a guy have to do to get taken seriously around here??

Dwayne

[AZCEP]

Besides, why should you get all the points, I just posted a dancing elf thingy, and, you guessed it...not a single point awarded! What does a guy have to do to get taken seriously around here??

Dwayne

Way to answer your own question. +15 for realizing the futility of chasing an arbitrary system of approval.

Happy now?