BLS Skills -- What Should We Add?

[DesertMedic66]

I guess it's kinda like saying why allow an EMT to stop bleeding when an AEMT can do it. I think albuterol's benefit, safety and ease of administration make it a worthwhile drug to have on every ambulance. Honestly, and don't mean to offend anyone, but think Paramedics should be the minimum staffing level for an ambulance in the US.

RN's and doctors are the standard level of care providers in ED's in this country - no one ever says we cant afford them let's go to CNA's and hire an RN to be the physician in the ED. I don't see why we find excuses to compromise with not paying a Paramedic a decent wage to staff every ambulance.

If we went this route then the OP's question wouldn't even matter.

I wouldn't say that paramedic needs to be the minimum staffing level. It doesn't take a paramedic to take vitals, CPR, gurney, and drive. IMHO there should be at least one medic on an 911 ambulance. We run a couple of dual medic rigs and one of the medics just plays EMT all day. Pointless to pay a paramedic a paramedics pay to due an EMTs job.

 

[Handsome Robb]

We run a couple of dual medic rigs and one of the medics just plays EMT all day. Pointless to pay a paramedic a paramedics pay to due an EMTs job.

Our dual medic rigs alternate calls. They both act as paramedics. If one is going to play EMT all day then pay him/her an EMT wage.

 

[18G]

I don't want to hijack the thread but a patient, no matter the priority, deserves to have a highly trained and college educated healthcare provider to arrive at their side.

I don't think that is too much to ask for. ED's get patient's that only require a CNA or LPN but hospital's demand RN's. Why? Because the RN can go much deeper if need be and screen for stuff that a a lower nurse level can't. And the public demands it. Same applies to EMT's except the public doesn't demand it because most communities are blind and don't know what their missing.

An EMT get's assigned a call for weakness as BLS. There are many differentials to consider with a vague complaint of weakness. That weakness could be a CVA, MI, hyperkalemia, hypovolemia, etc, etc. This patient requires more than some vitals and being placed on a stretcher. No what I'm saying?

I was an EMT for many, many years in a paid capacity full-time for a FD so I know the limitations very well. I felt often like all I did was take vitals, ask a bunch of questions to get answers I couldn't do anything about, and transport to the hospital. Heck, many answers I get now I can't do anything about.

Just want to see the bar raised.

 

[DesertMedic66]

Our dual medic rigs alternate calls. They both act as paramedics. If one is going to play EMT all day then pay him/her an EMT wage.

Company isn't allowed to due that. If they are hired as a medic they get medic pay for any work they do.

I get EMT pay no matter what I do. If I play VST, mechanic, paperwork, sit on my butt and do nothing because my partner called off I still get my EMT pay.

 

[NYMedic828]

Company isn't allowed to due that. If they are hired as a medic they get medic pay for any work they do.

I get EMT pay no matter what I do. If I play VST, mechanic, paperwork, sit on my butt and do nothing because my partner called off I still get my EMT pay.

I think the point Rob was going for is not literally to pay a medic less money for their title but rather to replace the second medic with an EMT to save money.

 

[DrParasite]

I don't want to hijack the thread but a patient, no matter the priority, deserves to have a highly trained and college educated healthcare provider to arrive at their side.

I am college educated... but I don't think my degree in history is going to help me on a job.....

I don't think that is too much to ask for. ED's get patient's that only require a CNA or LPN but hospital's demand RN's. Why? Because the RN can go much deeper if need be and screen for stuff that a a lower nurse level can't.

and yet, they will usually have a doctor within shouting distance if they get something that is over their head.

An EMT get's assigned a call for weakness as BLS. There are many differentials to consider with a vague complaint of weakness. That weakness could be a CVA, MI, hyperkalemia, hypovolemia, etc, etc. This patient requires more than some vitals and being placed on a stretcher. No what I'm saying?

or the patient might just feel weak, not be having a CVA, MI, be isokalemic (if that's the right word), normal volemic, etc, and need a ride to the ER for a further evaluation. or more likely just needs a ride to their PMD for a doctors exam.

I was an EMT for many, many years in a paid capacity full-time for a FD so I know the limitations very well. I felt often like all I did was take vitals, ask a bunch of questions to get answers I couldn't do anything about, and transport to the hospital. Heck, many answers I get now I can't do anything about.

Just want to see the bar raised.

I wouldn't object to the bar being raised, but you said if yourself, even as a paramedic, many of the answer you get now you can't do anything about. Sucks being all educated and still being unable to do anything to help the person any more than a person with an advanced first aid card right?

 

[ironco]

Out here where I'm at people are just glad to have professionals to get any emergency care at all. And while we are just "basics"I wonder why people think that we can't do anything. Maybe passing on the grief they get from RNs for just being "medics"

 

[EpiEMS]

What the OP is suggesting is exactly what the new AEMT level provider can do. Why add additional skills to EMT-Basic when the AEMT is there??

In WV, a Basic can give NTG, ASA, glucagon and albuterol - all carried on the ambulance. And just recently protocol was developed to permit 12-lead acquisition and transmission.

I am in favor of Basics giving albuterol and hopefully all EMT Basics are allowed to use CPAP.

I'm a fan of the AEMT, absolutely. Then again, when the EMT level provider is supposed to be able to provide what the National Standard Scope calls "fundamental" care for "critical" patients, and "simple" care for "emergent" patients. I would say that not only are assessments and treatments like glucometry, 12-lead (placement and transmission only!) NTG, ASA, IM glucagon, nebulized albuterol both fundamental to good basic triage, treatment, and transport, but absolutely vital - yet they're still missing from the BLS providers in many places. If we had these skills, we'd be wasting ALS resources less, for one, and appropriately treating those patients before ALS arrives (as well as being much more useful in an ALS-assist situation).

:EDIT:

And let me add Combi-tubes and King LT airways to this. They can certainly help (and because they don't take the time of an ET tube to place, they might be better in the prehospital setting).

It is also worth mentioning that to prevent our emergent patients from progressing to critical, early interventions couldn't hurt.

 

[milesh1]

???

Not sure what the deal is else where but in Colorado, with the addition of IV certification and ECG interpretation to your EMT-B, you can already do pretty much all of the things you mentioned, and as far as carrying drugs goes, it depends on your ambulance service. I know we carry all of those that you listed as a BLS provider. Having said that though all our trucks have a paramedic on them.

 

[zmedic]

Here's my thinking: Anything that civilians can do for themselves, that may save lives, an EMT should be able to do with minimal training. Examples
Aspirin for chest pain
Glucometer
Epi pen
And now narcan intra nasal.

The first three are things that patients learn how to use in a 10 minute visit with the doctor and they get a script. Narcan they've started giving out to heroin users and their families. So I'm down with those. (and for people who say BLS doesn't need Narcan, you don't work somewhere that the nearest medic is 45 minutes away. sure you can bag a patient for 45 minutes but I'm not sure that the risk of aspiration is better than just giving them a small does of a drug that has almost no risk and get them breathing on their own.)

Now a lot of the other stuff that has been mentioned you need to train people on. Which is fine. But the whole idea of having something like the EMT-I (or A or whatever) is to give people that info all at once. From a system standpoint I think that's a lot easier than having an hour class of selective spinal imobilization, an hour on combitubes, and hour on this, an hour on that. Or if it's so crucial, add it to the EMT class. But that class would have to be longer than it is now.

 

[stemi]

Definetely EKG lead placement and even interpretation. It really isnt that much of a skill to ask for especially with easy books like Dubin's Rapid Interpretation of EKGs. It would really come in handy while monitoring a patient. Also perhaps use of monitors for ETCO2 and pulseox. If we can do BPs, why not those?

 

[NYMedic828]

Definetely EKG lead placement and even interpretation. It really isnt that much of a skill to ask for especially with easy books like Dubin's Rapid Interpretation of EKGs. It would really come in handy while monitoring a patient. Also perhaps use of monitors for ETCO2 and pulseox. If we can do BPs, why not those?

You are comparing taking a BP to obtaining, monitoring, treating and interpreting an ECG? Most EMTs I know couldn't tell you what Vfib or Vtach even looked like. Heck, a good few can't take an accurate BP. (some medics/AEMTs I know for that matter can't either...)

EMTs already monitor SpO2 in most areas.

AEMT/EMT-I and paramedic exist because this needs to be taught at a different level. Paramedic is still far behind what needs to be taught to be proficient in any of these things.

This is all I am seeing

 

[stemi]

You are comparing taking a BP to obtaining, monitoring, treating and interpreting an ECG? Most EMTs I know couldn't tell you what Vfib or Vtach even looked like. Heck, a good few can't take an accurate BP. (some medics/AEMTs I know for that matter can't either...)

EMTs already monitor SpO2 in most areas.

AEMT/EMT-I and paramedic exist because this needs to be taught at a different level. Paramedic is still far behind what needs to be taught to be proficient in any of these things.

I see where you're coming from, perhaps not all, but it could be something that could be taken into consideration. A lot of the EMTs I work with are very sharp and perhaps would make great medics, but I feel that there would be quite a few who could benefit from it being a skill, at least setup and interpretation, not treating perhaps. Maybe taught basic stuff like vfib and vtach?

Perhaps EKGs are pretty easy to me because setup and interpreted them for a living before. I do think your perspective is probably better than mine though.

 

[EMT1A]

Being able to monitor o2 sats especially since you can take it with an automated pulse ox

 

[Handsome Robb]

I see where you're coming from, perhaps not all, but it could be something that could be taken into consideration. A lot of the EMTs I work with are very sharp and perhaps would make great medics, but I feel that there would be quite a few who could benefit from it being a skill, at least setup and interpretation, not treating perhaps. Maybe taught basic stuff like vfib and vtach?

The biggest problem with that is the "lowest common denominator" factor. There are plenty of sharp, driven EMTs out there but for every one of those you have 10 that aren't. Therein lies the problem.

Placement of leads us a no brainer and as far as 3/4 leads are concerned an EMT that can't figure out "white on right with clouds over grass and smoke over fire" probably shouldn't be providing patient care. When it comes to 12-leads I'm all for teaching EMTs to place them, provided they do it correctly, seeing as poor placement can lead to problems.

Not trying to bash on nurses but I've been in ACLS classes that some nurses had trouble interpreting basic rhythms. I can't imagine making it a standard for EMTs. The big problem I see is having them trying to interpret a more complex rhythm and getting themselves in way over their head and causing more problems than benefit.

When it comes to Sp02 there's no reason EMTs can't do it. Our basics can. They just have to understand that it's only one piece of the puzzle, not "see x do y".

 

[stemi]

Not trying to bash on nurses but I've been in ACLS classes that some nurses had trouble interpreting basic rhythms. I can't imagine making it a standard for EMTs. The big problem I see is having them trying to interpret a more complex rhythm and getting themselves in way over their head and causing more problems than benefit.

Very good point on that. Come to think of it, I've actually seen a lot of nurses the exact same way, again, not to bash nurses or anything. Many CCRNs are the best at EKGs, but then again, not every nurse. When interpreting rhythms that contain large amounts of common comorbidities, people can get terribly confused, especially if they are new.

EKGs are easy enough to read in books, but out in the real world, especially on very sick patients, it can get really tough.

 

[Bullets]

Now i dont think EMTs need any form of ECG monitoring, but for arguments sake

What if we gave them 3 leads, and educated them to "this is sinus rhythm, know it, love it, enjoy it. If you see anything else, call ALS" kind of thing

 

[Veneficus]

Now i dont think EMTs need any form of ECG monitoring, but for arguments sake

What if we gave them 3 leads, and educated them to "this is sinus rhythm, know it, love it, enjoy it. If you see anything else, call ALS" kind of thing

Why not just get rid of BLS and cut out the middleman?

Would the cost of putting a monitor on every BLS rig increase or decrease how often ALS is called and would it be worth it?

Why not just make the BLS people go to paramedic school so they can actually do something if they see something wrong?

We don't need more "basic skills."

 

[8jimi8]

Annnnnd entire post summed up by Vene.

No more basics. Mandatory degrees for all paramedics. and mandatory tools to do the job.

What a concept.

just for giggles.

When would you NOT want to administer a rectal suppository?

I'm all for emt's being able to place and obtain ECGs, but all of this education you are talking about is covered... in the next levels of certifications.

No, i do not believe in turning a 120 hour class into ricky rescue.

NTG without a 12 lead is moronic.

 

[Anthony7994]

I was able to do all of those besides the diazepam and naloxone. Crazy how limited BLS scope is in other states.