Biggest problem at the EMT(BLS) Level?

[Rockies]

I am not saying lets just give everyone a wider scope with no additional training, I am saying we should be getting this training to begin with.

Good luck cramming that into the semester long course to begin with.

 

[Wheel]

Just wondering what the biggest problems my fellow EMTs feel affect the EMT level of care.

Personally I feel that EMT-Basic has too basic of a scope.

Shouldn't we be able to use CPAP, pull 12 leads, give Narcan, have our own supply of NTG and ASA, drop Kings/LMAs, amongst other things? I honestly think we should also be able to hang a bag of NS and grab peripheral IV access for certain C/Cs? With that, if we had the above, along with glucose testing, and d50... We would keep ALS free for the serious crap.

What kind of serious stuff would you be freeing up ALS for? If they aren't going to respiratory calls (you have CPAP and supra glottic airways), chest pain (you have ASA, nitro, 12 leads), diabetic emergencies (you have D50 and IV access), then what are they going for?

My opinion is that BLS doesn't need a wider scope. They need a more thorough education in assessment and physiology. Skills are simple. The knowledge of when to use them is not. Frankly there are too many BLS providers giving oxygen willy nilly for no reason other than "because my protocols say so", that I can't see giving them a bunch of cool toys to play with without having a better knowledge base to back it up.

 

[Christopher]

Just wondering what the biggest problems my fellow EMTs feel affect the EMT level of care.

Personally I feel that EMT-Basic has too basic of a scope.

Shouldn't we be able to use CPAP, pull 12 leads, give Narcan, have our own supply of NTG and ASA, drop Kings/LMAs, amongst other things? I honestly think we should also be able to hang a bag of NS and grab peripheral IV access for certain C/Cs? With that, if we had the above, along with glucose testing, and d50... We would keep ALS free for the serious crap.

Come join us in North Carolina and you can do just about all of that (no IV's). I know our politicians make us look like we're a bunch of toothless, shirtless, moronic rednecks...but in spite of all of that we're actually really good at EMS.

If your EMT scope is too basic it is your State or medical director's fault.

 

[Christopher]

Good luck cramming that into the semester long course to begin with.

If North Carolina can do it, your State can too. We're literally the bottom of the barrel in education and manage to do it.

 

[cprted]

Personally I feel that EMT-Basic has too basic of a scope.

Well, it is called EMT-Basic

Shouldn't we be able to use CPAP, pull 12 leads, give Narcan, have our own supply of NTG and ASA, drop Kings/LMAs, amongst other things? I honestly think we should also be able to hang a bag of NS and grab peripheral IV access for certain C/Cs? With that, if we had the above, along with glucose testing, and d50... We would keep ALS free for the serious crap.

You think that patients requiring CPAP, Nitro, Narcan, a King, D50 etc don't qualify as serious?

 

[toxik153]

My EMT hours are 252...not under 200.

 

[emt11]

the original 220, plus at least an additional 100-150. However long is needed in order to teach these skills effectively.

At that point your somewhere around 100 hours shy of the AEMT, so why not tack that on and boom you have a wider scope.

 

[DesertMedic66]

My EMT hours are 252...not under 200.

Not all EMT programs are that long. There are many that are in the 126 hour range.

 

[Greywind]

I'm currently in rural Montana and am able to do many of these skills as an EMT-Bl all the way up to and including ET intubation and administering morphine for some patients. My scope is quite advanced. I believe that basics should be allowed to do these skills withe proper training. Take your class, get your practice, do your competency skills test and have a certain number of patients in which you performed these tasks and I would think you should be cleared to perform the tasks without supervision.

 

[NomadicMedic]

Or, you could just take the extra education, learn the WHY as opposed to just the HOW and voila! You're a paramedic.

Basics are called basics for a reason. Because the initial education was enough to teach basic life support. If you want a wide scope, get more education.

 

[TransportJockey]

I'm currently in rural Montana and am able to do many of these skills as an EMT-Bl all the way up to and including ET intubation and administering morphine for some patients. My scope is quite advanced. I believe that basics should be allowed to do these skills withe proper training. Take your class, get your practice, do your competency skills test and have a certain number of patients in which you performed these tasks and I would think you should be cleared to perform the tasks without supervision.

You're in the land of the merit badge courses. How many 'additional certifications' are there for basics up there? Four or five? Unless those courses were 50+ hours each then I don't see how you were taught the pathophys behind why you are doing that and why you shouldn't do it

 

[VFlutter]

Basics intubating? Screw CRNA school, I'm moving to Montana!!

 

[Greywind]

Yes, I am in the land of merit badge courses. My scope allows me to do all of these things but I don't do them as I have not had the need to yet. I have myself closely monitored by a paramedic mentor and also a basic mentor. I strive to be the best EMT that I can be and will not do something just because I can do it.

 

[Carlos Danger]

I'm currently in rural Montana and am able to do many of these skills as an EMT-Bl all the way up to and including ET intubation and administering morphine for some patients. My scope is quite advanced. I believe that basics should be allowed to do these skills withe proper training. Take your class, get your practice, do your competency skills test and have a certain number of patients in which you performed these tasks and I would think you should be cleared to perform the tasks without supervision.

I completely agree that people should be allowed to perform these skills with the proper training. Anyone can learn anything with the proper training. Afer all, physicians are just laypersons who obtained "the proper training" to do what they do.

The problem is, three hours is not "proper training" to learn advanced airway management. You could quadruple those hours and it wouldn't be nearly enough.

I honestly can't believe that any medical director would sign off on that.

 

[triemal04]

You have to remember that Montana is different than almost all other states. There are still large areas that are truly "frontier" areas, and, as in Alaska, there are places that, weather dependent, may be days away from a hospital, not just minutes or hours. While I don't neccasarily agree with how this type of thing usually get's done, I can see the reasoning behind it. And let's be honest...giving someone morphine (or a fentanyl lozenge, or narcotic patch, or any of the multitude of ways to give a pain reliever other than an injection), especially if you have access to narcan, is relatively benign.

Intubation is a bit different, and probably just a throw back to a time when there weren't as many supraglottic airways available as there are now; to be honest I'm surprised it hasn't been removed in favor of one of those.

If people are going to do/give something they absolutely need to be properly taught how to do it, I'm not saying anything at all against that. What I am suggesting it that, in certain very specific situations, there may be exceptions to that.

Now, if this guy lives in any type of population center with even somewhat easy access to advanced care, then all bets are off.

 

[emt11]

You have to remember that Montana is different than almost all other states. There are still large areas that are truly "frontier" areas, and, as in Alaska, there are places that, weather dependent, may be days away from a hospital, not just minutes or hours. While I don't neccasarily agree with how this type of thing usually get's done, I can see the reasoning behind it. And let's be honest...giving someone morphine (or a fentanyl lozenge, or narcotic patch, or any of the multitude of ways to give a pain reliever other than an injection), especially if you have access to narcan, is relatively benign.

Intubation is a bit different, and probably just a throw back to a time when there weren't as many supraglottic airways available as there are now; to be honest I'm surprised it hasn't been removed in favor of one of those.

If people are going to do/give something they absolutely need to be properly taught how to do it, I'm not saying anything at all against that. What I am suggesting it that, in certain very specific situations, there may be exceptions to that.

Now, if this guy lives in any type of population center with even somewhat easy access to advanced care, then all bets are off.

Having some of my wife's family living in Montana, and looking at possibly moving there one day. From my understanding, the classes are recognized state wide and the only thing stopping you at that point is the medical director.

 

[triemal04]

Having some of my wife's family living in Montana, and looking at possibly moving there one day. From my understanding, the classes are recognized state wide and the only thing stopping you at that point is the medical director.

I know. I have no clue how widely all the little extra certs are used, but it wouldn't surprise me at all if they were misused, even to the point of places that should have paramedics not having them in favor of an EMT with XYZ extra tacked on.

This is probably one of those things that started out with the best of intentions and as an appropriate idea...and then fell flat. Kinda common for that to happen unfortunately.

 

[Carlos Danger]

If people are going to do/give something they absolutely need to be properly taught how to do it, I'm not saying anything at all against that. What I am suggesting it that, in certain very specific situations, there may be exceptions to that.

"First, do no harm".

When it comes to invasive airway management, the threat of harm from someone not knowing what they are doing is very high. Probably always higher than just sticking to skilled BLS airway management. Frontier or not, there is never a justification for handing a complete layperson (which is exactly what an EMT-B is after a 3-hour intubation course) an ETT and blade and telling them to go to work.

Paramedics get at least 30 hours of airway training in the classroom alone - plus manikin time, OR clinical, and ride time - and there are still a lot of people who think as a group paramedics suck at airway management because they don't get nearly enough education in it.

I would love to see the statewide QI data on EMT-B intubation.

 

[TheLocalMedic]

Seems like the general consensus is: if you want a bigger scope, become a paramedic. I agree wholeheartedly. EMT-basics simply lack the depth of knowledge (and often experience) to be given much more than they currently have.

That being said, there are a few things that I feel ought to be added to the EMT scope here in Northern Cal. The three big ones are ASA, Narcan and blood glucose determination.

But then again, most 911 providers here are all ALS, so the only areas lacking these things are the rural, outlying departments that staff BLS ambulances. And I don't really see a need for all those EMTs running around with the IFT companies to have anything more than they do now. Most are, sadly, glorified taxi drivers.

 

[triemal04]

"First, do no harm".

When it comes to invasive airway management, the threat of harm from someone not knowing what they are doing is very high. Probably always higher than just sticking to skilled BLS airway management. Frontier or not, there is never a justification for handing a complete layperson (which is exactly what an EMT-B is after a 3-hour intubation course) an ETT and blade and telling them to go to work.

Paramedics get at least 30 hours of airway training in the classroom alone - plus manikin time, OR clinical, and ride time - and there are still a lot of people who think as a group paramedics suck at airway management because they don't get nearly enough education in it.

I would love to see the statewide QI data on EMT-B intubation.

I was actually thinking more along the lines of narcotics, not airway management. As I said that's probably a throwback to when there weren't any good SGA's around and the thinking was along the lines of "well, the patient's already dead, so where's the harm?" Ignoring that even in dead people improper intubation attempts can be harmful. Best intentions don't always work out for the best...

And I'm one of the people that thinks that paramedics as a group suck at intubation because we don't get enough education and practice at it.