# How do they get away with it?



## ilemtbwantn2bTXEMT-P (Apr 25, 2011)

Serious question here for anyone to answer to, a company I recently left in IL got away with carrying only oxygen on BLS Rigs and no other medications at all even when it was in the EMT Scope of Practice and the System SOPs 
How can they get away with that?


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## Tommerag (Apr 25, 2011)

If the medical director signs off on it. I'm not familiar with IL, what other meds can BLS give?


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## ilemtbwantn2bTXEMT-P (Apr 25, 2011)

Tommerag said:


> If the medical director signs off on it. I'm not familiar with IL, what other meds can BLS give?



He doesnt do the inspections if he did I'm sure there would be trouble but in IL we can give everything the National Scope of Practice allows, although I left IL I'm just wondering how they're getting around Illinois Dept. of Public Health and the EMS System Inspections on that according to our system we're supposed to also have the Nitro Spray Baby Aspirin Oral Glucose and Albuterol there and they don't


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## LucidResq (Apr 25, 2011)

Yeah, and on a BLS-only rig how often are those medications necessary? I guess there are some places that might use it, but I have yet to meet anyone who has given activated charcoal within the past 15 years. I guess it depends on how your system works with ALS availability, but any patient who requires something like aspirin for an MI or epi for anaphylaxis really needs a paramedic and their toolbox of skills and interventions more than they need an EMT and those drugs.


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## ilemtbwantn2bTXEMT-P (Apr 25, 2011)

LucidResq said:


> Yeah, and on a BLS-only rig how often are those medications necessary? I guess there are some places that might use it, but I have yet to meet anyone who has given activated charcoal within the past 15 years. I guess it depends on how your system works with ALS availability, but any patient who requires something like aspirin for an MI or epi for anaphylaxis really needs a paramedic and their toolbox of skills and interventions more than they need an EMT and those drugs.



Yeah no totally agree there, that in those cases you need ALS but we were supposed to be carrying them in the event we would have to wait for ALS on a Suspected MI with Chest Pain call, because you'd get fired over calling 911 for ALS Assist and they gave us the Nebulizers but no Albuterol, yeah I have never seen the Charcoal except in a textbook but I have given Albuterol more than once, as well as adminstered the Aspirin.


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## mycrofft (Apr 25, 2011)

*Sounds screwy to me.*

"Yeah no totally agree there, that in those cases you need ALS but we were supposed to be carrying them in the event we would have to wait for ALS on a Suspected MI with Chest Pain call, because you'd get fired over calling 911 for ALS Assist and they gave us the Nebulizers but no Albuterol, yeah I have never seen the Charcoal except in a textbook but I have given Albuterol more than once, as well as adminstered the Aspirin."

If you are "BLS" and your scope of practice under law has certain limits, you may not exceed those because the paramedics are going to be late. You have to have specific legal permission to give drugs. A company protocol will not protect you if the law says "no".

The symptoms of a common occupational illness amongst relatively new EMT-B's (and Medical First Responders, etc) include the overwhelming itches to be equipped for anything, and to include out-of-scope stuff they want to use because the emergency demands it.

You may be well-shut of that company.


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## Anjel (Apr 25, 2011)

We have 02 oral glucose and an epi pen. 

The nitro is supposed to be if the patient has their own prescribed to them. Then you can assist them in taking it. The same thing with albuterol inhaler. If it's theirs. And you have a protocol for it. Then you assist them in taking their own. Ambulances here aren't required to carry it. 

And if you go by national standards. Then you aren't required to have nitro, aspirin, and albuterol. For BLS. 

However, Epipen and oral glucose IMO should be on every rig, because most all protocols include those. 

I don't even have a protocol for Activated Charcoal anymore so we don't carry it.


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## Frozennoodle (Apr 25, 2011)

We carry a full ALS load on all our units.  As an interesting aside, our new regional protocols allow for the administration of premixed 5ml nebulized albuterol with med control authorization for BLS units.


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## mycrofft (Apr 25, 2011)

*Am Red Cross LAyperson First Aid allows "helping" pt take some meds*

Nitro tabs, "epi-pens, asthma MDI's, and oral glucose.


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## ffemt8978 (Apr 26, 2011)

LucidResq said:


> Yeah, and on a BLS-only rig how often are those medications necessary? I guess there are some places that might use it, but I have yet to meet anyone who has given activated charcoal within the past 15 years.


I've given activated charcoal twice in the past 5 years.  I've been lucky in that the patients were able to keep it down until they got to the ER, at which time they proceeded to repaint the exam room walls Linda Blair style.


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## mycrofft (Apr 26, 2011)

*I think the larger and more interesting question posed here is...*

...what if your service overstocks ambulances beyond your legal scope of practice, or has a culture of "Well, in a real pinch you can exceed your legal practice by..." fill in the blank: chest tube, open chest cardiac massage (as one poster said years ago), IV Valium?


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## Frozennoodle (Apr 26, 2011)

mycrofft said:


> ...what if your service overstocks ambulances beyond your legal scope of practice, or has a culture of "Well, in a real pinch you can exceed your legal practice by..." fill in the blank: chest tube, open chest cardiac massage (as one poster said years ago), IV Valium?



Then you're working for a service run by a bunch of whackers.  I can see some BLS providers getting tripped up on performing ALS skills on a double-basic truck stocked for ALS (We had a guy in paramedic school perform a 12-lead on a patient on a double-basic rig and he got reamed and recently was fired) but most people have enough sense not to do those things.  The ones that don't wind up on the other end of a pink slip, state suspension, and possibly civil and criminal action.


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