BLS Skills -- What Should We Add?

[NomadicMedic]

Okay. You can have ASA.

 

[DesertMedic66]

Okay. You can have ASA.

That's administered per rectum right?

 

[NomadicMedic]

Only if you have skinny fingers.

 

[Veneficus]

GTN is far more useful in patients who have acute pulmonary edema anyway, I don't really think it has much of a role in myocardial infarction unless the patients pain or ST/T wave changes are significantly relieved. I mean they have called us because (potentially) their GTN is not working, so where is the point in giving them more? same goes for if their pain is not significantly relieved then its not working so why keep giving it?

the GTN in acute coronary syndrome is diagnostic. If you have somebody with chest pain which is relieved by nitro, it is very likely angina related and not an MI.

It is more useful for people without a 12 lead, like a basic.

 

[Bullets]

That's administered per rectum right?

We have a proposal in the legislatures to require every 911 ambulance to Carry Diastat. Apparently some mother had the ear of a senator and was upset her son had a seizure and the only way we could treat it is with iv medications. She felt this caused undue harm having to stick her son.

 

[NomadicMedic]

Sounds familiar to Washington. A relative of a political figure dies from anaphylaxis. A law was passed that BLS truck had to carry epi pens. Now there's the added expense of hundreds of dollars every year or two to replace expired epi pens.

Many counties in Washington have moved to 1mg ampules of epi with a 1ml syringe and have taught basics how to draw up the correct dose. At least it's cheaper to toss an amp of epi 1:1,000 than two epi pens when it expires.

And FWIW, I was involved in the follow up assessment of this skill. 60 days after training, at least half of the EMTs could not perform the skill satisfactorily.

 

[Bullets]

Sounds familiar to Washington. A relative of a political figure dies from anaphylaxis. A law was passed that BLS truck had to carry epi pens. Now there's the added expense of hundreds of dollars every year or two to replace expired epi pens.

Many counties in Washington have moved to 1mg ampules of epi with a 1ml syringe and have taught basics how to draw up the correct dose. At least it's cheaper to toss an amp of epi 1:1,000 than two epi pens when it expires.

And FWIW, I was involved in the follow up assessment of this skill. 60 days after training, at least half of the EMTs could not perform the skill satisfactorily.

Sounds like your getting robbed by the pharmacy. NJ allows epi- pens with medical director approval. We have saved 2 people in the three years since they got approved. They cost $30 a piece and are good for 18-24 months. $60 every two years is a pittance compared to saving someone that we can actually help

 

[Medic Tim]

Sounds like your getting robbed by the pharmacy. NJ allows epi- pens with medical director approval. We have saved 2 people in the three years since they got approved. They cost $30 a piece and are good for 18-24 months. $60 every two years is a pittance compared to saving someone that we can actually help

I have never seen an epi pen cost less than 100 bucks

 

[NomadicMedic]

I'm certainly not arguing that epi is effective, and I personally believe the the cost is justifiable for an easy to use item that has a definite life saving use. However, the average cost per unit was $70 and each BLS truck had to carry an EpiPen and in EpiPen Jr. and realize, that was anything that was certified as a BLS "response unit". Have a fire engine with BLS gear? They had to carry an EpiPen and EpiPen Jr. The majority if them would sit in a bag and just expire.

My real issue was (I say was since I'm no longer in WA) with the BLS providers not knowing when or how to administer epi appropriately or correctly. Once the medical directors decided, under pressure from private ambulance management and fire chiefs, that the expense of replacing epi-pens every year to two years was prohibitive they moved to a milligram of Epi with a syringe. That's a little nerve racking.

I responded to a call for an allergic reaction. I arrived on scene to find a patient with no Erway issue and some slight urticaria. He had taken 50 mg of Benadryl prior to our arrival and was in no distress. There was a BLS provider there, who arrived before I did, and he was struggling to try and snap the top off an amp of epi. When I asked him what he was doing he said, "this guys having an allergic reaction and he needs Epi…"

Yikes. An afternoon of training and injecting an orange with saline was not enough to get these guys up to speed. That's not to say he wouldn't have jammed an EpiPen into this guy's leg either…

 

[Clare]

Intramuscular adrenaline for anaphylaxis for the Emergency Medical Technician (BLS) level is coming if rumours are correct.

The Clinical Practice Guidelines give explicit guidance on when it is appropriate to administer adrenaline including that "allergy" must be differentiated from anaphylaxis.

Sounds like your people need more training perhaps, but I do not think it's an overly difficult skill, its much easier than reconstituting glucagon and only mildly more difficult than drawing up sterile water for injection in that you need to change from a drawing up needle to a sharp needle before you administer it.

 

[Medic Tim]

Intramuscular adrenaline for anaphylaxis for the Emergency Medical Technician (BLS) level is coming if rumours are correct.

The Clinical Practice Guidelines give explicit guidance on when it is appropriate to administer adrenaline including that "allergy" must be differentiated from anaphylaxis.

Sounds like your people need more training perhaps, but I do not think it's an overly difficult skill, its much easier than reconstituting glucagon and only mildly more difficult than drawing up sterile water for injection in that you need to change from a drawing up needle to a sharp needle before you administer it.

The injection is easy to teach. When and where and why on the other hand.....

keep in mind EMT training in the US is less than 200 hours

 

[ExpatMedic0]

The injection is easy to teach. When and where and why on the other hand.....

keep in mind EMT training in the US is less than 200 hours

I think its even closer to 100. It is 120 hours for our national right?

 

[Veneficus]

I think its even closer to 100. It is 120 hours for our national right?

It has been increased from 120 to 150, but even that barely permits coverning the new material added.

 

[ExpatMedic0]

Clock hours are a funny thing though. The NW of the USA uses quarter credits instead of semesters. So for us, One quarter credit hour is equal to 25 clock hours of instruction. This means EMT is 6 credits and Paramedic 52 credits. On the quarter credit system about 90ish credits is an AAS.

When you look at EMT being 6 credits comparatively.... I do not think we should be giving these people any extra skills. I think we should be giving them more training.
And yes I even said training! Not education ;-)

 

[Veneficus]

And yes I even said training! Not education ;-)

Probably a much better idea than the pseudoeducation of random facts on powerpoint they are enduring now.

 

[ThirtyAndTwo]

Also I think EMT's should be taught how to take a blood glucose reading, in PA that is a paramedic skill but its probably easier to do than get an accurate manual BP and is obliviously very useful in potential diabetic emergencies. Its a waste of time having to ask a family member to do it and it makes us look like we don't know what we are doing when they hand us the meter and we say "sorry we aren't trained to do that"

 

[Engineered]

Being that I work in the Denver metro area, I think every system should elevate up to where we are. As a Emt with an IV cert (additional 24 hours classroom and 12 hours clinical) I can start iv's, push narcan iv and in, d50 ( and all of its lower concentration equivelents), albuterol, bgl test, give boluses and some other small department dependent things. This makes us more then just glorified taxi drivers, and the system has worked well here. (Some departments I have been told have the emts place the 3 lead and 12 lead pads.)

 

[Medic Tim]

Being that I work in the Denver metro area, I think every system should elevate up to where we are. As a Emt with an IV cert (additional 24 hours classroom and 12 hours clinical) I can start iv's, push narcan iv and in, d50 ( and all of its lower concentration equivelents), albuterol, bgl test, give boluses and some other small department dependent things. This makes us more then just glorified taxi drivers, and the system has worked well here. (Some departments I have been told have the emts place the 3 lead and 12 lead pads.)

This is very similar to our EMT's or BLS medics. The difference being the training is 1-2 years as opposed to maybe 200 hours.

 

[hogwiley]

What should BLS add? As far as EMT training they should add A&P as a prerequisite. It doesn't have to be some advanced A&P class, but a simple one semester essentials of A&P should suffice. This would eliminate a lot of yahoos who go to EMT school because it sounds cool and they get to drive around with lights and sirens in a uniform.

There's no excuse not to do it. The field is flooded with EMTs so its not like there's a shortage, and a lot of these EMTs take multiple times to pass the NREMT, so why not require A&P?

 

[Tigger]

This is very similar to our EMT's or BLS medics. The difference being the training is 1-2 years as opposed to maybe 200 hours.

200 hours is nowhere sufficient to do what we are expected to do with the little add-on cert here. While I like being more useful to my medic, developing a skill takes more than a 24 hour class and a day at the ED getting 10 sticks.