Calling all PA EMTs!

[trevor1189]

What would you like to see added to the state's BLS protocols? Some more progressive states allow advanced airways, etc. Anything you'd like to see added to the protocols?
BGLs, combitube? Fine the way it is?

Just wondering. EMS providers from other states feel free to chime in.

Thanks!

 

[ResTech]

I am a PA EMT... they already have Primary use of Epi (carried onboard) and CPAP for BLS. The only other thing I would like to see is albuterol. No glucometers as they will not change care at all.

With most of PA being the old two-tier response system, BLS from the FD and ALS from a hospital as chase, BLS units arrive onscene first in many cases and on average of 10mins prior to ALS. Its not uncommon for ALS to be 15-20mins out. So early albuterol would be great. Many States already allow BLS albuterol.

 

[vquintessence]

Narcan IN?

Glucometers?

 

[trevor1189]

I am a PA EMT... they already have Primary use of Epi (carried onboard) and CPAP for BLS. The only other thing I would like to see is albuterol. No glucometers as they will not change care at all.

With most of PA being the old two-tier response system, BLS from the FD and ALS from a hospital as chase, BLS units arrive onscene first in many cases and on average of 10mins prior to ALS. Its not uncommon for ALS to be 15-20mins out. So early albuterol would be great. Many States already allow BLS albuterol.

Like I said in another thread glucometers won't change treatment but would be valuable information to pass off to the receiving facility.
I didn't even think of albuterol, but thay is a good one. Fortunately, where I live ALS isn't too far behind, but it would still be nice.

As for CPAP, I like the fact that it is in our scope of practice but we have to be trained on it, and I haven't ever seen a class for it available.

 

[vquintessence]

I am a PA EMT... they already have Primary use of Epi (carried onboard) and CPAP for BLS. The only other thing I would like to see is albuterol. No glucometers as they will not change care at all.

With most of PA being the old two-tier response system, BLS from the FD and ALS from a hospital as chase, BLS units arrive onscene first in many cases and on average of 10mins prior to ALS. Its not uncommon for ALS to be 15-20mins out. So early albuterol would be great. Many States already allow BLS albuterol.

IMHO, albuterol has been a nightmare more often than not in many instances, and that problem extends beyond my services. More BLS providers have been cited and/or faced remedial training for improper application and actions concerning albuterol.

Remedial training after the fact is too common (obviously necessary). It's VERY difficult to train an EMT in the specific MOA, indications, contra, side effects (etc) when they have no true formal education in A&P; it's not fair to either party, mostly concerning the pt. It's like beating a puppy for pissing in your bed when you haven't taken the time to properly train it to go outdoors...

Some of the more common problems encountered range from:

Canceling medics in a non-judicious manner for SOB events, because "albuterol will fix it".

Pts being given albuterol simply because it was an option.

Pts receiving albuterol (sometimes multiple..) who were immediately recognized by receiving facilities as having cardiac wheezes with other gross presentations of CHF symptoms. Those calls from facility staff are always fun. :sad:


If the choice to give it to BLS ever came up again, it'd most likely be shot down. However, there are many BLS providers that know better... and perhaps the added scope will be another inch in the push towards expanding the curriculum?

 

[EMTinNEPA]

Blood Glucometry.

Combi-Tube.

That's about it, really. Can't do much more without increasing the overall educational standards. Possibly nitro, but only with online medical command.

Edit: When I say "possibly nitro" I meant to be carried on the trucks. PA EMTs are already allowed to administer one dose of nitroglycerin to a patient with chest pain without online medical direction if it is the patient's own prescribed nitroglycerin and the patient hasn't already used it, the patient's blood pressure isn't too low, and the patient hasn't used ED drugs in the past 7 days. Additional doses require online medical direction.

 

[Sasha]

Possibly nitro

Nitro shouldn't be given without an IV and 12 lead on board. I'm suprised people are allowed to self medicate with it's potential to bottom out pressure.

 

[EMTinNEPA]

With most of PA being the old two-tier response system, BLS from the FD and ALS from a hospital as chase, BLS units arrive onscene first in many cases and on average of 10mins prior to ALS. Its not uncommon for ALS to be 15-20mins out.

Actually, most of my region has done away with hospital-based EMS. ALS services are provided by private companies via transport-capable medic-basic trucks. Out of the 40 or some-odd ALS services in surrounding counties, I can only think of 5 units that are non-transport capable, and only two of them are hospital-based. And only one of those doesn't have a transport-capable unit from the same service ready to back them up if the volunteers don't crew. For instance, my county used to have 3 paramedic chase units (two hospital-based, one private service based). Both hospital-based services were swallowed up by transport-capable private services and the third service is no longer in business.

 

[ResTech]

In South-Central, PA there are many, many hospital based ALS services and most transport units are BLS from the FD.

I think the King airway is a better airway than the Combitube due to it being a single lumen and non-latex and both cuffs fill simultaneously.

 

[Pudge40]

I am a PA EMT... they already have Primary use of Epi (carried onboard) and CPAP for BLS. The only other thing I would like to see is albuterol. No glucometers as they will not change care at all.

With most of PA being the old two-tier response system, BLS from the FD and ALS from a hospital as chase, BLS units arrive onscene first in many cases and on average of 10mins prior to ALS. Its not uncommon for ALS to be 15-20mins out. So early albuterol would be great. Many States already allow BLS albuterol.

I never knew that pa lets BLS trucks carry EPI. I was told in class only if they have a perscription for Epi can we assist with it. I just read the protocol and you are right hmm one more thing that they didn't tell us in the half @$$ed class I took.

Blood Glucometry.

Combi-Tube.

That's about it, really. Can't do much more without increasing the overall educational standards. Possibly nitro, but only with online medical command.

Edit: When I say "possibly nitro" I meant to be carried on the trucks. PA EMTs are already allowed to administer one dose of nitroglycerin to a patient with chest pain without online medical direction if it is the patient's own prescribed nitroglycerin and the patient hasn't already used it, the patient's blood pressure isn't too low, and the patient hasn't used ED drugs in the past 7 days. Additional doses require online medical direction.

It does not matter if they have taken nitro before we have gotten there we can still give one dose as long as pressure is above 100 systolic and they have not taken any ED treatment for 24-48 hours* before our arrival. *From PA BLS protocols effective date of 11-01-08 protocol 501.

 

[EMTinNEPA]

It does not matter if they have taken nitro before we have gotten there we can still give one dose as long as pressure is above 100 systolic and they have not taken any ED treatment for 24-48 hours* before our arrival. *From PA BLS protocols effective date of 11-01-08 protocol 501.

When I was in EMT class, I was taught one dose before command, period, and seven days, but then again, my EMT class might have been behind the times. And 100 is a bit of an arbitrary number when you think that 100 isn't necessarily normotensive for everybody and thus doesn't necessarily indicate hemodynamic stability.

 

[Pudge40]

When I was in EMT class, I was taught one dose before command, period, and seven days, but then again, my EMT class might have been behind the times. And 100 is a bit of an arbitrary number when you think that 100 isn't necessarily normotensive for everybody and thus doesn't necessarily indicate hemodynamic stability.

Yup points well taken I was just posting what the protocol says. BTW I have the protocols in PDF format if you would like them I can send them to you. There is a place to download them but I forget where to go.

 

[Shishkabob]

Like I said in another thread glucometers won't change treatment but would be valuable information to pass off to the receiving facility. .

A glucometer darn well better change your treatment.



As for NTG, each place differs in systolic BP contraindiciations. Some say nothing below 90, others say nothing below 100.

 

[ResTech]

Linuss... how is a glucometer gonna change the treatment at the BLS level? If a provider does an actual assessment and ascertains a HPI, you don't need a glucometer to make the determination of rather or not to give oral glucose.

Pudge, some Medical Directors will not allow EMS services to carry Epi-Pens onboard. It just depends on your Medical Director. It is an optional level program, not mandatory.

 

[Sasha]

A glucometer darn well better change your treatment.

A glucometer, just like a pulse ox, can be wrong and you should rely more on s/s then actual numbers for your treatment plan. So no, it doesn't change treatment.

 

[Shishkabob]

Yes, glucometers can be calibrated wrong, but you can't discount every reading as "wrong" when making a determination, otherwise there'd be no point in having one. Same as with a pulse-ox. It ALONE shouldn't change how you do things, but to say it doesn't change how you treat something is ludicrous.


Someone falls. Do you give them glucose right away, or do you do a d-stick to possibly rule out hypoglycemia? My money is on the latter, and as such, it just changed your treatment, by making you look at other possible causes if the BGL is "normal"



AMS can be caused by a heckuva lot more than just low blood suger, and the sooner you rule it out, the quicker you can move on to other causes.



And guess what. That glucometer just changed your treatment.

 

[Sasha]

Yes, glucometers can be calibrated wrong, but you can't discount every reading as "wrong" when making a determination, otherwise there'd be no point in having one. Same as with a pulse-ox. It ALONE shouldn't change how you do things, but to say it doesn't change how you treat something is ludicrous.


Someone falls. Do you give them glucose right away, or do you do a d-stick to possibly rule out hypoglycemia? My money is on the latter, and as such, it just changed your treatment, by making you look at other possible causes if the BGL is "normal"



AMS can be caused by a heckuva lot more than just low blood suger, and the sooner you rule it out, the quicker you can move on to other causes.



And guess what. That glucometer just changed your treatment.

Not the glucometer alone, it will not change treatment plans and for an EMT-Basic it makes no difference. Unresponsive and AMS is a contra to oral glucose and there is nothing they can do for an unresponsive person then mantain a basic airway and transport. Also giving someone D50 will only briefly spike their BGL and it will come down again, no real harmful effects, so if your glucometer is broken you can still give it a try to look for improvements in mental status. if they are reading 80 and still AMS after other causes have been ruled out, you bet your butt I would try it. 70-100/80-120 is not everyone's normal range.

 

[ResTech]

Linuss...You do make a point... I just know from the tons of hypoglycemic patients I have assessed and treated, I can get a pretty good indication of hypoglycemia. Combine the physical exam, the history of events, and current meds.... and you got a pretty clear picture. Of course not all will be so defined but the majority are.

Im not saying I am against BLS having glucometers and I do think they would make for a nice adjunct... especially since lay people can use them but yet EMT's can't... makes ya look kinda stupid when ya have to ask a family member to check the BG level. They are simple to use and easy to maintain... but I just don't see any real difference in pt. treatment from their use.

 

[Shishkabob]

Res, you and I are pretty much on the same page. We're not fighting if basics should get BGCs.. already have a thread for that fight ^_^

Not the glucometer alone, it will not change treatment plans and for an EMT-Basic it makes no difference. Unresponsive and AMS is a contra to oral glucose and there is nothing they can do for an unresponsive person then mantain a basic airway and transport. Also giving someone D50 will only briefly spike their BGL and it will come down again, no real harmful effects, so if your glucometer is broken you can still give it a try to look for improvements in mental status. if they are reading 80 and still AMS after other causes have been ruled out, you bet your butt I would try it. 70-100/80-120 is not everyone's normal range.

Where did I ever say it alone would change how you treated? Not once, as I recall.

But if you are saying that a tool, combined with a providers knowledge, will not change how you view something, then you and I are at a disagreement.

That's akin to saying a 12-lead won't change how you approach a chest pain patient.

 

[Pudge40]

Linuss... how is a glucometer gonna change the treatment at the BLS level? If a provider does an actual assessment and ascertains a HPI, you don't need a glucometer to make the determination of rather or not to give oral glucose.

Pudge, some Medical Directors will not allow EMS services to carry Epi-Pens onboard. It just depends on your Medical Director. It is an optional level program, not mandatory.

I realize that it is optional. I just never knew that it was even an option in PA. I still have a lot too look over in the protocols.