Scope of Practice in your District?

[danvtemt]

I'm an EMT-I in a small EMS district in rural Vermont. The state has 13 districts, of which only about half are Paramedic level. EMS has been slow to evolve here. Our district Medical Director believes that paramedicine is not worth the effort and expense here. Many of us argue that we have transport times in excess of 30 minutes to the nearest hopsital (this is any hospital, not a Trauma Center or other specialty), and certainly an increase over the current Intermediate scope is in order.

Our statewide Intermediate level allows no ET intubation or advanced meds (we use Combitube for airway, are allowed ASA, NTG, Epi for anaphalaxis only, thiamin, D50, albuterol, oral glucose, glucagon, narcan, and of course O2.) IV access has a standing order for only a few protocols, we have no IO access. No standing orders at all for ASA or NTG, the only s.o. for a med is O2, D50, and oral glucose, and a bolus of LR for a code.

My question is, I have a feeling this is pretty uncommon out there...not having a higher level of ALS even considered by the medical director. True or not? Comments??

Dan

Check out my EMS Blog at www.WayOutEMS.blogspot.com

 

[Stevo]

Hi Dan

can you remember when Vermont ems today listed the amount of cert levels in the state?

i can recall (though i can't surf it up) single digits in the 80's, now it's hundreds (and for a small state with the pop. of Boston, that's not too bad) , so i would think the evidence of a medic's validity in the rural setting seaks for itself

~S~

 

[medic5740]

Lack of ALS

We are providing ALS service on an Island in the middle of Lake Michigan with an area of 85 square miles. This island is 32 miles from mainland Michigan. We have a year round population of under 650 people with summer population figures in the thousands. We have only about 100 runs per year, but almost 75% of those runs require more than what a basic EMT is allowed to do in your area. Our transport time is no less than 30 minutes if the patient has his emergency right next to the air transport aircraft.

Our Basic EMTs can give epi-pens for anaphylaxis, nitro and aspirin for chest pain, and each vehicle has an AED. Specialists (Intermediates) are allowed to do D50, albuterol, intubate, and, of course, start IVs in addition to the above. These were all originally special protocols written because we are so rural. We were used by others as guinea pigs to see if this could work.

We were not satisfied with our limited treatment capabilities, so we became ALS. It is really difficult to keep a volunteer service running when you move up to ALS. Anyone who does this much education, training, and clinical time does not usually want to stay on as a volunteer. So your medical director is probably correct about the expense.

I want to tell you that the main difference is the caring patient care that we can provide including the pain management for fractures besides the albuterol for respiratory emergencies and the drugs for ACLS protocols. Our patients truly appreciate what we are able to do to make them comfortable, so they don't mind supporting our group with some property taxes.

You might try getting your local politicians on board. That might make a difference. If your local government official was to suggest that some of these treatments would be good for the voters in his district, the doctor might listen.

Check out my website: http://ruralemsisdifferent.com for a couple rural EMS stories and some pictures, and I'd love to hear a story or two from you about how your patient(s) could have benefited from a higher level of care.

 

[Rattletrap]

In Ohio some counties the scope of practice can be next to nothing to the full state scope of practice in the same county depending on the medical director.

http://www.ems.ohio.gov/PDF/EMS_SCOPE_Practice102605.pdf

 

[bstone]

I can see how this would be very frustrating. Are you a NREMT-I? 85 or 99 standard? I might think going up to the 99 standard would help. Check into it with your PMD.