# Rectal Tylenol on NRP Practical?



## Pavehawk (Feb 12, 2013)

A friend of mine (no really, an actual friend, not me) just took the paramedic practical portion of the NRP in Atlanta the other day. 

He had to retest a peds station because he "failed to give a rectal tylenol suppository" to a post febrile seizure patient. 

When he talked to the proctors about the testing he was told that this (rectal tylenol) was a common skill in this area (he trained elswhere and moved there for a job with AFD) It is my understanding that NREMT is supposed to be a standard and not a local protocol thing.

The question of course is... where in the National Standard ciriculum is rectal tylenol administration??

If there are any NREMT folks hanging out on the forum how about weighing in on this.

(BTW he did paass his retest and got his NRP so all is well)


----------



## DesertMedic66 (Feb 12, 2013)

As for the NREMT (medic should be the same) we test students out on the National level. If there is something in their scope additional they are not tested on it (intubation, IV, IM meds, etc). 

If he was testing at a specific location for a job they can make their own tests to follow the local protocols. 

Personally I've not heard of rectal Tylenol being in anyone's scope (at least in my area).


----------



## Pavehawk (Feb 12, 2013)

firefite said:


> As for the NREMT (medic should be the same) we test students out on the National level. If there is something in their scope additional they are not tested on it (intubation, IV, IM meds, etc).
> 
> If he was testing at a specific location for a job they can make their own tests to follow the local protocols.
> 
> Personally I've not heard of rectal Tylenol being in anyone's scope (at least in my area).



It was not for a job, it was for the NREMT... I have not seen that in any scope of practice either... but Im sure someone somewhere does it.

A bunch of us from my area were planning on going up to ATL to test this summer now we are hmmm, hard to study for stuff that just magically appears on the test.


----------



## Veneficus (Feb 12, 2013)

Just a quick bit of info on curriculums. They do not specify by bullet point what needs to be taught and what doesn't. 

They specify concepts that need to be taught by bullet point. The details of this can be filled in by the respective program or instructor.

an NSAID to treat pediatric fever is not going to be listed as: "Tell students to give tylenol for a pediatric patient suffering from a febrile seizure."

I would argue that if a paramedic didn't know that, then they really need to not be functioning at the ALS level. 

But... This whole story seems a bit fishy to me. 

He claims he failed for not giving the rectal tylenol...

But, the reason for failure has to be marked and detailed on the NR sheet.

The NR rep has to review the sheets for completeness and accuracy. Which also includes making sure the rules are followed and intentions met. 

If this person did indeed fail a skills station for this, it must be listed as a critical fail, otherwise, if that is all that was wrong, the person testing would be well above the 71% mark required on points.

Since I have never seen that listed as a critical fail, I would think it was listed as "failure to treat or treatment which is harmful or dangerous." 

The reason for such needs to be explained and especially documented since it is somewhat subjective.

I could definately see this question as part of the NR-paramedic (Please don't use NPR, that already means something in medicine and it is not national registry paramedic) computer exam.  

I would encourage this person to report this directly to the NREMT headquarters as there is a deficincy not only in the specific skill proctor, but also the NR rep providing oversight.

There must be more to the story...


----------



## MrJones (Feb 12, 2013)

Veneficus said:


> ...(Please don't use NPR, that already means something in medicine and it is not national registry paramedic) computer exam....



Assuming you meant NRP as used by the OP and not NPR (National Public Radio), have you contacted the decision makers at NREMT with your concerns?


----------



## Veneficus (Feb 12, 2013)

MrJones said:


> Assuming you meant NRP as used by the OP and not NPR (National Public Radio), have you contacted the decision makers at NREMT with your concerns?



That's nice, but it has also meant "Neonatal Resuscitation Program" longer and around the world.

It is like naming an EMS provider level ACLS. It confuses everyone. It would be no different than naming a nonacute condition something that was easily abbreviated MI.

I understand the intention, and it was good, get the "technician" name removed from paramedic, but the result sucks, because not only is it confusing, they didn't substantially increase the education required so the name changes, but they are still techs.


----------



## MrJones (Feb 12, 2013)

Veneficus said:


> That's nice, but it has also meant "Neonatal Resuscitation Program" longer and around the world.
> 
> It is like naming an EMS provider level ACLS. It confuses everyone. It would be no different than naming a nonacute condition something that was easily abbreviated MI.
> 
> I understand the intention, and it was good, get the "technician" name removed from paramedic, but the result sucks, because not only is it confusing, they didn't substantially increase the education required so the name changes, but they are still techs.



I'm not necessarily disagreeing with your POV. I was only pointing out that NREMT made the decision to use those initials and, like it or not, those initials are what people are going to be using.


----------



## Veneficus (Feb 12, 2013)

MrJones said:


> I'm not necessarily disagreeing with your POV. I was only pointing out that NREMT made the decision to use those initials and, like it or not, those initials are what people are going to be using.



It is not whether I like it or not, it is just one more way in which EMS providers have chosen to seperate themselves from the rest of the medical community. 

I predict it will end up doing more harm than good to the reputation of US paramedics in the eyes of the rest of the medical community.

Not the first major mistake the NREMT has made, won't be the last.


----------



## Pavehawk (Feb 12, 2013)

I have no dog in this fight... I didn't take the test, nor have the incident. If I had I would have been in a better position to say something, and would have. I did suggest that he take this to NREMT... he is not interested ,as he passed, gets his patch... and doesnt want to make waves.

I'm just curious as to why it happened, how it happened, and what any NREMT proctors might have to say about it. NREMT is adament about impartial proctors and standardized tests I wanted to know how things like this "slip by" the folks who get paid to test to a national standard.


----------



## Veneficus (Feb 12, 2013)

Pavehawk said:


> I have no dog in this fight... I didn't take the test, nor have the incident. If I had I would have been in a better position to say something, and would have. I did suggest that he take this to NREMT... he is not interested ,as he passed, gets his patch... and doesnt want to make waves.
> 
> I'm just curious as to why it happened, how it happened, and what any NREMT proctors might have to say about it. NREMT is adament about impartial proctors and standardized tests I wanted to know how things like this "slip by" the folks who get paid to test to a national standard.



That is an easy question to answer.

An NR practical test has to have one recognized NR rep. 

The agency holding the test gets to choose the proctors.(and pay them) You do not need to hold an NR card to be a proctor, just a state card that says you are of the level being tested.

Proctors are given "instructions" prior to testing. AKA coffee and doughnuts with some paramedic (usually a good old boy) speaking about the test in the background.

It is a nice time when you see medics who you went to school with and wound up at different agencies than, a little networking for jobs, maybe even try to get a hook up with that cute female who is a paramedic but none of the good old boys seems to know who she is or where she came from. 

They don't even go over the criteria or the sheets during this "meeting" and if they did, I haven't heard it in more than 10 years of being a proctor. Even when I was actively listening to the speech.

Most centers will pick "easy" proctors, who will give applicants a lot of leeway. Now and again an A**hole tries to show off their knowledge and power as a "supermedic" to the student and does something like you described. 

The NR rep is supposed to catch this and take corrective action. (whatever level seen fit, usually, just letting the proctor know that was not cool) 

Some centers, particulrly those who have their own program, like to "punish" or "demonstrate" that the student should have gone through their program andare easy on their students and hard on outsiders. 

Fewer still select these A**holes on puropose as the last way they can assert their clout over students. 

Because there are always a lot of complaints, the NR complaint system for students is extremely flawed and heavily biased in favor of the preceptors. 

There is a way to put this bias in check, but many places do not use it. Some places even only apply the check to their students, and not outsiders testing that day.


----------



## MrJones (Feb 12, 2013)

Veneficus said:


> It is not whether I like it or not, it is just one more way in which EMS providers have chosen to seperate themselves from the rest of the medical community.
> 
> I predict it will end up doing more harm than good to the reputation of US paramedics in the eyes of the rest of the medical community.
> 
> Not the first major mistake the NREMT has made, won't be the last.



Really? It doesn't seem to have hurt the nursing profession - 



> The Nurse Refresher Program (NRP) was created  over 30 years ago by nurse educators throughout Idaho....



And let's not forget....

National Register of Patients 
National Registry of Patients 
Neonatal Resuscitation Provider
Neuopilin
Neurotensin related peptide
Non-repeat patient
nucleus raphe pallidus 
nucleus raphe pontis 
nucleus recessus posterioris 
nucleus reticularis parvocellularis 

I think the use of a common acronym to designate a nationally registered paramedic is at or near the bottom of the list of things we need to worry about in the EMS profession.

I'm just sayin'....


----------



## EMT B (Feb 12, 2013)

West Virginia has PO tylenol in their NREMT scope of practice


----------



## Veneficus (Feb 12, 2013)

MrJones said:


> I think the use of a common acronym to designate a nationally registered paramedic is at or near the bottom of the list of things we need to worry about in the EMS profession.
> 
> I'm just sayin'....



But it is probably the only thing EMS providers can change that affects them.

As well, at this point, with EMS reputation in medicine as low as it is, it wouldn't help to add anymore fuel to the fire.

consider the context when choosing your acronyms, 

"I was at an NRP test and I failed to give an NSAID to a kid with a febrile seizure. But eventually I passed and now I am an NRP."

That is much easier to confuse than: "I was at the NRP test and damn it if somebody didn't think that meant nucleus raphe pallidus"


----------

