BLS Skills -- What Should We Add?

[Veneficus]

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.

With all of the logisitcal issues regarding inhalents, why not just add IV morphine or fent?

It costs less, easier to account, and is so easy, even the drug abusers on the street can do it.

(disclaimer, I do not believe BLS should be doing pain management with anything other than NSAIDs, if people really value pain management, they need to come up with the money for local ALS, but I offer the above in an effort to solve the problems with nitrous)

 

[Doczilla]

There's even cheaper ways than THAT.

"I called 911 for a sprained ankle, and he handed me a whipped cream can! The bill was $800!"

Profit.

 

[emtevan]

narcan to basics

i have an idea if an emt cant handle medications and or treatments then they shouldnt work on an ambulance.why take stuff away because people cant handle it.Same with medics if u cant do medications and the treatments then dont be a medic.Dont take stuff away from the emt's and medics who can do it right.If someone wants to be a cashier and they screw up the scanning process will that company fire the person or would they take out the scanners and put something else in its place?they would fire the person well it should be the same for ems.

 

[emtevan]

narcan for basics

i also think basics should have pulse ox and glucometers and nasal narcan.its pretty pathetic when an ambulance shows up and cant give the narcan yet the police show up and they have it.i also think its funny when medics say well if a basic wants to do more then go to medic school.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.i think als can do way more then they should hell if u want als to do more then GO TO MED SCHOOL.

 

[Tigger]

i also think basics should have pulse ox and glucometers and nasal narcan.its pretty pathetic when an ambulance shows up and cant give the narcan yet the police show up and they have it.i also think its funny when medics say well if a basic wants to do more then go to medic school.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.i think als can do way more then they should hell if u want als to do more then GO TO MED SCHOOL.

I work for a private company that provides all three of those things to its BLS crews, and we are located in your area.

That being said, don't you think that we need a little more education before they give us more "stuff?"

 

[Christopher]

i also think basics should have pulse ox and glucometers and nasal narcan.its pretty pathetic when an ambulance shows up and cant give the narcan yet the police show up and they have it.i also think its funny when medics say well if a basic wants to do more then go to medic school.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.i think als can do way more then they should hell if u want als to do more then GO TO MED SCHOOL.

Wow, med school for 12-Leads...really?

We run 12-Leads as basics on our industrial fire brigade and at our fire service. In fact, the State of NC expects EMT-Basics to know how to apply and acquire a 12-Lead ECG.

I don't disagree that we need more education, but when I make such claims I usually capitalize "i" and spell out "you"...but that is just me.

 

[Achilles]

i also think basics should have pulse ox and glucometers and nasal narcan.its pretty pathetic when an ambulance shows up and cant give the narcan yet the police show up and they have it.i also think its funny when medics say well if a basic wants to do more then go to medic school.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.i think als can do way more then they should hell if u want als to do more then GO TO MED SCHOOL.

I was doing twelve leads during my basic clinicals. I wasn't reading rhythms, just placing leads, putting their PT id number in and age and, Doctor's name.
They even let me press the print button

Also, we can use a glucometer as well as a pulse ox.

 

[Veneficus]

.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.

Like what?

 

[NYMedic828]

i also think basics should have pulse ox and glucometers and nasal narcan.its pretty pathetic when an ambulance shows up and cant give the narcan yet the police show up and they have it.i also think its funny when medics say well if a basic wants to do more then go to medic school.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.i think als can do way more then they should hell if u want als to do more then GO TO MED SCHOOL.

So if medics want to do more they should go to medical school but if basics want to do more they...should just be handed it?

Last time I checked when an EMT wanted to do more they want to paramedic school...

EMTs here have pulseox, glucometry and just got narcan...

Do you even know what a pulseox actually tells you that it woul be relevant to your assessment and treatment of applying a NRB to the patient to ensure they receive a massive overdose of oxygen?

 

[TransportJockey]

i also think basics should have pulse ox and glucometers and nasal narcan.its pretty pathetic when an ambulance shows up and cant give the narcan yet the police show up and they have it.i also think its funny when medics say well if a basic wants to do more then go to medic school.no thats crap i think basics should do more and i dont mean 12 leads or ivs just the other stuff i suggested.i think als can do way more then they should hell if u want als to do more then GO TO MED SCHOOL.

Lol you'll :censored::censored::censored::censored: bricks if you ever read the NM scope of practice for basics. But our basics are rather well trained... but still not enough education for what they are given. Honestly with how little education basics really have, giving them more toys to play with could be the last thing we do.

 

[EpiEMS]

Lol you'll :censored::censored::censored::censored: bricks if you ever read the NM scope of practice for basics.

Wow! Your basics can do supraglottic airways, CPAP, start a 12-lead without anybody telling them to (not interpret)? That's awesome.

 

[NomadicMedic]

Wow! Your basics can do supraglottic airways, CPAP, start a 12-lead without anybody telling them to (not interpret)? That's awesome.

That would be great if they were with a medic partner. Otherwise, it's just half assed ALS.

 

[EpiEMS]

That would be great if they were with a medic partner. Otherwise, it's just half assed ALS.

The supraglottic airways are pretty foolproof, and CPAP's easy enough to use (plus, it can really help in many cases, no?). The 12-lead placement makes sense, too – if a basic can accurately place the leads, transmission allows the ED to activate the cath lab, or divert the ambulance to a facility with a cath lab, etc.?

What's the objection?

 

[NomadicMedic]

<5 minute transport time, no objection.

What I do find objectionable is bureaucrats trying to convince their public constituents that EMT basics who can use CPAP and SGA and stick a 12 lead on somebody are just as good as paramedics. And if you think that doesn't happen, think again.

We continue to dilute the educational process giving basics more skills to do without education to back them up. I notice how nobody complains about giving basics more to do… But if a paramedic started to step into the nursing realm, the fur would fly.

Either let's just realize that EMT B is simply that, a basic entry-level point... Or let's revamp the training and make the entry-level point closer to EMTI 99 and increase the paramedic training to be more community minded and focused on social service and preventative care along with advanced procedures.

I just don't think cramming more skills into a basic's toolbox is the right thing to do.

 

[Christopher]

<5 minute transport time, no objection.

What I do find objectionable is bureaucrats trying to convince their public constituents that EMT basics who can use CPAP and SGA and stick a 12 lead on somebody are just as good as paramedics. And if you think that doesn't happen, think again.

We continue to dilute the educational process giving basics more skills to do without education to back them up. I notice how nobody complains about giving basics more to do… But if a paramedic started to step into the nursing realm, the fur would fly.

Either let's just realize that EMT B is simply that, a basic entry-level point... Or let's revamp the training and make the entry-level point closer to EMTI 99 and increase the paramedic training to be more community minded and focused on social service and preventative care along with advanced procedures.

I just don't think cramming more skills into a basic's toolbox is the right thing to do.

I think leaving basics with a BVM as their only choice for patients when NIPPV would suffice is wrong.

I think supraglottic airways...probably aren't necessary in any BLS service with ALS help reasonably close.

I think 12-Lead acquisition (and transmission) is critical for BLS.

...aaand I think we need to make Paramedic education the lowest common denominator and give the rest first aid cards.

 

[firecoins]

We should add paramedic training to their EMT class.

 

[NomadicMedic]

Christopher, I think you usually make good points, but in the case of 12 leads for basics, I think you're off the mark.

Maybe it works in the most rural of rural areas, like the Dakota's where a paramedic is far away and BLS may be the only thing coming, but in suburban /urban environments, it is just one more thing that slows down the process.

If I, as a paramedic, are planning to transport a chest pain patient, I want the BLS crew singularly focused on getting the patient moved to the ambulance and then getting me and my patient to the hospital safely. If I feel comfortable with the BLS provider's skills, I may delegate tasks to them under my supervision. I don't need them stopping forward motion to the hospital to perform 12 leads or anything else.

I know the basics will hate me for this, but if you want to perform ALS skills, then go to paramedic school.

That's it.

 

[Christopher]

Christopher, I think you usually make good points, but in the case of 12 leads for basics, I think you're off the mark.

Maybe it works in the most rural of rural areas, like the Dakota's where a paramedic is far away and BLS may be the only thing coming, but in suburban /urban environments, it is just one more thing that slows down the process.

If I, as a paramedic, are planning to transport a chest pain patient, I want the BLS crew singularly focused on getting the patient moved to the ambulance and then getting me and my patient to the hospital safely. If I feel comfortable with the BLS provider's skills, I may delegate tasks to them under my supervision. I don't need them stopping forward motion to the hospital to perform 12 leads or anything else.

I know the basics will hate me for this, but if you want to perform ALS skills, then go to paramedic school.

That's it.

We acquire 12 leads prior to ALS arrival on our BLS industrial fire brigade. Saves ~10 minutes from first medical contact to acquisition. We've had 3 STEMI's caught prior to ALS arrival, with ECG in hand, ASA on board, and patient packaged.

If somebody made an AED + 12-Lead that would be a game changer, something to go on every BLS/ILS truck around.

 

[ffemt8978]

Maybe it works in the most rural of rural areas, like the Dakota's where a paramedic is far away and BLS may be the only thing coming, but in suburban /urban environments, it is just one more thing that slows down the process.

And therein lies the crux of the problem. There is no "one size fits all" solution for EMS, and what works or is appropriate for one area doesn't for another. We need to stop trying to make the square peg fit in the round hole.

 

[NomadicMedic]

But we're in EMS. we've been trying to stuff that round peg in the square hole since the 70s.