# How "Basic" is BLS in your area



## vc85 (Jan 5, 2014)

I am just wondering how 'basic' is BLS in your area.  I was reading some of the other threads and I'm amazed.

In my region/area an EMT-B can do

CPR
AED
Oxygen
Pulse Oximetry
Glucometry
Oral Glucose Administration
Epi-Pen
Albuterol
Asprin
Atropine auto injector (Organophosphate poisoining and WMD)
Assisted Nitro
OPA
NPA
Clotting Sponges
1 attempt to reduce a fx if distal pulse is missing
Plus all of the splinting, backboarding, bandaging, etc

And on the way:

Nasal Narcan
CPAP
Expanded Nitro protocol (Systolic of 100)
Epi-pen for asthmatics not responsive to albuterol with med-control
Venturi masks
Automatic Transport vents

Talked about possibly coming

ETCO2 readings (numbers, not waveform)
King/rescue airways

Hearing some of the stories of what BLS can do in other parts of the country, make this seem like a fully stocked ALS unit


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## STXmedic (Jan 5, 2014)

Your system is on the high end for what it allows basics to do. Our basics can do all of the same, plus King and IO, but can't use CPAP, Vents, or epi for asthma. Again, this is the high end of the spectrum. There are systems that don't allow pulse oximetry.


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## Aprz (Jan 5, 2014)

I have worked in three counties all in California as an emergency medical technician on an ambulance: Santa Clara County, Alameda County, and Contra Costa County (current). The scope of practice is similar in all three counties.

Chest compressions
Spinal immobilization
Splinting
Defibrillation via automatic external defibrillators 
Positive pressure ventilation via bag-valve mask
Head-tilt chin-lift
Jaw thrust
Nasopharyngeal airways
Oropharyngeal airway
Manage the airway via position
Oral glucose
Oxygen via nasal cannula, non-rebreather mask, or bag-valve mask
Bleeding control with direct pressure or tourniquets (we have combat application tourniquets)
Pain management via hot/cold packs
Irrigation
Assist with patient's own medications, particularly nitroglycerin (NTG), albuterol, or EpiPen.

We cannot do pulse oximetry or glucometry. We cannot manage the patient's airway using advance airways such as king airways or combitubes.


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## NomadicMedic (Jan 5, 2014)

Our basics here are allowed do most of that. CPAP in some trucks. A pilot of IN Narcan is coming. 

Useless, as it will all just expire on the trucks because 90% of the time the medics arrive first.


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## chaz90 (Jan 5, 2014)

In my old system in Colorado, EMTs are able to start IVs, administer saline boluses, give D50, albuterol, NTG assist, ASA, Narcan, King tubes, plus everything else you mentioned in the first part of your post. As far as I know, they still can't do CPAP, Epi for asthma, Venturi masks (kind of surprised you guys carry these), or vents of any kind. 

This was in a system where a basic was always with a medic on the ambulance. There were events staffed by EMTs only where some of the scope could potentially be used without ALS ALS present. Our EMT firefighters worked off a slightly more restrictive scope and didn't do anything involving IV access. A lot of this was put in place for our rural, outlying FR volunteer fire departments. They wanted to be able to do some of these additional things as they waited ~30-45 minutes for an ALS ambulance from the city. 

I'm not convinced it was always a good thing having a vollie who runs 10 calls a year turning your patient into a cushion before you got there, but it proved useful a handful of times. I absolutely loved it as a basic working on the ambulance itself. Our EMTs started as many IVs as the medics, and in some cases more. We were quite competent with them, and it was great to be able to do that for the medic on the truck as they worked on other things.


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## TransportJockey (Jan 5, 2014)

Here they can do splinting and bandaging, oxygen admin, atrovent, albuterol, Asa, Narcan (IM/IN), epi pen or drawing up and administering epi in a 0.3cc syringe with mcep. Charcoal, APAP, all Supraglottic airways, NPAs, OPAs, CPAP, BGL checking, auto transport vents.... Plus probably some stuff I'm missing


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## vc85 (Jan 5, 2014)

Yeah I realized I left out a few things from reading this post.  Obviously all of the positioning we can do, ice/heat packs, irrigation,  we can give activated charcoal with medical direction. We can also use tourniquets, and those are now a second line treatment after direct pressure

Some of the more advanced airway stuff (Auto Transport Vents, Venturi, etc)I believe are in the process of getting authorized or just got authorized.  Carrying them is a different story and I don't know if we will or won't yet


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## TheLocalMedic (Jan 5, 2014)

I'm pretty near where you are, Aprz, so it's about the same.  Pretty limited EMT scope.  But then again, unless it's a pretty rural area with a BLS fire dept ambulance, all the ambulances on the road are running with a medic.  So there really isn't much need for EMTs to have a big scope.  

And if I am confident in my partners skills/knowledge, it's not uncommon for me to let them jump in and start doing ALS-ish stuff while I'm doing my assessment and overseeing them.


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## cprted (Jan 5, 2014)

OPAs
NPAs
King LT
AED
IV Fluids NS and D10
IM Glucagon
Oral Glucose
IM and IV Narcan
IM Epi
Oral Benadryl
Nitro
ASA
Entonox
Traction Splinting

CPAP is just rolling out for our ALS, in theory BLS will get it in 1 or 2 years.


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## Jim37F (Jan 6, 2014)

Los Angeles County EMT Scope of Practice

CPR and AED
Oxygen (NRB, BVM, NC, and humidifier)
OPA and NPA
Ventilate ETT, perilaryngeal airway devive (King LTS-D) and tracheostomy or stoma
Suction oropharynx and tracheostomy tube or stoma
All the usual bandaging and splinting and spinal immobilization
Tourniquets for when direct pressure and elevation isn't working
Hemostatic dressings (only currently approved for SWAT teams)
Field triage and extrication
All the usual BELLSRP vitals plus Pulse Oximetry when available  
Monitor, adjust and turn off IV fluids (Normal Saline, Ringers Lactate, and Glucose solutions)
Monitor IV infusions with additves adjusted to a TKO rate (Folic Acid, Thiamine, Multivitamins, and Magnesium Sulfate only with the multivitamins)
Monitor IV infusions with additives at a preset rate via infusion pump (Potassium Chloride 20mEq/1000ml and Total Parenteral Nutrition)
Transport patients with NG, OG, GT tubes, saline/heparin lock, foley catheter, tracheostomy tube, ventricular assist device, surgical drains, medication patches, indwelling vascular lines (PICC and PVAD)
Transport patients with any prescribed medication with an automated or patient operated medication pump, any prescribed pain medications via a patient controlled analgesia pump
Administer Oral Glucose for suspected Hypoglycemia and Aspirin for suspected myocardial chest pain
Assist patients with the administration of prescribed medications (sublingual Nitro, Epipens, Bronchodilator inhaler or nebulizer)
Set up for ALS procedures under direction of a Paramedic


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## TransportJockey (Jan 6, 2014)

I'll make it easier. Here's the link for the NM state scope 
http://www.nmems.org/documents/ScopeofPracticeRule72711-Dec312012.pdf


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## STXmedic (Jan 6, 2014)

I'd like to see Farrow's EMT-B protocol... :blink:


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## TransportJockey (Jan 6, 2014)

STXmedic said:


> I'd like to see Farrow's EMT-B protocol... :blink:




They have guidelines not protocols lol. I can't wait to go do my ride time with him and Sam.


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## STXmedic (Jan 6, 2014)

They damn near have a medical license to practice over there :lol:


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## PotatoMedic (Jan 6, 2014)

farrow's?


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## TransportJockey (Jan 6, 2014)

FireWA1 said:


> farrow's?



Presidio EMS, in TX


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## lilith88 (Jan 8, 2014)

*king*

we can now do king airways and I think it should be a basic skill all over


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## RookieRescue (Jan 10, 2014)

:blink:LaCo here, things we are allowed to do:


Spike bags
Transport


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## NPO (Jan 10, 2014)

RookieRescue said:


> :blink:LaCo here, things we are allowed to do:
> 
> 
> Spike bags
> Transport



The policies got updated 12/1/13 and some things were added and others reworded. Interesting things to note are:
Addition of pulse ox
Addition(?) of CPAP
Administration of Asprin (agency provided, no longer has to be prescribed)

Also, most emts dont know about the pump policy. Just the other day I took a patient on a drip via infusion pump BLS. 

We are also "Allowed to set up ALS procedures under the direction of a paramedic." Vague. But there it is.


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## rlcpr (Jan 10, 2014)

Our scope in RI is fairly expansive (in comparison to CT where I have worked as a Basic, and the national).

Medications:

Acetaminophen (oral/rectal)
Activated Charcol
Albuterol (nebulizer)
Aspirin
Calcium Gluconate 2.5% (gel)
Epinephrine 1:1,000 IM
EpiPen Auto Injector
Glucagon IM
Glucose (oral)
Naloxone IN
Nitroglycerin (assist patient)
Atropine Organophosphate Auto Injector
Oxygen

We can also insert an EOA (esophogeal obtruator airway), obtain a blood glucose, and monitor end tidal/capillary CO2 (with department specific training), in addition to the national standards.


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## TransportJockey (Jan 10, 2014)

rlcpr said:


> We can also insert an EOA (esophogeal obtruator airway), obtain a blood glucose, and monitor end tidal/capillary CO2 (with department specific training), in addition to the national standards.




EOA? People still carry those?


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## NomadicMedic (Jan 10, 2014)

Only in Rhode Island.


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## Carlos Danger (Jan 10, 2014)

TransportJockey said:


> EOA? People still carry those?



I wonder if they keep them next to the MAST pants?


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## TheLocalMedic (Jan 10, 2014)

And the seizure bite sticks.


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## Av8or007 (Jan 11, 2014)

And the spine boards


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## Handsome Robb (Jan 11, 2014)

TransportJockey said:


> EOA? People still carry those?




Maybe I'm too young? Esophageal something airway in assuming. 

Our special events EMTs can give:
Aspirin
Cool-it
Epi-pen (patient's)
Metered dose inhaler (patient's)
Nitroglycerine
Oral Glucose 

And they can use:
OPAs
NPAs
AED
Traction splinting (although they get reemed if they don't call ALS for pain management prior to applying it, so once we get there they kinda become our gophers)
Pulse Oximetry


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## Carlos Danger (Jan 11, 2014)

Robb said:


> Maybe I'm too young? Esophageal something airway in assuming.



Esophageal Obturator Airway. 

A horrible device that looks like the mask from a BVM with a huge ETT sticking out of the middle of it. You'd insert the tube blindly, inflate the cuff, and maintain a mask seal and ventilate. The intention was that the cuff would obturate the esophagus, essentially allowing BVM ventilations with a reduced risk of aspiration. They were known for causing esophageal rupture, pharyngeal and occasionally glottic trauma, for not allowing adequate ventilation pressures, and for generally just not working. They may have caused more aspiration than they prevented.

I am kind of surprised that they are still even being made, never mind that any agency would choose to use them over a King or an LMA. 

Other than that, the RI scope for EMT-B's looks very progressive.


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## CodeBru1984 (Jan 13, 2014)

Here's the link to San Diego County Protocol's. I can also do airway management utilizing King Airway (as part of the PETCO contract) as soon as I complete the PETCO courses.


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## Asclepius911 (Jan 26, 2014)

This is how I view BLS EMT in LA county: can be explained in 3 bullets: 
1.Oxygen; along with BLS airway adjuncts, and bagging with anything (Als airway, trach tube, stoma, and mouth) with an "ambu" bag 
2. Immobilization devices/splints: such as c-collar/backboard/pizza box cut-outs, traction splints 
3. Transport- anyone with low risk  fluids such as NaCl/ D5W

Everything else I feel that fire "ems" thinks EMTs are to dumb to do such as: 
Pulse ox (never supported by ambo company), AED (only fire), and BGL (is way to complex for EMTs to do, you must have a paramedic precision to push the auto-prick device, and a near nurse precession to place a droplet of blood on the glucometer test strip), any meds (exept for glucose, if you'd call it a medication, I can give a Pepsi to a pt that will have a similar effect- which by the way, oral glucose goes grate in coffee)


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## UnkiEMT (Jan 26, 2014)

Halothane said:


> I wonder if they keep them next to the MAST pants?



Hey, I've used a MAST.

A MAST, some air splints, some towels, a kitchen knife, a spare uniform and a LOT of tape, set it all up behind a backlit shower curtain and you have comedy.


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## vcuemt (Jan 27, 2014)

My agency tracks pretty well with the Virginia SOPs. As usual, VA beats a path straight down the middle when it comes to what we can do. The big bump in VA comes from sitting on the fence since 1607.

(pdf) http://www.vdh.virginia.gov/OEMS/Files_page/Training/ScopeOfPractice-procedures.pdf


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## emt_irl (Jan 30, 2014)

Texas really seems the place to be in ems in america huh? Anything ive read from Texas re: scope of practice looks impressive and progressive.

the basic scope in some places is insultingly low.

here is the clinical practice guidelines for irish emt's : http://www.phecit.ie/Images/PHECC/C...es/2012 Edition CPGs/EMT CPG 2012 Version.pdf if you skip to page 92 onward you'll see a tick box system of what each level of care is allowed to preform.

and if interested here's the link to find paramedic and advanced paramedic's guidelines:
http://www.phecit.ie/PHECC/Clinical...spx?Hkey=23dd59a6-6b5b-4d0b-9874-6e3467c026e0


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## hobozach (Jan 31, 2014)

:censored::censored::censored::censored: I thought CT had it bad but no pulse ox? Damn.
But in response to OP, AEMTs cant even do some of the things you listed in CT. (Narcan, Albuetrol, Hell they cant even do an IO.)


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## Handsome Robb (Jan 31, 2014)

emt_irl said:


> the basic scope in some places is insultingly low.




You can't expect a whole lot from a class that's 120 hours long...

That's fewer hours than are involved in our FTO process alone for AEMT/EMT-Is.


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## triemal04 (Jan 31, 2014)

emt_irl said:


> the basic scope in some places is insultingly low.
> 
> here is the clinical practice guidelines for irish emt's : http://www.phecit.ie/Images/PHECC/C...es/2012 Edition CPGs/EMT CPG 2012 Version.pdf if you skip to page 92 onward you'll see a tick box system of what each level of care is allowed to preform.


Actually, that's pretty good for an EMT.  With what's listed you can actually do quite a bit for most patients, and really, ones who truly need more care need someone with quite a bit more education and training.  

Now that I've said that, what does that level of training in Ireland require as far as education?

And...under the "cardiac" guidelines...there's a checkbox for being allowed to provide "emotional support"...now that's just funny...


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## NomadicMedic (Jan 31, 2014)

triemal04 said:


> Actually, that's pretty good for an EMT.  With what's listed you can actually do quite a bit for most patients, and really, ones who truly need more care need someone with quite a bit more education and training.
> 
> 
> 
> ...




Why is that funny? A person experiencing a cardiac event may be scared or nervous. Emotional support is part of the job. Kudos to them for including it in the protocol.


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## triemal04 (Jan 31, 2014)

DEmedic said:


> Why is that funny? A person experiencing a cardiac event may be scared or nervous. Emotional support is part of the job. Kudos to them for including it in the protocol.


It's a list of what they are allowed to do and not allowed to do; their scope of practice it appears...so...if "emotional support" is not marked as being allowed by a particular level...it would appear they can't provide it.  :lol:

Like I said...funny.


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## NomadicMedic (Feb 1, 2014)

Ahhh. I misunderstood. :/ sorry for that.


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## hogwiley (Feb 1, 2014)

When I first started working as a Basic, I had FTOs and EMT partners who taught me things that I've since found out were just flat out wrong. I think this is part of the reason why many people with a lot of EMT experience do miserably in Paramedic school. They developed a bunch of bad habits and got some false notions stuck in their heads that are hard to get rid of. 

The farther I get in Paramedic school the more convinced I am that EMTs should be pretty much limited to driving the ambulance and not much else.


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## NomadicMedic (Feb 1, 2014)

hogwiley said:


> The farther I get in Paramedic school the more convinced I am that EMTs should be pretty much limited to driving the ambulance and not much else.


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## emt11 (Feb 2, 2014)

hogwiley said:


> When I first started working as a Basic, I had FTOs and EMT partners who taught me things that I've since found out were just flat out wrong. I think this is part of the reason why many people with a lot of EMT experience do miserably in Paramedic school. They developed a bunch of bad habits and got some false notions stuck in their heads that are hard to get rid of.
> 
> The farther I get in Paramedic school the more convinced I am that EMTs should be pretty much limited to driving the ambulance and not much else.



Then you wind up with a company like mine with a system that makes the Paramedic tech every single 911 call no matter the C/C even the stubbed toe at 3am, and you wind up with a bunch of EMT-I's and AEMT's with very limited tech experience and are stuck driving every call every shift until they become Paramedics then their just thrown to the wolves with an "upgrade" program that last 1-2 months.


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## hogwiley (Feb 2, 2014)

> Then you wind up with a company like mine with a system that makes the Paramedic tech every single 911 call no matter the C/C even the stubbed toe at 3am



Maybe I was exaggerating a little, but I do feel like you have a lot of EMTs on the road don't know anywhere near as much as they think they do, so this is probably the reason why their scope is being increasingly restrained. They don't know enough to know any better.



> and you wind up with a bunch of EMT-I's and AEMT's with very limited tech experience and are stuck driving every call every shift until they become Paramedics then their just thrown to the wolves with an "upgrade" program that last 1-2 months.



Well the problem here seems to be the 1 to 2 month upgrade. I've never even heard of an AEMT/I85 to Paramedic bridge class and don't really see much reason for one. AEMT school is what, 2 or 3 months, with maybe 80 hours of clinicals and no internship? Paramedic school is typically a year and a half with a minimum 600 to 1000 hours of clinicals and an internship, so that's a pretty long bridge to cross.

As for EMTs not getting tech experience before they become Paramedics, I've encountered Paramedics who hit the road with NO EMT experience of any kind, and they managed. Just sign up for more clinicals and Intern shifts during medic school, although yeah it sucks you aren't getting paid.


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## RescueRider724 (Feb 2, 2014)

We run a BLS Quick Response Service (QRS) truck, with additional modules after obtaining your EMT License you can also use pulseOx, We carry Epi  pens (adult and peds) that we can administer via auto injector as a prescribing agency, and every Rescue and Ambulance in our region has CPAP on board.  We also have a portable suction bag. There is talk in the wind of expanding the scope to king airways as well if you are NR certified...see if that happens. We are saturated with medics in Western Pa though, so not sure if that will make a difference or not.


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## emt11 (Feb 3, 2014)

"See the bold part"  I think some of the issue here is, that were from different states. My state uses NREMT. The entry level to work on an ambulance is I'85 which currently being phased out. We have very few EMT-B's. Most Basics work at dialysis only companies or work at services "out in the sticks". I'85 school in itself was usually 6-9 months depending on the program before the state and NREMT stopped teaching/testing for it. The current AEMT programs run right at a year. Currently, the way things are being done is for a brand new EMT student will be taught to the Basic level and test NREMT for EMT-Basic. They are not required to apply to the state but must pass NREMT-B to test for NRAEMT. The schools then turn around and teach the students everything that is needed to operate as an AEMT skills/knowledge etc. 

Currently, their is a minimum of 32 hours required on an ambulance with no hospital time required for the AEMT level. Their is no program in the area to my knowledge that requires an internship, no has their been one in the past to my knowledge. The following forms are the clinical forms that all students must complete and submit to the state at the end of their ride time, it also outlines everything that is required from their ride time. 

This is the EMT-B or EMT file review
http://dph.georgia.gov/sites/dph.georgia.gov/files/New File Review Forms EMT fillable.pdf
You'll note that the EMT file review is extremely simple, mostly because the state does not use the level but still has it around. 

This is the AEMT file review
http://dph.georgia.gov/sites/dph.georgia.gov/files/New File Review Forms AEMT Fillable.pdf

This is the Paramedic file review
http://dph.georgia.gov/sites/dph.georgia.gov/files/New File Review Forms Paramedic Fillable.pdf




hogwiley said:


> Maybe I was exaggerating a little, but I do feel like you have a lot of EMTs on the road don't know anywhere near as much as they think they do, so this is probably the reason why their scope is being increasingly restrained. They don't know enough to know any better.
> 
> 
> 
> ...


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## emt_irl (Feb 4, 2014)

triemal04 said:


> Actually, that's pretty good for an EMT.  With what's listed you can actually do quite a bit for most patients, and really, ones who truly need more care need someone with quite a bit more education and training.
> 
> Now that I've said that, what does that level of training in Ireland require as far as education?
> 
> And...under the "cardiac" guidelines...there's a checkbox for being allowed to provide "emotional support"...now that's just funny...




By the book its 140 hours of education, id say its split close enough to 50/50 in regards to theory and practical. then we sit a 100 question MCQ and we sit 8 osce's(objective structured clinical exam) It's really noticeable over here who went to a certificate printing school  and who went through a much more reputable class. Myself a few others i work with in the end sat through nearly 200 hours of training as we went to extra cpd events and training sessions to get a better education, even though we only needed the basic amount to pass the exam.


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## STXmedic (Feb 18, 2014)

rinaric15 said:


> where around here can someone get BLS training and certificate? i heard kennet had one at the hospital? anywhere elese around here? i need the certification for the school i wanna apply for



Umm... Huh? You may have better luck if you don't ask a completely random question in an already established thread... Try making it its own topic and be more specific on details, such as location.


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## vcuemt (Feb 18, 2014)

rinaric15 said:


> where around here can someone get BLS training and certificate? i heard kennet had one at the hospital? anywhere elese around here? i need the certification for the school i wanna apply for


Nah, Kennet got it at the community college. You're thinking of Keit.


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## brian328 (Feb 23, 2014)

As a basic working 911 in SoCal, I was a "gurney jockey" for the FD as some people say. Take a BP and pulse, MAYBE get a blood sugar and set up a 12 lead. Mostly moving patients and transporting..

As a basic working 911 in Texas, I am able to do far more. Assessments, transport decisions, CPAP, airways, give certain meds, etc.. And EMS is in charge of just about every emergency call other than a fire.


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## Drax (Mar 2, 2014)

vc85 said:


> I am just wondering how 'basic' is BLS in your area.  I was reading some of the other threads and I'm amazed.
> 
> In my region/area an EMT-B can do
> 
> ...



CPR
AED
Oxygen
Pulse Oximetry
Glucometry
Oral Glucose Administration
Epinephrine
Aspirin
Assist w/ prescribed Albuterol via neb or meter-dose
Assist w/ prescribed Nitro
Activated Charcoal
OPA
NPA
Clotting Sponges
1 attempt to reduce a fx if distal pulse is missing
Plus all of the splinting, backboarding, bandaging, tourniquets etc


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## Jay (May 12, 2014)

vc85 said:


> In my region/area an EMT-B can do...



*Where are you located vc85?*

This is not a bad list at all, in Pennsylvania there are notable exceptions including:


Pulse Oximetry - BLS only allowed with training.
Glucometry - ALS skill ONLY, however...
Oral Glucose Administration - BLS can provide as long as the patient uses his/her own meter.
ASA - By local protocol only unless "assisting" patient with their own.
Atropine auto injector - ALS skill only (to the best of my knowledge).
Clotting Sponges - Have not been "trained" on their use.
As for your "On the way" list:


Nasal Narcan - Have *NOT* heard anything yet but *really do wish it is on the way! For the sake of our patients. 
*
CPAP - Like Pulse Oximetry in PA, meaning with proper training.
Epi-pen for asthmatics not responsive to albuterol with med-control - This may be allowed by local protocol, if anyone knows knows please "chime in".
Automatic Transport vents - I know that we can "assist" but this is always with a Paramedic/EMT crew running ALS. If anyone in PA knows if this expands to BLS please "chime in".
As far as I know ETCO2 and any airways with the exception of OPA/NPA are strictly ALS skills and will remain that way for the foreseeable future.


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## SeeNoMore (May 12, 2014)

When are BLS folks using Automatic Transport Vents?


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## Clare (May 13, 2014)

Adrenaline (IM, IN and nebulised),
Automated defibrillation,
Automated cardioversion,
Entonox
Glucagon,
Glucose gel
GTN spray,
Ibuprofen,
Ipratropium,
Laryngeal mask airway,
Loratadine,
Methoxyflurane
Nasopharyngeal airway,
Ondansetron (oral),
Paracetamol
Prednisone (oral),
PEEP,
Salbutamol,
Tramadol (oral),
Urinary catheter troubleshooting


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## TransportJockey (May 13, 2014)

SeeNoMore said:


> When are BLS folks using Automatic Transport Vents?



NM basics are technically allowed to on use them, with the rationale that they can use etco2 and place combi/lma/king tubes, so giving them something for long transport times would be ok.


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## Tigger (May 13, 2014)

TransportJockey said:


> NM basics are technically allowed to on use them, with the rationale that they can use etco2 and place combi/lma/king tubes, so giving them something for long transport times would be ok.



Are NM basics allowed to use waveform capno? Here in Colorado BLS only services with SGAs can only use colormetric indicators.


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## TransportJockey (May 13, 2014)

Tigger said:


> Are NM basics allowed to use waveform capno? Here in Colorado BLS only services with SGAs can only use colormetric indicators.



Yep. The state also allows basics to use CPAP so they were given some extra assessment options, but it's a medical director allowable skill


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## Tigger (May 13, 2014)

TransportJockey said:


> Yep. The state also allows basics to use CPAP so they were given some extra assessment options, but it's a medical director allowable skill



Gotcha. I can use the monitor for non-waveform confirmation, but that's pretty moot since the chance of me being alone on a call with a rig and enough hands to drop one is awfully small.


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## Bearamedic (May 28, 2014)

Just the things i have heard other basics not being able to do. (WV)

1:1000 epi IM 
Albuterol
NTG SL
ASA 325mg
12 lead acquisition
Monitor kvo IV ns
Pulse OX
EpiPen
Glucometer
Oral glucose
CPAP
Capnography
AED
Activated Charcoal
Tracheostoma suctioning
King airway and combitube.
Acetaminophine 10mg/kg 
MarkI kits
Ventilators (simple)
Geezer squeezers
Insert hands vaginally during troubled births


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## uglyjon (Jun 11, 2014)

In my area an EMT is lucky we get to do chest compressions.  Seriously there is nearly no difference between first responders and EMT's in their scope.  NPA's are considered ALS.  Nothing but stretcher fetchers here where I am at.


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## BASICallyEMT (Jun 11, 2014)

uglyjon said:


> In my area an EMT is lucky we get to do chest compressions.  Seriously there is nearly no difference between first responders and EMT's in their scope.  NPA's are considered ALS.  Nothing but stretcher fetchers here where I am at.



Interesting.... How busy is your 911 system?


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## MedicDelta (Sep 27, 2014)

Emergency Medical Responder(comparable to EMT-B) from Canada here! 
The national scope of practice for EMRs in Canada includes:
CPR/AED BLS
Basic Airway Management(OPA, NPA)
Obtaining a blood glucose level 
Pulse oximetry
BP
Lung/breath sounds 
Spinal immobilization 
Pupil response 
Oxygen administration 
Entonox(specific to British Columbia) 
Aspirin ASA
Assist with Nitro spray 
Albuterol and other MDIs
Glucose gel


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## MedicDelta (Sep 27, 2014)

Oh and assisting with an Epi-Pen auto injector


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## drjekyl75 (Sep 28, 2014)

My company runs in multiple counties and each have slightly different protocols.

For the most part EMT-B's can:

Combi-Tube / King Airway 
Aspirin
Nitro (patient assist)
C-Pap has come and gone a couple of times
Epi-Pen autoinjector
Albuterol (patient assist)
Glucose (oral)
Pulse Oximetry
Glucometry
AED
OPA / NPA
Bleeding control, also have combat application tourniquets

and there's probably a few main one's I'm missing!


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## Tigger (Sep 29, 2014)

chaz90 said:


> In my old system in Colorado, EMTs are able to start IVs, administer saline boluses, give D50, albuterol, NTG assist, ASA, Narcan, King tubes, plus everything else you mentioned in the first part of your post. As far as I know, they still can't do CPAP, Epi for asthma, Venturi masks (kind of surprised you guys carry these), or vents of any kind.



Not much has changed. 

Our new medical direction has gotten us a countywide waiver for IOs and dislocation reductions (patella, anterior shoulder, and digits).


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## JDEMT18 (Feb 2, 2015)

(Start note I have provided only examples there is more that i did not say in our scope) Where I am from our BLS I believe the most basic in the U.S. and possibly the world. (not and exaggeration the truth EMTs are not common anywhere outside NA or UK which means...) We have no scope nor do our medics. Other states EMRs can do as much as our EMTs and EMT-Is in other states can do as much as our medics with a course that is half the length. EMS agencies in my area are so excited because we are aloud to carry EPI Pens on the rig now. The same item a 5yo has in his pocket everyday is a big deal to have on an ambulance!!! We might be soon able to assist in 1 nebulizer dose of the patients own nebulizer. These are major steps which is very depressing.  We can't use glucometers, can't give pain relief or NSAIDs, no endotrachel suctioning, can't confirm a intubation, spinal assessments or even realign bones in some situations. We can only carry 3 meds on our trucks namely oral glucose, IN narcan and epi. (side note to use narcan you have to take a whole separate course and get approval through your Med director to use it which means most but not all can use it even though its on the truck and EMRs got Narcan before EMTs did as well) We cannot use rescue airways even though they are proven to be very easy place and have good outcomes. EMTs in my area cannot even setup, acquire or interpret EKGs or help prepare an intubation. Most other places this is aloud but sometimes is considered a skill in their scope of just an accepted and trust base thing or common knowledge. Our medics can't do much either. For example only can do needle crics not surgical which is proven to be quicker and provide better outcomes. Our medics have to also call most things through a MD at the ER before doing it. They cannot close wounds yet other EMT-Bs who take EMT-T courses can. Also our medics never do procedures in their scope because the distance to the hospital or if the MD in the ER says not to. The OEMS in my area is slow to change and will stay that way for some time. The system is so regulated yet so unregulated. My instructor a few months back had a whole rant on this topic. His example was that the rules to setup a BLS unit in my area is all you need is an ambulance with an AED, o2, first aid kit and some people trained in CPR thats it. I read up and he is right the regulations for a ambulance only have recommended equipment to carry nothing is required. It says BLS ambulance SHOULD (don't have to) be staffed with 2 EMTs. Our system is very bad. Another instructor who was a medic said he worked in 2 neighboring states for a short experience and was required to operate under our areas scope not the locations he was working and said he felt really useless on calls and could not do anything compared to the other medics. There are states which large scopes of practice and where 16yos can be EMTs and are doing more than an 30yo EMT with 10 years under their belt from my area. I love medicine and want to do more and also this scope of practice does effect patient outcomes which means it should be changed.


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## LMEMT (Feb 3, 2015)

We actually have almost the same protocol, vc85. The things that you have coming on the way are things that we have right now, though. And we can't use the epi-pen for asthmatics.


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## coffeegal (Feb 10, 2015)

I work in North and South Carolina. Pretty much the same, with SC being a little more...
MEDS:
Narcan-up to 10 mg in NC-even for pediatrics, more if needed with med-control....I hope we wouldn't ever need this much!
Oxygen
Albuterol (if patient has a prescription, can give from our meds though)
Aspirin
Acetaminophen
Nitro tablets (if patient has a prescription, can give from our meds though)
Oral glucose
Epi-pens, adult and jr.
We don't carry atropine, 2-pam or activated charcoal, but are able to administer.

OTHER:
Vitals
CPR
AED
Pulse Oximetry
Glucometry
OPA
NPA
3 attempts to reduce a fx if distal pulse is missing
All of the splinting, backboarding, bandaging, etc
Nasal Narcan-up to 10 mg in NC even for peds
CPAP-SC Only
Tourniquet application
King/rescue airways
Anything related to paramedic assist, (12-lead placement, IV prep, medication prep, etc.)
Birth Babies
In some counties of SC I've heard BLS trucks can run a 12-lead to go ahead and send to the doc at the hospital so that they get a look at it before arrival.

I've posted the links to the state protocols, however some counties vary from the state, just an FYI
Here is SC Protocols: http://www.scdhec.gov/Health/FHPF/EMS_TrainingProtocolsRequirements/ProtocolsForms/
Here is NC Protocols: http://www.ncems.org/nccepstandards.html


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