Paramedics transporting patients with drips and pumps

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Patricia G Medina

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Hi, IN Texas, can Paramedics with no additional training, transport running IV pumps and Drips (running , but locked for no titration and fixed), during interfacility transports for higher level of care.
- example: a stemi patient being transported on 3 setups and monitored by Paramedic only?
- it is my understanding that Texas is a Delegated state, and whatever the medical director allows you to do under His medical direction, is okay as long as it is in the company’s protocols?
- I got this information from the Texas Administrative code Title 22 part 9, chapter 197.
 
Anything you do must be approved by your medical director and within the scope of practice for a paramedic. As long as it meets those to criteria, you’re good.

Titrating medications is within a paramedics scope of practice, so not sure why you added that caveat?
 
Agreed. I have never worked anywhere that I thought transporting drips was "special". And absolutely titrating...I had quite a few runs titrating nitroprusside....talk about BP ups and downs. Anyways, this is and should be a common, educated/trained practice for Paramedics.
 
IMHO, as long as the Paramedic is familiar with the meds, the equipment, and knows how/why/when to titrate a given medication, it should be absolutely OK for a Paramedic to transport a patient needing meds that requires titration. Critical Care nurses that are willing to do transport aren't exactly a large pool of nurses, so they should be utilized for very specific cases. In the county where I work, Paramedics that do "Critical Care" are few and far between (if at all) and those Paramedics are basically utilized in a role where they're monitoring a heparin drip, or monitoring a nitro drip or something similar or perhaps monitoring a vent patient. They have very little ability to titrate anything. This is far below what they're actually trained to do as their training programs are usually something geared toward doing actual CCT in states that allow for that level of care.

IOW: doing the vast majority of "CCT" runs should be a very common thing for Paramedics to do, not the 911 medics, but those specifically educated for CCT.
 
Most areas can run Epi and Dopamine drips (or at least where I work/ed and have talked to can).
So what is the difference between dripping/titrating meds and a pump? they are more precise and you have to be trained on them

Where I used to work, I transported a lot of different medications on drips and pumps; as long as I went over it with the sending doc and called medical control at the receiving hospital. Problem was without sending the patient to a larger hospital they would die, and they can't fly everyone
 
Where I live, paramedics absolutely can and do transport patients on multiple infusions. If there's a ventilator or something more advanced involved, they will have a critical care paramedic do it. Very rarely does an RN come along on transport unless it's by air. I would imagine TX allows for the same. The medic may need specific orders to manage certain drugs, or they may need to be CCT certified.
 
FiremanMike said:
Anything you do must be approved by your medical director and within the scope of practice for a paramedic. As long as it meets those to criteria, you’re good.

Titrating medications is within a paramedics scope of practice, so not sure why you added that caveat?
Click to expand...
HI, Thank you for your response. Yes, I added that because we do a lot a higher level of care transports where we get there to the ER, and the patient is a stemi patient. Then, the patient is connected to like 3 IV drips on pump. The MOT states that the only personnel needed, are paramedics for this transport. The problem is that the medics are not critical care and they don't want to transport the patient on drips, since they are under the impression that it is out of their scope of practice.
-The spill is that the medication is on a pump, but there is no titration needed on the heparin, insulin or nitro drip, since the medication is initiated by the free standing ER and the pump is fixed and locked so they can't accidently press on anything except for the stop or pause button.
- However, our paramedics are under the impression that you need a nurse for any pump transports. I am under the understanding that whatever the medical director allows for each EMT, that's the scope of practice we are supposed to follow.
_ These are emergency transports and there's no time to find a nurse to go on the call. I also understand that whatever medical direction or order you are given at the ER, that's the order we are supposed to follow and it supersedes any delegated standing orders.
 
johnrsemt said:
Most areas can run Epi and Dopamine drips (or at least where I work/ed and have talked to can).
So what is the difference between dripping/titrating meds and a pump? they are more precise and you have to be trained on them

Where I used to work, I transported a lot of different medications on drips and pumps; as long as I went over it with the sending doc and called medical control at the receiving hospital. Problem was without sending the patient to a larger hospital they would die, and they can't fly everyone
Click to expand...
Thank you for your reply. That's the point where I don't see how hard it is to transport a patient on a pump that is fixed and doesn't require the medics to regulate, titrate or anything. All they can do if they run into trouble with the pump, is stop the pump and perform at their highest level of training.
 
Patricia G Medina said:
HI, Thank you for your response. Yes, I added that because we do a lot a higher level of care transports where we get there to the ER, and the patient is a stemi patient. Then, the patient is connected to like 3 IV drips on pump. The MOT states that the only personnel needed, are paramedics for this transport. The problem is that the medics are not critical care and they don't want to transport the patient on drips, since they are under the impression that it is out of their scope of practice.
-The spill is that the medication is on a pump, but there is no titration needed on the heparin, insulin or nitro drip, since the medication is initiated by the free standing ER and the pump is fixed and locked so they can't accidently press on anything except for the stop or pause button.
- However, our paramedics are under the impression that you need a nurse for any pump transports. I am under the understanding that whatever the medical director allows for each EMT, that's the scope of practice we are supposed to follow.
_ These are emergency transports and there's no time to find a nurse to go on the call. I also understand that whatever medical direction or order you are given at the ER, that's the order we are supposed to follow and it supersedes any delegated standing orders.
Click to expand...
Not being comfortable with something and being out of scope of practice are two different things.

Critical care paramedic is extra training and sometimes even its own certification, but it is not a level recognized by any accrediting bodies and doesn’t have its own special scope of practice.

Heparin and nitro drip transports are definitely in the paramedic scope of practice, I’m honestly unsure about insulin. Transporting patients on an infusion pump is also within the “normal paramedic” scope of practice.

I personally don’t buy the “we’re not comfortable taking a person on a pump” argument, especially since it’s locked out for some reason and can’t be adjusted. If I were in a supervisory position over this crew, we would have a hard discussion about putting their big kid pants on and getting the patient to their destination.
 
Patricia G Medina said:
HI, Thank you for your response. Yes, I added that because we do a lot a higher level of care transports where we get there to the ER, and the patient is a stemi patient. Then, the patient is connected to like 3 IV drips on pump. The MOT states that the only personnel needed, are paramedics for this transport. The problem is that the medics are not critical care and they don't want to transport the patient on drips, since they are under the impression that it is out of their scope of practice.
-The spill is that the medication is on a pump, but there is no titration needed on the heparin, insulin or nitro drip, since the medication is initiated by the free standing ER and the pump is fixed and locked so they can't accidently press on anything except for the stop or pause button.
- However, our paramedics are under the impression that you need a nurse for any pump transports. I am under the understanding that whatever the medical director allows for each EMT, that's the scope of practice we are supposed to follow.
_ These are emergency transports and there's no time to find a nurse to go on the call. I also understand that whatever medical direction or order you are given at the ER, that's the order we are supposed to follow and it supersedes any delegated standing orders.
Click to expand...
Your medics are either weak or lazy and are very incorrect if they believe this. Texas has no restrictions on who can take what within your agency’s protocols and processes (including MD authorization) and doesn’t formally recognize critical care credentials in the same way that some other states do.

Where is this?
 
RocketMedic said:
Your medics are either weak or lazy and are very incorrect if they believe this. Texas has no restrictions on who can take what within your agency’s protocols and processes (including MD authorization) and doesn’t formally recognize critical care credentials in the same way that some other states do.

Where is this?
Click to expand...
south Texas
 
Patricia G Medina said:
_ These are emergency transports and there's no time to find a nurse to go on the call. I also understand that whatever medical direction or order you are given at the ER, that's the order we are supposed to follow and it supersedes any delegated standing orders.
Click to expand...
A sending facility cannot provide orders that are outside the paramedic's scope of practice. Obviously scope of practice varies significantly in Texas, but that doesn't mean the sending doc can just ask the paramedics to do whatever he or she wants.
 
When we got something like a sending facility asking us to do something that wasn't normally in our scope of practice, we would call the receiving hospital Doctor (medical control for the transport) and say this is what is going on, do you have a problem signing off on me doing it so that the patient doesn't die?
They would ok it, give their name, and the sending hospital would make sure we knew what we were doing, looking for side effects, what to do if there were issues, etc
 
johnrsemt said:
When we got something like a sending facility asking us to do something that wasn't normally in our scope of practice, we would call the receiving hospital Doctor (medical control for the transport) and say this is what is going on, do you have a problem signing off on me doing it so that the patient doesn't die?
They would ok it, give their name, and the sending hospital would make sure we knew what we were doing, looking for side effects, what to do if there were issues, etc
Click to expand...
If you did this in Colorado (I understand you were not), your certification would be in investigated and likely suspended in short order.

There is a list of meds Colorado paramedics (and a longer one for critical care paramedics) can take on transfers provided your agency has a guideline for maintaining it. If the medication is not on the list, you need a waiver. If you don’t have a waiver or guideline and do it anyway, medical control will not save you from serious problems.
 
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