So i have a question... EMT-B Handling Meds

[jonesy0924]

I don't see a problem with an emt-b handing meds to a medic or spiking a bag as long as it is allowed by your agency and med director...also if the emt-b is properly trained...however that being said it is the medics responsiblilty to make sure the meds are correct and given properly,....

 

[TransportJockey]

D50 and narcan are both in the basic scope of practice in nm

D50 is an ILS drug, not anywhere near being in the BLS scope. NM basics have glutose in their scope.

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[EMS_Monkey]

What is the difference between drawing up Epi and drawing up something else? both would be "professional acts". In oregon emt-b'c can draw and administer epinephrine.
Just a thought... and I still wouldnt draw up ALS drugs just because I want to cover my own behind.

 

[slb862]

All the EMT-B's I work with, they are expected and willing to set up my IV's. They are willing to "get" my lock box of secured medications. They are willing to grab and hand me my medications. They are NOT willing, nor do I ask them to draw the medications up, or administer the medication to a patient. But, I will ask them to witness and sign when I waste a controlled substance.
AND, I am MORE than willing to educate, anyone willing to learn, about the drug I administered. (of course when time permits)

 

[AMF]

D50 is an ILS drug, not anywhere near being in the BLS scope. NM basics have glutose in their scope.

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ehh... BLS is kinda defined as noninvasive, meaning no drugs, though obviously there are a few. Intermediates here can give D50 wet but need a module to give narcan so I figured it was lower on the pyramid, but now that I look, I see you're right. Although they do teach it in nm basic refreshers so perhaps its purposefully ambiguous.

 

[usalsfyre]

It depends entirely on the level
of trust I have in the other provider. Other paramedics have fluster clucked med draws I've asked them to do before. I also believe in trust....but verify.

 

[NomadicMedic]

It's funny, but my regular partner at my 911 job was my right hand man on ALS calls. We worked in a van that was pretty tight and he would have drugs out and ready to go. I'd say, "I need 20 of dilt" and he'd pull the med, verify with me, repeat back "20 mg of dilt, it's 5 mg per ml, so here's 4 ml", draw it up and hand me the syringe stuck in the vial. Of course, he was an EMT-I, going to medic school and worked with me enough that he knew what I wanted and I knew that he knew his stuff. When it was just me and my partner, it was a huge help.

Would I let him independently draw up meds? No, but as a "medic assistant", which our partners were, it was invaluable.

 

[TransportJockey]

ehh... BLS is kinda defined as noninvasive, meaning no drugs, though obviously there are a few. Intermediates here can give D50 wet but need a module to give narcan so I figured it was lower on the pyramid, but now that I look, I see you're right. Although they do teach it in nm basic refreshers so perhaps its purposefully ambiguous.

In NM, BLS is slightly more invasive than a lot of other states. Our basics can and do (depending on the system ) give drugs on a regular basis. And intermediates needing an extra module to give Narcan? That's very odd.

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[HotelCo]

In NM, BLS is slightly more invasive than a lot of other states. Our basics can and do (depending on the system ) give drugs on a regular basis. And intermediates needing an extra module to give Narcan? That's very odd.

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What kind of drugs? Epi pens? Assist nitro?


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[TransportJockey]

What kind of drugs? Epi pens? Assist nitro?


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Assist NTG, give Epi (pens or drawing up in a dose limiting syringe), albuterol and atrovent, narcan, and asa are the primary ones given regularly. Charcoal, APAP, and oral glucose are also in there but given less frequently.
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[Shishkabob]

We don't carry Epi-pens at my service, but EMTs are taught and expected to draw up 1:1 in allergic reactions.

 

[firetender]

Missing link; Confidence

The part that the OP communicated that stuck out for me was that it doesn't appear he really knew what he was doing, or had not had a lot of practice. The medic who asked him to draw up clearly had no REAL idea of his level of competence.

It's fair to say a lot of medics who have experience and trust with their less-trained partners "delegate" some responsibilities -- especially of set-up -- but in this case the OP didn't have the confidence and his senior medic didn't have enough experience with the OP to warrant a request for something that has potential to cause harm to the patient.

 

[mycrofft]

I find two things of overriding interest here.

1. The number of people whose reply to the proposition that it is out of scope is "Well, I'm comfortable with it!"

2. The almost, if not total, absence of the concept that we, personally, might make a mistake.

When a recurrent response is "Well, someone's going to get into trouble", then the reason there are punitive rules to back up protocols becomes clear.

I hear this a lot from EMT-B's and I've been guilty of this sort of hubris myself in the past. I'll do it again, but not with a patient.

 

[MrM27]

When we get hired where I work they put you through additional training as an EMT. There are several things they make sure you learn and know how to do. I work for a very large ems organization and every thing we do on job is approved by our medical director and he is willing to make his voice heard.

1. Spike a saline bag.
2. Take a full 12 lead ekg.
3. Load an iv plum set/nitro cartridge into the pumps.
4. Fully set up a portable ventilator.

I feel it helps us grow as EMT's. There are many guys who learn it then don't bother to assist the medics because they feel that's not their job. But the truth of the matter is, why wouldn't you do "the most" you can do for any patient when needed. We call those lazy EMT's "skells". Be better than that. We are never expected to or should we ever draw up drugs of any kind into any needle/syringe/shooter. But the more you learn and can do, the better the work enviroment is for everyone. And after years of working in the same 911 system you gain the confidence of the medics and the nurses you work with on a daily basis.

MrM

 

[jjesusfreak01]

The EMT should be able to obtain a syringe, fill it with the correct dosage of medication, and then hand it with the vial still sitting on the end of the needle to the paramedic. In this way it can make the medic's job easier, but still requires them to check the Rs before administration. If you're on a scene where you don't have more than one medication in use, the emt can draw up the med, clear out the air, check the dosage, remove them needle, and hand the syringe and vial to the medic to check, so the medic has to do nothing but check the dose, drug, and go.

There's no reason an EMT can't be helpful with medications without causing any danger to the patient or the medic.

 

[Handsome Robb]

The EMT should be able to obtain a syringe, fill it with the correct dosage of medication, and then hand it with the vial still sitting on the end of the needle to the paramedic. In this way it can make the medic's job easier, but still requires them to check the Rs before administration. If you're on a scene where you don't have more than one medication in use, the emt can draw up the med, clear out the air, check the dosage, remove them needle, and hand the syringe and vial to the medic to check, so the medic has to do nothing but check the dose, drug, and go.

There's no reason an EMT can't be helpful with medications without causing any danger to the patient or the medic.

Agreed, with the proper training. You also work in a very high end and progressive system that is well respected around the nation. That can't be said about many systems in U.S. EMS, unfortunately.

 

[emsunit37]

confidence is the key to anything you do in ems. the service where I work are mostly EMT-B with endorsements to administer IV's fluids, some medications, intubation with a combitube and several other endorsements. Basically it all depends on where you are and what your protocols are but if any questions you can always ask your medical director

 

[EMTBHillbilly]

An EMT I know was once told, during a cardiac arrest, to push a dose of epi into a JV cath.
The medic had his hands full and he knew and trusted his EMT.

 

[Lady_EMT]

Were you wrong? Yes. I believe this was the original question.

But, realistically, things like this happen in the field. And if the medic trusts you enough to let you fill a syringe, the more power to you. EMTs/AEMTs exceeding their scope of practice happens quite commonly if they know what they're doing. And it's true, sometimes medics need an extra set of hands. If s/he is a good medic, s/he'll understand when you politely decline and tell them you aren't trained, therefore aren't allowed to do it. I've asked people to board/collar/get me a BGL, and the MRTs/EMRs (whatever they're called) will give me those puppy dog eyes and remind me they can't do it, and I have no problem with that. But in the same hand, I have a few MRT friends who I trust more than some medics, who I know can backboard/collar with their eyes closed, and they help me package.

But in the eyes of the legal system, you filling a syringe = your head on a shiny silver platter

 

[EMTBHillbilly]

EMTLady, There are things that happen for the good of the patient that do not get mentioned or discussed. . . it's called "street med."