BLS Skills -- What Should We Add?

[Handsome Robb]

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

Only give them prefills with a max of 0.4 mg in them. That's about the only idea I have other than not giving it to them.

Intermediates here can give narcan. With that said one of the first lines of our OD protocol says "Cardiac Monitor", so sure the intermediate can give the drug but the medic is still taking the call.

 

[zmedic]

there is 0 reason to give insulin in the field

Don't do it. Don't even talk about it.

 

[firecoins]

We should make the EMT-B go through a medic program and than, they could do everything a medic does. We should just make that the baseline.

 

[DesertMedic66]

We should make the EMT-B go through a medic program and than, they could do everything a medic does. We should just make that the baseline.

What about the systems that use EMTs to mainly drive the ambulance? You would be putting those EMTs through a medic program just so they could get paid more to drive an ambulance (someone has to drive. So if it's not one medic then it's the other medic). Probably not the most cost effective way of running a system.

 

[firecoins]

What about the systems that use EMTs to mainly drive the ambulance? You would be putting those EMTs through a medic program just so they could get paid more to drive an ambulance (someone has to drive. So if it's not one medic then it's the other medic). Probably not the most cost effective way of running a system.

WHy do you need a driver to have any EMS training? Cops can drive, firefighters can drive, CFRs can drive. EMT-Bs want to give ALS drgs without extra training. Put them in a medic program.

 

[DesertMedic66]

WHy do you need a driver to have any EMS training? Cops can drive, firefighters can drive, CFRs can drive. EMT-Bs want to give ALS drgs without extra training. Put them in a medic program.

Not in Cali. State requires the driver of an ambulance to be at least an EMT.

 

[firecoins]

Not in Cali. State requires the driver of an ambulance to be at least an EMT.

than by god he should be a medic.

 

[Tigger]

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

The best I can come up with is provide Naracan doses of the .4mg variety instead of 2mg. Obviously it's not going to stop every misuse but it might be a start...

 

[Veneficus]

Just my logic but if...

We are now talking about repackaging medication or ordering 2 seperate packages of the same medication for a different dose, then we need to not be figuring out how to make administration idiot proof, we just need to not let the idiots play with it.

 

[Tigger]

Just my logic but if...

We are now talking about repackaging medication or ordering 2 seperate packages of the same medication for a different dose, then we need to not be figuring out how to make administration idiot proof, we just need to not let the idiots play with it.

Nothing to say that medics can't use the .4mg prefills of narcan, it is preferred in one area that I work.

Also are double medic trucks that uncommon? They are commonplace here in MA, even after the state started allowing P/B configurations.

 

[NYMedic828]

It has been my experience, be it brief, that most people respond very well to a dose of narcan as low as 0.2-0.4mg. It's rare that I need to go above that to attain the desired effect of maintaining respiration.

It has also been my experience that incompetence as we already know is quite abundant. I know medics who don't see that much due to where they "practice" and they may use narcan once every 3 years. They aren't aware that all you really need is a few drops and they slam the entire amp in anyway.

I feel that just because you give an EMT and a medic the same skill, it doesn't always mean the medic will be more competent. It should, but it doesn't.

The two pilot programs that have began recently in my region use a 0.2mg Prefilled IN syringe.

 

[Veneficus]

Nothing to say that medics can't use the .4mg prefills of narcan, it is preferred in one area that I work.

Also are double medic trucks that uncommon? They are commonplace here in MA, even after the state started allowing P/B configurations.

My statement applies equally to medics.

Whether medication application or surgical procedure, if a majority of providers can't do it right, they shouldn't be doing it.

We should not be using technology or packaging to make up for poor ability.

 

[EpiEMS]

My statement applies equally to medics.

Whether medication application or surgical procedure, if a majority of providers can't do it right, they shouldn't be doing it.

We should not be using technology or packaging to make up for poor ability.

But there's no reason not to try using technology and/or packaging to improve efficacy, though.

 

[the_negro_puppy]

I've never used Narcan...

However our protocols call for 1.6mg IM for adult.

We don't really have a choice in regards to dose :glare:

 

[MikeCivitello]

Many have suggested carrying Nitrous Oxide (laughing gas) but it has some FDA restrictions I believe was what came out of the topic.

Do you have more information on what "FDA restrictions" came up? Nitrous Oxide and Oxygen are not restricted for use in the US by the FDA. Its used every day in dental offices, hospitals and by first responders.

You may be confusing the "pre-mixed" 02 and N20 gas that is commonly used in other countries. This is not approved for use in the US by the FDA.

 

[Tigger]

Do you have more information on what "FDA restrictions" came up? Nitrous Oxide and Oxygen are not restricted for use in the US by the FDA. Its used every day in dental offices, hospitals and by first responders.

You may be confusing the "pre-mixed" 02 and N20 gas that is commonly used in other countries. This is not approved for use in the US by the FDA.

That was the issue, without it being premixed some believe that it is too bulky to carry around. Personally I still think we could carry it, it's not something that you would bring into every call and in some cases it could just be left in the ambulance until the patient is loaded assuming that getting them onto the stretcher without a significant increase in pain is possible.

 

[medicdan]

That was the issue, without it being premixed some believe that it is too bulky to carry around. Personally I still think we could carry it, it's not something that you would bring into every call and in some cases it could just be left in the ambulance until the patient is loaded assuming that getting them onto the stretcher without a significant increase in pain is possible.

As I think the past discussions have indicated, accountability seems to be the reason it hasnt been widely utilized.

 

[Cup of Joe]

As I think the past discussions have indicated, accountability seems to be the reason it hasnt been widely utilized.

I'm going to go with this. We have plenty of room on our type-IIIs for another tank (and whatever installed hardware may be needed). It could also probably fit in many type-I or type-II vehicles.

How do you stop people from abusing it? Maybe mandating that before and after tank pressures be written on the PCRs and separate forms filled out to provide accountability within the agency (provider who initiated its use, before and after tank pressures, time administration was started, when it was ended, mix ratios, etc)?

I would like to see BLS have some form of pain management (more so in areas with extended transport times) but ultimately, are BLS providers ready for that responsibility?

 

[EpiEMS]

I would like to see BLS have some form of pain management (more so in areas with extended transport times) but ultimately, are BLS providers ready for that responsibility?

In some areas, BLS providers can give narcotics for pain management:

For example, Montana has a program of "endorsements" for various levels of providers so that medical directors can increase the scope of practice for differing levels to fit local circumstances. Viz.: http://bsd.dli.mt.gov/license/bsd_boards/med_board/pdf/emt_med_endorse.pdf

 

[MikeCivitello]

I'm going to go with this. We have plenty of room on our type-IIIs for another tank (and whatever installed hardware may be needed). It could also probably fit in many type-I or type-II vehicles.

How do you stop people from abusing it? Maybe mandating that before and after tank pressures be written on the PCRs and separate forms filled out to provide accountability within the agency (provider who initiated its use, before and after tank pressures, time administration was started, when it was ended, mix ratios, etc)?

I would like to see BLS have some form of pain management (more so in areas with extended transport times) but ultimately, are BLS providers ready for that responsibility?

I think concerns of abuse will always be there. Having a firm policy, standards on security, and who has access to the N20 cylinders - along with zero tolerance will be critical. Perhaps some others that are currently using N20 can chime in with what they do - or suggestions?

Unfortunately with N20 cylinders there is no way to determine what is in the cylinder by means of cylinder pressure. The gas is in a liquid form - similar to propane - and turns to a gas as it is released. This means the cylinder regulator will always read full - until it is just about empty - and the pressure will drop.