You say education can (must) go beyond just bean counting and litigation issues. I agree. That's why there's a paramedic program to properly educate, and provide the tools to administer advanced procedures. When one of your basics eventually kills someone via an epi admin, how will you fend off the inevitable litigation?
There's are few queries here so I'll start with some background that may cover a few bases up front.
Our "basics" aren't so basic anymore - now roughly EMT-I at closest comparison with equivalents in the US - 3 yrs education at uni. "ALS" skills used to be taught as education updates but are now incorporated into the uni programme. (Now age, experience, on road training etc that's another story which is why the MICA guys have always cringed and squirmed a fair bit about our "ALS" colleagues). Having said that there is plenty of work at and least a good proportion have come a fair way over the last 3 or 4 yrs.
Vicarious liability covers the legal angle pretty well assuming the operator was working within guidelines. The process and laws covering us here are probably a little different to the US.
What tools do your BLS providers have to treat any untoward reactions resulting from epi admin? I don't mean an AED and epi IV for an arrest after epi IV/IM admin for asthma.
The BLS guys have IV/IM/IN/Neb/oral admin routes in training to cover the skills. They can fluid load as well. They also all have 3lead monitoring with 12lead training to be introduced sometime in the near future - (that'll sort the men from the boys). So when an anaphylaxis needs treating the pt will get full assessment, monitoring, IV line + fluid loading, Epi, repeat Epi, MICA backup coming etc. The guys all have medium level airway skill sets as well with OP/NP/LMA/laryngo/BVM but no ETT.
This type of job is coded as a two tier response ie ALS (BLS) car + MICA unit. In the case of anaphylaxis an Epi admin say in the setting of a fast tachy is not likely to go on to SVT/VT. Guys will use good judegment if they have concerns and will consult for further options if need be. Alternately they can use less Epi or withhold till a MICA unit arrives. If things go awry, which is always a possibility, there at least some backup options. Four years now and no court cases so far. (crosses fingers)
So, you mean to tell me that your basics administer IV/IM pharmocological intervention without intubation capabilities or cardiac monitoring/12 lead? What training have your basics received past the BLS level to fully understand the effects of their procedures? Epi IM for an arrest? I don't recall seing that on any ACLS algorithms
The first part here is covered above I think as well as the training side. Our "basics" like I say aren't really basics. No 100hrs training here - 3yrs minimum.
(I didn't say/mean they give IM at arrests - muddled the terms up - just that they can give various drugs IV/IM/IN routes etc sorry for the confusion on that one).
Having said all this the first part above about the MICA guys squirming and cringing - thats what you're getting at from a Paramedics point of view and I am with you 100%. Our guys are better covered educationally and with careful planning, supervision and hands on practice you're guidelines could be upgraded as well. (Melbourne is 3 1/2 million people and about 1700 ambos - not a bad study cohort for efficacy studies on various skillsets).
The guys get a reasonable workload but there are a hundred reasons why we MICA types have reservations about our on-roaders doing so much. However, no major dramas yet, a lot are developing an experience base and they can guarantee we MICA types watch, critique, mentor and jump up and down when a "basic" (on a basic) gets a bit carried away with himself or the bosses loosen up the guidelines too much.
Hope that covers it.
Cheers
MM
Yet we should restrict the EMTs from a beneficial treatment because they operate in a system that was provided to them
