How "Basic" is BLS in your area

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vc85

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I am just wondering how 'basic' is BLS in your area. I was reading some of the other threads and I'm amazed.

In my region/area an EMT-B can do

CPR
AED
Oxygen
Pulse Oximetry
Glucometry
Oral Glucose Administration
Epi-Pen
Albuterol
Asprin
Atropine auto injector (Organophosphate poisoining and WMD)
Assisted Nitro
OPA
NPA
Clotting Sponges
1 attempt to reduce a fx if distal pulse is missing
Plus all of the splinting, backboarding, bandaging, etc

And on the way:

Nasal Narcan
CPAP
Expanded Nitro protocol (Systolic of 100)
Epi-pen for asthmatics not responsive to albuterol with med-control
Venturi masks
Automatic Transport vents

Talked about possibly coming

ETCO2 readings (numbers, not waveform)
King/rescue airways

Hearing some of the stories of what BLS can do in other parts of the country, make this seem like a fully stocked ALS unit
 
Your system is on the high end for what it allows basics to do. Our basics can do all of the same, plus King and IO, but can't use CPAP, Vents, or epi for asthma. Again, this is the high end of the spectrum. There are systems that don't allow pulse oximetry.
 
I have worked in three counties all in California as an emergency medical technician on an ambulance: Santa Clara County, Alameda County, and Contra Costa County (current). The scope of practice is similar in all three counties.

Chest compressions
Spinal immobilization
Splinting
Defibrillation via automatic external defibrillators
Positive pressure ventilation via bag-valve mask
Head-tilt chin-lift
Jaw thrust
Nasopharyngeal airways
Oropharyngeal airway
Manage the airway via position
Oral glucose
Oxygen via nasal cannula, non-rebreather mask, or bag-valve mask
Bleeding control with direct pressure or tourniquets (we have combat application tourniquets)
Pain management via hot/cold packs
Irrigation
Assist with patient's own medications, particularly nitroglycerin (NTG), albuterol, or EpiPen.

We cannot do pulse oximetry or glucometry. We cannot manage the patient's airway using advance airways such as king airways or combitubes.
 
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Our basics here are allowed do most of that. CPAP in some trucks. A pilot of IN Narcan is coming.

Useless, as it will all just expire on the trucks because 90% of the time the medics arrive first.
 
In my old system in Colorado, EMTs are able to start IVs, administer saline boluses, give D50, albuterol, NTG assist, ASA, Narcan, King tubes, plus everything else you mentioned in the first part of your post. As far as I know, they still can't do CPAP, Epi for asthma, Venturi masks (kind of surprised you guys carry these), or vents of any kind.

This was in a system where a basic was always with a medic on the ambulance. There were events staffed by EMTs only where some of the scope could potentially be used without ALS ALS present. Our EMT firefighters worked off a slightly more restrictive scope and didn't do anything involving IV access. A lot of this was put in place for our rural, outlying FR volunteer fire departments. They wanted to be able to do some of these additional things as they waited ~30-45 minutes for an ALS ambulance from the city.

I'm not convinced it was always a good thing having a vollie who runs 10 calls a year turning your patient into a cushion before you got there, but it proved useful a handful of times. I absolutely loved it as a basic working on the ambulance itself. Our EMTs started as many IVs as the medics, and in some cases more. We were quite competent with them, and it was great to be able to do that for the medic on the truck as they worked on other things.
 
Here they can do splinting and bandaging, oxygen admin, atrovent, albuterol, Asa, Narcan (IM/IN), epi pen or drawing up and administering epi in a 0.3cc syringe with mcep. Charcoal, APAP, all Supraglottic airways, NPAs, OPAs, CPAP, BGL checking, auto transport vents.... Plus probably some stuff I'm missing
 
Yeah I realized I left out a few things from reading this post. Obviously all of the positioning we can do, ice/heat packs, irrigation, we can give activated charcoal with medical direction. We can also use tourniquets, and those are now a second line treatment after direct pressure

Some of the more advanced airway stuff (Auto Transport Vents, Venturi, etc)I believe are in the process of getting authorized or just got authorized. Carrying them is a different story and I don't know if we will or won't yet
 
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I'm pretty near where you are, Aprz, so it's about the same. Pretty limited EMT scope. But then again, unless it's a pretty rural area with a BLS fire dept ambulance, all the ambulances on the road are running with a medic. So there really isn't much need for EMTs to have a big scope.

And if I am confident in my partners skills/knowledge, it's not uncommon for me to let them jump in and start doing ALS-ish stuff while I'm doing my assessment and overseeing them.
 
OPAs
NPAs
King LT
AED
IV Fluids NS and D10
IM Glucagon
Oral Glucose
IM and IV Narcan
IM Epi
Oral Benadryl
Nitro
ASA
Entonox
Traction Splinting

CPAP is just rolling out for our ALS, in theory BLS will get it in 1 or 2 years.
 
Los Angeles County EMT Scope of Practice

CPR and AED
Oxygen (NRB, BVM, NC, and humidifier)
OPA and NPA
Ventilate ETT, perilaryngeal airway devive (King LTS-D) and tracheostomy or stoma
Suction oropharynx and tracheostomy tube or stoma
All the usual bandaging and splinting and spinal immobilization
Tourniquets for when direct pressure and elevation isn't working
Hemostatic dressings (only currently approved for SWAT teams)
Field triage and extrication
All the usual BELLSRP vitals plus Pulse Oximetry when available
Monitor, adjust and turn off IV fluids (Normal Saline, Ringers Lactate, and Glucose solutions)
Monitor IV infusions with additves adjusted to a TKO rate (Folic Acid, Thiamine, Multivitamins, and Magnesium Sulfate only with the multivitamins)
Monitor IV infusions with additives at a preset rate via infusion pump (Potassium Chloride 20mEq/1000ml and Total Parenteral Nutrition)
Transport patients with NG, OG, GT tubes, saline/heparin lock, foley catheter, tracheostomy tube, ventricular assist device, surgical drains, medication patches, indwelling vascular lines (PICC and PVAD)
Transport patients with any prescribed medication with an automated or patient operated medication pump, any prescribed pain medications via a patient controlled analgesia pump
Administer Oral Glucose for suspected Hypoglycemia and Aspirin for suspected myocardial chest pain
Assist patients with the administration of prescribed medications (sublingual Nitro, Epipens, Bronchodilator inhaler or nebulizer)
Set up for ALS procedures under direction of a Paramedic

nusate5a.jpg
 
I'd like to see Farrow's EMT-B protocol... :blink:
 
STXmedic said:
I'd like to see Farrow's EMT-B protocol... :blink:
Click to expand...


They have guidelines not protocols lol. I can't wait to go do my ride time with him and Sam.
 
They damn near have a medical license to practice over there :lol:
 
farrow's?
 
king

we can now do king airways and I think it should be a basic skill all over
 
RookieRescue said:
:blink:LaCo here, things we are allowed to do:


Spike bags
Transport
Click to expand...

The policies got updated 12/1/13 and some things were added and others reworded. Interesting things to note are:
Addition of pulse ox
Addition(?) of CPAP
Administration of Asprin (agency provided, no longer has to be prescribed)

Also, most emts dont know about the pump policy. Just the other day I took a patient on a drip via infusion pump BLS.

We are also "Allowed to set up ALS procedures under the direction of a paramedic." Vague. But there it is.
 
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Our scope in RI is fairly expansive (in comparison to CT where I have worked as a Basic, and the national).

Medications:
  • Acetaminophen (oral/rectal)
  • Activated Charcol
  • Albuterol (nebulizer)
  • Aspirin
  • Calcium Gluconate 2.5% (gel)
  • Epinephrine 1:1,000 IM
  • EpiPen Auto Injector
  • Glucagon IM
  • Glucose (oral)
  • Naloxone IN
  • Nitroglycerin (assist patient)
  • Atropine Organophosphate Auto Injector
  • Oxygen

We can also insert an EOA (esophogeal obtruator airway), obtain a blood glucose, and monitor end tidal/capillary CO2 (with department specific training), in addition to the national standards.
 
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