BLS Skills -- What Should We Add?

[NYMedic828]

where might one go looking for more info on this stuff? (other than google..)

Google is actually a pretty solid place to start if you know what to put in the search field.

Pathophysiology text may be of value.

Manufacturers manual for the device has good info as well believe it or not. (Masimo does anyway)

 

[mycrofft]

AND the software can't accomodate irregular pulses too well. Turn off the volume and yo will never know your pt's pulse is irregular, it will just give you either a single pulse rate, or a changing one.

 

[NYMedic828]

AND the software can't accomodate irregular pulses too well. Turn off the volume and yo will never know your pt's pulse is irregular, it will just give you either a single pulse rate, or a changing one.

You know that one from personal experience I bet :lol:

 

[VFlutter]

where might one go looking for more info on this stuff? (other than google..)

college...h34r:

Sorry I couldn't resist

 

[mycrofft]

You know that one from personal experience I bet :lol:

Yes, I do.

 

[Bullets]

AND the software can't accomodate irregular pulses too well. Turn off the volume and yo will never know your pt's pulse is irregular, it will just give you either a single pulse rate, or a changing one.

We use the Masimo RAD-57, a new "tool" which i absolutely despise. It does Heart Rate, Pulse Oximetry and CO levels (Cant think of the word). Now our EMTs and especially the FD think it is a catch all for detecting CO poisoning on CO Alarms.

EMTs also dont get why it the heart rate would jump from 50 to 100 then back to 50 then to 98 ect.

And the RAD-57 isnt even that accurate in measuring CO levels...48% accuracy compared to ABG tests

 

[NomadicMedic]

It is a good tool if you come across an apartment full of sick people though.

 

[NYMedic828]

We use the Masimo RAD-57, a new "tool" which i absolutely despise. It does Heart Rate, Pulse Oximetry and CO levels (Cant think of the word). Now our EMTs and especially the FD think it is a catch all for detecting CO poisoning on CO Alarms.

EMTs also dont get why it the heart rate would jump from 50 to 100 then back to 50 then to 98 ect.

And the RAD-57 isnt even that accurate in measuring CO levels...48% accuracy compared to ABG tests

FDNY ambulances carry them for use at fires/inhalation emergencies.

For pulse-oximetry we use the monitor.

Is it that accurate? Not necessarily. Is it better than nothing? Certainly.

 

[emt11]

To further from my last post, I forgot to mention that here(GA) an EMT-I or an AEMT is considered BLS, to include the I-99's that are still around. Your only ALS if your a medic.

 

[ThirtyAndTwo]

I think advanced training should be available in smaller segments, so that an EMT for instance could be trained to start an IV or read a cardiac monitor without going through an entire paramedic program.

As a college student with a desire to become a paramedic, I can tell you it was hard enough fitting the EMT-B class into my schedule and I can't even dream of taking a Paramedic course during semesters.

 

[MidwestEMT]

I think advanced training should be available in smaller segments, so that an EMT for instance could be trained to start an IV or read a cardiac monitor without going through an entire paramedic program.

Some areas have the option for an EMT to get an IV cert, but you'll be hard pressed to find an employer that allows it, unless you work primarily rural. Also, when it comes to cardiac rhythms, there is nothing saying you can't learn it as a B. Now while you wont be able to act according to the rhythms, or be able to use drugs to correct anything, knowing what you're seeing is a huge benefit. You can give a heads up for any intercepting medics, as well as (after you are sure) receiving facilities. It will also make 'learning' it in medic class a breeze. These days there are countless websites, videos, and books that you can self teach something as relatively basic as interpreting rhythms.

 

[Summit]

- Glucometry
- 3- and 12-lead placement and transmission
- Blind insertion airway devices
- SQ Epinephrine, i.e. EpiPens (carried on ambulance -- not just prescribed)
- Sublingual nitroglycerin (carried on ambulance -- not just prescribed)
- Rectal diazepam (carried on ambulance -- not just prescribed)
- MDI or Nebulized Beta agonists (carried on ambulance -- not just prescribed)
- IN naloxone

In CO these are standard for EMTs (EKG with an EKG class, IN/IV narcan with an IV class).

Non-Rx nitro is for AEMT and higher. Diazepam is for EMT-I and higher.

As all have said before, what is really needed is higher educational minimums at all levels.

 

[Eddie2170]

- Glucometry
- 4 lead setup and monitoring
- Blind insertion airway devices
- SQ Epinephrine, i.e. EpiPens (carried on ambulance -- not just prescribed)
- Sublingual nitroglycerin (carried on ambulance -- not just prescribed)
- MDI or Nebulized Beta agonists (carried on ambulance -- not just prescribed)

I do all of these in NY, but some of them are agency dependent.
A lot of stuff not necessarily covered is generally expected of EMTs in my area, and while we ride with the same medics frequently when you are new you tend to get taught a lot so that way on future calls you can do medic assistance, makes everyone's job easier, and obviously the more the medic teaches, the more I can help with next time so it's in everyone's best interest.

You obviously have to be willing to learn more, and even stuff not necessarily in your scope if you just take an interest in can always help you sometime in the future.

I do feel that some basic pharmacology knowledge should be added at some point because just starting out when you get handed a list of medications for a patient, especially a geriatric patient, you feel like such an idiot.

 

[Veneficus]

I think advanced training should be available in smaller segments, so that an EMT for instance could be trained to start an IV or read a cardiac monitor without going through an entire paramedic program.

As a college student with a desire to become a paramedic, I can tell you it was hard enough fitting the EMT-B class into my schedule and I can't even dream of taking a Paramedic course during semesters.

At one of the hospitals I worked at we taught one of the janitors how to look for STEMIs on a 12 lead to prove we could. He was pretty good at it actually.

IV drug abusers are really good getting lines.

But, now that I said that, your position is you want to learn more advanced skills in a truncated way because you don't have the time to be properly educated on them because you are busy doing something else more important to you?

That is an interesting perspective...

Let me take a wild guess... You are a pre-med or PA student?

The most important part of medicine is not skills. It is knowing when, why, and when not to. Just because you see somebody perform a skill and think you could too doesn't make you ready to.

I have had administrators watch me cut patients all day, does it mean they are ready to perform surgery? (It probably wouldn't be too hard to teach them how to harvest a saphenous vein or even a mamilary artery.)

You think it is not that dramatic?

Just the other day I posted a study, one of several I have read in the last few days of critical patients with >10% fluid overload having a 20-30% increase in mortality.

When that overload is >20%, mortality goes up 50% in the same population.

I posted another study some months ago showing a decrease in AKI in patients who recieved fluid with lower amounts of Cl- compared to Normal Sailine. The mechanism postulated is the formation of hypochlorite. The really powerful compound your immune cells use to kill just about everything. it is a free radical that does a fair amount of damage to the renal medula and the third zone of the liver. In the nonmedical world we call it "bleach."

Did you learn that watching people start an IV? Perhaps in General Chemistry?

Sorry, but this is exactly why EMS is so messed up in the US. A skills approach with no knowledge. Don't be part of the problem.

 

[Clare]

I still can't really understand how such a limited amount of training seems to be allowed in the US. the country that seems to like being known as the best in everything?

If you want to be a two bit volunteer out on some rural station here you have to complete the Diploma which takes at least 400 hours of learning and if you want to actually get paid for it and do complex stuff then it's a three year degree minimum.

Mind you I have never met nor worked with Americans so I can't say but somebody on here said something like a 150 hour course and you can't even check a blood sugar? crazy!

 

[Hunter]

I still can't really understand how such a limited amount of training seems to be allowed in the US. the country that seems to like being known as the best in everything?

If you want to be a two bit volunteer out on some rural station here you have to complete the Diploma which takes at least 400 hours of learning and if you want to actually get paid for it and do complex stuff then it's a three year degree minimum.

Mind you I have never met nor worked with Americans so I can't say but somebody on here said something like a 150 hour course and you can't even check a blood sugar? crazy!

It's not a US thing, it's a every state does things their own way. If you have a license to work in florida, you can't work anywhere else. I think if paramedic standards where nationalized things would be better, plus it would help the overall unity of ems in the country as a whole.

 

[Wheel]

I still can't really understand how such a limited amount of training seems to be allowed in the US. the country that seems to like being known as the best in everything?

If you want to be a two bit volunteer out on some rural station here you have to complete the Diploma which takes at least 400 hours of learning and if you want to actually get paid for it and do complex stuff then it's a three year degree minimum.

Mind you I have never met nor worked with Americans so I can't say but somebody on here said something like a 150 hour course and you can't even check a blood sugar? crazy!

I don't understand it either, just like how we're trying to add lab values, blood chemistry, more in depth physiology to the curriculum but still allowing diploma medics to teach the stuff when they themselves don't understand it. The more I learn about education standards of ems vs. other health professions vs. medics in other countries, the more I don't understand how people feel well prepared for this. I guess it's a classic case of "you don't know what you don't know."

I am aware that this is not the case for all medics and all programs in the US, but it still isn't rare.

 

[ExpatMedic0]

Its mind boggling, specifically EMT-B. The national standard is around 110 clock hours I believe which is accepted in most states. These are the people who can staff an ambulance on there own and respond to emergencies as the highest level of care in some areas until definitive care.
Even if you where to keep this a vocational tech occupation, I would be curious to look at morbidity mortality rates in a system like this vs a system with providers who have more education and training. 110 hours can be completed in less than 3 weeks in some programs

I still can't really understand how such a limited amount of training seems to be allowed in the US. the country that seems to like being known as the best in everything?

If you want to be a two bit volunteer out on some rural station here you have to complete the Diploma which takes at least 400 hours of learning and if you want to actually get paid for it and do complex stuff then it's a three year degree minimum.

Mind you I have never met nor worked with Americans so I can't say but somebody on here said something like a 150 hour course and you can't even check a blood sugar? crazy!

 

[EMT B]

Its mind boggling, specifically EMT-B. The national standard is around 110 clock hours I believe which is accepted in most states. These are the people who can staff an ambulance on there own and respond to emergencies as the highest level of care in some areas until definitive care.
Even if you where to keep this a vocational tech occupation, I would be curious to look at morbidity mortality rates in a system like this vs a system with providers who have more education and training. 110 hours can be completed in less than 3 weeks in some programs

why would you want to do it in such a short ammount of time. One of my fire co-workers is taking it at a community college. its over 2 college semesters, one night a week, for 4 hours. he says hes getting a lot out of it. i was misurable in my one college semester last year that was 8 hours a week. i think that time is necessary in between classes so that students have time to absorb all the information that they are getting thrown at them.

 

[JPINFV]

why would you want to do it in such a short ammount of time. One of my fire co-workers is taking it at a community college. its over 2 college semesters, one night a week, for 4 hours. he says hes getting a lot out of it. i was misurable in my one college semester last year that was 8 hours a week. i think that time is necessary in between classes so that students have time to absorb all the information that they are getting thrown at them.

Not all students are the same.