diff in paramedic and intermediate

[shorthairedpunk]

narco overdoses and diabetics are about the only on scene IVs I do, the rest can get em enroute

I dont put anybody in the bus unless I know they arent going to sign a refusal on me

 

[rescuecpt]

Depending on how the call gets EMD'd, I'll usually spike a bag enroute - that way if it's something like chest pain or OD I'm ready to rock when I walk in the door. Stick and run.

Then I can start pushing all my yummy drugs (medical control wants an IV in place for nitro).

 

[Jon]

Originally posted by ffemt8978@Jul 14 2005, 01:38 AM
I don't see the benefit of I's in a metro area, but in a rural area I think they can be a good thing. Given our long transport times around here, we can prep the patient for our ALS intercept and save the P's precious minutes that would be wasted by establishing a line. Of course, we don't start our lines on scene but do them during the transport. After all, BLS before ALS.

From a -P student standpoint.... -I's are nice, as a partner for a -P.... That way the -I can start a line and help the medic on a code or bad call. (Not that a lot of the BLS -P Drivers don't do that, unofficially ).

I've also heard of I's being able to push all drugs, under the orders of the medic onscene (giving Narcan or Epi while the medic intubates).

I's are good to have, to suplement medics, but shouldn't replace them.

But, if an -I can give ASA, NTG, Combivent, Epi, lidocane, Atropine, Narcan and d50, read a monitor and cardiovert/defib they could easily handle the 75%+ of "BS" ALS calls, leaving a fly-car medic free to respond on another call....

 

[Jon]

Originally posted by shorthairedpunk@Jul 14 2005, 09:34 AM
narco overdoses and diabetics are about the only on scene IVs I do, the rest can get em enroute

I dont put anybody in the bus unless I know they arent going to sign a refusal on me

I see it from another angle....

I'd rather get the patient into my rig, where I am "at home" and they are on "my turf" - espicially a drug overdose - less risk to me and my crew, espicially with weapons.

As for a diabetic, it is one thing I like to rule out onscene before transport, even if for no other reason than it helps me figure out a treatment plan.... just do a fingerstick while you partner is getting the litter ready - then you know if D50 is getting pushed when you get a line, or not.

Usually, the pt. is on the monitor, O2, IV'd and 1st round of meds given before transport.... the driver usually hops in the back and makes sure the medic has everything under control, then walks around and drives to the ED.

Jon

 

[emschicksrock]

Back to your original question, I think the difference depends on what state you live in. Even if you are Natonal Registry certified. In addition individual private companies and municipalities may have their own protocols and limitations.

I-85 is what they call Intermediate when you go to take your National Registry test. A lot of people around here still refer to the level by its old name of "Specialist". The level here is considered "Limited Advanced" depending on the level of licensure of the crew. If I run with a Paramedic, it is an "Advanced" rig. If I run with a fellow Intermediate, or with a Basic, it's "Limited Advanced".

Where I'm from we can intubate, start iv's, administer glucagon, ASA, oxygen, and assist pt. in taking their own nitro and albuterol without 'permission' from medical control. With med. control permission we can also push Epi, Albuterol, and Nitro. We can transport a patient with additional Paramedic non-narcotic drugs in the IV, but we can't start the IV. We can't transport if the IV is piggy-backed with serious stuff.

I think that there is a place for all levels, depending on where you run and what your patient demands are. Not all runs need advanced care. Why make people pay for it?

 

[Jon]

Originally posted by emschicksrock+Jul 27 2005, 09:02 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (emschicksrock @ Jul 27 2005, 09:02 PM)</td></tr><tr><td id='QUOTE'>With med. control permission we can also push Epi, Albuterol, and Nitro.[/b]

not to be a smart-a**, but I think it is kind of hard to "push" albutorol.... (Isn't terbutaline IV, though?)...

<!--QuoteBegin-emschicksrock@Jul 27 2005, 09:02 PM
We can transport a patient with additional Paramedic non-narcotic drugs in the IV, but we can't start the IV. We can't transport if the IV is piggy-backed with serious stuff.
[/quote]
So... you are saying that you can start an IV lock or NSS, but not durgs... but if the patient has a lidocaine drip, you can transport them with it running.. I think....

 

[emschicksrock]

Yes, those are the transport protocols. I can start D5 or NS without permission.

You're right about pushing the Abuterol, I'm new to this Board, I guess I better carefully edit before I post again.

Unless that was sarcastic humor, in which case I'll add that you may not push Albuterol, but when they need it the pt. is usually a pushover.

Edited to add/clarify: Albuterol is via Nebulizer

 

[Jon]

Originally posted by emschicksrock@Jul 31 2005, 03:52 PM
Yes, those are the transport protocols. I can start D5 or NS without permission.

You're right about pushing the Abuterol, I'm new to this Board, I guess I better carefully edit before I post again.

Unless that was sarcastic humor, in which case I'll add that you may not push Albuterol, but when they need it the pt. is usually a pushover.

Edited to add/clarify: Albuterol is via Nebulizer

I was just being picky... that's all.... I HOPE none of us have tried to give albutorol IV....

 

[usafmedic45]

I'm guessing someone has done it- given albuterol IV- because on the side of most albuterol bullets it says "NOT FOR INJECTION- INHALATION ONLY"

And yes, terbutaline can be given IV, but it can also be given as a neb treatment (although I've only seen it given as a neb once).

 

[Jon]

Originally posted by usafmedic45+Aug 1 2005, 01:01 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (usafmedic45 @ Aug 1 2005, 01:01 AM)</td></tr><tr><td id='QUOTE'>I'm guessing someone has done it- given albuterol IV- because on the side of most albuterol bullets it says "NOT FOR INJECTION- INHALATION ONLY"[/b]

Probably. How many of your co's rigs say "Gasoline" and "Deisel"??? Anyone here every made that oops before???

<!--QuoteBegin-usafmedic45@Aug 1 2005, 01:01 AM
And yes, terbutaline can be given IV, but it can also be given as a neb treatment (although I've only seen it given as a neb once).[/quote]
Yeah. My instructor is an RT as well, so he was very big on it. "Yeah, it is old, but it is in code carts and drug boxes to give IV, as it is more Beta II specific then Epi" and that sometimes Grandma/Grandpa would get terbutaline nebs, because they've worked for 20 years, and why mess with success.

 

[usafmedic45]

One service I used to work for had terbutaline as a backup for wheezing not broken by albuterol. It's good stuff.....it definitely has it's place.

 

[Ridryder911]

Not to say the least on that premature labor patient as well.....

Be safe,
Ridryder 911`

 

[rescuejew]

lets see, in Durham heres what I's can do (without med control or supervision from a Paramedic...)

IVs
12 leads
AED
Epi, Narcan, D50, Thiamine, SubQ Epi, IV benadryl, ASA, NTG, Albuterol, Atrovent
ET intubation
EJs
All the BLS stuff and we have been trained on Sternal IOs and Quick-Trachs.

I's function independently here, as we do not hire EMT-Bs. Most I's ride with a medic, but we take turns on calls and rotate unless the call requires Paramedic skills. We have been known to ride I trucks and call for a medic if necessary.

 

[Jon]

Originally posted by ridryder 911@Aug 5 2005, 10:37 PM
Not to say the least on that premature labor patient as well.....

Be safe,
Ridryder 911`

Tebutaline for premature labor???

I always thought that was Mag...

 

[medicNsand]

Originally posted by TTLWHKR@Jul 5 2005, 12:25 PM
Since I have nothing better to do at the moment, I made a list.
EMT-ADVANCED
EMT-AMBULANCE
EMT-BASIC
EMT-CRITICAL CARE TECH
EMT-CARDIAC TECH
EMT-DEFIBRILLATION
EMT-ENHANCED
EMT-INTERMEDIATE
EMT-I85
EMT-I99
EMT-MAST
EMT-PARAMEDIC
EMT-SHOCK TRAUMA TECH
WILDERNESS EMT
ECA (EMERGENCY CARE ATTENDANT)
CAA (CERTIFIED AMBULANCE ATTENDANT)
FR (FIRST RESPONDER)
MFR (MEDICAL FIRST RESPONDER)
PHRN (PREHOSPITAL REGISTERED NURSE)
ETT Emergency Trauma Technician
EMT I
EMT II
EMT III
MICP Mobile Intensive Care Paramedic
LP - Licensed Paramedic
NREMT-P - Nationally Registered Paramedic
NREMT-B
NREMT-I
CCEMT-P - Critical Care Paramedic

I compiled the list from several commercial sites that I didn't write down.

No Disrespect Sir, but you forgot the " Black-Ops" medic community. Working with LE/Federal agents/CIA/SWAT/Counter-Terrorism Groups and such.

 

[Flight-LP]

Originally posted by MedicStudentJon+Aug 7 2005, 06:42 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Aug 7 2005, 06:42 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ridryder 911@Aug 5 2005, 10:37 PM
Not to say the least on that premature labor patient as well.....

Be safe,
Ridryder 911`

Tebutaline for premature labor???

I always thought that was Mag... [/b][/quote]
Terbutaline is wonderful for pre-term labor as its B2 relaxant properties work directly on the uterus. Usually the only occasion it is given IV, it is infused at 10 - 25 Mcg/min..............

 

[trauma1534]

This is for medic4-2

Which region in VA are u in? I work in Western Virginia EMS region, I volunteer in ODEMSA, and work part time for another squad in ODEMSA. I used to be a member of a squad in BREMS. I would suggest to you that you take time to get aquainted with EMT-b before you move up. I have met quite a few providers who have gone zero to hero in 2 years and they are clueless in the back of the truck. As far as getting into EMS for a career, I would suggest that you find a Transport service. That is a great place to start. Get used to that, put a couple years in, move up to ALS and go for a squad. Most Squads want nice resume's. Get your Firefighter 1 also, alot of areas are starting to combine it. Chesterfield County pays pretty well, and the want you to have both certs. You deffinatly need your EVOC and why not go for the highest EVOC you can get, that way there are no limits in what you can drive. That is more bargining power for a good job. Another thing too, I don't know how close you are to North Carolina, but thier Paramedic is much cheeper than VA, and you can still get your regestry and cert in VA. That is what I am doing. I am taking Paramedic in NC. I stayed BLS for 8 years before I moved up to ALS, I have been ALS since May of this year.

As for what the diference between EMT-I and Paramedic is... in ODEMSA in Virginia, there are none... except for RSI and surg. crychs (spelling). I's can do everything a Paramedic can do.. they even needle crych. I's give all drugs in the box except for paralytics/RSI drugs. Our OMD is pretty cool. He let's us do alot at each level. In Western Virginia EMS councel, I's have to call for alot of orders. They are limited in which drugs they can use for what.

BREMS, EMT-B's can open the drug box and give glucagon, ASA, and a few others. They have an EPI pen they can use in the box too.

Just in VA, there are many differences in what each level can do, and not far apart on the map. I live almost on the line between 2 EMS councels or regions. I still can't get used to the difference in protocols. I work in both regions.

 

[ResTech]

Just to add to the terbutiline comments, a second B2-agonsist is nice to have on board for those COPD'rs that get a tolorance to albuterol. Sometimes when albuterol isnt working terbutiline will.. both are B2-agonsist but chemically different.

 

[Jon]

Originally posted by ResTech@Oct 29 2005, 04:33 AM
Just to add to the terbutiline comments, a second B2-agonsist is nice to have on board for those COPD'rs that get a tolorance to albuterol. Sometimes when albuterol isnt working terbutiline will.. both are B2-agonsist but chemically different.

What about Xopenex????

Although, I think it is Terbutaline, there is a B2 agonist that is IV injectable... VERY GOOD thing to have.

Jon

 

[ResTech]

Terbutiline is usually given IM for exacerbations of obstructive pulmonary diseases. Epi would be a B-2 agonist that can be given IV.