Capnography for EMT-B, a useful tool?

In the setting of a BLS provider that is trained to incubate or place and SGA, I can see it’s value and it should be mandatory.

Otherwise, there are so many things I’d like to see be universally equipped on all BLS trucks long before capnography that could actually advance the rank(SpO2, nebulizers, glucometers, AEDs, CPAP just to list a few)...
 
hometownmedic5 said:
In the setting of a BLS provider that is trained to incubate or place and SGA, I can see it’s value and it should be mandatory.

Otherwise, there are so many things I’d like to see be universally equipped on all BLS trucks long before capnography that could actually advance the rank(SpO2, nebulizers, glucometers, AEDs, CPAP just to list a few)...
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At some point, BLS becomes ALS with all that. More stuff, at one point or another, introduces variables that more stuff is required to deal with. But maybe ALS by degrees is the way some service areas get up to speed...
 
VFlutter said:
Semantics. Respiration does not happen to any significant degree without ventilation. Unlike oxygens ability to easily diffuse CO2 requires convection and dead space ventilation.
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Certainly not semantics nor can I parse why you think so. Ventilation is entirely mechanical. Respiration is physiological.
 
CALEMT said:
CPAP is pushing it in my book.
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CPAP is already in the book for EMTs. We are teaching CPAP this semester to the EMT students.
 
CALEMT said:
Wow, disregard then.
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Yep. This semester we are having to add in CPAP, Narcan IM/IN, and Epi 1/1000 IM to the EMT course.
 
DesertMedic66 said:
Yep. This semester we are having to add in CPAP, Narcan IM/IN, and Epi 1/1000 IM to the EMT course.
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State changing the scope of practice for EMT's or just allowing EMT's to assist paramedics with those listed.
 
CALEMT said:
State changing the scope of practice for EMT's or just allowing EMT's to assist paramedics with those listed.
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CPAP and Narcan IM/IN are already in the state scope for EMTs. There has been a lot of talk about allowing Epi IM due to the cost of the Epi pens. ICEMA, at least during their meetings, is really wanting to expand the EMT scope to the max it can be so we are having to add in extra time/classes to the EMT program. So you have the normal EMT class and we add in HazMat FRA, bloodborne/airborn pathogens, and CPR. Now we are having to add in a 8-16 hour documentation class, 8-16 hour modified TECC/TCCC class, and a pharm/med admin class.
 
DesertMedic66 said:
CPAP and Narcan IM/IN are already in the state scope for EMTs. There has been a lot of talk about allowing Epi IM due to the cost of the Epi pens. ICEMA, at least during their meetings, is really wanting to expand the EMT scope to the max it can be so we are having to add in extra time/classes to the EMT program. So you have the normal EMT class and we add in HazMat FRA, bloodborne/airborn pathogens, and CPR. Now we are having to add in a 8-16 hour documentation class, 8-16 hour modified TECC/TCCC class, and a pharm/med admin class.
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Funny how things change in the 5 years its been since I was in EMT school.
 
I would love to see capnography added to the emt scope. It would help guide treatments for asthma and other breathing problems, cardiac arrest, co poisining, and probably any other complaint involvng breathing problems.

Capnography doesnt need to require a life pack, they do sell smaller models similar to an old pulse ox device.

CPAP, IM epi, narcan, Albuterol, benedry,l SGA, these things used to be paramedic only and now people are seeing that EMT can give them too and adding to the emt scope in several areas. I wonder what else will be added in the future
 
I have heard of systems that did not allow EMT's to use pulse oximetry. I used to think that was absurd, but I can see how a system would prefer folks with as little training as EMT's have to allow basic clinical signs (obvious dyspnea or wheezing, skin color) to guide protocol selection rather than imperfect technology. I think the same can be said for capnography.

If a system has the resources to ensure that the EMT's are well trained in it's use, then why not. On the other hand, I can't think of any instance in which I think it would be necessary or appropriate for an EMT to use capnography to guide treatment. EMT protocols really should be "See A —> do B. See C —> do D" without a whole lot of room for diagnostic interpretation. Not to be insulting to EMT's (I've actually argued many times that I think in most systems, having well trained and equipped EMT's is more important than deploying as many paramedics as possible, and I think the research generally backs that up), but we do have to be realistic about the very limited education they get.

Generally speaking though, I think capnography is overrated in terms of it's usefulness as a diagnostic tool in a non-intubated patient, anyway.
 
VentMonkey said:
just seen as a “cool tool” to play with would you agree that your peers in general are ready to understand and appreciate its capabilities, let alone allow it to guide the therapies that they’d provide?
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Most of my peers could handle it if there were enough in-services :D
But seriously, I agree that we're pushing the limits of EMT knowledge with ETCO2.

DesertMedic66 said:
So you have the normal EMT class and we add in HazMat FRA, bloodborne/airborn pathogens, and CPR. Now we are having to add in a 8-16 hour documentation class, 8-16 hour modified TECC/TCCC class, and a pharm/med admin class
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You know, many folks on the board have said that AEMT should be the baseline for 911 response. With all of the additions to EMT that I see in a lot of places (CPAP, IM epi, glucometry, SGAs), I'm almost getting to the point of saying that EMT response is sufficient for the bulk of emergency calls in urban & suburban areas...
 
in the next county over from me (actually, they are northeast, but minor details), they use ETCO2 on every asthma patient. if the patient is wheezing, and the display shows a shark fin, give albuterol. if it doesn't, CPAP. Their clinical coordinator was trying to find a way to add it to their treament protocols.... so what did he do? he added pictures to the flowcharts, and got them approved for the state DOH. as Remi just said:
Remi said:
EMT protocols really should be "See A —> do B. See C —> do D" without a whole lot of room for diagnostic interpretation.
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If you hear wheezing and a shark fin, give albuterol. if you hear wheezing and no shark fin, CPAP. And both CPAP and albuterol in in the EMT's scope of practice here.

While I do think that EMT training is still lacking in many ways, many items that used to be paramedic only are now being given to EMTs. How long ago was defibrillation a paramedic only skills? and now AEDs are everywhere. And yes, there are still places where EMTs aren't allowed to use a pulse ox.... but why are we handicapping providers? If it's a new tool they can use to assess, why not let them use it?
 
My two cents (please forgive me)...respiration is the physiological occurrence of cellular mitochondria using an electron from an oxygen atom for the purpose of reducing ATP to ADP and energy (via Krebs Cycle, glycolysis and oxidative phosphorylation depending on certain factors and what's on the test that day). To measure that you need a metabolic cart and a whole lot of inputs and assumptions. In the process of respiration, CO2 is created. ETCO2 measures the amount of CO2 being exhaled from the body and can be used to assess the body's ability to remove it via ventilation. Those who rely on ETCO2 to measure respiration or ventilation use a series of assumptions to create the inference between the two (ETCO2 and its association to cellular respiration versus ETCO2 and its association to ventilation). In the case of malignant hyperthermia where the cells go into overdrive, ETCO2 will indeed increase in the presence of normal ventilatory status. Likewise, ETCO2 values will change with changes in ventilatory status.

Regarding CPAP as a BLS tool, New York has allowed CPAP with BLS crews for a couple of years now. A study in Ontario, Canada in 2012 determined that the skill set was appropriate in primary care paramedics (not sure how that translates to all US-based BLS crews). Regardless, if applying CPAP for indications of respiratory failure, one would think that ETCO2 (and thorough training) should be available to assess the efficacy of such therapy.
 
I think the obstructive vs nonobstructive waveform morphology is a fair method for guiding treatment. Obviously a paramedic with clinical judgement and critical thinking skills will put it all together, but it can certainly help newer medics or point you in the right direction at 4am.

We talk an awful lot about cognitive offloading and using diagnostic tools to help you make decisions without having to commit all of your focus is a great way to head down that road.
 
I would think that universal adoption of CPAP at the EMT level would prove to be much more beneficial than CO2 monitoring with regard to patient outcomes.

As far as the expanded formulary for EMT, it does seem much more fitting to merge the EMT/ AEMT training and education altogether.

@DesertMedic66 are they adding extended, and more in-depth curriculum to the EMT course where you teach?
 
VentMonkey said:
I would think that universal adoption of CPAP at the EMT level would prove to be much more beneficial than CO2 monitoring with regard to patient outcomes.
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I'm up for anything to cut the number of field intubations.
 
I can tell you we don't go in depth in cellular respiration at the EMT course that I teach..... and if the instructor does decide to supplement it (because it's pretty important information), most students won't pay attention because the chance of it being on an exam is low.
 
DrParasite said:
I can tell you we don't go in depth in cellular respiration at the EMT course that I teach..... and if the instructor does decide to supplement it (because it's pretty important information), most students won't pay attention because the chance of it being on an exam is low.
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So as an EMT instructor what do you make of all of this?

Do you think your students are, in general, ready for these added skills?

How much more training and education is needed at the EMT-level vs. when do we abolish both EMT and AEMT to create one “basic” level of provider prior to paramedic?

I like the honest answer, and quite frankly this is very much a problem with most things scholastically. We learn just enough to get by, right?
 
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