National Standards should all be the same across the Nation?

[1badassEMT-I]

My question is this should we have the same standards/protocols across the Nation......
SCOPES of Practice EMT-B in NC be the same as EMT-Bs in Ca or EMT-Is in WV the same as the EMT-Is in Texas. Should the EMT-Ps in Florida have the same protocol as NM.

I think in the interest of pt. care we should NOT vary protocol from state to state. As we all have the training standards the same why not have thwe same protocols......Have a set uniform standard across the nation for the same protocols....What do you think?

 

[JPINFV]

1. No, not all of the training standards are the same. In large part, the national standards are a guideline than a hard requirment.

2. Are you saying that middle of no-where BFE has the same challenges and patient population as downtown Los Angeles?

 

[1badassEMT-I]

1. No, not all of the training standards are the same. In large part, the national standards are a guideline than a hard requirment.

2. Are you saying that middle of no-where BFE has the same challenges and patient population as downtown Los Angeles?

The national standards are the guideline.....however I am not able to push meds I trained to push.....I am just asking do you think we should all have the same protocols uniform protocols....in our bag......sure where I am at I have alot of rural area where as you in Pomona is largely urban I wont run up against things that you will as well as you wont run into the same as me.....however I would to know that I can give the same care as you can if I did run into it.....make any sense?

 

[ExpatMedic0]

Yes we should, just like nurses and doctors do and most other providers.

 

[ExpatMedic0]

1. No, not all of the training standards are the same. In large part, the national standards are a guideline than a hard requirment.

2. Are you saying that middle of no-where BFE has the same challenges and patient population as downtown Los Angeles?

Thats why there are Intermediates....
To me your statement is like arguing doctors RTT, and nurses in downtown LA should should be completely different than those in BFE nowhere.

 

[MrBrown]

Yes, all Ambulance Officers should have the same education, scope of practice and continuing education requirements

 

[1badassEMT-I]

Yes, all Ambulance Officers should have the same education, scope of practice and continuing education requirements

Mr Brown how is the standards in New Zealand......hopefully not as mess up as us in the good ole USA......I just have a problem with from one state to the next. MY training is not worth a damn......and I think that needs to change..... I am trained NATIONALLY to push meds that could save a life however I am not allowed to push them in my state I practice in......To me 22 years of service thats is wrong!

 

[1badassEMT-I]

Yes we should, just like nurses and doctors do and most other providers.

Could not agree more with that statement

 

[MrBrown]

how is the standards in New Zealand......

Ambulance Technician
Diploma in Ambulance Practice (24 weeks)

• Oxygen
• Oro and nasophayrngeal airway
• Laryngeal mask airway
• Automated defibrillation
• 3 lead ECG monitoring
• Aspirin PO
• GTN SL (nitro)
• Salbutamol nebules
• Glucagon IM
• Paracetamol PO
• Methoxyflurane
• Ondansetron PO
• Combat application tq.

Paramedic
Bachelors Degree in Health Science (Paramedic)

• Intravenous cannulation
• IV fluid
• 10% glucose IV
• Manual defibrillation
• 12 lead ECG interpretation
• Synchronised cardioversion
• Adrenaline IM, IV, nebules
• Morphine IV, IM
• Ondansetron IV
• Naloxone IM, IN, IV
  
  Looking to add
• Midazolam IM, IN for seizures

Intensive Care Paramedic
Post Graduate Certificate in Intensive Care Paramedicine

• Endotracheal intubation
• Cricothyrotomy
• Intraosseous access
• Chest decompression
• Cardiac pacing
• Atropine IV
• Amiodarone IV
• Midazolam IM, IN, IV
• Ketamine IM, IV, PO
• Frusemide IV
  
  Selected Intensive Care Officers only
• Fentanyl IV
• Suxamethonium IV
• Vecuronium IV
• Heparin IV
• Streptase IV

 

[1badassEMT-I]

Ambulance Technician
Diploma in Ambulance Practice (24 weeks)

• Oxygen
• Oro and nasophayrngeal airway
• Laryngeal mask airway
• Automated defibrillation
• 3 lead ECG monitoring
• Aspirin PO
• GTN SL (nitro)
• Salbutamol nebules
• Glucagon IM
• Paracetamol PO
• Methoxyflurane
• Ondansetron PO
• Combat application tq.

Paramedic
Bachelors Degree in Health Science (Paramedic)

• Intravenous cannulation
• IV fluid
• 10% glucose IV
• Manual defibrillation
• 12 lead ECG interpretation
• Synchronised cardioversion
• Adrenaline IM, IV, nebules
• Morphine IV, IM
• Ondansetron IV
• Naloxone IM, IN, IV
  
  Looking to add
• Midazolam IM, IN for seizures

Intensive Care Paramedic
Post Graduate Certificate in Intensive Care Paramedicine

• Endotracheal intubation
• Cricothyrotomy
• Intraosseous access
• Chest decompression
• Cardiac pacing
• Atropine IV
• Amiodarone IV
• Midazolam IM, IN, IV
• Ketamine IM, IV, PO
• Frusemide IV
  
  Selected Intensive Care Officers only
• Fentanyl IV
• Suxamethonium IV
• Vecuronium IV
• Heparin IV
• Streptase IV

WOW I need to quit *****ing.....I can do more than Paramedics can down under..... here is just a few of what I can do here in the US....

Endotracheal intubation
Intraosseous access
Chest decompression
Cardiac pacing
Atropine IV
Manual defibrillation
12 lead ECG interpretation
Synchronised cardioversion
Naloxone
Intravenous cannulation
IV fluid
Fentanyl
Morphine
D-50
Valium
and others


And that is as a EMT-I

 

[MrBrown]

WOW I need to quit *****ing.....I can do more than Paramedics can down under..... here is just a few of what I can do here in the US....

Endotracheal intubation
Chest decompression
Cardiac pacing
Atropine IV
Manual defibrillation
12 lead ECG interpretation
Synchronised cardioversion
Naloxone
Intravenous cannulation
IV fluid
Fentanyl
Morephine
D-50
Valium
and others


And that is as a EMT-I

But when you can't spell the name of the drug you're gonna administer Brown gets worried .... :unsure:

... although should you trust me in that orange jumpsuit with "DOCTOR" written on it?

Seriously tho ... in particular endotracheal intubation is recognised here as a high level procedure requiring an advanced level of knowledge, skill and experience so it is restricted to a select group of Officers in order to retain competency

Some other skills like cardiac pacing and intraosseous access could probably drop down to Paramedic level as could midazolam. but would I feel confident using them with my current knowledge base ... bit of midaz for a seizure maybe but some of the cardiac stuff no.

Now certian skills (specifically thrombolysis and rapid sequence intubation) are viewed here as so complex and specalised requiring a level of knowledge. experience and skill that is even moreso highly specalised that they are restricted above Intensive Care Paramedic level in general to a selected group of Intensive Care Paramedics.

You can teach Whacker R. Rescue to stick in a drip, pop a few amps of some drugs and ram a tube down somebodys throat in a couple weeks (hell the Houston Fire Department do it in 12) but I would need quadruple that amount of time to teach the anatomy, physiology and pharmacology behind probably one of the skills mentioned above let alone let people go out and do it in that timeframe.

 

[1badassEMT-I]

Ok Brown I got the E out of morphine......to early here I tell you!

 

[JPINFV]

Thats why there are Intermediates....
To me your statement is like arguing doctors RTT, and nurses in downtown LA should should be completely different than those in BFE nowhere.

...except not all areas recognize intermediates and there are a dozen and a half levels of intermediates. Even still, the skills needed at the paramedic level are going to differ from area to area. It's a lot easier to justify, say, RSI, when your transport time is 30 minutes than 5 minutes.

 

[1badassEMT-I]

...except not all areas recognize intermediates and there are a dozen and a half levels of intermediates. Even still, the skills needed at the paramedic level are going to differ from area to area. It's a lot easier to justify, say, RSI, when your transport time is 30 minutes than 5 minutes.

I have to argue that there only two I levels I-85 and I-99 the I 99 will be the paramedics in 2014.......According to NR......I am a I-99 however I get your point!

 

[JPINFV]

Yes we should, just like nurses and doctors do and most other providers.

You mean scope of practice and standing orders for non-physicians should be determined by the facility that they work at instead of the state level? Sorry, I don't trust most ambulance companies to allow them to set their provider's scope of practice. It's definitely not fair to compare any level to physicians since physicians don't have a legal scope of practice similar to other providers (the scope of practice of an unrestricted license to practice medicine is medicine in it's entirety. If a psychologist wanted to do open heart surgery, legally he can. Ethically and liability, on the other hand).

 

[JPINFV]

I have to argue that there only two I levels I-85 and I-99 the I 99 will be the paramedics in 2014.......According to NR......I am a I-99 however I get your point!

The NREMT is only a testing agency who's standards follows the NHTSA standards and no one elses. Just because the NREMT only tests for specific levels and the NHTSA recommends specific standards and standards does not mean that the individual states are compelled to follow said standards.

Additionally, the EMT-I/99 will not necessarily be a paramedic. If the provider opts to take the EMT-I/85 transition course instead of the longer bridge course, then he will be an EMT-I/85.


Edit: In the above post about scope of practice, I meant a psychiatrist not a psychologist...

 

[1badassEMT-I]

The NREMT is only a testing agency who's standards follows the NHTSA standards and no one elses. Just because the NREMT only tests for specific levels and the NHTSA recommends specific standards and standards does not mean that the individual states are compelled to follow said standards.

Additionally, the EMT-I/99 will not necessarily be a paramedic. If the provider opts to take the EMT-I/85 transition course instead of the longer bridge course, then he will be an EMT-I/85.

You are wrong sir! In 2014 I-99 with the proper recerts over time will be the NREMT PARAMEDIC ........ The I-85 will become AEMT......NHTSA has already got the standards in line for the change NR just didnt do this on there own.....however you are right the state level has to adopt it......but dont you think if your state is a NR state they will go with it......HMMM now there is a tought.

here is the link to support what I am saying!!!! GO READ!!!

http://nremt.org/nremt/downloads/Newsletter_2009.pdf

I see your point dont get me wrong but why would want to go down a level instead of up!

 

[EMSLaw]

WOW I need to quit *****ing.....I can do more than Paramedics can down under..... here is just a few of what I can do here in the US....

And as long as we keep focusing on who gets to do the neat skills, rather than the level of knowledge involved, EMS in the USA will remain the sort of technician-level drudge work it is now.

I have to agree with Brown. While I think a Bachelor's Degree may be too much to ask right now, it would be nice to see people actually get some sort of didactic background to support their use of all the "neat skills". I admit to a certain degree of equivocation, because there are skills that are low-risk, high-benefit that I think should be more widely available among various EMS certification levels, but that being said, you need to know why you're doing something, and not just how to do it.

Otherwise, we're back in the days of Johnny and Roy, where paramedics were just a pair of hands to do what the doctor tells them over the radio.

 

[JPINFV]

All NREMT-Intermediate/99’s must take the Paramedic cognitive examination by their expiration date, or “fall back”to EMT Advanced without testing.

Emphisis added.

http://nasemso.org/Meetings/Annual/documents/ImplementationoftheEMSEducationAgendafortheFuture.3.pdf Page 31

Edit: There are additional descriptions of the transition courses somewhere on the EMS.gov website, but I'm having trouble finding it right now.

 

[1badassEMT-I]

And as long as we keep focusing on who gets to do the neat skills, rather than the level of knowledge involved, EMS in the USA will remain the sort of technician-level drudge work it is now.

I have to agree with Brown. While I think a Bachelor's Degree may be too much to ask right now, it would be nice to see people actually get some sort of didactic background to support their use of all the "neat skills". I admit to a certain degree of equivocation, because there are skills that are low-risk, high-benefit that I think should be more widely available among various EMS certification levels, but that being said, you need to know why you're doing something, and not just how to do it.

Otherwise, we're back in the days of Johnny and Roy, where paramedics were just a pair of hands to do what the doctor tells them over the radio.

Oh I agree with this 100% I get mad sometimes that we as a whole from Bs to Ps are not able to use what we are taught due to STATE protocols dont think we know what we are doing.......Like I said in a earlier post I can give Morphine but cant give Zofran because my state protocol does not allow it..... I make you sick with the Morphine but not help you from getting sick...makes me mad......but I am no DOCTOR .......nor do I have a understanding why they wont let me push it........