Paramedic Scope of Pratice

mikie

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We're often discussing/arguing what EMTs can and can't do.

What about paramedics? Do you think there are some interventions that are too 'advanced' (chest tube, etc) even after having more A & P background and far more diadatic & clinical training.

I'm not trying to spark argument at all, I'm just looking at it from another perspective. I'm not a medic (yet :rolleyes:), but am not familiar enough with all of their scope of practice.

So speak nicely to each other

-another way to pose the question, what is an example of a more advanced intervention your dept/service allows?
 

KEVD18

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im confused. are you asking what skills medics are allowed to do and you think shouldnt be allowed, or arent allowed and you think should.
 
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mikie

mikie

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im confused. are you asking what skills medics are allowed to do and you think shouldnt be allowed, or arent allowed and you think should.

I think I'm asking a few things but poorly worded it.

Are there some invasive procedures medics shouldn't be doing (ie- a parallel argument: should basics be able to combitube)?

Is there something you (general question) think they should be allowed to do (ie-drilling a hole in the brain to reduce ICP (not really, but something like that))?

Are medics in school long enough? (kinda a new question)
 

VentMedic

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It all depends on the agency, the motivation of the individuals and the medical oversight.

There are Paramedics that have a very broad scope in EMS, CCT and Flight. And then there are those, Naples FD being a recent example (Washington DC another) that should not go near meds until they retrain, re-educate and re-demonstrate they are competent.
 

Hastings

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Well, in theory, I can be asked to do something that the doctor believes is immediately necessary without any training in doing so, and there have been rare situations where that occurred. As such, I make sure I know my anatomy so that if a doctor ever gets on the radio and starts walking me through an unfamiliar procedure, I am prepared.

I have protocols which define a default scope of practice, but in the end, I can do as much as the doctor feels is necessary. There's been at least instance where I've been walked through a procedure I had no training or experience doing.
 

VentMedic

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I have protocols which define a default scope of practice, but in the end, I can do as much as the doctor feels is necessary. There's been at least instance where I've been walked through a procedure I had no training or experience doing.

Is this doctor your medical director?
 

EMT-P633

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I've been walked through a procedure I had no training or experience doing.


I would be interested in knowing what procedure was performed. If you wouldnt mind sharing.
 

Hastings

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I would be interested in knowing what procedure was performed. If you wouldnt mind sharing.

Field pericardiocentesis on a cardiac arrest. Working in the upper peninsula of Michigan. Called in and the doctor chose to walk me through the procedure over the radio, despite never being taught how to do it before (trained in Lansing, where no one would even dream of a Paramedic doing something like that).

Is this doctor your medical director?

Yes, he was.
 

EMT-P633

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D:censored::censored:M,

You do got Brass ones. I wouldn't have attepted it. Not sure on the rules and regs for UP but down here in TN if a medic here had done that I would have to think he would be infront of the state EMS board. Granted I am a new medic and it was your M.D. I honestly dont know how that would have played out down here.

Still courious tho, what was the outcome?
 

Hastings

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D:censored::censored:M,

You do got Brass ones. I wouldn't have attepted it. Not sure on the rules and regs for UP but down here in TN if a medic here had done that I would have to think he would be infront of the state EMS board. Granted I am a new medic and it was your M.D. I honestly dont know how that would have played out down here.

Still courious tho, what was the outcome?

Brief return of pulse, but dead on arrival to the hospital.

The transport time was >15 minutes and the patient was dead. No helicopter support. Under any other circumstances, I wouldn't have. But at that point, there's really nothing to lose. I was scared to death, did the best I could, and it didn't turn out as I hoped. That's how it works. As for ordering it, I think it was justified. Under the circumstances as they are up there, I don't think anyone would have questioned it.
 

VentMedic

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Brief return of pulse, but dead on arrival to the hospital.

The transport time was >15 minutes and the patient was dead. No helicopter support. Under any other circumstances, I wouldn't have. But at that point, there's really nothing to lose. I was scared to death, did the best I could, and it didn't turn out as I hoped. That's how it works. As for ordering it, I think it was justified. Under the circumstances as they are up there, I don't think anyone would have questioned it.

You could have had a lot to lose and so could your medical director.

Even those of us who are allowed to do advanced procedures must have documentation of competency and even still can be called to answer why it was done especially when the patient dies. The ME could also state that your procedure prevented any chance of ROSC or led to pt's death. This happened recently to a flight team who did what they had to do or thought they had to.

Your medical director would be questioned that if he felt you were capable of such procedures, why had he not bothered to train you?
 

Hastings

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You could have had a lot to lose and so could your medical director.

Even those of us who are allowed to do advanced procedures must have documentation of competency and even still can be called to answer why it was done especially when the patient dies. The ME could also state that your procedure prevented any chance of ROSC or led to pt's death. This happened recently to a flight team who did what they had to do or thought they had to.

Your medical director would be questioned that if he felt you were capable of such procedures, why had he not bothered to train you?

Wasn't trained in the rural setting of the UP. Trained in urban Lansing, MI. Moved to UP to work for a bit. Standards might be different up there. All I know is that I was young, new, scared to death, and ordered to do a procedure I had no idea how to do. I explained that I had never been trained on it or done it before, doctor stated would walk me through it over radio. With nothing for the patient to lose, I tried it. Attempted it, got it, drained it, shocked it, return of pulse, lost it.

Whether justified at the time or not, thankfully nothing bad came of it. Doctor explained everything to the family, the family thanked him for doing everything he could, and that was that. I certainly have a different opinion of doing things like that now that I have more experience though.
 
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reaper

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Most here that were trained more then 15 years ago can remember being taught things that you would never see in a medic class today. Things like, Chest tubes, centesis, and intercardiac epi. These are not taught any longer for reasons.

I do not carry the proper equipment for a centesis and doubt anyone else does. I would have told the Dr., sorry not gonna happen!:ph34r:
 

medicdan

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Okay, slightly different question-- assuming you have all the training and equipment you need-- what interventions are just too much in prehospital 911 (excluding specialized CCT RN/Medic/RT teams)?
I worked for some time with an MD on an ALS 911 truck-- and he knew his own limits. What procedures/therapies would you consiter to be too much for 911?
 
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Ridryder911

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His own limits? He is a licensed physician on or off duty. There is no difference for him, unlike an EMT, Nurse, etc... his license to practice medicine is 24 /7/ 365. It does not matter if he is in a hospital or in a ditch. Thus one of the many reasons many physicians do not get involved in EMS activities, they CANNOT be a lower level and will always be held accountable as a physician.

R/r 911
 

medicdan

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R/R, I'm not talking about liability, but the limits of pre-hospital therapy. At what point is it too much-- pre-hospital ultrasound? Ex-Lap? Should we put a portable x-ray onto every ALS to rule out c-spine fracture? TPA? Human Blood? ICP monitors? Burr Holes? Who should be performing these skills? Under what circumstances?
 

Onceamedic

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Thought of a third one we are allowed to do - (all in Wisconsin - Arizona is a whole different ball of wax) - post mortem C section. And as for the pericardiocentesis, we are taught to do it and expected to for tamponade. (once again, that was in Wisconsin. I think if I tried it here in Arizona I would be swinging off a pole)

PS - Ventmedic - no special equipment required. All that is needed is a 14 gauge angiocath and a large syringe.
 
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VentMedic

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Thought of a third one we are allowed to do - (all in Wisconsin - Arizona is a whole different ball of wax) - post mortem C section. And as for the pericardiocentesis, we are taught to do it and expected to for tamponade. (once again, that was in Wisconsin. I think if I tried it here in Arizona I would be swinging off a pole)

PS - Ventmedic - no special equipment required. All that is needed is a 14 gauge angiocath and a large syringe.

I didn't say anything about the equipment. Pericardiocentesis is still in my protocols for the helicopter and Specialty. I am still required go to the lab for training and retraining. I have used the skill only a few times in 30 years.

My post was about liability for the untrained.
 
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