EMT's Performing Selected ALS?

[FireMedic65]

alright, wow.. lots if people writing a lot in this post.. I'll admit it.. I didn't read most of it. so spare me the firing squad if someone already said this. ok, here it goes..

who cares.. an emt-b is trained to do what they can do, same with a medic. Some medics have higher training to do certain things other medics cannot. does that mean these other medics can't perform these things? YES.. thats exactly what it means. Get the training for the skill... and use it. I'm sure someone will jump on m case for this too.. but yea.. a volunteer BLS squad.. runs lets say 300 calls a year. Having several members "trained" to perform certain skills higher than your general emt-b. Ok.. so one day this "skill" is required.. and UH OH.. they haven't done that in months.. they are confident in doing it now.... what do they do?? OMG here is what.. they wait for ALS to get there? sure.. why not. but now people are going to have an issue with these people having this training, and when it comes time to use it.. they aren't able to for whatever reason. Now that leaves a grey area. They are trained.. but haven't done it for so long.. they can't perform it...

I guess I'm not making sense.. sorry.. I thought I was at first.. then i started to ramble..

[steph1030]

this seems like a heated topic and im sure everyone has their own opinins and the reasons behind them.But here's my 2 cents

If you are trained for it and can effectively adminuster the skill then it is ok

but that means keeping up with the skill.i mean you practiced in class and passed why shpuld that stop there?maybe if more companies did like some of the ones local to me(on our training nights alot of the times we practice the skills we know may not be used frequently just to keep everyone familiar with it)then maybe those who have to perform them wouldnt be so afraid to do so

[JPINFV]

To the post above me and the one above that. The question isn't about "training." You can train anyone to do just about anything. Sure, any could be trained to do a heart bypass. A little cutting here, a little sowing there. The problem isn't training, but the education required to understand when to use the skill, why you're using the skill, and when not to use the skill.

[steph1030]

jp i do agree with you.you can train a chimp to be an emt but alot of the time if the sklill is never used and in alot of places it is learned and then never used outside of school.If it is used (even in training scenarios)it is more likely to be remembered when it is actually needed to be performed

[Asysin2leads]

jp i do agree with you.you can train a chimp to be an emt but alot of the time if the sklill is never used and in alot of places it is learned and then never used outside of school.If it is used (even in training scenarios)it is more likely to be remembered when it is actually needed to be performed

Steph, please review the site rules as it applies to rules of grammar, punctuation, and the use of spell check. We like to keep it professional around here.

[scratrat]

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.......

Not to beat a dead horse but....

You obviously missed a lot of what people were saying.

No one said EVERY EMT sucks or anything like that. I came from an EMT job too. I would NEVER have felt comfortable as an EMT c/ something like an IO or LMA. I would have left that up to the medic. Maybe that's a bad thing on my part, but I was raised in a system where I knew my limits. Advanced care belongs to a advanced provider. I can't say I know your area, but my EMT school was 3 months long, 1 night a week. That was 10 years ago. Maybe it's gotten better, but I left that EMT program and learned nothing except a few anatomy things. I learned everything from experience and mostly from medic school. Medic school was actually a wake up call for my brain.

You also mentioned the Combitube which I also think shouldn't belong to BLS, but if your medical director is comfortable with it., great! On that note, I think the reason most people are saying no to BLS being afforded these skills, is because BLS agencies USUALLY do not have a medical director, or rather not one who actually involves himself. Unless you work in a BLS/ALS joint system. I never had a medical director as a BLS provider. It was all State Protocols.

I think what most people are saying is, not to discredit BLS, but how often are you going to be using these skills and tested on these skills? As a medic, at least where I am, you have to have x amount of successful tubes, otherwise you get remediation, x amount of successful IV's, x amount of IO's, ETC. Is your medical director going to update training at least yearly for all EMT's practicing these skills? Is every other BLS agency going to do the same? That's the point. Back in NJ where I came from, EMT's could basically kill somebody before the State actually stepped in and did something. EMT's could be dumb as a box of hair, but answered to NO ONE! They had no medical directors to answer if they screwed up, and only rarely did some BLS agencies investigate negligence on the EMT's part. I can't trust a program like that to give EMT's more to do harm to a pt with.

[Asysin2leads]

Here's my question, nifty, and if I'm missing something here, please, fill me in. You stated your EMT's are allowed to use an LMA and start an IV under supervision. Now, unless your medical director comes in off the golf course to do a ride along here and there, I assume you mean it is under the supervision of a paramedic. Okay, so, bear with me, it gets a little tricky here, if a paramedic is on scene, why isn't he the one starting the IV or doing an LMA? What exactly is he so busy doing that he isn't the one doing the skills? The answer "drawing up medication" is not acceptable, because first of all, drawing up a med takes about 0.5 seconds, and secondly, if I am supervising you starting an IV, then that is all I am doing. "Under supervision" means that someone is there watching you and guiding you along, it doesn't mean that they are somewhere in the room. Exactly what situation were these liberties created for? Oh, and I pray to all that is holy that no one in your service is playing with Lopressor who hasn't had A&P and pharmacology I.

[Niftymedi911]

No, Asysin2leads, I can assure you no one who isn't a medic is playing around with Lopressor, its a new medication (to our agency) that our Paramedic's can use. To answer your question about supervision, protocol states that the EMT can start IV's under the Medic's supervision. Like for instance the Cardiac arrest we had today. I started 2 18 G IV's one in each AC for med and fluid acsess while my Medic was intubating. Like someone else said about down here before, the state gives the power to the medical directors on what BLS and ALS can do procedure wise. More then likely the medic is doing the LMAing and such, they control the airway. I either set the med's up (drawing them up, unless its a narc then its a no no for me) set the tube up, etc or start the IV's so the p/t is intubated and we have med access all in a few seconds. Rescue helps out in between doing the rest. There is a gray area in our protocol's, which is what your picking up on Asysin2leads, our protocol book is nothing but a bunch of guidelines, it doesn't mean that they are gonna be used everytime, in order and so on and so forth. and besides most of the time if its a Priority 2, we have time in the back b/c of our short transport times, unless your in the rural area of our county. The medic is there to watch you while they might be setting up and administering an updraft or setting up a tridol drip. That's what I'm talking about. And instances where we have a priority one, my Medic takes airway, I take IV's, and rescue takes whatever else needs to be done. It help the medics here out a lot when it comes time to deal with a P1.

To answer the question about the training. All EMT's and Medic's must attend monthly in-services where we bring in Trauma Docs, Pedi Docs, Cardiac Docs etc. to talk and instruct on certain topics. We also hear from our medical director about his instances in certain cases etc.

Also, all EMT's and Medic's must go through what's called a "Mandatory Skills Credentialing", every 2 years. We are tested on knowledge and skill of our BLS and ALS capabilities. (Yes, an LMA is one of the EMT's skills here). I learned for the first time how to use an LMA in my FTO program when I first started here 2 years ago. If we fail we are put into an FTO rotation (3 months) and are remediated on the skills before we can go back out and practice BLS or ALS again.

The biggest by far attraction for people to come here and work is the fact, that you have the freedom to practice your skills and medicine without having to call a doc every 3 sec for orders. Everything is offline in our protocol books.

My EMT training was also 3 months long, but I went further and took A&P etc while I was in EMT school. I just have to go back for my core Medic classes (Clinicals, Cardiology, and Pharmocology) and earn my AS degree. I already have the rest of my credits.

[scratrat]

Your program sounds a lot like mine, actually it's one of the places I looked into before I moved down here. And that's all well and good. I work in FL too and our EMT's can do the same skills under our supervison, minus the LMA part.

What I'm referring to, is states like where I came from (NJ) where all BLS and ALS are seperate entities altogether. If an EMT deems it necessary for a medic to be there, they would call us and we met them to take care of the pt. They have no medical direction. And for some odd reason, the State has little control over them unless they kill someone, literally. In that kind of system, BLS should not be allowed to perform those skills. They don't have the skill set or the direction.

In your system, I think assisting c/ IV's and such is acceptable, but I'm ultimately responsible for that pt's outcome and I don't know if I could trust every single EMT here doing LMA's and more invasive, possibly harmful, skills. Some yes, some no.

And kudos to you for taking your education further than necessary (at the time of being an EMT).

[Dustdevil]

Like for instance the Cardiac arrest we had today. I started 2 18 G IV's one in each AC for med and fluid acsess while my Medic was intubating.

That's a relief to hear, because in the other topic, you stated that you started 2 IVs in each AC, which sounded a little extreme to me.

I just figured it was another case of an EMT taking advantage of a situation to practise outside of his education by overdoing it.