NYC EMTs get EpiPens

AJ Hidell said:
By the way, minus 5 for posting in the wrong forum. Prescription drug administration is ADVANCED Life Support.
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Not always....

NTG is prescription, and basics can assist with it. Albuetoral inhalers are prescription, and basics can assist...
 
AJ Hidell said:
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.
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Huh. Because my system has been batting around the prospect of putting an Epi-Pen on board our BLS units for the very reasons I mentioned. It's true that giving a report to a MD takes time, but it's not guaranteed an ALS interceptor is going to make it in time.

It makes little difference to me at this time, as EMT-E's in Virginia are allowed to drop SQ epi when warranted and are considered ALS (in the "shock/trauma" capacity), but having it on hand for BLS with medical advisory still doesn't seem like a bad idea...

Until you rightly point out the peripheral circulatory shut down, of course. I would hope that an ALS wouldn't be stupid enough to then administer a SQ epi in addition to the pen injection before getting the IV access and Benadryl drop. Though a lot of that epi wouldn't make it to where it needs to go, wouldn't enough of it make it in order to buy time? Isn't that why Epi-Pens are prescribed in the first place?

I'm speaking for the early caught reactions, of course, but even a more advanced case seems like you'd want to say "A little is better than nothing."

Abuse with any new item is always a warranted with a new item or treatment, but I think the Docs would be able to keep the overly zealous among us from going crazy and dosing everyone with adrenaline.
 
exodus said:
Not always....

NTG is prescription, and basics can assist with it. Albuetoral inhalers are prescription, and basics can assist...
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So how does that contradict anything I said? :unsure:
 
PapaBear434 said:
Huh. Because my system has been batting around the prospect of putting an Epi-Pen on board our BLS units for the very reasons I mentioned. It's true that giving a report to a MD takes time, but it's not guaranteed an ALS interceptor is going to make it in time.
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Right. But we're talking about NYC, not wherever you are.
 
AJ Hidell said:
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?
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I think you picked the wrong battle in this thread AJ... But when you pick battles to fight all the time, I guess you are bound to get it wrong every once in a while. ^_^ There are a lot of EMT-BASICS that can do way more than a lay person and they are not considered ALS.

Side note, my towns BLS rigs carry both regular and junior dose Epi pens.
 
AJ Hidell said:
So how does that contradict anything I said? :unsure:
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Because you said administering prescription drugs is an ALS procedure... :unsure:
 
Trevor, as an EMT-B student, you are about the least qualified person here to tell me when I am right or wrong. And you have proven that with this last post.

EMT-B is not synonymous with BLS. They are not the same thing. One is a title. The other is an intervention. Whether or not you are an EMT-B or not, if you are performing an ADVANCED intervention, you are performing ADVANCED Life Support. Dr. Bledsoe, who wrote the paramedic textbook, says the very same thing. You have to pull your head out of the semantic games and understand that your certification level does not define the level of an intervention. If your system allows an EMT to intubate, that does not make intubation BLS. It simply makes your EMT's ALS.
 
/bursts into room all cheery!


/gets stared at by AJ


/backs out of room very slowly
 
AJ Hidell said:
Trevor, as an EMT-B student, you are about the least qualified person here to tell me when I am right or wrong. And you have proven that with this last post.

EMT-B is not synonymous with BLS. They are not the same thing. One is a title. The other is an intervention. Whether or not you are an EMT-B or not, if you are performing an ADVANCED intervention, you are performing ADVANCED Life Support. Dr. Bledsoe, who wrote the paramedic textbook, says the very same thing. You have to pull your head out of the semantic games and understand that your certification level does not define the level of an intervention. If your system allows an EMT to intubate, that does not make intubation BLS. It simply makes your EMT's ALS.
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If an Epi Pen is in the BLS Scope of Practice then it is not an ALS intervention. It is considered BLS intervention... You can't just lump prescription drug administration as ALS like you did.
 
AJ Hidell said:
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?
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EMT-B discussing their scope of practise in the BLS forum is not a "limit" Maybe we shouldn't break it down to BLS and ALS. Both EMTs and medics take C-Spine precautions. We should just consider it medical care.
 
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As a NY EMT-B, who has seen a bonafide save with an eppipen, I cthink I can speak for rural EMTs all over. MANY of the tx in my district are 20 to 30 minutes AFTER we get the patient to the unit. Getting them out of the woods is another story.
The call we had was a logger, in the woods, stung with ALS further away that the closest hospital (20 min). We have been able to carry Epi at the BLS level for about 5 years with Medical directors approval, and an inservice. I know this rubs the advanced guys the wrong way when basics horn in on the lifesaving but it sure was a wonderful thing to have on board that day. I'm sure the guys wife and kids think so too!
 
AJ Hidell said:
Oxygen can also be administered by a lay person without medical training. Different case.
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EpiPens can be administered by laypeople without any training. That is why there are pictures and instructions on the sides.
 
Aidey said:
EpiPens can be administered by laypeople without any training. That is why there are pictures and instructions on the sides.
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I'm going to add another thing here: Public AED's.

Yes, better used by somebody who is trained BUT AED's placed for access by the general public should need arise have verbal, written and illustrated instructions.

My city is implementing these all downtown and I believe in our city transit centres.
 
nomofica said:
I'm going to add another thing here: Public AED's.

Yes, better used by somebody who is trained BUT AED's placed for access by the general public should need arise have verbal, written and illustrated instructions.

My city is implementing these all downtown and I believe in our city transit centres.
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We have them everywhere. Public parks, stadiums, marinas, pet stores...
 
PapaBear434 said:
We have them everywhere. Public parks, stadiums, marinas, pet stores...
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I believe our city has them in the majority of our high-traffic locations. I think it's bloody good to have them, too. Some people need to be defibbed before we get to them. At the same time I believe everyone should have CPR and AED training to at least some degree.
 
Aidey said:
EpiPens can be administered by laypeople without any training. That is why there are pictures and instructions on the sides.
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These word games are above you, Aidey. They require a physicians order. Therefore, they are ALS. Period.

Again, we're not labelling the people administering the intervention. We are labelling the intervention itself. You are neither ALS nor BLS. You are an EMT. The interventions you provide are both ALS and BLS.

The problem with attempting to label advanced interventions as "BLS" is that it cheapens the seriousness of that intervention, causing way too many providers to take them for granted with the typical EMT attitude of, "Well, it's just BLS, so it's not really that dangerous", which could not be farther from the truth. Instead of reclassifying Epi as BLS, why don't you reclassify yourself as ALS, take pride in that privilege, and accept it in a professional manner rather than arguing with the people who have spent three decades paving the way for you to have that privilege?
 
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I've seen real saves using SC/IM Epi. The stupid 26 year old kid decided not to take his EpiPen with him on a caming trip. If it wasn't for the BLS administration of the Epi the kid would have surely died.

Here's another one in favor of BLS EpiPens. Just make sure there is plenty of ConEd, test and checkoff to go with it.
 
bstone said:
If it wasn't for the BLS administration of the Epi the kid would have surely died.
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It wasn't BLS administration. It was ALS administration by an EMT.
 
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