EMT's Performing Selected ALS?

[Ridryder 911]

Hey.. here is NEW concept, instead of trying to add onto the basic level. Let's be sure that they can actually perform ...hmmm maybe "basic life support" satisfactory, since BLS/ CPR has demonstrated better outcomes than airway and IV placements.. and GASP!!.. that is the skills that they are already trained (at least supposed) to do.

WOW! You mean no substitute(s) or an excuse to have a placebo ALS, but actually place well needed money and educational time for reinforcing something that we already we know works... But then again, a physicians and their groups may not get published... aww!

R/r 911

[whit72]

As an EMT I would say no. Not because I don't believe EMTs have the mental capacity. But why would you waste massive amounts of resources training EMTs to perform skills that will not increase success rates. We all know the survival rates of arrest pts. It doesn't matter the level of the provider performing the skill if the attempt, if successful will not increase the success rates. If there was a substantial increase in survival rates from ACLS methods vs non-ACLS methods that might be a logical decision however there is little difference in the survival rates between the two.

Why don't we use those resources to de-mystify bystander CPR. To get the public involved. This is a proven method to increase the survival rates of arrest pts. Lets not concern ourselves with re-educating EMTs in a situation that will affect very few pts.

[Imagine89]

NONO NONONO NONONON NONONONONO NONONONONONONO NONONONONO NONONONONONO.

We, as EMTs, and I am a basic, already do too much based sheerly on protocol, and not enough on education. Performing a complex procedure with only a few hours of education is a fantastic way to ensure more law suits against the companies that allow this.

Your NOs were broken up because long strings of words distort screen size. AK

[Dustdevil]

Your NOs were broken up because long strings of words distort screen size. AK

Screen distortion notwithstanding, ya gotta admit that was a pretty awesome post. :thumbright:

[Eydawn]

Unless it's a proven intervention that allows some facet of care to be vastly improved (read- definitely not dead vs. maybe not dead), and the background education (note- education, not training) is increased to allow for that intervention to be performed with a full physiological understanding as well as technical skill competency, then ABSOLUTELY NOT.

The IO definitely falls into that category; why would one establish something that invasive when all you can do is pour saline in it? Do you even understand what bone tissue is composed of, and what needs to be taken into consideration when introducing foreign materials into that tissue? Is it going to make that much of a difference when you don't have the knowledge to utilize this procedure?

The LMA- I don't know enough about it to be able to tell whether or not it would be beneficial. I've always seen it discussed in terms of a secondary airway device, kind of like the Combitube or the King LT. That is, it allows you to establish a BETTER, but NOT PATENT airway in your patient. I've heard the LMA can slip if placed incorrectly or not inflated correctly, and that it has a higher rate of vocal cord damage.

Here's a question for you; does one have to visualize the trachea when inserting the LMA, or is it a blind pseudo-intubation device? If you have to visualize the trachea, then you definitely need more physiology and anatomy to be able to do more than go "Ok, the instructor said there's these goopy white lines and it goes between them!" If it's a blind intubation device that can be placed with a simple understanding of physiology (like the Combitube) then perhaps it has merit and educating basics in its use would be a good idea.

I know I certainly wouldn't want to try to use them until I had the knowledge- not a checklist of "if you see this then do this"- to make the decision whether or not to use them. And I'm a basic.

Wendy

CO EMT-B

MI EMT-B

[whit72]

Imagine Wrote:

We, as EMTs, and I am a basic, already do too much based sheerly on protocol, and not enough on education.

If that is the case then the fault lies with you. It is all what you do with the information provided. If you are performing a skill or administering a medication without the necessary understanding whether provided in your class or not. If your allowed to perform it you should have a thorough understanding of it. "I didn't learn why in my class" is not a sufficient excuse. I did it because its in my protocols is a excepted answer, however I believe you are selling yourself and your pt. short if you do not have a thorough understanding of the skill or the medication you are performing or administering. Its your responsibility to have the understanding of how and why.

[scratrat]

I voted on. I know I started out too at one time, but not with invasive procedures. After 6 years of being a medic and 5 at a basic level, i would never trust enough EMT's to allow it's use. Don't get me wrong, I've have worked with many EMT's who do a better job than my paramedic cohorts, but I've also seen too many blatant, stupid errors. Not knowing how to ventilate properly with a BVM (how can you use an LMa if you can't even use a BVM), not recognizing resp failure in the CHF'er who's on a nasal @ 4 lpm, not recognizing that the reason they can't hear the BP is because they're asystolic and probably have been for quite some time....

This stuff really happened. How can I trust that EVERY EMT is getting enough training AND retraining to ensure adequate skill levels? Especially when stuff like the above happens? On a paid squad handling a lot of calls too, not a small volunteer organization that doesn't get out much.

Oh, and splinting the non-fractured arm! I swear to g**! That was my favorite.

[Niftymedi911]

You guys all need to go back to your roots with the attiudes about EMT's, where did every single medic come from? An EMT.

Now, I'm not much for supporting EMT's to do ALS care, BLS is EMT's and ALS is Medics, No questions asked, but the bashing of EMT's is getting kind of worn out. Yes, we might not have the higher education levels that you guys might have, thats plain and simple. But EMT's wether you work for BLS or ALS provider are your partners, the people who should be watching your back, I cannot tell you how many times I've saved a medic's ass from write up or even worse injury resulting in loss of work. The EZ IO is ALS, I personally, believe the LMA should be BLS. If we can insert a Combitube which does more damage to an airway then a LMA does, then why not an LMA? Our medical director for my agency allows EMT's to insert LMA's with supervision in the field if the medic cannot intubate. He also allows us to start IV's in the field under medic supervision. The LMA is simply a slide into until it stops not forcing into the trachea. It's a secondary device, I though secondary device's were BLS? If you would like an updated copy of our medical protocol's let me know, the ones on our website are 2 years old, we are unveiling a revised protocol guidlines book, which includes the LMA, and administration of Lopressor we now carry on our trucks.

I've also read on here some members' generalizing all EMT's. THAT IS BS!!! Just bc you have some really crappy EMT's does not mean they are all the f***ing same. Who knows, I might just be one of those anomalies who's actually an educated EMT and can do the skills efficently, apprioriately, and safe. I don't know.......

[JPINFV]

You guys all need to go back to your roots with the attiudes about EMT's, where did every single medic come from? An EMT.

That's like saying we shouldn't criticize student drivers because, hey, we were all student drivers at one time.

Now, I'm not much for supporting EMT's to do ALS care, BLS is EMT's and ALS is Medics, No questions asked, but the bashing of EMT's is getting kind of worn out. Yes, we might not have the higher education levels that you guys might have, thats plain and simple. But EMT's wether you work for BLS or ALS provider are your partners, the people who should be watching your back, I cannot tell you how many times I've saved a medic's ass from write up or even worse injury resulting in loss of work.

Are you seriously arguing that EMTs have enough education to be able to do advanced procedures and trouble shoot them if needed? Sure, there are a few procedures that I think should be added at the basic level, but the ones I think should be added are more assessment based. Even with that, I can't seriously recommend adding to the BLS scope of practice without a serious increase in the education required to begin practicing as a basic.

The EZ IO is ALS, I personally, believe the LMA should be BLS. If we can insert a Combitube which does more damage to an airway then a LMA does, then why not an LMA? Our medical director for my agency allows EMT's to insert LMA's with supervision in the field if the medic cannot intubate. He also allows us to start IV's in the field under medic supervision. The LMA is simply a slide into until it stops not forcing into the trachea. It's a secondary device, I though secondary device's were BLS? If you would like an updated copy of our medical protocol's let me know, the ones on our website are 2 years old, we are unveiling a revised protocol guidlines book, which includes the LMA, and administration of Lopressor we now carry on our trucks.

Just wondering, when did your service become the standard for all EMS? Comparing protocols are useless because it will vary by location in large part due to the unique demands of each system.

I've also read on here some members' generalizing all EMT's. THAT IS BS!!! Just bc you have some really crappy EMT's does not mean they are all the f***ing same. Who knows, I might just be one of those anomalies who's actually an educated EMT and can do the skills efficently, apprioriately, and safe. I don't know.......

Dude, everyone stereotypes. Stereotypes are around because there is at least some truth to it.

[medic001918]

You guys all need to go back to your roots with the attiudes about EMT's, where did every single medic come from? An EMT.

Now, I'm not much for supporting EMT's to do ALS care, BLS is EMT's and ALS is Medics, No questions asked, but the bashing of EMT's is getting kind of worn out. Yes, we might not have the higher education levels that you guys might have, thats plain and simple. But EMT's wether you work for BLS or ALS provider are your partners, the people who should be watching your back, I cannot tell you how many times I've saved a medic's ass from write up or even worse injury resulting in loss of work. The EZ IO is ALS, I personally, believe the LMA should be BLS. If we can insert a Combitube which does more damage to an airway then a LMA does, then why not an LMA? Our medical director for my agency allows EMT's to insert LMA's with supervision in the field if the medic cannot intubate. He also allows us to start IV's in the field under medic supervision. The LMA is simply a slide into until it stops not forcing into the trachea. It's a secondary device, I though secondary device's were BLS? If you would like an updated copy of our medical protocol's let me know, the ones on our website are 2 years old, we are unveiling a revised protocol guidlines book, which includes the LMA, and administration of Lopressor we now carry on our trucks.

I've also read on here some members' generalizing all EMT's. THAT IS BS!!! Just bc you have some really crappy EMT's does not mean they are all the f***ing same. Who knows, I might just be one of those anomalies who's actually an educated EMT and can do the skills efficently, apprioriately, and safe. I don't know.......

The problem isn't have a BLS partner, the problems is BLS providers wanting to continually add to their scope of practice without the required education and training to maintain a skill proficiency. Those are much bigger issues than the "EMT bashing." If you're an EMT that is competent in your own skill set and understands why the scope of practice is limited, that's great and there's no bashing involved. I still haven't really read any significant responses as to why people voted that BLS providers should be able to perform some of these ALS interventions, yet people have voted. Many other providers who have voted no have clearly and concisely explained why. This ignorance and willingness from any other provider to back up their position with a reasonable arguement (and hopefully factual) goes a long way towards getting someone respected in the field. But that's not the case here. We have people voting to increase the scope, but not even trying to explain why it should be that way.

And a secondary airway device doesn't really make it a BLS adjunct. It's just what the name implies, a secondary device in the event of a failure of the first line. How does that automatically make it BLS? An example is that front line IV access is peripheral, if we can't secure an IV on a critical patient we can go to the EZ-IO as a secondary device...does that make the IO a BLS adjunct? No, it's just another tool that we are allowed to use in a situation that it's required (and FYI, our cardiac arrest protocols have the IO as front line access).

As to you having saving "saved a medics ass." Good for you, I think. It's sad that the medics you're working with don't appear to be self sufficient enough to maintain their own level of care if their basic partner has done this multiple times as your statement implies. I work with my partners, but they don't save my ass or prevent me from making medical mistakes. It's my job to make sure that I use due diligence in assuring that the care that I provide is proper and adequate. I don't ever rely on the hope that my basic partner will have to step up to run the call for me or to prevent me from making what they percieve to be a mistake. The biggest thing that a basic partner can do is to be proficient in their own skill set, allowing me to do job. That way when we work together, the whole job gets done. If we show up to a chest pain patient, I shouldn't have to ask that you put oxygen on the patient (I'll even accept the question of do you want a mask or nasal as long as you're taking the initative to put oxygen on the patient); that is something that you should be doing anyway and without direction. It's part of your skill set. If I'm still directing every last aspect of patient care when I work with a basic than they're not really ready for any kind of increased scope of practice. I still don't think you'll find myself (or many other medics for that matter) that will be dependant on a basic to save them from making a mistake. Sometimes as a medic, we're thinking things through a little more or maybe we've picked up on something that you didn't.

Shane

NREMT-P