BLS Skills -- What Should We Add?

[Clare]

Oh good heavens I must say this has made for most interesting reading. How on earth do you cope with not being able to do basic things like obtain an ECG, check a blood sugar level or give drugs like glucagon and salbutamol?

A couple of years ago the base level was renamed from "Ambulance Officer" to "Emergency Medical Technician". I don't really like that title but I guess it's here to stay.

The delegated scope of practice is updated every two years in September and since 2007 has been increased each time. I don't know what will be added next but the list is currently as follows:

Entonox, methoxyflurane, nasopharyngeal airway, nebulised salbutamol, nebulised ipratropium, GTN spray, IM glucagon, laryngeal mask airway, oral ondansetron, oral loratadine, nebulised adrenaline, PEEP valve, tourniquet.

This does not include what are called "ordinary" interventions that are "not formally described within any delegated scope of practice" such as oropharyngeal airway, blood sugar measurement, obtaining a 12 lead ECG etc which may be performed by all levels including First Responders.

 

[EpiEMS]

Oh good heavens I must say this has made for most interesting reading. How on earth do you cope with not being able to do basic things like obtain an ECG, check a blood sugar level or give drugs like glucagon and salbutamol?

A couple of years ago the base level was renamed from "Ambulance Officer" to "Emergency Medical Technician". I don't really like that title but I guess it's here to stay.

I remember reading that the medics in NZ, like those in AUS, are undergraduate-level (first degree?) trained. What's the level of training for BLS providers? In the states, it's vocational training, equivalent to, say, one or two standard university-level courses (I've seen places where it's 3 course hours, some with 6).

 

[rescue1]

My EMT-B course was 4 credits at college, same as any other standard course. Which makes it equivalent to 1/32 of what I had to complete for a bachelor's degree.

I'm not sure if that amount of education is enough to achieve the level of scope that Australian EMS has.

 

[Clare]

I remember reading that the medics in NZ, like those in AUS, are undergraduate-level (first degree?) trained. What's the level of training for BLS providers? In the states, it's vocational training, equivalent to, say, one or two standard university-level courses (I've seen places where it's 3 course hours, some with 6).

Emergency Medical Technician (BLS) is a Diploma (about a year) whereas Paramedic requires a Degree and Intensive Care Paramedic is a Post-Graduate course.

I think in the future paid recruitment will be from Degree graduates only and certainly in Auckland there is a not much hope of being hired with the Diploma only because its a minimum of two or so years to upgrade to Paramedic but a Degree graduate only takes six to nine months.

I am a graduate and am upgrading to Paramedic level but I have taken longer than most because I wanted to.

Australia does not have a BLS level as all services there need a Degree.

Here are the different levels

Emergency Medical Technician (BLS)
Entonox, methoxyflurane, nasopharyngeal airway, nebulised salbutamol,
nebulised ipratropium, GTN spray, IM glucagon, laryngeal mask airway, oral
ondansetron, oral loratadine, nebulised adrenaline, PEEP valve, tourniquet.

Paramedic (ILS)
All of the above, plus manual defibrillation, synchronised cardioversion, IV
cannulation, IV fluid administration, IV glucose, SC lignocaine for IV
cannulation, plus morphine, fentanyl, naloxone, ondansetron,
IM adrenaline, IV adrenaline for cardiac arrest, IV amiodarone for cardiac
arrest, ceftriaxone, naloxone, IM and IN midazolam for seizures.

Intensive Care Paramedic (ALS)
All of the above, plus laryngoscopy, endotracheal intubation, capnography,
cricothyrotomy, chest decompression, IO access, IO lignocaine, adrenaline,
atropine, amiodarone, adenosine, midazolam, ketamine, pacing,
vecuronium, suxamethonium (selected personnel only).

 

[EpiEMS]

Emergency Medical Technician (BLS) is a Diploma (about a year) whereas Paramedic requires a Degree and Intensive Care Paramedic is a Post-Graduate course.

I think in the future paid recruitment will be from Degree graduates only and certainly in Auckland there is a not much hope of being hired with the Diploma only because its a minimum of two or so years to upgrade to Paramedic but a Degree graduate only takes six to nine months.

Makes sense to me. I don't see a bachelor's degree requirement for US EMS in the near future, but I'm curious what it'd do as far as scopes go.

Just curious, no EpiPens at the BLS level?

 

[Clare]

Just curious, no EpiPens at the BLS level?

An Epipen is an "ordinary intervention" that is not formally described in any scope of practice so can be administered by anybody including First Responders.

A scope of practice includes "... medicines and [specific] interventions ..." whereas things like pulse oximetery, BGL, acquiring a 12 lead ECG are not a specific intervention they are more obtaining clinical information rather than providing a specific intervention to the patient so can be performed by all levels including First Responders.

An epi-pen is not described within a scope of practice because it is something Joe Smith is taught to do in a first aid course and in fact any member of the public can do.

 

[Amberlamps916]

How to weigh the gurney for dialysis.
How to decipher what the foreign nurse at the snf is telling you.
How to read what's in the "Packet" that those nurses love to refer to when asked something they don't know.
How to transfer patient to dialysis chair.
How to occupy your time while waiting for Mrs. Shmeegelstein's Dr's appointment to finish.

 

[TheLocalMedic]

How to weigh the gurney for dialysis.
How to decipher what the foreign nurse at the snf is telling you.
How to read what's in the "Packet" that those nurses love to refer to when asked something they don't know.
How to transfer patient to dialysis chair.
How to occupy your time while waiting for Mrs. Shmeegelstein's Dr's appointment to finish.

Lol, yes.

 

[Amberlamps916]

Somebody had to show some love towards the IFT side of BLS.

 

[patzyboi]

I think it'll be helpful for BLS to be able to have and use a cardiac monitor (BLS units dont have them here in cali)

and those 10 or so drugs in the orange book to actually be administered (BLS not able to administer any medication in cali)

 

[DesertMedic66]

I think it'll be helpful for BLS to be able to have and use a cardiac monitor (BLS units dont have them here in cali)

and those 10 or so drugs in the orange book to actually be administered (BLS not able to administer any medication in cali)

How do you think it would be useful for a cardiac monitor on BLS?

 

[patzyboi]

How do you think it would be useful for a cardiac monitor on BLS?

Well for one thing it'll give you a set of vitals on the spot.

 

[JPINFV]

I think it'll be helpful for BLS to be able to have and use a cardiac monitor (BLS units dont have them here in cali)

and those 10 or so drugs in the orange book to actually be administered (BLS not able to administer any medication in cali)

§ 100063. Scope of Practice of Emergency Medical Technician.
(a) During training, while at the scene of an emergency, during transport of the sick or injured, or during interfacility transfer, a certified EMT or supervised EMT student is authorized to do any of the following:
...
(D) basic oxygen delivery devices;
...
(8) Administer oral glucose or sugar solutions.
...
(13) Perform automated external defibrillation when authorized by an EMT AED service
provider.
...
(14) Assist patients with the administration of physician prescribed devices, including but not limited to, patient operated medication pumps, sublingual nitroglycerin, and selfadministered emergency medications, including epinephrine devices.

§ 100064. EMT Optional Skills.
(a) In addition to the activities authorized by Section 100063 of this Chapter, LEMSA may establish policies and procedures for local accreditation of an EMT student or certified EMT to perform any or all of the following optional skills specified in this section.
...
(c) Administration of naloxone for suspected narcotic overdose.
...
(d) Administration of epinephrine by auto -injector for suspected anaphylaxis and/or severe asthma.
...
(e) Administer the medications listed in this subsection.
(1) Using prepackaged products, the following medications may be administered:
(A) Atropine
(B) Pralidoxime Chloride

http://www.emsa.ca.gov/laws/files/ch2emtIupdate.pdf


Shrug. What more are you looking for? Besides oxygen, most of the other EMT level medications aren't used except in extremely rare circumstances. I could argue that ASA should be added for ACS, but I don't like the idea that all chest pain is ACS.

 

[JPINFV]

Well for one thing it'll give you a set of vitals on the spot.

Ambulances already comes with a vital sign machine.

 

[NYMedic828]

I think it'll be helpful for BLS to be able to have and use a cardiac monitor (BLS units dont have them here in cali)

and those 10 or so drugs in the orange book to actually be administered (BLS not able to administer any medication in cali)

So you want an EMT to be a paramedic...

They have a class for that.

 

[JPINFV]

So you want an EMT to be a paramedic...

They have a class for that.

To be fair, there is bit of a bait and switch where EMT class talks about everything that's supposed to be in the scope and all of a sudden you're on an ambulance with only one of the medications you learned about. On the other hand the vast majority of the other medications aren't ever used by EMTs anyways.

 

[DesertMedic66]

Ambulances already comes with a vital sign machine.

Exactly what I was thinking.

I'm on a 911 ALS unit and the only vital sign our monitor gives us is the electrical heart rate and EKG reading...

 

[Veneficus]

Exactly what I was thinking.

I'm on a 911 ALS unit and the only vital sign our monitor gives us is the electrical heart rate and EKG reading...

Do your units have holes in the floor boards so you can power the ambulance with your feet?

It sounds like your monitor is second hand from the Flintstones

 

[DesertMedic66]

Do your units have holes in the floor boards so you can power the ambulance with your feet?

It sounds like your monitor is second hand from the Flintstones

LP12, we just got them "upgraded" to be able to transmit 12-leads 6 months ago. We were talking about upgrading to the Zoll X series but that hasn't happened yet.

 

[mycrofft]