Although, wouldn't it be nice to piss off a chronic heroin user?
This is exactly why most EMTs (and a hell of a lot of medics) have no business with naloxene.
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Although, wouldn't it be nice to piss off a chronic heroin user?
wait what? in almost 15 years in NJ EMS, I can say you do not ned a seperate cert to administer an unpresribed epipen. you need to take a short class at your agency (since I wasn't in most people's original class), but the records are all kept internally, and the state doesn't track who does and who doesn't take it.In NJ EMTs need a separate cert to administer an unprescribed epipen. This is how some of these skills should be treated. Valium and narcan I don't see a reason for they need in depth skills to administer and for me at least, medics are usually on scene within 5 minutes of bls so for us those wouldn't change much pt outcome. As for the rest, there should be classes you must take to be able to do these on a pt. Even setting up an iv for medics could be good
Here in Washington State you can get narcan when you exchange your dirty needles for clean ones at many places.
Ya, I know of a case where the users friends (who where also high on heroin) successfully used narcan they obtained to bring back in OD in their apartment.
Why no nitro?What the USA really needs is increased paramedic education at the basic level. In canada, our BASIC primary care paramedics have a two year college diploma, and the advanced care medics have 1-2 years more. Critical care paramedic is a year and a bit on top of ACP.
http://en.wikipedia.org/wiki/Paramedics_in_Canada
In ontario, most services allow PCP's to initiate IV therapy, insert SGA's (the king-lt), use CPAP .etc. Ontario PCP's will soon be able to perform manual defibrillation.
In canada, first responders are a tad under an EMT-B, and do NOT require full medical direction to use airway adjuncts AMFR skills off duty.
The best solution for canada and the US would be to bring up ALL medics to the PCP/ACP level, them make the FIRST RESPONDERS an EMT-B level with some extremely basic drugs such as epi-pen, asa and salbutamol (NO NITRO!).
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!
Nitro assist is definitely ok, but we shouldn't carry nitro. As a amfr 1 with additional training and knowledge, i am fully in support of us not carrying nitro due to the risks.
Under the Ontario protocols for nitro, a 12 lead is required to rule out rvi. This makes sense due to the harm that can result if nitro is given to a patient with right sided MI. Nitro assist ensures that the pt has a hx of nitro use. Now, just because you don't carry nitro would not mean that you would not be required to know and understand it's pharmacology - knowing when a protocol/guideline doesn't apply is just as, if not more than knowing when it does.
If you are talking paramedics, at any level then they do and should carry nitro.
Same would go for any fr service which trained the providers in ecg interp and 12 leads - ecg interp is not a regulated act, not taught as part of the amfr scope of practice, but it doesn't make it illegal for an mfr who has received the appropriate training/education to interpret an ecg.
Nitro assist is definitely ok, but we shouldn't carry nitro. As a amfr 1 with additional training and knowledge, i am fully in support of us not carrying nitro due to the risks.
Under the Ontario protocols for nitro, a 12 lead is required to rule out rvi. This makes sense due to the harm that can result if nitro is given to a patient with right sided MI. Nitro assist ensures that the pt has a hx of nitro use. Now, just because you don't carry nitro would not mean that you would not be required to know and understand it's pharmacology - knowing when a protocol/guideline doesn't apply is just as, if not more than knowing when it does.
If you are talking paramedics, at any level then they do and should carry nitro.
Same would go for any fr service which trained the providers in ecg interp and 12 leads - ecg interp is not a regulated act, not taught as part of the amfr scope of practice, but it doesn't make it illegal for an mfr who has received the appropriate training/education to interpret an ecg.
Nitro can be 'scary' in the wrong pts and if the pt doesn't have a hx of nitro use then you shouldn't give it w/o an iv which mfr's can't do - thus the reason why i don't think mfr's should carry nitro (along with a complete lack of education on pathophysiology and pharmacology). To give nitro also requires a 12 (in reality a 15 lead is much better) lead to rule out rvi
In the right pts, nitro can do a lot of good, such as ACPE/chf or the right mi pt.
Ontario land protocols require a 12 or 15 lead ekg. You are right though, it depends on if the pt is preload dependent.
An iv is required if no prior hx to allow treatment of hypotension if required.
That may be the protocol, but I think it is a bit conservative, unless you are using IV nitro.
Agreed. Patients self administer nitro all the time, without the benefit of a line or 12 lead prior.
I said it before, but I'll say it again because it seems to have gotten lost in the noise of this thread.
The real skills that BLS people need to learn are moving patients safely and effectively, customer service, and courteous, defensive driving.
Once they manage those, maybe then we'll let them touch some medical stuff.