How "Basic" is BLS in your area

[emt11]

When I first started working as a Basic, I had FTOs and EMT partners who taught me things that I've since found out were just flat out wrong. I think this is part of the reason why many people with a lot of EMT experience do miserably in Paramedic school. They developed a bunch of bad habits and got some false notions stuck in their heads that are hard to get rid of.

The farther I get in Paramedic school the more convinced I am that EMTs should be pretty much limited to driving the ambulance and not much else.

Then you wind up with a company like mine with a system that makes the Paramedic tech every single 911 call no matter the C/C even the stubbed toe at 3am, and you wind up with a bunch of EMT-I's and AEMT's with very limited tech experience and are stuck driving every call every shift until they become Paramedics then their just thrown to the wolves with an "upgrade" program that last 1-2 months.

 

[hogwiley]

Then you wind up with a company like mine with a system that makes the Paramedic tech every single 911 call no matter the C/C even the stubbed toe at 3am

Maybe I was exaggerating a little, but I do feel like you have a lot of EMTs on the road don't know anywhere near as much as they think they do, so this is probably the reason why their scope is being increasingly restrained. They don't know enough to know any better.

and you wind up with a bunch of EMT-I's and AEMT's with very limited tech experience and are stuck driving every call every shift until they become Paramedics then their just thrown to the wolves with an "upgrade" program that last 1-2 months.

Well the problem here seems to be the 1 to 2 month upgrade. I've never even heard of an AEMT/I85 to Paramedic bridge class and don't really see much reason for one. AEMT school is what, 2 or 3 months, with maybe 80 hours of clinicals and no internship? Paramedic school is typically a year and a half with a minimum 600 to 1000 hours of clinicals and an internship, so that's a pretty long bridge to cross.

As for EMTs not getting tech experience before they become Paramedics, I've encountered Paramedics who hit the road with NO EMT experience of any kind, and they managed. Just sign up for more clinicals and Intern shifts during medic school, although yeah it sucks you aren't getting paid.

 

[RescueRider724]

We run a BLS Quick Response Service (QRS) truck, with additional modules after obtaining your EMT License you can also use pulseOx, We carry Epi pens (adult and peds) that we can administer via auto injector as a prescribing agency, and every Rescue and Ambulance in our region has CPAP on board. We also have a portable suction bag. There is talk in the wind of expanding the scope to king airways as well if you are NR certified...see if that happens. We are saturated with medics in Western Pa though, so not sure if that will make a difference or not.

 

[emt11]

"See the bold part" I think some of the issue here is, that were from different states. My state uses NREMT. The entry level to work on an ambulance is I'85 which currently being phased out. We have very few EMT-B's. Most Basics work at dialysis only companies or work at services "out in the sticks". I'85 school in itself was usually 6-9 months depending on the program before the state and NREMT stopped teaching/testing for it. The current AEMT programs run right at a year. Currently, the way things are being done is for a brand new EMT student will be taught to the Basic level and test NREMT for EMT-Basic. They are not required to apply to the state but must pass NREMT-B to test for NRAEMT. The schools then turn around and teach the students everything that is needed to operate as an AEMT skills/knowledge etc.

Currently, their is a minimum of 32 hours required on an ambulance with no hospital time required for the AEMT level. Their is no program in the area to my knowledge that requires an internship, no has their been one in the past to my knowledge. The following forms are the clinical forms that all students must complete and submit to the state at the end of their ride time, it also outlines everything that is required from their ride time.

This is the EMT-B or EMT file review
http://dph.georgia.gov/sites/dph.georgia.gov/files/New File Review Forms EMT fillable.pdf
You'll note that the EMT file review is extremely simple, mostly because the state does not use the level but still has it around.

This is the AEMT file review
http://dph.georgia.gov/sites/dph.georgia.gov/files/New File Review Forms AEMT Fillable.pdf

This is the Paramedic file review
http://dph.georgia.gov/sites/dph.georgia.gov/files/New File Review Forms Paramedic Fillable.pdf

Maybe I was exaggerating a little, but I do feel like you have a lot of EMTs on the road don't know anywhere near as much as they think they do, so this is probably the reason why their scope is being increasingly restrained. They don't know enough to know any better.



Well the problem here seems to be the 1 to 2 month upgrade. I've never even heard of an AEMT/I85 to Paramedic bridge class and don't really see much reason for one. AEMT school is what, 2 or 3 months, with maybe 80 hours of clinicals and no internship? Paramedic school is typically a year and a half with a minimum 600 to 1000 hours of clinicals and an internship, so that's a pretty long bridge to cross.

As for EMTs not getting tech experience before they become Paramedics, I've encountered Paramedics who hit the road with NO EMT experience of any kind, and they managed. Just sign up for more clinicals and Intern shifts during medic school, although yeah it sucks you aren't getting paid.

 

[emt_irl]

Actually, that's pretty good for an EMT. With what's listed you can actually do quite a bit for most patients, and really, ones who truly need more care need someone with quite a bit more education and training.

Now that I've said that, what does that level of training in Ireland require as far as education?

And...under the "cardiac" guidelines...there's a checkbox for being allowed to provide "emotional support"...now that's just funny...

By the book its 140 hours of education, id say its split close enough to 50/50 in regards to theory and practical. then we sit a 100 question MCQ and we sit 8 osce's(objective structured clinical exam) It's really noticeable over here who went to a certificate printing school and who went through a much more reputable class. Myself a few others i work with in the end sat through nearly 200 hours of training as we went to extra cpd events and training sessions to get a better education, even though we only needed the basic amount to pass the exam.

 

[STXmedic]

where around here can someone get BLS training and certificate? i heard kennet had one at the hospital? anywhere elese around here? i need the certification for the school i wanna apply for

Umm... Huh? You may have better luck if you don't ask a completely random question in an already established thread... Try making it its own topic and be more specific on details, such as location.

 

[vcuemt]

where around here can someone get BLS training and certificate? i heard kennet had one at the hospital? anywhere elese around here? i need the certification for the school i wanna apply for

Nah, Kennet got it at the community college. You're thinking of Keit.

 

[brian328]

As a basic working 911 in SoCal, I was a "gurney jockey" for the FD as some people say. Take a BP and pulse, MAYBE get a blood sugar and set up a 12 lead. Mostly moving patients and transporting..

As a basic working 911 in Texas, I am able to do far more. Assessments, transport decisions, CPAP, airways, give certain meds, etc.. And EMS is in charge of just about every emergency call other than a fire.

 

[Drax]

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

CPR
AED
Oxygen
Pulse Oximetry
Glucometry
Oral Glucose Administration
Epinephrine
Aspirin
Assist w/ prescribed Albuterol via neb or meter-dose
Assist w/ prescribed Nitro
Activated Charcoal
OPA
NPA
Clotting Sponges
1 attempt to reduce a fx if distal pulse is missing
Plus all of the splinting, backboarding, bandaging, tourniquets etc

 

[Jay]

In my region/area an EMT-B can do...

Where are you located vc85?

This is not a bad list at all, in Pennsylvania there are notable exceptions including:

• Pulse Oximetry - BLS only allowed with training.
• Glucometry - ALS skill ONLY, however...
• Oral Glucose Administration - BLS can provide as long as the patient uses his/her own meter.
• ASA - By local protocol only unless "assisting" patient with their own.
• Atropine auto injector - ALS skill only (to the best of my knowledge).
• Clotting Sponges - Have not been "trained" on their use.

As for your "On the way" list:

• Nasal Narcan - Have NOT heard anything yet but really do wish it is on the way! For the sake of our patients.
  
• CPAP - Like Pulse Oximetry in PA, meaning with proper training.
• Epi-pen for asthmatics not responsive to albuterol with med-control - This may be allowed by local protocol, if anyone knows knows please "chime in".
• Automatic Transport vents - I know that we can "assist" but this is always with a Paramedic/EMT crew running ALS. If anyone in PA knows if this expands to BLS please "chime in".

As far as I know ETCO2 and any airways with the exception of OPA/NPA are strictly ALS skills and will remain that way for the foreseeable future.

 

[SeeNoMore]

When are BLS folks using Automatic Transport Vents?

 

[Clare]

Adrenaline (IM, IN and nebulised),
Automated defibrillation,
Automated cardioversion,
Entonox
Glucagon,
Glucose gel
GTN spray,
Ibuprofen,
Ipratropium,
Laryngeal mask airway,
Loratadine,
Methoxyflurane
Nasopharyngeal airway,
Ondansetron (oral),
Paracetamol
Prednisone (oral),
PEEP,
Salbutamol,
Tramadol (oral),
Urinary catheter troubleshooting

 

[TransportJockey]

When are BLS folks using Automatic Transport Vents?

NM basics are technically allowed to on use them, with the rationale that they can use etco2 and place combi/lma/king tubes, so giving them something for long transport times would be ok.

 

[Tigger]

NM basics are technically allowed to on use them, with the rationale that they can use etco2 and place combi/lma/king tubes, so giving them something for long transport times would be ok.

Are NM basics allowed to use waveform capno? Here in Colorado BLS only services with SGAs can only use colormetric indicators.

 

[TransportJockey]

Are NM basics allowed to use waveform capno? Here in Colorado BLS only services with SGAs can only use colormetric indicators.

Yep. The state also allows basics to use CPAP so they were given some extra assessment options, but it's a medical director allowable skill

 

[Tigger]

Yep. The state also allows basics to use CPAP so they were given some extra assessment options, but it's a medical director allowable skill

Gotcha. I can use the monitor for non-waveform confirmation, but that's pretty moot since the chance of me being alone on a call with a rig and enough hands to drop one is awfully small.

 

[Bearamedic]

Just the things i have heard other basics not being able to do. (WV)

1:1000 epi IM
Albuterol
NTG SL
ASA 325mg
12 lead acquisition
Monitor kvo IV ns
Pulse OX
EpiPen
Glucometer
Oral glucose
CPAP
Capnography
AED
Activated Charcoal
Tracheostoma suctioning
King airway and combitube.
Acetaminophine 10mg/kg
MarkI kits
Ventilators (simple)
Geezer squeezers
Insert hands vaginally during troubled births

 

[uglyjon]

In my area an EMT is lucky we get to do chest compressions. Seriously there is nearly no difference between first responders and EMT's in their scope. NPA's are considered ALS. Nothing but stretcher fetchers here where I am at.

 

[BASICallyEMT]

In my area an EMT is lucky we get to do chest compressions. Seriously there is nearly no difference between first responders and EMT's in their scope. NPA's are considered ALS. Nothing but stretcher fetchers here where I am at.

Interesting.... How busy is your 911 system?

 

[MedicDelta]

Emergency Medical Responder(comparable to EMT-B) from Canada here!
The national scope of practice for EMRs in Canada includes:
CPR/AED BLS
Basic Airway Management(OPA, NPA)
Obtaining a blood glucose level
Pulse oximetry
BP
Lung/breath sounds
Spinal immobilization
Pupil response
Oxygen administration
Entonox(specific to British Columbia)
Aspirin ASA
Assist with Nitro spray
Albuterol and other MDIs
Glucose gel