BLS pushing ALS drugs in a "pinch"

[Niftymedi911]

This is why we have a "shortage" of medics.

This whole forum reaks of the "Paramedic God" attitude.

What is the difference between ALS and BLS in a trauma scenario?

The ALS provider can watch a heart monitor and push medications.

BLS Provider can :

Insert Large bore IV's in both AC's running wide open with Ringer's ( oh wait a minute but thats an ALS medication right? Don't just exclude the narcotic's if your gonna be pissy about MS then you might as well be pissy about Ringer's or NS.)

Airway Adjuncts and/or suctioning the airway in case of respiratory failure or compromise

Use BVM to ventilate p/t.

Splinting and immoblization in life threating and non life threating instances

Rapid GCS assessments

Shock and Hemmorage Control

Can apply an AED in instances of trauma arrest, in which pretty much the only thing in a trauma arrest your gonna give is the fluid challenge, normally the p/t is asystole to try and fix why the heart is not beating. Unless it's V-Fib or V-tech pulseless, then it's your current ACLS protocol, which is ALS (watching the montior for heart rythm and giving ALS medications)

The most important thing a trauma p/t needs is what?

Rapid transport to a facility with the necessary surgeons are on staff awaiting p/t arrival. ( aka Golden Hour)

But I bet in instance's where you state in your report that you administered NS or LR at the aprropriate rate with an appropriate size IV but in reality the EMT (BLS) spiked it, aligator clipped it to the IV hub and let it rip while you (ALS) were trying to maintain airway, while fire was boarding the p/t. (OMG, thats lying on a run report).

Stop with the God attitude it's making the rest of us sick over here. (puking noises)

Everyone does it one way or another. For you to deny that you've seen it or let it happen just means your too niave to have a real open mind.

Kudos to Dust, should it happen no. Does it happen, Yes. But to deny it when in stances a medic could be busy with something else, Shame on you.

But don't sit there and bitch about when that EMT that sits right next to you and watches your back and life to make sure you go home at the end of your shift is in charge of a 80 y/o with "flu" like symptoms, who could use NS or LR to perk up b/c of dehydration, her sat's are boarderline and she has some junk in the lower bases (possible pneumonia) but you don't want to treat her and you leave it to him to treat the p/t. While you sit up front and drive blaring the radio at 0330 AM on a Sunday morning sipping a nice hot cup of Joe and it's 28 degrees outside.

[stcommodore]

Not at all...Everyone understands the laws but the situations we end up in often fall outside both natural laws, understanding any everything under the sun. Also, there are plenty of angles to spin this on, have you been through a shift and every call ran the exact same? All things being equal here I think people are using situations where they wanted to do more for the benifit of the patient. Many times like I said they weigh the "ends vs means" in there head and choose to act or not. So just like in that disaster situation with all bets off and logic be damned you tell me what you would do with an 747 into a 15 story highrise?

(please note i have a flare for playing devils advocate)

[paramedicmike]

The ALS provider can watch a heart monitor and push medications.

Hmmm...short sighted and misinformed at best.

Not at all...Everyone understands the laws but the situations we end up in often fall outside both natural laws, understanding any everything under the sun. Also, there are plenty of angles to spin this on, have you been through a shift and every call ran the exact same? All things being equal here I think people are using situations where they wanted to do more for the benifit of the patient. Many times like I said they weigh the "ends vs means" in there head and choose to act or not. So just like in that disaster situation with all bets off and logic be damned you tell me what you would do with an 747 into a 15 story highrise?

There are no angles to spin this on. If you are a BLS provider, you treat at a BLS level. How is this difficult to understand? Need help? Want to do more for your patient? Call for that help. It's a pretty simple concept.

That "means to an end" argument will not fly if you work outside your scope. After the incident is over you will be held to task for the actions you took. The "end" will be you losing your job and possibly your certification. The "means" to that end will be you having worked outside your scope and effectively broking the law.

As to your plane crash scenario, I'd let it burn until the fire guys put it out. Call for lots of help. Once people start bringing me patients, treat them appropriately and within the limit of my scope. If I can't do something that the patient needs, I'd get them someplace where they could get what they need. If I can't do that, then it all falls back to EMS lesson number one which states, "People die. And sometimes there's nothing you can do about it."

-be safe

[KSEMT122]

Paramedicmike said:

They're dancing around it, Bushy, because so many people in American EMS thinks they should be able to do things and rules/education be damned

Unfortunately, this is where American EMS gets hung up so many times. It's also a major reason why we here in the States aren't taken as seriously as some of us think we should be.

Here we go again with the BLS bashing ALS and vice versa. I wish this thread would be locked, because all we're doing is going around in circles. And when we come to the end of the line, everyone starts over on bashing eachothers skills.

Then we have people making this an issue of America VS the rest of the world EMS. INCREDIBLE!!!! I"m so sick and tired of seeing people on this forum trash the United States of America and the quality of OUR pre-hospital care! Especially when you are from the USA! If you aren't satisfied with the quality of OUR prehospital care then move to a country that best suits your needs! I doubt you'll find better, but hey if you do, more power to ya.

I'm all for discussing the differences in world EMS, but to start putting down the quality of service in one country verse another is just inappropriate.

[akroeze]

I'm all for discussing the differences in world EMS, but to start putting down the quality of service in one country verse another is just inappropriate.

I agree, because we can't look at it objectively and say taht Ehtiopia's EMS system is behind the level of other countries, that's just inappropriate!

[Just Plain Ruff]

NiftyMedic What Kool Aid are you drinking Your attitude is disoncerting. You are off base on quite a bit my friend:

This is why we have a "shortage" of medics. ----

This whole forum reeks of the "Paramedic God" attitude.

Your reply reeks of "I'm an EMT And I can do anything I want to, to hell with the rules"

What is the difference between ALS and BLS in a trauma scenario? The difference in a trauma scenario is that as a medic I can start an IV, give medications if needed and insert an ET tube. I can also watch the heart monitor also and treat those rhythms that are not conducive to life for very long. so my friend there is a significant difference between ALS and BLS.

The ALS provider can watch a heart monitor and push medications.

Yep als providers can watch the heart monitor and do something about it if we need to. All an EMT Can do is watch the heart monitor and tell the driver to "Go faster"

BLS Provider can :

Insert Large bore IV's in both AC's running wide open with Ringer's ( oh wait a minute but thats an ALS medication right? Don't just exclude the narcotic's if your gonna be pissy about MS then you might as well be pissy about Ringer's or NS.) ----

You are wrong there - in the US starting an IV Is a ALS intervention - don't tell me that down in Ft. Myers you can start iv's?? We're not being pissy just about the MS, we are pointing out the fact that it's out of the EMT's scope of practice to do anything that is considered ALS We'd be making as big a deal if it was a IV start or a manual defib also. It also revolves around the fact that the medic lied and falsified his report. Saying he did something ALS when his EMT actually did it. You really need to re-read what some of us are pointing out.

Airway Adjuncts and/or suctioning the airway in case of respiratory failure or compromise --- YEP BLS

Use BVM to ventilate p/t. ---Yep BLS

Splinting and immoblization in life threating and non life threating instances ---- YEP Bls

Rapid GCS assessments ---- Yep Bls

Shock and Hemmorage Control ---- yep bls

Can apply an AED in instances of trauma arrest, in which pretty much the only thing in a trauma arrest your gonna give is the fluid challenge, normally the p/t is asystole to try and fix why the heart is not beating. Unless it's V-Fib or V-tech pulseless, then it's your current ACLS protocol, which is ALS (watching the monitor for heart rhythm and giving ALS medications) ---- VA-fib and V-tech(spelling) are als and all other rhythms are not als rhythms Where did you get that from?

The most important thing a trauma p/t needs is what?

Rapid transport to a facility with the necessary surgeons are on staff awaiting p/t arrival. ( aka Golden Hour) ---- No one disputes this fact

But I bet in instance's where you state in your report that you administered NS or LR at the appropriate rate with an appropriate size IV but in reality the EMT (BLS) spiked it, aligator clipped it to the IV hub and let it rip while you (ALS) were trying to maintain airway, while fire was boarding the p/t. (OMG, thats lying on a run report). ---- I believe the EMT Can spike a bag of NS Or LR. Aligator(again spelling) and letting it rip (what do you mean by this??) IV STarts are ALS and I've never nor will I ever let an EMT start an iv that needs to be started.

Stop with the God attitude it's making the rest of us sick over here. (puking noises) ---- and your ranting about things above reeks of I'm better than anyone here.

Everyone does it one way or another. For you to deny that you've seen it or let it happen just means your too naive to have a real open mind. ---- NO ONE is denying that it happens. and to say that those of us who deny it happens or have let it happen is elitist because you have no clue about many of us here.

Kudos to Dust, should it happen no. Does it happen, Yes. But to deny it when in stances a medic could be busy with something else, Shame on you. --- and yes nobody is denying that it happens but I can count on one hand with 3 fingers missing the amount of time that I've been told of a co-worker letting someone of lesser certification/licensure do an ALS skill. I don't really believe that you Niftymedic are really posting here in sincerity. You're attitude disturbs me.

But don't sit there and bitch about when that EMT that sits right next to you and watches your back and life to make sure you go home at the end of your shift is in charge of a 80 y/o with "flu" like symptoms, who could use NS or LR to perk up b/c of dehydration, her sat's are borderline and she has some junk in the lower bases (possible pneumonia) but you don't want to treat her and you leave it to him to treat the p/t. While you sit up front and drive blaring the radio at 0330 AM on a Sunday morning sipping a nice hot cup of Joe and it's 28 degrees outside.

Wow that last paragraph is a doozy Nifty. Are you saying that you had an ALS patient and your medic did not take care of her and left her to your ultimate wisdom? You say she could have used a IV of NS or LR? Did you start that IV on that patient? IF you did you broke the law.

Don't come here and spout off the old PC term of EMT's save medics - that old and a stupid saying. I think that you have a lot to learn and to come here bashing and making outlandish statements as to being able to start two large bore IV's in the AC's. Go back and read your state standard of practice rules and what Florida allows emt's to do and what are als versus bls skills and then take a look at what the penalties are for going outside your scope of practice.

You really scare me with your attitude. At least I don't get down to Fort Myers very often, I'd hate to be treated by you who obviously think it's ok to practice outside your scope or your lazy fat bottomed medic partner who put you in back with a patient who qualified according to your description for ALS interventions.

[Thunderchild145]

ALS has a job to do, just like BLS. It's nice when the medic can focus on ALS because the BLS is being taken care of. It's hectic when this doesn't happen. On some patients, there just isn't a whole lot of ALS to do, but there is typically quite a bit of BLS so in all honesty the BLS should keep the basic busy such that they wont need to worry about ALS interventions that are beyond thier scope. I'm not "bashing" basics. The honest truth is I thought the paramedics job was easy till I learned to do it. It's not as cut and dry as EMT-B school. These things take time, and frankly I'd not let my partner do anything (other than like I said, push the buttons on the monitor. The exact ones I tell him to.) that could be considered ALS. He's seen the procedures done a million times, but he's never been formally trained how to do any of it. He hasn't practiced for weeks on dummies or done them on real people. At all. Ever. If I can't get the IV, then I can't get the IV. They'll get one in the ER. I shouldn't expect him to do any of that, and he shouldn't expect me to let him. It's not his job.

[brock8024]

I have read this and some people scare me to death. I am in medic school and have been a basic and intermediate for a while. The reason I went to medic school was so I could do all the neat stuff my medic was doing. I have had the chances to do a lot of stuff out of my scope of practice, but chose not to do that.

I had a doctor tell me a very wise thing one day, and will pass it on since I have lived by it since that day.

Everyone in the medical field is your friend, be it a doctor, nurse, medic, who ever it is. You may have known them for years even, but when it comes to them losing their license or you, well you will be the one walking away with out a license.

I have lived by this for a long time. I have tons of friends in this field and trust them. The one thing I do know is that most will not stand up for you if that means they lose their house and toys and license.

So the whole point of this is wether or not he told you to do it just remember, if it ever went to court and he was going to get in trouble and he wants to save his house and things you are going to roast.

Now as far as the basic vs medic thing GET OVER IT.

Everyone is a basic first and a good basic makes a awesome medic. A lazy basic makes a lazy medic. We need basics to help out but they can be doing a lot of other basic skills while the medic is tending to the ALS stuff.

Brock

[Niftymedi911]

Boy aren't I the fire starter??? LOL

BLS Provider can :

Insert Large bore IV's in both AC's running wide open with Ringer's ( oh wait a minute but thats an ALS medication right? Don't just exclude the narcotic's if your gonna be pissy about MS then you might as well be pissy about Ringer's or NS.) ----

You are wrong there - in the US starting an IV Is a ALS intervention - don't tell me that down in Ft. Myers you can start iv's?? We're not being pissy just about the MS, we are pointing out the fact that it's out of the EMT's scope of practice to do anything that is considered ALS We'd be making as big a deal if it was a IV start or a manual defib also. It also revolves around the fact that the medic lied and falsified his report. Saying he did something ALS when his EMT actually did it. You really need to re-read what some of us are pointing out.

Look it up, the state of Florida legally allows EMT-B's to start IV's in the field. They do not honor EMT-I so they make it up to us by combining the different qualifications on Basic and Intermediate. And it can be legally documented in the PCR that I started an IV in the field. I've started countless IV's in the field. Believe it or not I've saved my medic's ass quite a few times bc they couldn't get the stick and the p/t needed one and I got like a 22 in the the rt hand with the smallest vein I've ever had to try after. As the manual defib part, all of our monitors are manual and AED compliant, but our agency also offers a 12 lead course in cardiology for EMT's who just as a CEU would like to take the course. I elected to take this. So yes I cannot per protocol manual defib, but I do have a step a head of most of the EMT's here.

As in reguards to my attitude, you couldn't tell obvisiously the sracasticness in my post. ( As with nothing but words on a screen) I was being only sarcastic about the whole ALS / BLS thing except for the large bore IV's that I can do. I just like sturring the shit up and I had an open opportunity, you guys left it wide open. Anyway, if you want to go even further read our medical protocols. We are one of the most prograssive systems medically. We can't say # 1 but we pretty damn close!!!! Our medical director loves us. He said to me the other day, he'll be behind me with whatever treatment modality I choose as long as I can produce evidence that it was in the p/t's best interest of their outcome.

But it is the truth about being burned, I have had many issues b/c I'm young and they think that they can get away with it. But I do not tolerate it. That instance happened about 2 weeks ago during a cold speel and the lady needed a little help. I was cool for about 10 minutes and then I told her to get the hell back here and do your job. Of course I got my hands slapped by a Duty officer for having the attitude I do with her in front of the p/t, but I got my point accrossed. But yes to tell you the truth, the whole priority 3 ans 2 thing happens a lot down here. And believe it or not there is also (some)instances where medics make priority 3's, 2's.

[BushyFromOz]

I dont get you people....

A scenario was presented where a BLS person administered a drg SPECIFICALLY Morphine Sulphate

It has since been proven this is against the law fro the BLS officer to do so

Now, some of you are tryin to make up scenarios where this would be a valid course of action, being unsuccessful, you have resorted to blaming it on the "paragods" for basic bashing and asked to have th thread locked? Are you adults or children?