# question regarding scope of practice for EMT-Is in GA



## yanagster (Feb 26, 2009)

Just a thought. But why is it that, in GA, an EMT-I can start an IV even though he can't medicate but an EMT-I cannot intubate a patient. I understand the dangers presented when intubating of having to pass through vocal cords and not break teeth with the laryngoscope. I do not doubt the importance of knowing and starting IVs either, but all we can ultimately do with that by ourselves is help a person out that is dehydrated. I would just figure that intubation could be a practical skill that an EMT-I could utilize.


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## medic417 (Feb 26, 2009)

Actually both should only be Paramedic skills.  At the basic and intermediate levels you are trained skills.  You actually need education to understand the reasons why, what to expect good and bad, also the real dangers to these skills.  W/o education the use of skills are taken way to lightly.


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## jrm818 (Feb 26, 2009)

The list of complications from intubation are a lot longer than that...many of which cannot be treated by an EMT-I.  You need not only the ability to stick a tube down the trachea, but also to cope with (hopefully all) of the possible/probable complications. Pneumothorax, bronchial and esophogeal intubations, lacerations of any of the soft bits between the mouth and lungs, brocnchospasm, inflammatory responses, vagal stimulation can cause all kinds of havoc depending on the pt, etc. etc.

I know how to intubate a dummy...the acual process of passing the tube is not so hard to teach in principle.  Thats the part that seems easy.  Now add to it very detailed knowledge of the anatomy and physiology of the upper airways, the innervation of those areas adn various reflexes that occur when you jam plastic down someone's throat, the multiple controlled clinical exposures needed to become proficcent, the various techniques needed to cope with people whose physiology is different from recussi-annie, and once you do that, you get to get into the physiology of respiration and ventilation, etc.  Actually it wouldnt be so bad if all this was covered in all the EMT courses, but the amount of time required to acutally teach all that, with the necissary background, is a bit more than the current time requirements.

The complications from IV's are _relitavely _more benign.  Certianly non-existant, but generaly not so bad.


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## AJ Hidell (Feb 26, 2009)

yanagster said:


> I would just figure that intubation could be a practical skill that an EMT-I could utilize.


It was, around the late 1970s.  We've grown since then.  Years of disaster have taught us what a bad idea it was, and apparently someone in Georgia was smart enough to see the writing on the wall and rescind the privilege.  We have outgrown the belief that paramedic practice is nothing more than a collection of monkey skills to be handed out in steps.  We are now coming to understand that true education is a pyramid, not an inverted triangle.  The skills are built upon the foundation.  The foundation must come first.  That has invalidated the entire concept of an "intermediate" level of EMS practice.  Therefore, you now see the entire country progressively moving away from it altogether.


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## amberdt03 (Feb 27, 2009)

in texas, they are allowed to intubate. but i agree with medic417 in that it should be only a medic skill.


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## medic417 (Feb 27, 2009)

amberdt03 said:


> in texas, they are allowed to intubate. but i agree with medic417 in that it should be only a medic skill.



While it is a required skill to be tested in Texas many Medical Directors in Texas do not allow EMT-I's to intubate.


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## reaper (Feb 27, 2009)

SC just yank it away from basics and I's starting Jan. 1 2009. The uproar from all the basics and I's is funny to read. The sad part is the many medics that are backing their argument!!!!!!!!


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## joncrocker (Feb 27, 2009)

I'm sure you all know that TN is a different state in that it doesnt have EMT-Bs or EMT-Is, it has EMT-IV and EMT-P. EMT-IVs can do all basic skills plus start ivs and give a handful of meds. Really weird and confusing for some. But in my EMT class we were taught intubation on dummies even though that is out of our scope.


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## VentMedic (Feb 27, 2009)

joncrocker said:


> I'm sure you all know that TN is a different state in that it doesnt have EMT-Bs or EMT-Is, it has EMT-IV and EMT-P. EMT-IVs can do all basic skills plus start ivs and give a handful of meds. Really weird and confusing for some. But in my EMT class we were taught intubation on dummies even though that is out of our scope.


 
So for TN, is it EMT-IV as in IntraVenous and not "EMT-4"?

We thought TN had gone and added another level just for the FFs.

http://www.newschannel9.com/news/care_975929___article.html/chattanooga_firefighters.html

*Chattanooga Firefighters to Begin Level-4 EMT Care*

February 24, 2009



> Starting later this week, Chattanooga firefighters will begin giving *level four, E.M.T.* care at emergency scenes. Right now they are just taking care of first responder needs. Details of the enhanced care will be released at a news conference later this afternoon.


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## joncrocker (Mar 1, 2009)

Idk about the level 4. Idk know what that is   but my license states EMT Intravenous therapy.  What is level 4?


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## rhan101277 (Mar 1, 2009)

I received a copy of the registry, that I got from the NREMT.  It said that there will be 4 national levels starting in 2011.  Hope it will get all this EMT-1,2 etc. basic, intermediate, advanced stuff sorted out.


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