BLS Approved Meds.

[Richard B the EMT]

And don't forget the MARK I kits!.

Seth

For the uninformed, those are the multiple packages of anti nerve agent meds, in auto-injectors, used similarly to epi-pens.

The kit is only to be opened on authority of on line medical control, but if that order comes down, it will be citywide in nature, not just one ambulance crew.

Thanks for the reminder, Seth.

[whit72]

Oh boy this topic is sure to start a firestorm

[Richard B the EMT]

In New York State, Ammonia Inhalants were removed from the list of acceptable treatments years ago.

[Dustdevil]

Nobody should be carrying anything that they have not been thoroughly and properly educated on. I don't recall ever seeing any EMT (or paramedic, for that matter) class educate anybody about antibiotic topicals or even the basics of antiseptic theory. I think that pretty well speaks for itself.

[SSG G-man]

Where I am we carry alcohol wipes for checking BGL and some EMT-Bs in our county are approved to start IVs. I took the class room portion, but due to circumstances, did not get the requisite number of supervised field sticks in the allotted time period.

In MD the only drugs we can use as a Basic are O2, activated Charcoal, Assist with Epi, Assist with Nitro, Oral Glucose.

I am a little shaky. I have been off the box for three months due to an injury. I plan on a refresher before I get back on the box!! But I am off at least another three months!

[Just Plain Ruff]

Ok here is what I don't understand.

EMT-B's can assist with giving Nitro to a patient with chest pain if it is the patients own medication. Does anyone else see a problem with that?

As a medic, I never ever ever give a nitro without an IV established.

Why would we give the ability to give a medication that if you ask the majority of medics on the City if they would give Nitro to a patient without having an IV present and they would say, NOPE wouldn't do it.

So we give a medication that potentially has the ability to drop a blood pressure, in the extreme to bottom it out, and we give this ability to a EMT with 120 hours of training but no ability to establish an IV.

Does anyone else see a problem with this?

[vs-eh?]

In Ontario, PCP's (BLS) can administer NTG spray (chest pain and/or CHF), given a proper assessment, certain vital sign parameters, and medication restrictions (previous NTG use and no ED meds x 48 hours).

There are only a handful of services that allow PCP's to start IV's. We also carry all the drugs we administer, there is no "assisting" with drugs here.

A couple of days ago I administered NTG spray to an unstable angina patient prior to starting an IV (hypertensive post self NTG admin, but ALS can obviously administer without prior use).

Proper assessment is key for both BLS or ALS nitro administration, with BLS knowing they don't have that "life line" should the patient become grossly hypotensive. Proper education and discretion that the PCP possesses may lead them down the NTG route or to perhaps just stick with ASA and oxygen.

I don't know if 120 hours gives you that education or discretion...

[Richard B the EMT]

NYS/NYC protocols indicate that as long as the BP is at or above a specific minimum, and the patient has not taken more than 2 Nitro pills prior to the BLS' intervention, or taking Viagra (or similar sexual enhancement drugs), and verifying the expiration date of the Nitro, and confirming that the Nitro is a prescription for the patient, and not another individual, the EMT-B may assist the patient in taking the patient's own Nitro pills.

As always, I hammer on the fact that the protocols I use may be contradicted by the protocols used in your location. At your home community, YOUR local protocols rule, as mine do by me!

[Just Plain Ruff]

i agree with the protocols and such but should we be trusting a medication like Nitro to be given by an emt with no ability to reverse or fix what sometimes can be a disastrous result.

How many medics on this site have given nitro and the patients BP bottomed out? I'd be interested in how often this really happens.

120 hours barely scratches the surface and we are giving them the ability to help admin a medication like this one.

[RomeViking09]

My work so far has been at a Boy Scout Summer camp where we provided only BLS care in camp. We are given off-line direction to give more meds than a normal BLS service and we stock of our meds that normally the PT would have to have an Rx for and we also have some drugs in stock we can only use with On-Line Direction.

Our drug list is the Following:

Acetaminophen PO

Aspirin PO

Ibuprofen PO

Naproxen PO

Hydrocodone w/Acetominophen PO (On-Line Direction Required)

Diphenhydramin HCL PO

Pseudoephedrine HCL PO

Epinephrine 1:1000 IM, .3 ml Auto-injector, .15 ml Auto-injector (On-Line Direction Required for use of IM Injections)

Cephalexin PO

Calcium Carbonate PO

Bismuth Subsalicylate PO

Activated Charcoal

Loperamide HCL

Nitro SL (On-Line Direction Required)

O2

Glucose

Albuterol MDI

Now we are over 1 hour from any kind of ALS care (by air or road) normal time to scene for ALS is about 1 hr 45 min we also keep all camper Rx meds and have to assist and log them while the camper is in camp unless a parent is with them (this included SQ and IM Insulin) All health lodge staff are trained in Wilderness Medicine Protocols in addition to their over medical training (Past summer's Staff 1 Wilderness First Responder, 1 LPN with no EMS or Emergency Training, 1 EMT-I/85 who was on camp part-time) we also had 1 retired EMT and 1 Retired FF/Parmedic that worked at the camp and most weeks had 1 or 2 Adult Leaders with groups that where RNs, EMTs, or Medics