BLS Skills -- What Should We Add?

[NYMedic828]

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

No, it's crazy that it isn't as limited in some states and more over isn't controlled on a federal level.

I see no reason in adding all these skills to a BLS level. A couple things sure, but at some point your are just creating an even lesser trained AEMT.


EMT wants to play AEMT/medic become an AEMT.

AEMT/medic wants to play doctor, become a doctor.

 

[rescue1]

PA allows EMT-B's to administer CPAP, carry Epi-pens, monitor SPO2 levels and titrate O2 administration, though inexplicably no glucometer (which I could do in MD).

Ideally, I agree with Vene. If we have ALS as the standard, this conversation would be unnecessary. The skills that ideally require constant practice and education (intubation, for example) and maybe some advanced pharmacology could be administered by "super ALS" or whatever you want to call it, in fly cars that respond to priority calls, and practice community paramedicine on the side.

But until then, I don't think I'm cool with giving basics a lot of extra skills. I know far too many who have barely mastered the blood pressure cuff, and at least one who gave a patient tachycardia by spraying half her albuterol inhaler down her throat. Aspirin, fine. Naxalone has minimal side effects...I could be talked into it. But I'm not OK with non-prescribed nitro...we just don't have the education and heart monitoring skills to make an informed treatment plan for a cardiac case.

 

[EpiEMS]

No, it's crazy that it isn't as limited in some states and more over isn't controlled on a federal level.

The system's not federal for good reasons. The states regulate medical practice, for one. And since the EMS system is parochial by nature, it can fit the needs of the community - greater standardization isn't necessarily going to be helpful (whether due to cost, etc.). Even hospitals aren't standardized. Sure, there are requirements and levels of care, but there is a range - say, the rural ED that operates with a PA during off hours (or all the time, even!) all the way to the R Adams Cowley Shock Trauma Center. It wouldn't be cost effective for a Level I trauma facility to be everywhere:censoredand probably wouldn't improve outcomes very much either). The same argument follows for EMS providers. And the fire service. And police departments. And every other public service.

I see no reason in adding all these skills to a BLS level. A couple things sure, but at some point your are just creating an even lesser trained AEMT.

What distinguishes an EMT from an AEMT? I'm of the opinion that it is invasive procedures - starting an IV, namely.

 

[Tigger]

The system's not federal for good reasons. The states regulate medical practice, for one. And since the EMS system is parochial by nature, it can fit the needs of the community - greater standardization isn't necessarily going to be helpful (whether due to cost, etc.). Even hospitals aren't standardized. Sure, there are requirements and levels of care, but there is a range - say, the rural ED that operates with a PA during off hours (or all the time, even!) all the way to the R Adams Cowley Shock Trauma Center. It wouldn't be cost effective for a Level I trauma facility to be everywhere:censoredand probably wouldn't improve outcomes very much either). The same argument follows for EMS providers. And the fire service. And police departments. And every other public service.



What distinguishes an EMT from an AEMT? I'm of the opinion that it is invasive procedures - starting an IV, namely.

Not sure how not all hospitals being able to provide the best of the best care is related. No one is arguing that every EMS provider should either, levels are inevitable to keep costs reasonable.

Of note, Crowley Shock Trauma is not (unless it has recently changed) even recognized by the ACS as a Trauma Center, perhaps this is not such a good argument for states regulating all facets of healthcare.

The main difference between AEMT and EMT? AEMT is more hours. If we keep adding hours to the EMT class (and we need to if skill additions happen), then the hours start getting awful close to AEMT. At this point why not just eliminate EMT?

 

[NYMedic828]

I don't think people grasp the concept fully that professions such RN and MD are standardized titles.

EMS is really the only field of healthcare that comes to mind that has such a strong variance depending upon region.

As an MD or RN, I can live and work in NY now, and move to florida tomorrow and already start looking for work. As a paramedic, I more than likely need to jump through hoops to have my certification recognized before I can even apply for work.

Even more ridiculous, My certification is not fully valid if I travel 10 minutes east of my home. Within a 20 mile span of my residence, I have 3 separate regions with 3 separate sets of protocols. You can't possibly argue that that is not ridiculous.

EMS needs to be standardized NATION wide. You wanna have the NREMT do it, great. Tell them to get off their asses and start being useful.



What differs an EMT from an AEMT is the same as what differs an AEMT from a paramedic.

Education. Nothing more, nothing less. Thats all their is to it. Has nothing to do with the skills, it has to do with knowledge behind them. I can teach anyone to stab you in the arm with toradol, but that doesn't mean they know why they are doing it.

It just makes no sense to add 10 skills to the EMT level, when a level capable of all these things and an already too basic understanding of them already exists at the next level.

 

[Dwindlin]

Of note, Crowley Shock Trauma is not (unless it has recently changed) even recognized by the ACS as a Trauma Center, perhaps this is not such a good argument for states regulating all facets of healthcare.

ACS has nothing to do with states. The process is voluntary, you have to apply. Just because they aren't "recognized" (read paid the ACS a :censored::censored::censored::censored:-ton of money) doesn't mean they aren't one of the premier trauma centers in the world.

 

[Tigger]

ACS has nothing to do with states. The process is voluntary, you have to apply. Just because they aren't "recognized" (read paid the ACS a :censored::censored::censored::censored:-ton of money) doesn't mean they aren't one of the premier trauma centers in the world.

If you say you are the best but refuse to submit to the same standards of the "rest of the best," are you still the best? Many states use the ACS verification process as their own for defining trauma centers, which makes complete since. It is certainly to everyone's advantage to nationally standardize trauma center criteria to allow for accurate comparisons. Why can't we do this in EMS?

 

[EpiEMS]

EMS needs to be standardized NATION wide. You wanna have the NREMT do it, great. Tell them to get off their asses and start being useful.

But if EMS is protocol-based and inherently depends on the license of an MD, then we've got a problem -- MDs are licensed by states. MDs have no scope of practice per-se (at least, explicitly, a GP is probably not going to place an ETT in his/her office, say). EMS providers, on the other hand...

To be clear, I don't disagree with you. Physicians, PAs, and nurses have national standard exams - the USMLE (COMLEX for DOs), PANCE, and NCLEX - but their licensure depends on states. I don't see a problem with encouraging states to take NREMT (at its various levels) passage in the same way they do other national licensure exams. It'd make sense. But, and I think this merits a mention, because EMS providers are inherently limited by being vocationally trained (as technicians), it does make sense for medical directors to be able to give endorsements on a service-by-service or a state-by-state (or region-by-region) basis.

 

[NYMedic828]

Apparently the county that neighbors mine has began an EMT narcan IN pilot program and already used it effectively on one patient in respiratory arrest.

 

[shiroun]

Apparently the county that neighbors mine has began an EMT narcan IN pilot program and already used it effectively on one patient in respiratory arrest.

x2. I heard about that. They've had the program for a little while, and its apparently only for police.

 

[Tigger]

Apparently the county that neighbors mine has began an EMT narcan IN pilot program and already used it effectively on one patient in respiratory arrest.

Boston EMS has been doing this for a bit with their BLS units (which there are lots of compared to ALS), with good results apparently.

 

[zmedic]

We're piloting intranasal narcan for BLS EMS in New York, my agency hasn't use it yet but it's on the trucks

 

[LOPLII]

i think how to do insulin is very useful to know as emt-b

 

[EpiEMS]

Apparently the county that neighbors mine has began an EMT narcan IN pilot program and already used it effectively on one patient in respiratory arrest.

Question from somebody who hasn't ever seen Narcan used except in training: have you ever seen adverse effects?

 

[usalsfyre]

i think how to do insulin is very useful to know as emt-b

:rofl:

Negative sir, handing out sliding scales to Basics has disaster written all over it.

 

[Medic Tim]

Question from somebody who hasn't ever seen Narcan used except in training: have you ever seen adverse effects?

I have seen over zealous medics push way to much and have a combative ptas a result. I have also seen narcan given to a pt who was also on some sort of stimulant.

 

[Handsome Robb]

i think how to do insulin is very useful to know as emt-b

False. See Kyle's answer for my reasoning.

I have also seen narcan given to a pt who was also on some sort of stimulant.

That'll ruin your day real quickly.

 

[EpiEMS]

I have seen over zealous medics push way to much and have a combative ptas a result. I have also seen narcan given to a pt who was also on some sort of stimulant.

Aren't they supposed to titrate to effect? :EDIT: The medics, not the patients

 

[Handsome Robb]

Aren't they supposed to titrate to effect? :EDIT: The medics, not the patients

You're giving some medics way too much credit.

 

[EpiEMS]

You're giving some medics way too much credit.

Truth.
Is there a solution, that is, if you were to bring IN narcan to the BLS level?