NYC EMTs get EpiPens

[bstone]

http://www.jems.com/news_and_articl...UCH1@MAC.COM&utm_campaign=JEMS+eNews+04-07-09

I think it's about time, but I just demand that the level of education be on par with the level of care. A mandatory 4 hour ConEd, exam and check off should be required before just giving the an EpiPen.

 

[AJ Hidell]

Although an FDNY ALS ambulance is typically dispatched to 9-1-1 calls for suspected anaphylactic shock, BLS crews could be asked to respond if caller information is inaccurate or in the rare case that ALS resources will be delayed.

What a joke. I notice they FAIL to provide any statistics that would support this move. That's because there probably are none. Most medics go through an entire career without ever seeing a true anaphylaxis. And those that do usually find that SQ epi is inadequate to make a difference.

This is going to cost the bankrupt City of New York a lot of money for zero return.

 

[PapaBear434]

What a joke. I notice they FAIL to provide any statistics that would support this move. That's because there probably are none. Most medics go through an entire career without ever seeing a true anaphylaxis. And those that do usually find that SQ epi is inadequate to make a difference.

This is going to cost the bankrupt City of New York a lot of money for zero return.

Think so? Were do you run, AJ? Rural, city, or suburban? Because in my run area (suburban and city) we see a true anaphylatic emergency at least once a week. By the time we show up, the person is unconscious or barely there, obvious difficulty breathing (a few arrests too) and all the other symptoms with it. Maybe city folks are too stupid to avoid peanuts, I don't know.

Either way, we deal with this a lot. Usually it's the Benadryl treatment that does the most good, and the epi injection buys time to get the IV in. This is always done by ALS, obviously.

But as Epi-pens are an BLS skill, provided you have medical control of course, I see no reason not to have them available so long as they still require medical control to administer. When I was still running as BLS, we had a couple cases of a major reaction where our unit showed up before ALS, and they even said they wished we could have dropped an Epi-Pen to stave off the reaction a bit until they were able to make it.

Besides the reasoning you usually have of wanting everyone to get mediced up instead of passing more and more down to the Basic level (a valid complaint, but not pertinent to the current discussion), what don't you like about this prospect? You worried people are going to be too eager to use it and do it needlessly? I wouldn't want to trust basics with that call either, necessarily, because you would be putting a lot of responsibility into a very little education. But as I said, so long as Medical Control authorization is still required and it would be their call and their call alone, I don't see why it wouldn't be a bad idea to have them on hand just in case.

 

[bstone]

As long as the level of skill is at the level of education (and vice-versa) I have no problem with this.

 

[AJ Hidell]

Maybe city folks are too stupid to avoid peanuts, I don't know.

LOL! Well, most of the patients you describe would not benefit from SQ epi because they have already shut down peripherally. The ones that have not shut down peripherally are usually not bad enough off to need it. So what you are left with is a very few cases where it is actually indicated. Popping in a couple of SQ epis in a peripherally compromised patient is not a benign intervention. When the medics get there and give them IM or IV epi, the patient is going to also receive those two SQ doses that have been sitting in the SQ fat, just waiting to be picked up by a returning circulation. Now you have someone with a heart rate (and possibly BP too) of 220, which isn't a whole lot better off than they were!

You worried people are going to be too eager to use it and do it needlessly? I wouldn't want to trust basics with that call either, necessarily, because you would be putting a lot of responsibility into a very little education.

That is definitely a huge concern. It results in the same problem we have with EMT-Is, where there is a lot of doing things just because their protocols "allow" them to. The invasive skills that are allowed of EMTs and Is are so very rarely actually indicated that the tech looks for any excuse to perform them, resulting in improper care. If you've got time to explain it all to a physician online, then you've got time for your medics to arrive.

Ask any system that carries Epi Pens how much they spend a year on them, and how many of them actually get used. The number is miniscule. Then QA the times they were used and narrow that down to the ones that were truly indicated and beneficial to the patient, and the number gets even lower. It's just almost impossible to justify this in an urban system.

 

[bstone]

As an Intermediate my protocols allow SC/IM Epi with offline protocol.

 

[firecoins]

As long as the level of skill is at the level of education (and vice-versa) I have no problem with this.

The title of the thread is wrong. FDNY EMTs carry epi pens. Other NYC emts already had it. FDNY EMS is not the only agency that provides 911.

NYC EMTs get more than 4 CMEs on it.

NY State has allowed BLS agencies to carry EPI Pens on their ambulance with permission from their medical director. Many agencies have carried them for years.

 

[AJ Hidell]

By the way, minus 5 for posting in the wrong forum. Prescription drug administration is ADVANCED Life Support.

 

[bstone]

NYC EMTs get more than 4 CMEs on it.

NY State has allowed BLS agencies to carry EPI Pens on their ambulance with permission from their medical director. Many agencies have carried them for years.

The more the ConEd the merrier!

 

[firecoins]

By the way, minus 5 for posting in the wrong forum. Prescription drug administration is ADVANCED Life Support.

It might be but its being carried on BLS busses.

 

[bstone]

By the way, minus 5 for posting in the wrong forum. Prescription drug administration is ADVANCED Life Support.

Oxygen is a drug. I think they carry it on BLS buses.

 

[AJ Hidell]

Oxygen can also be administered by a lay person without medical training. Different case.

 

[bstone]

Oxygen can also be administered by a lay person without medical training. Different case.

But it is a prescription drug. Do you disagree?

 

[AJ Hidell]

It might be but its being carried on BLS busses.

EMT and BLS are not synonymous. It doesn't matter whether it is an EMT or a brain surgeon administering it, drug administration is still ADVANCED Life Support.

 

[firecoins]

EMT and BLS are not synonymous. It doesn't matter whether it is an EMT or a brain surgeon administering it, drug administration is still ADVANCED Life Support.

FDNY EMS put epi pens on BLS busses. FDNY EMS paramedics do not man the BLS busses. NYS allows epi bens to be carried on BLS busses. NY paramedics do not carry epi pens but draw up more exact doses.
Could EMT-B not discuss items in their scope of practise in the BLS forum?

I don't think FDNY EMS BLS units need it.

 

[silver]

LOL! Well, most of the patients you describe would not benefit from SQ epi because they have already shut down peripherally. The ones that have not shut down peripherally are usually not bad enough off to need it. So what you are left with is a very few cases where it is actually indicated. Popping in a couple of SQ epis in a peripherally compromised patient is not a benign intervention. When the medics get there and give them IM or IV epi, the patient is going to also receive those two SQ doses that have been sitting in the SQ fat, just waiting to be picked up by a returning circulation.

I may be confused but don't epipens deliver IM not SQ?

 

[AJ Hidell]

FDNY EMS put epi pens on BLS busses. FDNY EMS paramedics do not man the BLS busses. NYS allows epi bens to be carried on BLS busses. NY paramedics do not carry epi pens but draw it up.

Why would an EMT-B giving an epipen qualify for the ALS forum?

You're talking semantics. You're just playing with the silly words that FDNY uses to label their ambulances. This isn't about FDNY. This is about medical care. What I am talking about is the reality that, no matter who is performing it, prescription drug administration is ADVANCED care. I'm not saying EMTs shouldn't be doing it. I'm not saying that doing it makes them paramedics. I'm not saying that FDNY should re-label their "buses". I am simply noting the fact that, if a lay person cannot legally do it, then it is ADVANCED Life Support. How are you not getting this?

 

[Juxel]

I'm highly embarrassed to admit that my ALS service carries EPI-pens instead of a multi-use vial of epi because they are that terrified of a lawsuit. We never made the mistake of using 1:1000 when we should have used 1:10000, but we still made the switch.

Just for reference: Epi-pens cost about $50 for one dose whereas a multi-use vial costs less than $1 per dose.

 

[firecoins]

EMT and BLS are not synonymous. It doesn't matter whether it is an EMT or a brain surgeon administering it, drug administration is still ADVANCED Life Support.

are basic EMT-Bs not allowed to discuss items in their scope fo practise in the BLS forum?

 

[AJ Hidell]

are basic EMT-Bs not allowed to discuss items in their scope fo practise in the BLS forum?

In this forum, you can discuss anything you want, anywhere you want. The moderators obviously don't care. I'm just making the point that their scope of practice is not limited to BLS, so they shouldn't limit their discussion to the BLS forum. Why not step outside of that confining box and embrace the ALS that is within your scope?