Naloxone Admin By EMT's

[chaz90]

Let's tone down the personal attacks here and maintain civility. Good discussion so far in this thread, so let's keep it that way.

 

[RobertAlfanoNJEMT]

I do not understand why there is not more emphasis on on BLS placing an airway instead of mask ventilation. With little exception, if the patient can tolerate an OPA, they can tolerate a King or whatnot, and that should be placed. I guess I don't see the downsided of placing an airway in an obtunded patient, aside from those who can have whatever is causing there airway compromise reversed quickly (ie opioids).

Our first responders are actually getting worse with mask ventilation (as am I), as we no longer ventilate cardiac arrest patients until an SGA or ET is in place, if that even happens. For many of our first responders, the only time they use mask ventilate patients is on cardiac arrests, so I expect that they will be even more apprehensive than they already are when it comes to providing ventilation to a patient who is not apneic but still needs to be ventilated.

There is good emphasis on securing an air way... Someone who's airway cannot be maintain by themselves is to be secured with an OPA or NPA... And BVM ventilation is done whenever adequate tidal volume is not achieved... Neither of them are difficult skills

 

[TransportJockey]

Sorry I forgot that Texas is known as the educational center of the country...

I never said we were. But TX doesn't jave governing agencies for EMS that have actively pushed to LOWER the requirements for BLS. NJ does.

 

[chaz90]

There is good emphasis on securing an air way... Someone who's airway cannot be maintain by themselves is to be secured with an OPA or NPA... And BVM ventilation is done whenever adequate tidal volume is not achieved... Neither of them are difficult skills

Let's clear up a couple things here. How do you define a patient's inability to maintain their own airway?

Neither oropharyngeal or nasopharyngeal adjuncts "secure" a patient's airway. As adjuncts, they assist in very specific parts of the continuum of airway management and have important roles in effectively ventilating a patient.

Lastly, BVM ventilation is a vitally important skill EMS providers as a whole (BLS and ALS) do a shockingly poor job at performing. I would wager you don't do nearly as good of a job at it as you think you do and have likely had relatively few opportunities to practice it on patients where you measure its effectiveness. Don't overestimate your own abilities as you transition to being a very new EMT freshly out of school.

 

[RobertAlfanoNJEMT]

I never said we were. But TX doesn't jave governing agencies for EMS that have actively pushed to LOWER the requirements for BLS. NJ does.

It is not easy to become an EMT in NJ... We have some of the toughest standards in the nation... A required 210 classroom hours 6 critical exams through out that, a crap ton of critical practical exams and a standardized state exam

 

[Flying]

It is not easy to become an EMT in NJ... We have some of the toughest standards in the nation... A required 210 classroom hours 6 critical exams through out that, a crap ton of critical practical exams and a standardized state exam

Null point. Becoming an EMT isn't hard period. CNAs go through more classroom hours and the exams are hardly anything to bother with if you have basic reasoning skills.

What TransportJockey is talking about is how NJ has ended up vetoing multiple initiatives to improve and standardize statewide EMS.

 

[TransportJockey]

It is not easy to become an EMT in NJ... We have some of the toughest standards in the nation... A required 210 classroom hours 6 critical exams through out that, a crap ton of critical practical exams and a standardized state exam

Im curious where you got the 210 hours figure. NHTSA mandates 120 hours. Although most states go over that on a regular basis (I did initial training in NM and our course was nearly 180 hours seven years ago, before we became a registry state. Which goes with the expanded EMT scope in nm)
The rest of what you describe sounds typical of an emt class

 

[DesertMedic66]

It is not easy to become an EMT in NJ... We have some of the toughest standards in the nation... A required 210 classroom hours 6 critical exams through out that, a crap ton of critical practical exams and a standardized state exam

My program in CA was about 208 hours total with 3 critical tests and critical daily exams not including NREMT and the hands on tests.

You can ask pretty much any EMT or medic in CA and they will tell you it's not that hard to become an EMT...

 

[RobertAlfanoNJEMT]

I'm not saying it is hard to become an EMT trust me all I am saying is that NJ isn't the easiest state to become one in..

 

[EMT2015]

I'm not saying it is hard to become an EMT trust me all I am saying is that NJ isn't the easiest state to become one in..

Compared to??

 

[Chewy20]

210 hours?!

I'm not saying it is hard to become an EMT trust me all I am saying is that NJ isn't the easiest state to become one in..

So by the statement you are an EMT in more than one state? Thought so.

 

[CALEMT]

You can ask pretty much any EMT or medic in CA and they will tell you it's not that hard to become an EMT...

Not just CA, pretty much anywhere. All you need is a semi functioning brain and a pulse to become a EMT...

 

[NomadicMedic]

Or as one of my former instructors said, "as long as the check clears..."

 

[exodus]

NJ, so weve had Narcan for about a year now in hands that are not ALS providers. My issue i with this is that this was slammed through by the police departments, which forced DOH to catch up. So now we could carry narcan but still cant use a glucometer.

There are numerous reports of saves because its in the interest of the police departments to make it public that this massive taxpayer funded program is "doing something" so they call the papers and get the dogs and ponys out for one save a town might do a year. Weve been told in NJ that we are locked in a life and death struggle with this heroin epidemic yet the busiest towns in this county have done single digit opiod overdoses last year and this. Obviously i can only speak to the specific situation in my area of NJ, but the numbers arent supporting the success

What exactly will you be doing with this glucometer and how will it affect your treatment? How will it benefit or prevent harm in your patients?

 

[RobertAlfanoNJEMT]

What exactly will you be doing with this glucometer and how will it affect your treatment? How will it benefit or prevent harm in your patients?

Well if we could use glucometers we wouldn't be giving glucose to hyperglycemic patients, which we are currently encouraged to do

 

[Flying]

Well if we could use glucometers we wouldn't be giving glucose to hyperglycemic patients, which we are currently encouraged to do

You roll onto the scene and find the patient. How does a person who is currently hyperglycemic present?

 

[exodus]

Well if we could use glucometers we wouldn't be giving glucose to hyperglycemic patients, which we are currently encouraged to do

When's the last time you have seen an ALOC hypERglycemic patient? If you have a patient with a diabetic history and they are altered. 99.999% of the time they will be hypOglycemic.

Please show me where it's encouraged to give a hypERglycemic patient oral glucose and encouraged. (How do you even know they're hypERglycemic, you don't have a glucometer?)

Sure it's an extra tool in the bag and makes it look like you're doing something more, but the costs of outfitting all the units, maintenance, training, protocol writing, insurance additions, etc, etc are very expensive for very little upgrade in care, probably several hundreds of thousands of dollars. You can use other signs to determine of the patient is possibly hypERglycemic. This is the same thing as pulse ox on BLS rigs, sure it's nice to have, but there are other ways to see if your patient is perfusing adequately.

 

[CALEMT]

Well if we could use glucometers we wouldn't be giving glucose to hypoglycemic patients, which we are currently encouraged to do

Fixed it for you..

I would like to think that since you claim NJ is the "hardest" state to become a EMT in that you would be able to differentiate HPYERglycemia and HYPOglycemia and between those two who needs glucose and who doesn't.

 

[teedubbyaw]

Baby jesus

 

[RobertAlfanoNJEMT]

Fixed it for you..

I would like to think that since you claim NJ is the "hardest" state to become a EMT in that you would be able to differentiate HPYERglycemia and HYPOglycemia and between those two who needs glucose and who doesn't.

No I meant what I wrote... Hyperglocimia is blood sugar that's too high... We are told to give oral glucose to all patients in a diabetic emergency hyper or hypoglycemic!