# Taking Blood Glucose - Scope of Practice



## DV_EMT (Dec 15, 2009)

Alright... so heres a random one that an EMT buddy asked me the other day... 

So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).

My question is this... If NREMT allows a Nationally Certified EMT-B to do something... but the County you work for doesn't include it in their scope of practice... who has the final "say" County or National?

Also... what if your licenced in... lets say TX... but not licenced in Ca. and you are witness to a heart attack (in CA) and are allowed "under TX scope of practice" to adminsiter aspirin. Are you allowed to give the aspirin to the PT in CA... even though what you did was your "usual" scope of practice.

Thanks in advance!


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## MrBrown (Dec 15, 2009)

DV_EMT said:


> Alright... so heres a random one that an EMT buddy asked me the other day...
> 
> So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).
> 
> My question is this... If NREMT allows a Nationally Certified EMT-B to do something... but the County you work for doesn't include it in their scope of practice... who has the final "say" County or National?



National Registry has no regulatory power or licensing clout whatsoever which is why it was so frustrating trying to get reciprocity in California as each County's EMSA set the scope of practice. So it's the county.


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## Shishkabob (Dec 16, 2009)

The NREMT is a testing agency, nothing more. They have no say in what you can or cannot do in scope of practice... Just make test on national standards.


As for what we can do in other states, if I'm working in an EMT capicity I have to follow that states rules. If I'm acting in the capicityoff a lay person, as that is what I am if I don't work there, scope of practice for their EMTs is irrevelent.


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## gamma6 (Dec 16, 2009)

go with the county COGs not NR. NR is just a standard.


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## guardian528 (Dec 16, 2009)

under most circumstances, if there are ever 2 different regulations on the same thing, the stricter one must be followed.

however, we're getting expanded scope next year


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## gamma6 (Dec 16, 2009)

i'm noticing that here in texas we can do a lot load more stuff......i've heard that cali has some strict rules....


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## DV_EMT (Dec 16, 2009)

guardian528 said:


> under most circumstances, if there are ever 2 different regulations on the same thing, the stricter one must be followed.
> 
> however, we're getting expanded scope next year



lol... i'll talk to salvucci MD and Lampola about that... salvucci's pretty liberal nonetheless about scope of practice... even in VC... if he even brings Activated charcoal back... i'll be shocked.


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## Aidey (Dec 16, 2009)

The scope of practice set out by the NREMT is just a guideline that explains what each level is supposed to be taught.

Your county/agency protocols are what you are legally bound to, and what you have to follow. Those are the things that your MD is willing to let you do while practicing under their license. 

In your TX vs CA scenario it's basically moot because you aren't legally certified in CA. Anything you do can be considered practicing without a license/certification. 

Something like administering ASA, which is taught to lay persons, _may_ be ok. I would be very hesitant to do anything that is considered invasive, or anything that could be considered an intervention beyond CPR/rescue breathing or other things taught to lay people.


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## Seaglass (Dec 16, 2009)

I'm certified in multiple states. I can do several things, like taking blood glucose or administering activated charcoal, in one that I can't touch in another. If I'm in a state where I'm not licensed and happen across something, I'm just a bystander who knows first aid and can give a coherent report... which is pretty similar to what I am if I run across something in a county where I'm licensed, since it's not like I run around with a bag full of gear. 

Like everyone else said, the county has the authority. When in doubt, follow the stricter protocol. CYA and all that.


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## trevor1189 (Dec 16, 2009)

DV_EMT said:


> Alright... so heres a random one that an EMT buddy asked me the other day...
> 
> So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).
> 
> ...


Since the NREMT does not have a "national medical director" you have no standing orders to give ASA or any other procedure/treatment they test you on that you cannot do under your county/state scope of practice. If you really think someone could benefit from ASA, 1. You might say have you taken an Aspirin? This might encourage them to do it. Most likely won't hurt, assuming they aren't allergic in which case they might reply no because I'm allergic to it. 2. Call 911, I know here 911 operators are told have Pt.'s chew 324mg ASA if that's where their EMD cards take them.

As for the TX vs CA thing, if your not certified in CA you are simply a lay person who knows advanced first aid. You have no scope of practice. You can recommend people to do what seems logical in an emergency, if you don't tell them you're an EMT, their probably not going to find out.

BTW if you can "see" the person is having a MI, my guess is the are already receiving medical attention ie ECG. 

2 cents, no legal advice.


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## DV_EMT (Dec 16, 2009)

Thanks everyone for the input. Most of your responses were what I was thinking... but I always like to get second... third, fourth opinions.


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## trevor1189 (Dec 16, 2009)

I would also like to throw in that I think taking BGLs should be part of the EMT scope. It's very simple, it doesn't cost much to implement and it is a nice little diagnostic tool to have with some pt.'s.

Ok, so that's 4 cents.


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## JPINFV (Dec 16, 2009)

DV_EMT said:


> lol... i'll talk to salvucci MD and Lampola about that... salvucci's pretty liberal nonetheless about scope of practice... even in VC... if he even brings Activated charcoal back... i'll be shocked.



One of the issues with charcoal is that charcoal isn't in the state SOP of basics, but included as an add on. Saying that, somehow OC just put glucose monitoring in for basics provided that the basic is being supervised by a paramedic. Now I personally don't see an issue with basics doing D-sticks when working with paramedics provided proper training, however I'm not quite sure where in state law this is in the scope of basics without the rest of the skills package.


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## JPINFV (Dec 16, 2009)

Aidey said:


> The scope of practice set out by the NREMT is just a guideline that explains what each level is supposed to be taught.



Point of clarification. The National Highway Safety Administration (NHTSA) sets the national scope of practice and educational guideline recommendations that each state can choose to follow. These guidelines are what the NREMT designs their exams off of. NREMT doesn't set the guidelines themselves.


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## daedalus (Dec 16, 2009)

guardian528 said:


> under most circumstances, if there are ever 2 different regulations on the same thing, the stricter one must be followed.
> 
> however, we're getting expanded scope next year



Who? Santa Barbara or Ventura? It is definitely not going to happen down here in Ventura and many in SBC are going to protest this. I am hoping Salvucci will pass on getting EMTs do anything more than what they are allowed to do now, which is already far to much for their amount of education. 

Oh, and to answer the question about EMTs doing blood sugars or giving ASA, absolutely not in the OP's County, and most of California. It does not matter what the national curriculum says you can do, if your county medical director does not allow it, you cannot do it.


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## Scott33 (Dec 16, 2009)

trevor1189 said:


> I would also like to throw in that I think taking BGLs should be part of the EMT scope. It's very simple, it doesn't cost much to implement and it is a nice little diagnostic tool to have with some pt.'s.



The problem has never been the taking of the actual blood glucose, but what to do if your patient _is_ hypoglycemic. In the absence of a gag reflex that would usually be transport or call for ALS.

Funnily enough, many ALS agencies (FDNY for example) don't use glucometry in the field, as hypoglycemia can easily be suspected and treated without the need for a glucometer. 

A good history and physical exam can be as useful as any glucometer - all you would lack is a number for the PCR.


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## VentMedic (Dec 16, 2009)

DV_EMT said:


> lol... i'll talk to salvucci MD and Lampola about that... salvucci's pretty liberal nonetheless about scope of practice... even in VC... if he even brings Activated charcoal back... i'll be shocked.


 
JPINFV started this thread almost two years ago.
*Activated Charcoal: The Next EMS Myth? *

http://www.emtlife.com/showthread.php?t=6625

As far as the blood glucose, it would really be nice if schools taught the difference between the NREMT, the state scope of practice and what the medical directors allow. I can not believe all the posts on this forum where some think the NREMT is "a scope of practice" to be followed instead of the protocols from one's medical director.


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## guardian528 (Dec 16, 2009)

daedalus said:


> Who? Santa Barbara or Ventura? It is definitely not going to happen down here in Ventura and many in SBC are going to protest this. I am hoping Salvucci will pass on getting EMTs do anything more than what they are allowed to do now, which is already far to much for their amount of education.



Talking to our Clinical Education Specialist, he says its already through, and that we are going to be training and implementing it next year. possibly this is just for our company (amr), but one of the fire departments(it was either lompoc or guadalupe fire) already has expanded scope for EMT's so it is already somewhere in SB county.


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## emt1972 (Dec 16, 2009)

gamma6 said:


> i'm noticing that here in texas we can do a lot load more stuff......i've heard that cali has some strict rules....



It is because of the abundance of hospitals in close proximity.  In the more desolate counties of California, the scope of practice is expanded.

It would be nice to be able to do finger sticks... because is it hypoglycemia or something else? Oh well...


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## gamma6 (Dec 16, 2009)

emt1972 said:


> It is because of the abundance of hospitals in close proximity.  In the more desolate counties of California, the scope of practice is expanded.
> 
> It would be nice to be able to do finger sticks... because is it hypoglycemia or something else? Oh well...



i could see that with the hospitals being close by..

can you guys take saline bags during a transfer from a hospital?


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## emt1972 (Dec 16, 2009)

gamma6 said:


> i could see that with the hospitals being close by..
> 
> can you guys take saline bags during a transfer from a hospital?


We can... It has to be less than %10 dextrose nor may it be mixed with any IV medications.


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## DV_EMT (Dec 16, 2009)

guardian528 said:


> Talking to our Clinical Education Specialist, he says its already through, and that we are going to be training and implementing it next year. possibly this is just for our company (amr), but one of the fire departments(it was either lompoc or guadalupe fire) already has expanded scope for EMT's so it is already somewhere in SB county.



That'd be guadalupe fire, I asked my EMT bud about expanded scope last night and he said that because guadalupe fire is BLS and about 10-15 out of ALS range... that they have expanded scope for basics (what is included in that scope... im not sure)


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## gamma6 (Dec 16, 2009)

emt1972 said:


> We can... It has to be less than %10 dextrose nor may it be mixed with any IV medications.



rock on, we have an employee with us out here from cali. when she first got on the trucks, most of the medics were mad cause she was used to the cali SOP and not ours where we are. she wouldn't do much at first cause she wasn't sure what she could and couldn't do. she's much better now...nice person too


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## DV_EMT (Dec 16, 2009)

gamma6 said:


> rock on, we have an employee with us out here from cali. when she first got on the trucks, most of the medics were mad cause she was used to the cali SOP and not ours where we are. she wouldn't do much at first cause she wasn't sure what she could and couldn't do. she's much better now...nice person too



In LA county... you can transport any pt with an IV provided that they're on a pump that has been already set by a nurse. (there may be certain restrictions the the prior statement)


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## emt1972 (Dec 16, 2009)

DV_EMT said:


> In LA county... you can transport any pt with an IV provided that they're on a pump that has been already set by a nurse. (there may be certain restrictions the the prior statement)



Interesting how things change county to county, we can't take a pump (unless it is CCT)... It has to be gravity fed...

^_^


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## DV_EMT (Dec 16, 2009)

emt1972 said:


> Interesting how things change county to county, we can't take a pump (unless it is CCT)... It has to be gravity fed...
> 
> ^_^



down here... basic scope is O2, defib, PO glucose (but no glucose needle stick) and vitals. pretty thin scope..... which is why i'm planning for medic school!


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## EMSLaw (Dec 16, 2009)

DV_EMT said:


> down here... basic scope is O2, defib, PO glucose (but no glucose needle stick) and vitals. pretty thin scope..... which is why i'm planning for medic school!



That's not far off from the National Standard Curriculum.  Maybe you're missing activated charcoal, but that's not common anymore anyway.


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## Shishkabob (Dec 16, 2009)

emt1972 said:


> It is because of the abundance of hospitals in close proximity.  In the more desolate counties of California, the scope of practice is expanded.
> 
> It would be nice to be able to do finger sticks... because is it hypoglycemia or something else? Oh well...



No. No, that has nothing to do with it.  The reason Texas has a more liberal scope than Cali is that there IS no state scope in Texas. Texas is something called a "delagated practice" state, meaning we can do anything and everything our med control teaches us and allows us to do, from chest thoracostomies to surgical chricotomies to neuro surgery if they so choose. 

I am actually surprised more states don't follow this model aside from the 2 or 3 that do.  Let a companies MD decide what he wants his medics to do, as in tge end it's his license.


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## DV_EMT (Dec 16, 2009)

Linuss said:


> No. No, that has nothing to do with it.  The reason Texas has a more liberal scope than Cali is that there IS no state scope in Texas. Texas is something called a "delagated practice" state, meaning we can do anything and everything our med control teaches us and allows us to do, from chest thoracostomies to surgical chricotomies to neuro surgery if they so choose.
> 
> I am actually surprised more states don't follow this model aside from the 2 or 3 that do.  Let a companies MD decide what he wants his medics to do, as in tge end it's his license.



that would be great in a big state like california (even though texas is bigger  )


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## JPINFV (Dec 16, 2009)

emt1972 said:


> Interesting how things change county to county, we can't take a pump (unless it is CCT)... It has to be gravity fed...
> 
> ^_^



Same in Orange County. Basics can transport a handful of different fluids (saline, TPN, etc) provided that a nurse sets the rate to TKO. Also, we can transport any patient operated pump.


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## DV_EMT (Dec 16, 2009)

JPINFV said:


> (TPN, etc) provided that a nurse sets the rate to TKO. Also, we can transport any patient operated pump.




TPN are so much fun to make!


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## VentMedic (Dec 16, 2009)

JPINFV said:


> Also, we can transport any patient operated pump.


 
Does that include PCAs (Patient Controlled Analgesia) with the good meds?  Do you get to carry the key?


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## JPINFV (Dec 16, 2009)

Yes, but I can't remember actually transporting a patient on a locked PCA. I vaguely remember a few transports with patients on patient controled medication pumps (I don't remember if it was analgesia or other medications), but these were definately a different style than the hospital style PCAs that I'm familiar with.


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## DV_EMT (Dec 17, 2009)

transporting with a PCA..... thats not a good idea... just legally speaking.


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## JPINFV (Dec 17, 2009)

What extra legality is there if it's a PCA that the patient is cleared to take home for home care? It's like saying EMT-Bs shouldn't transport patients that have fentanyl despite the patch being something that is prescribed and self administered, despite being a schedule 2 narc.


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## DV_EMT (Dec 17, 2009)

JPINFV said:


> What extra legality is there if it's a PCA that the patient is cleared to take home for home care? It's like saying EMT-Bs shouldn't transport patients that have fentanyl despite the patch being something that is prescribed and self administered, despite being a schedule 2 narc.



for IFT's... it creates discrepancies for Narcotics... which in turn could require that the DEA becomes involved... which is no fun.

take for instance... the fentanyl is a transdermal SR medication... but a PCA is usually 50mL of straight Fentanyl, Dilaudid, or other medications. Thats 1mg/mL x50 mL's. Can you imagine the potential lawsuits and legal actions happen if a Basic decides that he wants to take that PCA? Perhaps he/she manages to get a hold of the PCA Pump Key (which isn't that hard to do) and while the PT is... let say asleep for a long transport... decides to swap the 60mL syringe with 60mL of NS or SW?

It's just a bad idea. I'm not saying that most basics will do the above... but not everyone is a good apple.

that's my 2 cents on that


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## JPINFV (Dec 17, 2009)

Couldn't the same be said for any schedule 2 perscription that a patient fills on their own though? People aren't only on pumps in the hospital/nursing home. Similarly, what's stopping a paramedic or RN from swapping out narc with saline during a transport?


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## daedalus (Dec 17, 2009)

JPINFV said:


> Couldn't the same be said for any schedule 2 perscription that a patient fills on their own though? People aren't only on pumps in the hospital/nursing home. Similarly, what's stopping a paramedic or RN from swapping out narc with saline during a transport?



That has already happened, in my own neighborhood. 

http://www.vcstar.com/news/2008/oct/07/nxxfcwilsonfolo08/

I agree with JP, and would like to add the following. EMTs can transport patients on PCA. Just because you have a RN, or Paramedic, or Pharmacist, or Physician, does not make you anymore honest than an EMT. There is not problem with EMTs taking patients on PCA, there is only a problem with dishonest drug abusers.


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## CAOX3 (Dec 17, 2009)

DV_EMT said:


> for IFT's... it creates discrepancies for Narcotics... which in turn could require that the DEA becomes involved... which is no fun.
> 
> take for instance... the fentanyl is a transdermal SR medication... but a PCA is usually 50mL of straight Fentanyl, Dilaudid, or other medications. Thats 1mg/mL x50 mL's. Can you imagine the potential lawsuits and legal actions happen if a Basic decides that he wants to take that PCA? Perhaps he/she manages to get a hold of the PCA Pump Key (which isn't that hard to do) and while the PT is... let say asleep for a long transport... decides to swap the 60mL syringe with 60mL of NS or SW?
> 
> ...



As stated what stops a paramedic or RN from doing the same?


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## reaper (Dec 17, 2009)

Yea, have to say that it makes no sense?


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## Sasha (Dec 17, 2009)

> take for instance... the fentanyl is a transdermal SR medication... but a PCA is usually 50mL of straight Fentanyl, Dilaudid, or other medications. Thats 1mg/mL x50 mL's. Can you imagine the potential lawsuits and legal actions happen if a Basic decides that he wants to take that PCA? Perhaps he/she manages to get a hold of the PCA Pump Key (which isn't that hard to do) and while the PT is... let say asleep for a long transport... *decides to swap the 60mL syringe with 60mL of NS or SW*?



I'd be more worried about a paramedic doing that than a basic.. I don't know about there, but here basics on IFT trucks don't carry saline and syringes to do the switch.


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## JPINFV (Dec 17, 2009)

Syringes are easy enough to come by if you're resourceful and every truck I've been on have had saline in bottles for irrigation (not IV bags).


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## Lifeguards For Life (Dec 17, 2009)

Sasha said:


> I'd be more worried about a paramedic doing that than a basic.. I don't know about there, but here basics on IFT trucks don't carry saline and syringes to do the switch.



they dont have syringes in their airway kits, to inflate combitunes?


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## Sasha (Dec 18, 2009)

Lifeguards For Life said:


> they dont have syringes in their airway kits, to inflate combitunes?



Ask the EMTs on basic trucks where you did your clinicals if they even carried combitubes, LMAs or King Tubes.


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## Lifeguards For Life (Dec 18, 2009)

Sasha said:


> Ask the EMTs on basic trucks where you did your clinicals if they even carried combitubes, LMAs or King Tubes.



i've never been on a basic truck at american, if that's who you are referring too. The majority of my rides have been at the fire houses, all ALS


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## JPINFV (Dec 18, 2009)

Combitubes aren't in the scope of practice for basics everywhere.


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## exodus (Dec 18, 2009)

Sasha said:


> Ask the EMTs on basic trucks where you did your clinicals if they even carried combitubes, LMAs or King Tubes.



We do in SD. Though, I would never use one :/ Never been properly trained on it's use...


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## redcrossemt (Dec 18, 2009)

DV_EMT said:


> In LA county... you can transport any pt with an IV provided that they're on a pump that has been already set by a nurse. (there may be certain restrictions the the prior statement)



Does this include medications, or just fluids?

Re the PCA discussion, if it's a patient's home PCA, I don't see a problem with it. If it's an IFT to another hospital with a hospital PCA, then I would guess ALS transport is indicated.


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## eveningsky339 (Dec 18, 2009)

DV_EMT said:


> Alright... so heres a random one that an EMT buddy asked me the other day...
> 
> So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).
> 
> ...



Strict regulations like these befuddle me.  If you, as an EMT-B, witness an MI, you cannot administer aspirin... a bystander with a touch of common sense, though, can stroll up and do so.  

Same with epi, or nitro, or any other BLS drugs that an MD may prescribe-- the patient can administer it, but a basic can't, even though said basic probably has a greater degree of knowledge in pharmacology (as little as it may be). 

But I digress...


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## VentMedic (Dec 18, 2009)

redcrossemt said:


> Re the PCA discussion, if it's a patient's home PCA, I don't see a problem with it. If it's an IFT to another hospital with a hospital PCA, then I would guess ALS transport is indicated.


 
I would say the hospital to hospital IFT would definitely require a higher level of care.  These patients may still be acute in their illness or surgical procedures. There are many issues to consider and things that can go wrong which is why these patients are often on a floor capable of tele - transmission of ETCO2 and pulse oximetry.    

There are also some state licensing reguations as it pertains to who can handle narcotics.  If these are locked in the PCA device, some could argue they are locked up safely.


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## VentMedic (Dec 18, 2009)

eveningsky339 said:


> but a basic can't, even though said basic probably has a greater degree of knowledge in pharmacology (as little as it may be).
> 
> But I digress...


 
Actually the person who has been prescribed the epipen or nitro probably has way more education about pharmacology and their disease process than the EMT-B even if they only got a few minutes from their doctor or pharmacist.   The EMT-B, even for "expanded" scope, teaches very little about the actual pharmacology or the pathophysiology of the disease.


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## eveningsky339 (Dec 18, 2009)

VentMedic said:


> Actually the person who has been prescribed the epipen or nitro probably has way more education about pharmacology and their disease process than the EMT-B even if they only got a few minutes from their doctor or pharmacist.   The EMT-B, even for "expanded" scope, teaches very little about the actual pharmacology or the pathophysiology of the disease.



Unfortunately, I have to agree with you here.  I couldn't believe how little pharmacology we were taught in basic school; ended up having a few long chats with the medics to help me better understand certain principles.


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## Aidey (Dec 18, 2009)

VentMedic said:


> I would say the hospital to hospital IFT would definitely require a higher level of care.  These patients may still be acute in their illness or surgical procedures. There are many issues to consider and things that can go wrong which is why these patients are often on a floor capable of tele - transmission of ETCO2 and pulse oximetry.



What about a non acute patient? For example, a hospice patient being transferred from home to a hospice house because the family can no longer provide care for the patient? Would the presence of the PCA pump automatically qualify a transfer like that as an ALS run?


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## VentMedic (Dec 18, 2009)

eveningsky339 said:


> Unfortunately, I have to agree with you here. I couldn't believe how little pharmacology we were taught in basic school; ended up having a few long chats with the medics to help me better understand certain principles.


 
Excellent!

Now if you are really serious about pharmacology, enroll in a college level course before you enter Paramedic school.   You might be surprised as how easy the Paramedic pharmacology will be but a little frustrated by how over simplified it is since few to no prerequisites are required.   

This is why some believe it is "thinking out of the box" when a medication is used for a purpose they never heard of.  But, there is just so much information one can fit on a 4x6 note card.  If they had taken a college level pharmacology class they would already have known about the "thinking out of the box" stuff even if they medical director did not allow it due to everyone being held to the knowledge of the lowest denominator.  However, if you advance to a progressive CCT or Flight team or even a good 911 ALS service, the advanced education and knowledge can be very useful.


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## VentMedic (Dec 18, 2009)

Aidey said:


> What about a non acute patient? For example, a hospice patient being transferred from home to a hospice house because the family can no longer provide care for the patient? Would the presence of the PCA pump automatically qualify a transfer like that as an ALS run?


 

That would depend on your state and local statutes for medications and what constitutes their definition of locked, secure and licensed. 

In a couple counties that I am familiar with in California, a heplock can be transported by BLS but if ANYthing is attached it gets ALS or CCT.  If the IV, including the PCA, is a med a California Paramedic can not even babysit and that includes most meds unfortunately, a CCT with an RN is required.


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## iacuras (Dec 20, 2009)

Quick question here. I've been doing quite a bit of international flying lately, and was wondering if someone on the plane had a medical emergency, and I was the only health care provider on the flight, what would I be able to do? I'm an EMT-B with an IV cert. Would I be able to start an IV?
My gut instinct would be to have the crew of the plane patch me through to a doc at an ER on the ground who could approve or deny my actions. Thoughts?


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## akflightmedic (Dec 20, 2009)

Here are two threads to get you started.

I will recap very briefly but you should read those threads. What good is an IV going to do if you are the only medical person?

Second, on international flights, I assure you out of the 250-400+ on board, one of them has more medical training than you, even the Indian doctor who barely speaks English.

The attendants will ask to see your certs before rendering aid most times unless true crisis exists and then they will still ask to see them after all is said and done. They always patch you through to their medical control after verifying your status.

They carry full ALS kits on board with a wide range of pharmacology and airway support.

I have tended to many medical emergencies as I have been flying international coming up on 5 years now. I have NEVER been the only medical person on board, I may have been the only one stupid enough to volunteer, but never the only one. 

(As a side note, I have received multiple gift baskets to my home address, several bottles of champagne including Dom, lots of free miles and over 1000 dollars off for future flights)...not that I volunteer to get these things but they are nice thank yous.


http://emtlife.com/showthread.php?t=12873&highlight=plane+emergency

http://emtlife.com/showthread.php?t=554&highlight=plane+emergency


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## apumic (Dec 20, 2009)

akflightmedic said:


> Second, on international flights, I assure you out of the 250-400+ on board, one of them has more medical training than you, even the Indian doctor who barely speaks English.



True, although some may choose not to reveal themselves to avoid taking on liability. While it's quite sad, with medical malpractice such an issue, a physician lacking any advanced tools may feel fairly uncomfortable about trying to assess a pt in-flight and deciding upon whether or not some sort of emergency care (that they likely have minimal resources for on-board) needs to be rendered. Obviously, in those cases, an EMT-B (or even paramedic or flight nurse) is definitely _not_ the best option; however, an MD may abstain from revealing him/herself to avoid being caught up in such a scenario. If advanced healthcare providers refused to reveal themselves, it _might_, in the rarest of circumstances, be possible for an EMS provider to be the one to raise his/her hand and volunteer to assist the potential pt.


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## VentMedic (Dec 20, 2009)

apumic said:


> True, although some may choose not to reveal themselves to avoid taking on liability. While it's quite sad, with medical malpractice such an issue, a physician lacking any advanced tools may feel fairly uncomfortable about trying to assess a pt in-flight and deciding upon whether or not some sort of emergency care (that they likely have minimal resources for on-board) needs to be rendered. Obviously, in those cases, an EMT-B (or even paramedic or flight nurse) is definitely _not_ the best option; however, an MD may abstain from revealing him/herself to avoid being caught up in such a scenario. If advanced healthcare providers refused to reveal themselves, it _might_, in the rarest of circumstances, be possible for an EMS provider to be the one to raise his/her hand and volunteer to assist the potential pt.


 
You are going to be limited regardless. The ALS meds available will only last so long. If you can not add additional fluids, pressors and drips, the patient may still be FUBAR somewhere over the Atlantic or Pacific Ocean. 

Regardless of the title, the airline's medical control will be on the communication line to help. The instructions are generally very clear. 

You also seem a little eager looking to get your 15 minutes of fame. 

I prefer not to board a flight wishing for someone to need medical assistance because I don't want bad health to happen to anyone and definitely not while several thousand feet in the air and a few thousand miles from land.


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## DV_EMT (Dec 20, 2009)

In response to the comment about... "what is to stop a Medic or RN from stealing a narcotic"... my response would be that an RN or Medic probably has spent too many hours studying and in classes... as well as money to risk stealing a narcotic... whereas a basic has a semester of training only.


In response to the Airplane question,

There are very few medical emergencies that happen in the air... and like AK said, they do have a variety of equipment in the air.

However, i did read an article somewhere that the equipment bags are sometimes not as "up to par" as some medical staff need them to be. From what i recall from the article... they are assembled py people that have no medical training and work an assembly line type of job. Now i've never seen any of the packs personally... so I couldnt begin to ell you either way if its good or bad, but just keep in mind that, yes they have them, and most all i believe have an AED.


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## zmedic (Dec 20, 2009)

Discussion thread of dealing with emergencies in the air, including medical kits:

http://forums.studentdoctor.net/showthread.php?t=497551&highlight=airplane


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## CAOX3 (Dec 21, 2009)

DV_EMT said:


> In response to the comment about... "what is to stop a Medic or RN from stealing a narcotic"... my response would be that an RN or Medic probably has spent too many hours studying and in classes... as well as money to risk stealing a narcotic... whereas a basic has a semester of training only..



Because addiction is based on educational background,.  Ridiculous


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## DV_EMT (Dec 21, 2009)

CAOX3 said:


> Because addiction is based on educational background,.  Ridiculous



you would be surprised...


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## CAOX3 (Dec 21, 2009)

DV_EMT said:


> you would be surprised...



What would suprise me is if you could provide any statistical information to back up this ludacris statement.


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## DV_EMT (Dec 21, 2009)

CAOX3 said:


> What would suprise me is if you could provide any statistical information to back up this ludacris statement.




:nosoupfortroll:

I'm not going to waste my time.... because its not a ludacris statement.


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## Lifeguards For Life (Dec 21, 2009)

DV_EMT said:


> :nosoupfortroll:
> 
> I'm not going to waste my time.... because its not a ludacris statement.


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## CAOX3 (Dec 21, 2009)

DV_EMT said:


> :nosoupfortroll:
> 
> I'm not going to waste my time.... because its not a ludacris statement.



Ok if you say so.


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## Sasha (Dec 21, 2009)

DV_EMT said:


> :nosoupfortroll:
> 
> I'm not going to waste my time.... because its not a ludacris statement.



I didn't find his post trolly at all, however I found your assertion that it is indeed a fact without the resources to back it up and then abrupt subject change when challenged to be a little on the troll side.


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## Seaglass (Dec 22, 2009)

Sasha said:


> I didn't find his post trolly at all, however I found your assertion that it is indeed a fact without the resources to back it up and then abrupt subject change when challenged to be a little on the troll side.



To throw in some random, statistically meaningless anecdotes, I have personally known two physicians and a veterinarian who became addicted to drugs, as well as a handful of students, and reliably heard of several more. I don't think high levels of education mean immunity to addiction, especially working in high-stress jobs with plenty of access.


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