Biggest problem at the EMT(BLS) Level?

[EMT856]

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.

 

[DesertMedic66]

A lot of services already allow most if not all of the items mentioned to be used at the EMT level.

More skills = more time in the classroom.

 

[EMT856]

I know that EMTs in NJ as well as a lot of other states do not.

 

[DesertMedic66]

I work for a very restrictive system in SoCal and can hang NS, obtain a 12-lead, and do BGL testing.

The major issue is lack of education. The EMT level is less than 200 hours of training (more around 120 hours). With more education come more skills.

 

[DrParasite]

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.

Narcan yes, ASA yes, BGL testing, yes, the rest no.

remember, you need to think about the lowest common denominator. many EMTs would be able to both do the skills you describe, but I know too many dumb people in EMS that i wouldn't trust with a band aid, let along administering d50.

Also remember, drugs do expire, especially if they aren't used frequently. the cost will play a factor

 

[EMT856]

What if there was a separate class you could take to expand your scope by a little bit? And supraglottic airways are almost foolproof.

 

[medicdan]

What if there was a separate class you could take to expand your scope by a little bit? And supraglottic airways are almost foolproof.

Become an Advanced EMT, and lobby for your state to incorporate that SOP. More time in the classroom + a verifiable certification = more "skills".

 

[TransportJockey]

Almsot everything you mentioned is in the SOP for EMT-Bs here in NM... that being said, I think ya'll in most areas have too BROAD of a scope for what you actually get in the classroom. EMT-B is advanced first aid. Nothing more. You need more time in the classroom before I would feel comfortable giving basics a broader scope.

 

[SixEightWhiskey]

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.

In NH, state protocol allows EMTs to do 12-leads, narcan, ASA, nitro and 7 other meds, do glucose testing, drop King LTs/Combitubes, and perform advanced spinal assessments/clear c-spine under strict protocol so we don't have to backboard every single MVA or fall pt just based on MOI. Having moved here from a different state and also being an EMT in MA (where the protocol for 99% of situations is 'initiate transport, call ALS'), working in NH is very refreshing.

I agree with what some of the other posts have said about people in EMS who you wouldn't trust to even take a set of vitals correctly, which is why NH requires an additional scope of practice course (including practicals) in order to do these more advanced skills.

 

[EMT856]

In NH, state protocol allows EMTs to do 12-leads, narcan, ASA, nitro and 7 other meds, do glucose testing, drop King LTs/Combitubes, and perform advanced spinal assessments/clear c-spine under strict protocol so we don't have to backboard every single MVA or fall pt just based on MOI. Having moved here from a different state and also being an EMT in MA (where the protocol for 99% of situations is 'initiate transport, call ALS'), working in NH is very refreshing.

I agree with what some of the other posts have said about people in EMS who you wouldn't trust to even take a set of vitals correctly, which is why NH requires an additional scope of practice course (including practicals) in order to do these more advanced skills.

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.

 

[TransportJockey]

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.

So how long do you think initial training should be?

 

[EMT856]

So how long do you think initial training should be?

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

 

[TransportJockey]

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

The skills a monkey can be trained how to do. What about more pathophys and pharmacology to teach them what they actually are doing. And to help teach them when to NOT do the fancy skills.
We are one of the only vocations in medicine that is so proud of themselves based on what skills we can do. And not what knowledge we have. Hence we we are a technical vocation and not a profession or a career.

 

[JPINFV]

What if there was a separate class you could take to expand your scope by a little bit? And supraglottic airways are almost foolproof.

Like a paramedic class?

The problem with limited tools with limited education is that you end up with providers who both only have a hammer and only know about hammers... and when that occurs, everything looks like a nail, including screws.

 

[Tigger]

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.

We have all of this in Colorado with an extra 24 hour course. Which is not nearly enough time, but the point is that it exists. CPAP requires a waiver.

The purpose of course is really to become a better "paramedic assistant," and that's all it should be. It does not teach a better assessment or anything of that nature, and frankly I have seen plenty inappropriate interventions performed by our BLS volunteers that were done only "because we can so we did." Everyone forgets to actually assess the patient and instead concentrates on getting an IV, which misses the point of you know, patient care.

I work for a very restrictive system in SoCal and can hang NS, obtain a 12-lead, and do BGL testing.

The major issue is lack of education. The EMT level is less than 200 hours of training (more around 120 hours). With more education come more skills.

How do you hang NS if you can't start IVs?

 

[DesertMedic66]

We have all of this in Colorado with an extra 24 hour course. Which is not nearly enough time, but the point is that it exists. CPAP requires a waiver.

The purpose of course is really to become a better "paramedic assistant," and that's all it should be. It does not teach a better assessment or anything of that nature, and frankly I have seen plenty inappropriate interventions performed by our BLS volunteers that were done only "because we can so we did." Everyone forgets to actually assess the patient and instead concentrates on getting an IV, which misses the point of you know, patient care.


How do you hang NS if you can't start IVs?

BLS units don't run 911 calls in my area. So as the medic is getting the IV we can hang NS or get a saline lock. We are able to monitor NS during BLS transports including changing bags of NS if a new on is needed.

 

[mycrofft]

Basic means basic. Want more, then train higher.
At any level, the first lesson is know what not to do!

 

[jpregulman]

I would agree, the basic level should be a more advanced level (with more training of course).

There is progress however. Under my protocols in OH EMTs can now give Narcan w/o online med control, give their own ASA, drop kings/LMAs, glucose testing, apply and transit 12 leads and CPAP


CO lets their EMTs give d5w and NS as well as start lines with extra training.

 

[NomadicMedic]

It's my belief that the focus in EMT class should be on how to perform high performance CPR, moving patients safely, driving the vehicle safely and developing interpersonal relationship skills.

Those are the 4 most important skills an EMT can have, yet they're glossed over, if they're covered at all.

 

[TransportJockey]

It's my belief that the focus in EMT class should be on how to perform high performance CPR, moving patients safely, driving the vehicle safely and developing interpersonal relationship skills.

Those are the 4 most important skills an EMT can have, yet they're glossed over, if they're covered at all.

Sounds like a good plan to me