EMT's Performing Selected ALS?

[medic001918]

I personally allow every EMT I work with to start IVs, and push meds... especially if it is one planning on going to medic school.

After reading your post again, I'd like some clarification...does this mean you're allowing EMT's (basics) to start IV's and push meds? If so, I find it hard to believe that you'd encourage someone to practice out of their scope. This would make you rather irresponsible as a leader for encouraging this practice.

Shane

NREMT-P

[Asysin2leads]

I'm glad that an EMT from my agency is on here to say something to these big-headed ego driven medics. Maybe they should check out the national numbers on failed intubations. We need to be more critical of ourselves before we bash EMTs. I personally allow every EMT I work with to start IVs, and push meds... especially if it is one planning on going to medic school. I agree that they should be, as well as us medics, extremely skilled BLS practitioners. I think we all need to check or CPR skills from time to time, concidering that's where you are really going to change the outcome.

Yeah, the other day I let the janitor have a whack at IV's and intubation. Why not? You know, FL, not for nothing, as they say in my neck of the woods, but if you are letting your basics play with the sharps, you are not only guilty of a fairly serious crime, you are also endangering your patients and setting up your EMT's for major ramifications. Way to go, hero.

[whit72]

Nifetymedic wrote:

To answer your question about supervision, protocol states that the EMT can start IV's under the Medic's supervision.

Asysnin2leads wrote:

Yeah, the other day I let the janitor have a whack at IV's and intubation. Why not? You know, FL, not for nothing, as they say in my neck of the woods, but if you are letting your basics play with the sharps, you are not only guilty of a fairly serious crime, you are also endangering your patients and setting up your EMT's for major ramifications. Way to go, hero.

His medical control allows it. Whats the problem. Funny, when the medic is allowed to work out side his scope, or training, the system is called progressive. If its the EMT its a "fairly serious crime and endangering our pts." Gimmie a break. If the education or training is there whats the issue? Its an IV people, their not bypassing the LAD here.

[BushyFromOz]

Funny, when the medic is allowed to work out side his scope, or training, the system is called progressive.

thats not progressive, thats hypocritical, and im sure many people will refute your statement.

[FL_Medic]

After reading your post again, I'd like some clarification...does this mean you're allowing EMT's (basics) to start IV's and push meds? If so, I find it hard to believe that you'd encourage someone to practice out of their scope. This would make you rather irresponsible as a leader for encouraging this practice.

Shane

NREMT-P

The state of florida does not recognize EMT-I. I allow them to perform these skills under my direct supervission, after I have practiced with them at the station. I allow them 1 intubation aattempt, and make it a timely one. I only allow them to push certain medications and do so with my full attention and step by step instruction. EMTs aren't retards and I am not even going to respond to the janitor comment made after yours. work is much easier if you work as a team, I would never say that these are skill that should be performed without further education, but our agency does make every EMT take a course on intubations, and IVs before they hit the roads. So that combined with in statio n training on a regular basis.. I can't see what the big deal is. By the way thank you everyone for your great attitude.

[FL_Medic]

From what he tells us of your medics there in Lee County, it doesn't sound like either of you have anything to be proud of, outside of employment.

And to think that I actually respected you two short posts ago. :?

Actually I have alot to be proud of. Our agency is groundbreaking and progressive to say the least. Are protocols have been reviewed and adopted by many other agencies throughout the nation. We have been complimented in JEMS on numerous occassions for best preactices. Every agency has cretin medics though, and I will admit there are a few of them that work here. I wouldn't say it is the majority or even close. I have all the confidence in the world of my skills, knowledge and ability as a good medic, so with that alone I am proud..

[FL_Medic]

"We should check our CPR skills from time to time, but I strongly disagree with your statement that that is where we are "really going to change the outcome." It's statistically been proven (repeatedly) that our success rate with prehospital resuccitation is dismal at best. That's a product of many things...the biggest being time. There's not much we're going to do to defeat that. It takes time for someone to recognize a problem, activate EMS and for us to respond. I would go as far as saying that we provide the biggest change to a patient outcome in a patient prior to their arrest. When we just might be able to do something to prevent the arrest from occuring in the first place (think CHF, MI, etc). Once a patient arrests, their chances of survival are miniscule at best. Let's not kid ourselves into thinking that's where our best efforts lie. "

I can agree with this, I was just trying to make a simple point. When I am on a call and am getting ready to perform a treatment modality I always remind myself BLS before ALS, and I think that we are getting really amped up and concered with intubation when we need to make sure our CPR skills are at there best. I only say this from an experience that opened up my eyes and I will share it.

I was on a code back in November, and as you may not know our system has firefighters respond with us. This particular FD is a BLS one. We had a few months prior just had our CPR changes and the new ratios were now a county wide standard. I got to the call and went to work, I had a viable patient that was initially in v-fib. I took meds & monitor/defib and the senior medic took airway, the firefighters performed CPR. This was one of the smoothest codes I ever had, No problem with the IV got all the meds on board quickly and efficiently, and the patient was intubated properly in record timing. The patient didn't make it. This was nothing new, and I know saves are far and few between, but I had a good feeling about this one. I said to my partner afterwards "I thaught we had this one" and he looked at me and said "maybe we would have if those firefighters new how to perform CPR". I had remembered hearing him during the code make a few requests to them in regards to CPR but thaught nothing of it. He then told me that (before intubation)not only were they not performing the new ratio of chest compressions, but they weren't even performing the old one, just slow, poorly skilled CPR. I thaught from then on I would never let the possibility of losing a save from poor CPR ever happen again. Since I go to the station of the FD I will be working with for the month and we do some simple medical training, and go over a few things. usually they are more than happy to do this.

I dunno how relevant this story is, but I think about it all the time. And BLS before ALS is my constant reminder to myself.

Also my medical director braught up some stuff related to this post in our most recent inservice. Failed intubations seem to be a never ending problem, and giving all those people that want to take intuabtion away from us a reason to do so. He proposed that we start putting are egos asside and if we aren;t good at intubating to do what we are good at (combi or ALM). He wants us to practice intubation more but not be so ressistant to secondary devices. A patent combi tube is better than an esophageal intubation.

[Code 8 Paramedic]

I voted Yes.. but only with the extra training.. and while working with a paramedic! Im a new medic, but one thing Ive noticed is that its easier to run the code, when the people around you are allowed to do more skills... If the EMT im with can pop in the IO while im intubating, or setting up my monitor, its time saved. I do not think that 2 EMTs should be popping in IO's and LMA's and trying to run a code by themselves. Just my 2 cents

[FL_Medic]

I voted Yes.. but only with the extra training.. and while working with a paramedic! Im a new medic, but one thing Ive noticed is that its easier to run the code, when the people around you are allowed to do more skills... If the EMT im with can pop in the IO while im intubating, or setting up my monitor, its time saved. I do not think that 2 EMTs should be popping in IO's and LMA's and trying to run a code by themselves. Just my 2 cents

100% agree

[Asysin2leads]

Nifetymedic wrote:

To answer your question about supervision, protocol states that the EMT can start IV's under the Medic's supervision.

Asysnin2leads wrote:

Yeah, the other day I let the janitor have a whack at IV's and intubation. Why not? You know, FL, not for nothing, as they say in my neck of the woods, but if you are letting your basics play with the sharps, you are not only guilty of a fairly serious crime, you are also endangering your patients and setting up your EMT's for major ramifications. Way to go, hero.

His medical control allows it. Whats the problem. Funny, when the medic is allowed to work out side his scope, or training, the system is called progressive. If its the EMT its a "fairly serious crime and endangering our pts." Gimmie a break. If the education or training is there whats the issue? Its an IV people, their not bypassing the LAD here.

According to Fl, he lets his EMT's all start IV's. Florida only has EMT-Basics and Medics, and I for all my searching I can not find any formal augmentation courses for an EMT-B to be allowed to start IV's. It is one brave medical director if he allows EMT-B's to be sticking people with IV catheters. Hey, Fl, I was thinking of retiring, may you could give me the name of your county you work in, I'll take a vacation, have some chest pains, and then have some mysterious irreversible nerve damage after on of your basics puts an IV in on me. Whaddya say? I have a feeling I know what the court would say when an untrained medical provider is performing skills like that and causes injury to a patient and you can prove causation. You know, its funny, FL medic whines about egos, but then goes and makes a statement "Sure, the rest of the country says 120 hours of training isn't enough to play with invasive procedures, and neither does any one of the governing bodies of EMS, but you know what, its okay because its under MY supervision." I have an idea, how about you stop trying to play Mr. Teacher Special Person and guiding your padwan learners through the process of an IV, do your job as a paramedic, start the IV, treat the patient, go to the hospital, and call it a day? You think you might benefit your patient a little more that way? You wanna talk about egos? Guys like you love letting people who aren't supposed to be doing certain things do them because they get a certain rush and power trip out of the whole deciding who gets to play and who doesn't. Maybe on the playground you got to rule over all when you had the shiny new ball and could decide who plays with it and who doesn't, but this is the adult world, and you are playing with patient's health and well being by your actions.