BLS pushing ALS drugs in a "pinch"

[akflightmedic]

In Florida, the medical director can provide an IV class to basics and authorize those basics under his control to intiate IVs.

However FL does not recognize nor have this level.

A few other services I know of tried this and quickly got away from it as you can imagine all the implications of allowing such.

The director allowing Basics to do IVs is no different than him saying they can give neb treatments. If he is willing to allow it under his license, then so be it.

[ERDoc]

I think that there are 2 issues here. The first is, should the basic be pushing meds. I think the answer to that is it depends on the medic. If the medic is comfortable then I see no problem with it. The medic is the one running the show and should something happen, he is the one that is accountable. If a nurse pushes a med and something bad happens to a pt, it is the doctor that will have to answer (although the nurse is not off the hook either). The second issue is the documentation. This was pure stupidity on the medics part. NEVER falsify info. You don't have to put all of the details in the report, but don't put lie in there. He could have just said that the morphine was given with no mention of who gave it. However, should an issue ever arrive from it NO ONE should lie about the details.

[Just Plain Ruff]

ok, thanks for that clarification AK

I don't have a issue with Emt's starting iv's as long as they have been trained in doing so.

I do have a problem with them giving anything but a small number of meds. Albuterol, aspirin and the like. But nothing more than that.

Territorial, no, I just think that this is asking too much of them.

Nifty, after AK explained it and my looking it up on the florida depart of EMS page http://www.fl-ems.com/EMT_Paramedic/EMTParamedichome.html I have a better handle on what florida allows.

no offense intended in disputing your claims.

[OzMedic]

There is no excuse for falsifying a run sheet! That is what I perceive as the biggest problem with this scenario. In my service an ACP can be authorised by an ICP to push drug etc under their direction. The run sheet has 2 check boxes next to each intervention with administering officer and authorising officer. Obviously it is entirely on the senior clinicians head if something goes wrong as it was their responsibility to ensure that the procedure was performed correctly. This means that you would probably not get a first year student to do it but if the person has years of experience and for instance can give other IV meds besides the one you are authorising then it is permitted. ICP's in my service are often utilised as a back-up for other crews and in this instance they are expected to assist the ACP crew with any interventions necessary without taking over the case. This allows the ACPs to maintain clinical exposure and learn about more advanced interventions increasing their knowledge base. An ICP will often drive allowing the ACP to continue patient care allowing them to monitor the situation by on-going dialog. Additionally ACP's will mentor student ACP's in the same manner as they are not authorised to do anything until they are qualified. First hand experience like this is vital for the learning process. I realise that a lot of this does not have relevance to the scenario initially presented but it may be valuable information to anybody that has a hand in driving change in the system if that is what the majority wishes. It would seem that a lot of posts on here are only against the practice because it is against the rules and not because they disagree with the concept.

A few posters eluded to the medico-legal aspect of the given scenario and what would happen in court etc. Not aside from the issue of internal discipline that can sack/deregister you for going outside the guidelines a court of law may not be so black and white. aside from the falsification issue which is a slamdunk wrong often legal court proceedings are judged by the "reasonable man" scenario which dictates that put in a similar situation what would a representation of the defendants peers do to determine if it was reasonable. That means not a Dr or an EMT basic but medics of the same training and experience as the defendant. In this instance what the regulation says may have very little to do with the result (I know, your still out of a job but it's just an interesting point). Now please forgive me if this is totally not what the US legal system is like and if it is not then I'm sorry because it strikes me as quite fair.

I'm sorry if this is way off the main point of this thread I guess what I'm trying to say is that delegation and education are both very important factors in being a medic in my system and to achieve either we need to allow others to practice under our authority.

[Dustdevil]

Texas is the same way, and I would imagine actually that quite a number of other states may be too. The Medical Director is the ultimate authority on who can and cannot do what in any given system. If he wants his medics doing nothing more than BLS, that's how it will be. If he wants his EMTs practicing ACLS, that too is how it will be. In reality, it rarely happens that Medical Directors will go far outside of established norms, but yes, it does happen. And the state has no say about the matter, as they have no authority to restrict the Medical Director's practice of medicine, which includes his right to delegate.

[Niftymedi911]

Hey Ruff its all good, I could see myself saying the same thing if I read a post like that. I am also sorry for the whole FL mix up thing, I was told that it was the state. But ideally it is actually the medical director who has the authority.

Now, someone said this:

It's easy to think you're the best when you have never seen another way.

You know your probably right, I have worked in various cities private and 3rd service. For example Rural/Metro in Orlando, FL AMR in Miami, FL Manatee County EMS, Sarasota County, FL and a private agency in NJ.

In those this is the most progressive agency in FL out of working in the different areas. So I might not have seen it any other way, but I wouldn't want it any other way, to be honest, I'm very happy working for LCEMS.

www.lee-ems.com/ems/default.htm

That's our agencies website

[whit72]

This is beyond beating a dead horse, we have moved on to beating the completely decomposed skeletal remains of something that resembled a dead horse two weeks ago.

I think the main issue in this case was, why did he have the basic push the med?

If it was because he was lazy. He was wrong.

If it was cool to let his basic partner push a med. He was wrong.

If the basic asked him if he could push it, and he agreed. He was wrong.

This medic wasn't elbow deep in a difficult airway, he wasn't clamping off exposed, pumping arterial bleeds, he wasn't running a mega code, the basic wasn't pushing ACLS pre-filled syringes, or pushing buttons on a monitor. If that was the case I would still disagree with it. However I would be able to at least understand it.

You can assume that eventually the sh#t will hit the fan, all you can do is be prepared to handle it when it does. This comes with gaining a working relationship with your partner, in time you wont even have to speak, it will just flow like a gentle stream down a winding snow tipped mountain in the middle of the concrete jungle.

You cant for the most part pre-plan how you will handle situations that arise when you are out there, you have to handle them as they come. For that you need complete understanding and confidence in the person you work with, that he will fulfill his obligations which will in turn allow you to fulfill yours. Thats why your called partners.

Its not only the fact that he allowed the basic to push the med, its the fact that he allowed him to push it in a situation he didn't feel he could justify, he felt the need to lie about it.

[NREMT-Basic]

As the person who started this thread from hell:

The medic got spanked with a letter in his service jacket.

The Basic was warned that was a no-no but that her Ops Manager understood she felt she was doing what she was being told to do.

Also, Whit, I learned early on not to questions anyones judgement calls if you werent on scene or in the box when the spit hit the spam. You are making some assumptions (alot of them actually) and you werent there, you dont know what was going on, the Basic is my friend and I dont know what all was going on. I asked for opinions, got more than I wanted, so....anyway, i make no judgements about this since I wasnt there. What I do know is that the medic took full responsibility, as he should have done, and the matter is closed.

[hfdff422]

There are a lot of things a basic can do to assist a medic. Pushing meds and doing anything invasive are the two big no-nos. Some states do provide levels that increase the skills certifications (EMT-A, EMT-I). But these are really pretty pointless, as nothing is going to substitute for a good medic course. Drugs are outside the realm of BLS-Period!! Why there has been so much discussion is really beyond me.

[ergo343]

It's just interesting because in Israel, the lowest (non-youth) level is trained to start IVs. I guess thats just a different approach to EMS. Or it's just the sadistic people who enjoy watching 18 year-olds stick each other with needles....

And. It's not uncommon for the Basics to measure out doses of medications and push them. Everything is under the guidance of a Paramedic or a Doctor, and is checked before being pushed, but still, they are given a lot of responsibility (as long as the driver trusts you). I guess in this country we are just a lot less square...