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



## Pneumothorax (Jun 17, 2011)

So right now i function as an EMT-B(non transporting FD), I recently went on a call where my pt was seizing, when the Paramedics arrived.. i gave verbal report and assisted them in pt care. The medic asked me to draw up the versed , while he was starting the line and asking the pt more questions.

One of the commanding officers there with me  and said that i cant draw the med up (medic told me what vial, syringe, needle etc to get..i wasnt trying to be a superhero) (&...the pt is actively seizing)...

now i checked my protocols & didnt see anything that said i cant assist the medic-- I wasnt going to give the drugs or anything... 

I didnt back talk or anything..cuz that would be stupid. I just wondered if anyone else can fill me in if i was in the wrong? at any rate ill never do it again LOL.


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## Anjel (Jun 17, 2011)

Pneumothorax said:


> So right now i function as an EMT-B(non transporting FD), I recently went on a call where my pt was seizing, when the Paramedics arrived.. i gave verbal report and assisted them in pt care. The medic asked me to draw up the versed , while he was starting the line and asking the pt more questions.
> 
> One of the commanding officers there with me  and said that i cant draw the med up (medic told me what vial, syringe, needle etc to get..i wasnt trying to be a superhero) (&...the pt is actively seizing)...
> 
> ...




I would never do it. That is your license.

Say something happens. They trace it back to you and then the lawyers have a field day because your not trained in how to do that in the first place. that's their suit right there. 

Be very very careful


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## medicdan (Jun 17, 2011)

You shouldn't be handling any meds unless specifically authorized to by an ALS-assist class or protocols that allow you to give it under your own license/certification, especially narcotics. Ever. Unless you are signing the narc box in and out, and are trained to draw up meds, it's a bad idea. You're free to grab all of the components for the medic (syringe, needle, drug box), or can help them by doing other tasks (spiking an IV bag, if trained, preparing the monitor, readying the stretcher, etc).

Of course, each state and region is different, so please defer to local protocols. It might be worth doing some research of DEA documents, or what drug security policies are in your area.

Good Luck!


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## mycrofft (Jun 17, 2011)

*At scenes, wear a t shirt that says in big letters "EMT-B"*

emt.dan's got it. Especially handling narcs.


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## medicdan (Jun 17, 2011)

emt.dan said:


> You shouldn't be handling any meds unless specifically authorized to by an ALS-assist class or protocols that allow you to give it under your own license/certification, especially narcotics. Ever. Unless you are signing the narc box in and out, and are trained to draw up meds, it's a bad idea. You're free to grab all of the components for the medic (syringe, needle, drug box), or can help them by doing other tasks (spiking an IV bag, if trained, preparing the monitor, readying the stretcher, etc).
> 
> Of course, each state and region is different, so please defer to local protocols. It might be worth doing some research of DEA documents, or what drug security policies are in your area.
> 
> Good Luck!



I'll give you a quick example of what I'm talking about. I am certified, and work as an EMT-Basic, but as the driver (Basic) on a PB ALS ambulance, doing some combination of 911 and IFT (mostly IFT). I am trained (and permitted) under our medical director to perform certain skills as an ALS-assistant (spike saline bag, perform BGL, administer albuterol, etc) that I would not be able to while working purely BLS (at this company). 

However, while I can give an albuterol neb under the supervision of a medic without a problem, I cannot set up a combivent (ipratropium/albterol) treatment, despite the fact they are next to each other in the drug box, and set up the exact same way. I can spike a liter bag of saline, but not a liter bag of Lactated Ringers (using the exact same procedure). I don't have a set of keys to any of the medications, and although I sign the checkout of equipment and the truck, not the medications. 

Working in EMS, and being responsible (or party to the responsibility) for not only highly controlled substances, but also tens of thousands of dollars worth of equipment comes at a price, and that's often what may seem to be ambiguous lines in the sand. I strongly urge the OP and other forum members to learn what those lines are for your service, medical director, region, state, etc. I've worked in situations where narcotics have gone missing, or been tampered with, and it is a truly unpleasant experience... if you learn nothing else from my rant, please stay away from narcs unless permitted.


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## DesertMedic66 (Jun 17, 2011)

Look closely at your protocols. Mine say nothing about assisting a medic but it does say that an EMT-1 (EMT-B) may not draw up or administer a med. 

For me I would not have drawn them up even if the medic was yelling at me. That's one of the many reasons that I like having 2 medics on scene (1 fire medic, 1 ambulance medic).


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## MrBrown (Jun 17, 2011)

If you are not comfortable doing it, do not do it.

Brown is quite territorial about this sort of thing; if Brown works with a Technician they can give GTN, nebules etc all they like or draw up saline flushes.

Any IV drugs like adrenaline or morphine Brown will draw up unless Brown is working with a Paramedic (ILS) or Intensive Care (ALS).


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## Shishkabob (Jun 17, 2011)

Can someone tell me the difference between letting an EMT spike an IV bag and drawing up a syringe of a non-controlled substance?  




Hint:  There is none.


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## mycrofft (Jun 17, 2011)

*Sure, maybe .*

I actually woke up last night thinking about this one.
If "spiking the bag" was simply plugging A into B, and A and B were the only way to go and were verifiable by the person giving it, then it is a _*technical act.*_Drawing up a dose is a _*professional act*_, involving_* judgement and knowledge*_.

If I let someone else draw up a med into a syringe, unless I am directly watching them every step and I check the resultant dose, then I cannot chart or claim to have given that dose of that medicine. The best I can do is "I asked the EMT to draw up 2.5 ml of Wundadrug SR. I then injected 2.5 ml of a clear liquid drawn up by so-and-so to that order".

Example: for shot lines in Air Guard, med techs who had experience, and maybe a trainee under direct supervision and whose work was kept separate for checking, would draw up vials of ONE type of vaccine, usually for influenza. They were placed in a separate tray and it was labelled. The med techs or a nurse could then all just pick up the tray and administer flu shots.

On the other hand, if we were doing custom "touch-ups" to individuals' shot records, each dose was drawn and given by the tech or nurse giving the shot, since there were multiple vaccines, multiple patients in line, etc.

If I subconsciously mumbled that I needed 5 mg's of Wundadrug SR IM and a helpful EMT appeared with a syringe, I would have to ask them to bring me a new syringe and a vial of the med, then inspect the vial before drawing and administering.


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## Shishkabob (Jun 17, 2011)

mycrofft said:


> If I let someone else draw up a med into a syringe, unless I am directly watching them every step and I check the resultant dose, then I cannot chart or claim to have given that dose of that medicine. The best I can do is "I asked the EMT to draw up 2.5 ml of Wundadrug SR. I then injected 2.5 ml of a clear liquid drawn up by so-and-so to that order".



If someone lets someone else draw up a medication, and they never double check it themselves before giving it, there are bigger issues to be had.


I don't care if it's an Intermediate, another Paramedic, or a nurse who drew up the meds... I want to see the vial.


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## mycrofft (Jun 17, 2011)

*Agreed.*

But unless I actually check the vial beforehand and watch the needle go in, or there is verifiably no other vial there, I can't have direct knowledge. Unless this is a situation where my hands are tied up doing something immediately lifesaving (like doing a cric or fending off Young Frankenstein) but I can split my attention away to watch this dose occur (unlikely), I can't see where there is any benefit to having someone else draw up the dose.
Ask any clincial instructor; one of their worst nightmares is a student doing something like that and they don't catch it in time.


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## Pneumothorax (Jun 17, 2011)

firefite said:


> Look closely at your protocols. Mine say nothing about assisting a medic but it does say that an EMT-1 (EMT-B) may not draw up or administer a med.
> 
> For me I would not have drawn them up even if the medic was yelling at me. That's one of the many reasons that I like having 2 medics on scene (1 fire medic, 1 ambulance medic).



i went over my protocols and it doesnt say anything about not drawing up the med. I wouldnt dare administer it LOL..thats just job suicide.



emt.dan said:


> I'll give you a quick example of what I'm talking about. I am certified, and work as an EMT-Basic, but as the driver (Basic) on a PB ALS ambulance, doing some combination of 911 and IFT (mostly IFT). I am trained (and permitted) under our medical director to perform certain skills as an ALS-assistant (spike saline bag, perform BGL, administer albuterol, etc) that I would not be able to while working purely BLS (at this company).
> 
> However, while I can give an albuterol neb under the supervision of a medic without a problem, I cannot set up a combivent (ipratropium/albterol) treatment, despite the fact they are next to each other in the drug box, and set up the exact same way. I can spike a liter bag of saline, but not a liter bag of Lactated Ringers (using the exact same procedure). I don't have a set of keys to any of the medications, and although I sign the checkout of equipment and the truck, not the medications.
> 
> Working in EMS, and being responsible (or party to the responsibility) for not only highly controlled substances, but also tens of thousands of dollars worth of equipment comes at a price, and that's often what may seem to be ambiguous lines in the sand. I strongly urge the OP and other forum members to learn what those lines are for your service, medical director, region, state, etc. I've worked in situations where narcotics have gone missing, or been tampered with, and it is a truly unpleasant experience... if you learn nothing else from my rant, please stay away from narcs unless permitted.



youre 110% right. i learned my lesson! 



emt.dan said:


> You shouldn't be handling any meds unless specifically authorized to by an ALS-assist class or protocols that allow you to give it under your own license/certification, especially narcotics. Ever. Unless you are signing the narc box in and out, and are trained to draw up meds, it's a bad idea. You're free to grab all of the components for the medic (syringe, needle, drug box), or can help them by doing other tasks (spiking an IV bag, if trained, preparing the monitor, readying the stretcher, etc).
> 
> Of course, each state and region is different, so please defer to local protocols. It might be worth doing some research of DEA documents, or what drug security policies are in your area.
> 
> Good Luck!



yea. im gonna look some more stuff up, just so i can be completely informed.

everything was just so hectic and you know , we're there for the patient ultimately...but i guess i have to Cover my *** so i can continue to help 

thanks!


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## colorado207 (Jun 18, 2011)

maybe it's a good idea to have a good talk about meds with whomever you're working with beforehand. After reading this kind of thing, I'd almost want to make short list of things to discuss/ w co-workers w/ higher medical authority before getting into the thick w/ them. i dunno.


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## WTEngel (Jun 18, 2011)

Well you learned a lesson, and it sounds like no one was really worse for wear about it.

I really place more blame on the medic for this one, he/she should have known better and not put you in such a precarious position. It was not right of them to do that to you.

You handled the situation correctly (other than making the initial mistake) by taking your licks and moving on. 

This is a perfect example where you were counseled, learned your lesson, and moved on. Had you decided to be principled about the situation and try to justify it by claiming the medic authorized you, etc. it would have been much more trouble than it was worth I am sure, and probably would have resulted in a big deal being made out of a relatively minor situation.


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## Journey (Jun 18, 2011)

emt.dan said:


> However, while I can give an *albuterol neb *under the supervision of a medic without a problem, I cannot set up a *combivent *(ipratropium/albterol) treatment, despite the fact they are next to each other in the drug box, and set up the exact same way.



To be clear, you are speaking of Canada?

Combivent in the US is an MDI and not a liquid ampule. It would not be the same set up as a nebulizer. 

The Combivent liquid ampule at this time is not available in the US under that name. We do have Duoneb although most now just say ipatropium/albuterol since other pharmaceutical companies manufacture it.

To administer a Combivent MDI you would need to know the technique well enough to talk a patient through it. You would also need to document allergies and be able to reverse them if they did have a reaction to the lecithin in the propellant. However, this should be the only inhaler you would still have to worry about it and if you are in Canada, I doubt if this inhaler is still available and probably will not be much longer in the US.


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## medicdan (Jun 18, 2011)

Journey said:


> To be clear, you are speaking of Canada?
> 
> Combivent in the US is an MDI and not a liquid ampule. It would not be the same set up as a nebulizer.
> 
> ...



My mistake!!! I was talking about the Duoneb. I was just writing about the Combivent somewhere else... and must have slipped. Thanks for catching!


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## TransportJockey (Jun 18, 2011)

Here in NM, the narcs are on my person so a basic can't 'assist' me with those. Almost all the other drugs on the bus I'll have them get ready for me if I need it, I just double check the doseage before I push it, every time. But a lot of the drugs (epi, Albuterol, narcan) I use on a regular basis the basics can give and use as well, so it's not an issue


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## Shishkabob (Jun 18, 2011)

Meh, my Versed and Fentanyl are in a safe to which only I have the code, and Ativan is in a cooler to which only I have the key.


But still, no one has been able to answer the difference between an EMT spiking a bag, and drawing non-controlled substances in to a syringe.


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## TransportJockey (Jun 18, 2011)

There's not one. All of my basics spike bags for me daily. They draw up meds like Zofran for me, daily. The person with the authorization to give the drug should be the one pushing it, not them.


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## Handsome Robb (Jun 18, 2011)

I understand the need to draw up narcotics yourself. However, if you trust your partner what is wrong with them drawing up non narcotics while you handle something else. Of course check your dose, but if you trust your partner I don't see what's wrong with having them draw something up for you. But in other situations I would agree with handling the meds your giving from start to finish.


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## Shishkabob (Jun 18, 2011)

TransportJockey said:


> There's not one. All of my basics spike bags for me daily. They draw up meds like Zofran for me, daily. The person with the authorization to give the drug should be the one pushing it, not them.



Exactly!  Not a single difference between spiking a bag and drawing a med.


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## mycrofft (Jun 18, 2011)

*Technical versus professional.*

SPIKING BAG= go to the shelf, pick the primary bag, pick the drug, stick the spike into the bag, mix premeasured correct chemical into known volume primary IV solution (*a premeasured and strictly mechanical act*), then hang it or pass it over or whatever. If you can read and keep your cool anyone can do it.

DRAWING UP A MED: right med, right time, right dose, right patient, right route, and all that? Requires_* measurement and decision-making*_, unless it is a premeasured med and it is in only one form and dose on the vehicle.

A pharm tech could under supervision. A paramedic could because their training includes drugs, measures, and admin, and because the paramedic will also be giving it.


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## Shishkabob (Jun 18, 2011)

I don't know about you, but I have multiple IV solutions on my truck, from NS to LR to 5%, to Lidocaine, Dopamine and others.  Trusting your EMT to grab the right one, you should still double check it before you start the line, no?


So, what if you give your EMT the specific medication by hand?  You're taking the decision making process away from them and now making it, as you stated, a purely technical skill.  




So... what's the difference?


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## TransportJockey (Jun 18, 2011)

mycrofft said:


> SPIKING BAG= go to the shelf, pick the primary bag, pick the drug, stick the spike into the bag, mix premeasured correct chemical into known volume primary IV solution (*a premeasured and strictly mechanical act*), then hang it or pass it over or whatever. If you can read and keep your cool anyone can do it.
> 
> DRAWING UP A MED: right med, right time, right dose, right patient, right route, and all that? Requires_* measurement and decision-making*_, unless it is a premeasured med and it is in only one form and dose on the vehicle.
> 
> A pharm tech could under supervision. A paramedic could because their training includes drugs, measures, and admin, and because the paramedic will also be giving it.



I trust my partners here to measure up exactly how much I tell them. I'll tell them ccs and mgs and trust them to do the rest. When they give it to me, I double check the dose, then push it when I feel is the right time.  Our basics learn IM/SQ/IN drug admin, so it's different than in some states


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## mycrofft (Jun 18, 2011)

*Dose has to be drawn properly.*

(Shaken, rolled, or not aggitated; correct amount; menicus issues; assess if it has sediment or ought to be clear and colorless; effervesence from shaking or bubbles). 

After stopping to check the drug or hand it to them, then stopping to check the dose, why not just do it all yourself and save the potential time in the witness box or the boss's office?

Trust is good, but if it fails it nails you and your assistant and the pt.

I'm just going over what we had drilled into us in nursing, then on the job by our employer after the DEA reamed us a new one (while I was off premises) for for improper procedures. This isn't DC Comix, it's real life.


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## Farmer2DO (Jun 19, 2011)

Linuss said:


> I don't know about you, but I have multiple IV solutions on my truck, from NS to LR to 5%, to Lidocaine, Dopamine and others.  Trusting your EMT to grab the right one, you should still double check it before you start the line, no?
> 
> 
> So, what if you give your EMT the specific medication by hand?  You're taking the decision making process away from them and now making it, as you stated, a purely technical skill.
> ...



While I understand what you are saying, I don't agree with you.  Spiking a bag is not measuring.  I'm assuming that any bag that's spiked will then have the rate set by the paramedic, a process that requires confirming the fluid/drug and concentration.  Sure, a basic can spike a pre-mix bag of dopamine, but he's not setting the rate.

The only non-paramedics that draw up drugs are paramedic students or paramedic interns that are clearing with me as an FTO, and this is under my direct supervision.  I will let my student/partner draw up, but I hand him the vial, watch him draw it up, and confirm the empty vial and the correct dose in the syringe, and then watch him closely as he pushes it.  I'm the one responsible, and the only thing I will let others do (that aren't student or intern) is put together prefilled syringes during a code.  Our company won't even let an intern draw up controlled substances under my supervision.  I'm not allowed to pass controlled substances off to any one at any time, for any reason (unless it's a supervisor, say if I get injured or sick).  They insist on making the new paramedic's first time giving controlled substances in the field their first time ever doing it in an ambulance.  I don't agree, but in NYS this is taken VERY seriously.


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## TransportJockey (Jun 19, 2011)

Farmer2DO said:


> While I understand what you are saying, I don't agree with you.  Spiking a bag is not measuring.  I'm assuming that any bag that's spiked will then have the rate set by the paramedic, a process that requires confirming the fluid/drug and concentration.  Sure, a basic can spike a pre-mix bag of dopamine, but he's not setting the rate.
> 
> The only non-paramedics that draw up drugs are paramedic students or paramedic interns that are clearing with me as an FTO, and this is under my direct supervision.  I will let my student/partner draw up, but I hand him the vial, watch him draw it up, and confirm the empty vial and the correct dose in the syringe, and then watch him closely as he pushes it.  I'm the one responsible, and the only thing I will let others do (that aren't student or intern) is put together prefilled syringes during a code.  Our company won't even let an intern draw up controlled substances under my supervision.  I'm not allowed to pass controlled substances off to any one at any time, for any reason (unless it's a supervisor, say if I get injured or sick).  They insist on making the new paramedic's first time giving controlled substances in the field their first time ever doing it in an ambulance.  I don't agree, but in NYS this is taken VERY seriously.


I know in my area, that attitude would be ridiculous, since our basics can actually give IM/SQ some of th drugs I'm asking them to draw up. Narcs and Benzos still only get drawn up by me, but if I need benedryl, I see no reason they can't take the vial from me, draw up 2ccs like I tell them to, I double check the dose before I push it. 
After all, don't we all double check the dose we draw up ourselves before we push it? I know I check drug, dose, and route about 3-4 times from vial out to pushing.


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## Farmer2DO (Jun 19, 2011)

That exact situation got a paramedic in trouble in my area a few years ago.  She was treating a presumed allergic reaction, and had her basic partner draw up the "benadryl" and then she (the paramedic) pushed it.  She gave 3 doses of IV "benadryl" because the patient wasn't improving (yes, I know we don't repeat doses of benadryl in that short of a time period) and it wasn't until the patient care had been transferred to hospital staff that she realized the bottle in her bag that had been opened was 1:1000 epi, and not benadryl.  She had given 1 mg epi 1:1000 IVP X3.  The patient was in V. tach, had to be cardioverted, and had a troponin spike.

Granted, she didn't check to make sure it was the right drug, right dose etc.  But the system came down hard, and only in a cardiac arrest can non-ALS providers do anything, and that's assembling pre-loads.

One of my friends was new at the company, and his partner set up the neb with 2 unit doses of albuterol, 1 unit dose of atrovent (our standard first line cocktail) and then threw out the vials.  He dumped them out and did it himself, since he couldn't confirm the right dose.  Partner got mad, ALS chief backed him up.  And I agree with him.

Again:  my card, my number, my responsibility.  I call the shots.  Only interns and students handle drugs under my supervision.


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## Anjel (Jun 19, 2011)

basics here don't touch any meds. Period.

If I did I probably would loose my job.


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## MrBrown (Jun 19, 2011)

Brown does not mind a Technician (Ambulance Officer) administering any medicine for which they are qualified, drawing up saline or setting up an IV bag.

Adrenaline and morphine (our Paramedic drugs) can only be handled by, *gasp, the Paramedic.


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## Pneumothorax (Jun 20, 2011)

TransportJockey said:


> I know in my area, that attitude would be ridiculous, since our basics can actually give IM/SQ some of th drugs I'm asking them to draw up. Narcs and Benzos still only get drawn up by me, but if I need benedryl, I see no reason they can't take the vial from me, draw up 2ccs like I tell them to, I double check the dose before I push it.
> After all, don't we all double check the dose we draw up ourselves before we push it? I know I check drug, dose, and route about 3-4 times from vial out to pushing.



here in our EMS system EMT-B's can draw up and mix glucagon and admin, under our protocols.

and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig.  Its way easier to suck some unmixed juice up in a syringe.

& wherever you are you should always check the med if you didnt draw it up yourself--


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## sir.shocksalot (Jun 20, 2011)

Pneumothorax said:


> and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig.  Its way easier to suck some unmixed juice up in a syringe.


I'm confused, do you plan on injecting unmixed juice?
As a side note, what the heck is unmixed juice? Is that the fruit that the juice is made of?


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## CAOX3 (Jun 20, 2011)

Pneumothorax said:


> here in our EMS system EMT-B's can draw up and mix glucagon and admin, under our protocols.
> 
> and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig.  Its way easier to suck some unmixed juice up in a syringe.
> 
> & wherever you are you should always check the med if you didnt draw it up yourself--



You draw saline into the syringe then you inject it into the glucagon vial, remove syringe, shake, reinsert the syringe the medication will be at the bottom of the vial draw up the desired dose and leave foam in the vial.

There is no juice its medication, it isn't a difficult undertaking for most.


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## Pneumothorax (Jun 20, 2011)

> I'm confused, do you plan on injecting unmixed juice?
> As a side note, what the heck is unmixed juice? Is that the fruit that the juice is made of?.



by juice I mean the liquid in the vial...sorry---


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## usalsfyre (Jun 20, 2011)

Pneumothorax said:


> here in our EMS system EMT-B's can draw up and mix glucagon and admin, under our protocols.
> 
> and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig.  Its way easier to suck some unmixed juice up in a syringe.
> 
> & wherever you are you should always check the med if you didnt draw it up yourself--



Never really had much of an issue with glucagon. Now back when amiodarone came in the 5ml ampules...imagine trying to draw up a bubble bath


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## MagicTyler (Jun 20, 2011)

My paramedic instructor told us a story from at an agency he used to work at in the mid 90s:

A medic instructed his EMT to "put a gram of lidocaine in the line" (meaning put it in the NS bag), the EMT did exactly as he was told and put it right in the IV. The patient coded (and obviously died). Both were fired, and the medic lost his cert, the medic was charged in court. The EMT was not charged in court, and the state EMS office did not pull the cert of the EMT (even though he was outside his scope of practice). They determined that he was only following his medics orders and was not in a position to refuse.


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## HotelCo (Jun 20, 2011)

We only have NS here, so meds and spiking a bag ARE two completely different things. 

My basic/spec partners don't touch anything inside the drug box. 

Sent from my iPhone using Tapatalk


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## Chief Complaint (Jun 23, 2011)

Its very rare that there is a Basic riding on a rig in the county i have done my internships with, but i have seen one handling meds.  It was at the request of the medic who had his hands full and the Basic only grabbed them from the drug box, didnt draw anything up or push.

Ive heard stories of Basics pushing D50, but ive never seen it.


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## AMF (Jun 23, 2011)

Chief Complaint said:


> Its very rare that there is a Basic riding on a rig in the county i have done my internships with, but i have seen one handling meds.  It was at the request of the medic who had his hands full and the Basic only grabbed them from the drug box, didnt draw anything up or push.
> 
> Ive heard stories of Basics pushing D50, but ive never seen it.



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


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## dixie_flatline (Jun 23, 2011)

As a B in Maryland, I don't touch any ALS medications really, with the exception of spiking a bag.  However, we only carry 500 bags of LR, so it's not really possible to get the wrong bag.  All I do is assemble the bag+drip kit, and maybe get a saline lock ready.

The closest I get to touching "real" meds is when I'm cleaning up sharps.


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## jonesy0924 (Jun 23, 2011)

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,....


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## TransportJockey (Jun 23, 2011)

AMF said:


> 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. 

Sent from my PC36100 using Tapatalk


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## EMS_Monkey (Jun 23, 2011)

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.


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## slb862 (Jun 24, 2011)

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)


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## AMF (Jun 24, 2011)

TransportJockey said:


> D50 is an ILS drug, not anywhere near being in the BLS scope. NM basics have glutose in their scope.
> 
> Sent from my PC36100 using Tapatalk



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.


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## usalsfyre (Jun 24, 2011)

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.


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## NomadicMedic (Jun 24, 2011)

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.


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## TransportJockey (Jun 24, 2011)

AMF said:


> 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.

sent from my Nook Color using Tapatalk


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## HotelCo (Jun 24, 2011)

TransportJockey said:


> 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.
> 
> sent from my Nook Color using Tapatalk



What kind of drugs? Epi pens? Assist nitro? 


Sent from my iPhone using Tapatalk


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## TransportJockey (Jun 24, 2011)

HotelCo said:


> What kind of drugs? Epi pens? Assist nitro?
> 
> 
> Sent from my iPhone using Tapatalk




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.
sent from my Nook Color using Tapatalk


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## Shishkabob (Jun 24, 2011)

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


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## firetender (Jun 24, 2011)

*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.


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## mycrofft (Jun 25, 2011)

*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.


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## MrM27 (Jun 25, 2011)

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


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## jjesusfreak01 (Jun 26, 2011)

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.


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## Handsome Robb (Jun 26, 2011)

jjesusfreak01 said:


> 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.


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## emsunit37 (Jun 26, 2011)

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


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## EMTBHillbilly (Jun 28, 2011)

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.


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## Lady_EMT (Jun 28, 2011)

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


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## EMTBHillbilly (Jun 28, 2011)

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


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## JonTullos (Jun 28, 2011)

When I'm a medic, my partner will only do things that are within their scope of practice (vitals, O2, etc.).  That includes drawing up meds.  Absolutely not.  That's my patch on the line if something goes wrong.  I have no problem spiking a bag because all that's doing is putting a drop set into a bag of fluid and flushing the air.  There's no reason that another provider couldn't do that.


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## NomadicMedic (Jun 28, 2011)

I think it depends on where you work, what level the EMT is uptrained to, and how comfortable you are with their skills. I worked in a very busy 911 system where most of the EMTs were intermediates. They were expected to be the medic's assistant. Would I allow an EMT I didn't know to touch my med box? No way. But my partner was trained, able, and expected to help me when I needed it. In many cases, my EMT-I partner would start a line while I was doing other stuff. It's called teamwork, and why I think a medic and I are the a great team.


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## CAOX3 (Jul 2, 2011)

EMTBHillbilly said:


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



Really, if your medics need assistance drawing and administering medications they should be working double medic.

Street med, please there is no secret society of EMTs  that on a regular basis work outside of their scope.  If they do the system is broken.

Your EMTs should be able to handle the aspects of their job, while the medic tends to his responsibilities.  I have done  a million codes, traumatic arrests, stabbings, shootings you name it with only one medic  on scene and never once been asked to step outside my scope.

You need strong EMTs, if he doesn't have to worry about what your doing then he can concentrate on his obligations.


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## EMTBHillbilly (Jul 2, 2011)

"I have done a million codes, traumatic arrests, stabbings, shootings you name it with only one medic on scene and never once been asked to step outside my scope."

Really?  Come on, I mean, really?


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## usalsfyre (Jul 2, 2011)

Is drawing up the med (NOT administering it) really "working outside your scope"?  If it is, then is turning on the monitor working out of scope? Or handing the medic a ETT?  Because we could get into some REALLY high level ridiculousness. 

What is everyone so scared of?


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## Shishkabob (Jul 2, 2011)

usalsfyre said:


> Is drawing up the med (NOT administering it) really "working outside your scope"?  If it is, then is turning on the monitor working out of scope? Or handing the medic a ETT?  Because we could get into some REALLY high level ridiculousness.
> 
> What is everyone so scared of?



Ta-da.



You can't separate spiking an IV bag from drawing up other medications.  Same exact premise people.


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## CAOX3 (Jul 2, 2011)

usalsfyre said:


> Is drawing up the med (NOT administering it) really "working outside your scope"?  If it is, then is turning on the monitor working out of scope? Or handing the medic a ETT?  Because we could get into some REALLY high level ridiculousness.
> 
> What is everyone so scared of?



Scared? No.

Where do you draw the line then?  First it's drawing up the medication, next it's a little more, then a little more, finally the situation is out of control, 

You want EMTs to know their place but then you blur the lines, that's when the problems start.

And spiking a bag and drawing up medications is not the same, if it is then I challenge you to note it in your  report "had EMT draw up 2mg of ativan, then I administered it" let me know how that works out for you.

Its  not the act its the premise.

I'm no policy/protocol monkey by any stretch and I have the rips to prove it.  Its about the example you set and this isn't a good one.


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## usalsfyre (Jul 2, 2011)

CAOX3 said:


> Scared? No.
> 
> Where do you draw the line then?  First it's drawing up the medication, next it's a little more, then a little more, finally the situation is out of control,


The line? The line is simple, "who actually performs the invasive procedure".



CAOX3 said:


> You want EMTs to know their place but then you blur the lines, that's when the problems start.


Less "knowing your place" and more "stay with in your credentialing", which has to do with patients, not other ancillary stuff.



CAOX3 said:


> And spiking a bag and drawing up medications is not the same, if it is then I challenge you to note it in your  report "had EMT draw up 2mg of ativan, then I administered it" let me know how that works out for you.


There's four different fluids on my truck, not counting NTG, dopa and lidocaine infusions. So I've got to check what they do regardless. As far as charting who drew up the med,  that's not appropriate charting. Again, do you chart who applied the electrodes? Who handed you the cath for an IV? Nope, the guy who performs the intervention is responsible for it. 




CAOX3 said:


> Its  not the act its the premise.


Not sure what's wrong with the premise?



CAOX3 said:


> I'm no policy/protocol monkey by any stretch and I have the rips to prove it.  Its about the example you set and this isn't a good one.


Every Basic at my service is taught to draw up a med and administer it (epi 1:1000 IM). So what's wrong with having them use half that skill?


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## CAOX3 (Jul 2, 2011)

So if its accepted practice, put it on paper.

I mean thats the only true test, isn't it?

What are you scared of?  

Rules and boundaries are in place for a reason, no I don't agree with them all, they are in place for a reason and if we start allowing the lines to be crossed, then the system will collapse.  Like it is doing right now.  When I began in EMS there were EMTs and paramedics each had a defined scope now there are hundreds of different levels, expanded scopes and add on's.

When you need a paramedic, you ned a paramedic, not an EMT with additional weekend of training.  I have an expanded scope and I don't agree with all of it, because there its no substitute, for a experienced and educated paramedic and I think allowing EMTs to do a little more only muddies the water.  I can draw medications and we even administer a few, so I wouldn't have an issue theoretically, in practice I don't agreed with it because it s just opening a can of worms an the one time your busy and forget to check the vial and the wrong medication is administered everone is going down, from top to bottom.  Good providers who simply made a mistake.

I don't think its worth the hassle and I have yet to see the paramedic who doesn't have the time to tend to his duties, let the EMTs operate at their level and you should have plenty of time to operate at yours.


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## usalsfyre (Jul 2, 2011)

CAOX3 said:


> So if its accepted practice, put it on paper.
> 
> I mean thats the only true test, isn't it?


But it's not good charting. It's like charting the color of the patient's shirt. Totally irrelevant. Most EMS charting laughable anyway, throwing crap like this in makes it beyond idiotic.



CAOX3 said:


> Rules and boundaries are in place for a reason, no I don't agree with them all, they are in place for a reason and if we start allowing the lines to be crossed, then the system will collapse.  Like it is doing right now.  When I began in EMS there were EMTs and paramedics each had a defined scope now there are hundreds of different levels, expanded scopes and add on's.


There's been a stupid number of levels for years. Look at VA, they've had four levels pretty much since inception.



CAOX3 said:


> When you need a paramedic, you ned a paramedic, not an EMT with additional weekend of training.  I have an expanded scope and I don't agree with all of it, because there its no substitute, for a experienced and educated paramedic and I think allowing EMTs to do a little more only muddies the water.


EMT education focuses on absolutely the wrong things. Their job, in most systems is "paramedic assistant". Yet we insist on trying to cram enough info into 120 hours to make them an independent provider. None of my patients will ever get "an EMT with a few weekend courses" because my system recognizes that putting a paramedic at bedside is the best way of operating. As such, focusing the EMT's role on ways to assist the paramedic helps onscene efficiency.



CAOX3 said:


> I can draw medications and we even administer a few, so I wouldn't have an issue theoretically, in practice I don't agreed with it because it s just opening a can of worms an the one time your busy and forget to check the vial and the wrong medication is administered everone is going down, from top to bottom.  Good providers who simply made a mistake.


How's it different than grabbing the wrong vial yourself? Answer? Don't be caviler with meds, no matter who handles them. It will bite you in the backside.



CAOX3 said:


> I don't think its worth the hassle and I have yet to see the paramedic who doesn't have the time to tend to his duties, let the EMTs operate at their level and you should have plenty of time to operate at yours.


So your medics can start an IV with one hand and draw up epi with the other?


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## Shishkabob (Jul 2, 2011)

CAOX3 said:


> And spiking a bag and drawing up medications is not the same, if it is then I challenge you to note it in your  report "had EMT draw up 2mg of ativan, then I administered it" let me know how that works out for you.



Ativan is a controlled substance.  Lactated Ringers is not.  Benadryl is not. 


Our agency allows EMTs to administer Epi 1:1, SQ/IM... not from an Epi-pen, but from a syringe that they draw up themselves.  They are taught how to do this in our orientation academy, and are expected to be able to when called upon for it.  Clearly our agency has weighed the risks/benefits of allowing EMTs to draw meds in to syringes.


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## TransportJockey (Jul 2, 2011)

I agree w/ Linuss and usalsfyre again. My basic partners are trained to draw up meds during class in this state. They can administer two different meds they drew up IM/SQ. So... why is it a problem if I'm working an anaphylactic shock patient, and I'm starting the IV, if I have them draw up benedryl for me to push when I've got the IV in place? Hell, half the time they're drawing up and pushing the Epi IM for me while I'm getting everything else ready. If they're not doing that, they're tossing the patient on 5mg Albuterol (again, very much in their scope) while I'm doing the Epi.

And as for charting... What is documented (both when I worked in a hospital and on a truck) is who did the invasive skill, not who prepared it. My basics spike bags of LR or NS all the time for me. But I've never seen a PCR that states 'NS/LR spiked by EMT-B ____', have you? Same with meds.


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## usalsfyre (Jul 2, 2011)

As much as we hate on paramedic education around here, EMT training (cause I can't bring myself to call it education) is so jacked we'd be better off scrapping the whole thing.


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## TransportJockey (Jul 2, 2011)

usalsfyre said:


> As much as we hate on paramedic education around here, EMT training (cause I can't bring myself to call it education) is so jacked we'd be better off scrapping the whole thing.



No arguments from me there.


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## usalsfyre (Jul 2, 2011)

TransportJockey said:


> No arguments from me there.



And the funny thing is with some adjustments I think Intermediate is a pretty good starting point.


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## TransportJockey (Jul 2, 2011)

usalsfyre said:


> And the funny thing is with some adjustments I think Intermediate is a pretty good starting point.



I'd say a 2 semester EMT-I program that has more focus in A&P (like A&P1 during semester 1 and A&P2 w/ cadaver lab in semester 2) would make for a great entry level EMS position. And make requiring an AAS for EMT-P as a minimum make more sense.


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## jjesusfreak01 (Jul 2, 2011)

usalsfyre said:


> EMT education focuses on absolutely the wrong things. Their job, in most systems is "paramedic assistant". Yet we insist on trying to cram enough info into 120 hours to make them an independent provider. None of my patients will ever get "an EMT with a few weekend courses" because my system recognizes that putting a paramedic at bedside is the best way of operating. As such, focusing the EMT's role on ways to assist the paramedic helps onscene efficiency.



Personally, I like the way its done where I live. My EMT-B class was 190 hours of training in medical science, skills, and equipment. This qualifies you to work convalescence with no further training. To work EMS, I have a number of months of training in paramedic assist skills and driving. I'll have spent more than 250 hours as a third rider before I move to second. So, would you trust an EMT with 500 hours of training to draw up meds, to care for basic level patients, to drop a King airway (the coolest skill in my scope)? 

This is the way it should be. No EMS system should trust that a person's EMT-Basic class prepared them to work in the field. The agency should be ultimately responsible for training and testing their employees on the skills they expect them to use. 

At the same time, there is always going to be a place for the EMT Basic certification. I think its perfect for convalescence and firefighters. A convalescence EMT might occasionally need to suction a patient, will often need to administer O2 based on the needs of a patient, and will need to make transport decisions based on the condition of a patient (we occasionally have to refer pts to EMS, but this has to be an educated decision, not a CYA decision, as we often transport pts with AMS and very diminished vitals). A firefighter, on the other hand, can benefit from a basic cert by knowing how to take basic vitals, including BGL, knowing how to assist in immobilizing the pt, and having a general knowledge of some of the conditions faced by their patients.


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## mike1390 (Jul 3, 2011)

heres my thing if I really trust my partner then why not? would I ever not look over the dose? NO would I expect them to do my math for me? NO. prime example diabetic, Im tying to get a line and on my 3rd attempt I tell my EMT partner screw it get my glucogon... while I tend to my now pin coushin. once he draws up the easiest med then ill give it. Could be just me but again this is only if i really trust my partner not somebody im just working with.


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## CAOX3 (Jul 4, 2011)

I guess I'll agree to disagree.

My EMT class was two semesters, fourteen college credits, three days a week, anatomy and physiology were pre-reqs to be accepted.

The class has now been replaced, enrollment was down because you can get the same certification in three weeks.


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