Being "trained to do" a particular task and being "authorized to do" that same task are two separate things. I'm both a Paramedic and an RN. I'm going to focus specifically on the task of placing an EJ IV line as this highlights my point very well. As a Paramedic, if I deem it necessary to place an EJ IV line, then I can do so. Under that scope of practice, it's the same as any other peripheral IV placement. For a variety of reasons I prefer to not place an EJ for my first attempt at PIV placement but if it's the only option I have, I can do it. As an RN, I can place PIV's nearly anywhere, but if my patient is a diabetic, I must obtain an order to place one in a lower extremity/foot. I may NOT place a PIV in an EJ as it is not within my scope of practice at the hospital where I work. They do know and recognize that I'm also a Paramedic and therefore am trained in the task of EJ IV cannulation. Even if I obtain an order to place an EJ and have a provider present when I do, I still may not place that EJ IV. That would violate my authorized scope of practice.A gentleman asked me a question yesterday and I was not sure how to answer. E.g if an EMT-Basic is trained to push D-50 and a Medic is present, can he do so without violating scope of practice?
Perhaps a uniquely NJ thing, but paramedics riding a BLS agency. Theres a number of well paid and run BLS agencies and even more medics who still volunteer with their local BLS squads from whence they came.I simply cannot fathom a situation where I would let an EMT just push a drug (any drug) barring none of the caveats above.
And it doesn't apply in this case. Most paramedics who are on BLS ambulances are either 1) operating at the agencies BLS level, as the agency is only licensed as a BLS agency or 2) functioning within the job description of an EMT, as that is the only role that the agency recognized. Even the well paid BLS agencies (I know of one or two in Ocean County) that only hire paramedics, but they are still only permitted to function at the BLS level.Perhaps a uniquely NJ thing, but paramedics riding a BLS agency. Theres a number of well paid and run BLS agencies and even more medics who still volunteer with their local BLS squads from whence they came.
Paramedics that are working in a BLS-only capacity are only authorized to function in that BLS-only capacity and may not exercise their full Paramedic scope of practice. The only potential exception to this would be an instance where a Paramedic could be specifically authorized to perform specific interventions but that situation would be rare.Perhaps a uniquely NJ thing, but paramedics riding a BLS agency. Theres a number of well paid and run BLS agencies and even more medics who still volunteer with their local BLS squads from whence they came.
If discovered, absolutely possible.Charting a procedure done by another and claiming it as your work would result in a disciplinary action...would it not?
I've bolded and underlined the important factor. If nothing goes wrong, if no one asks questions, if the patient is happy and better off in the end, there is a near certainty that no disciplinary action would occur.It's all weird... but basically you must know your limitations and generally speaking, Paramedics working in a lower capacity may not exercise their full-scope from a legal standpoint. Informal agreements struck while on-scene don't change the legality, may result in better patient care, but also exposes all providers there to some legal risk... up to and including loss of certification/license if something goes wrong.
totally off topic, but of pull up for a n MVA, and need additional resources (helicopter, 5 more ambulances, PD because one of the drivers is waving his gun around because he's drunk, etc) since you have no radio or cell coverage, how do you call for help?Be able to justify it; more than half of our response areas at both my PT and FT jobs don't have cell or radio coverage. so calling medical control for orders is hard a lot of the time. So we do what we need to do, and ask forgiveness after the fact.
Drive away till you get service. Sometimes that's the rural EMS reality. I've requested helicopters using the patient's landline phone before.totally off topic, but of pull up for a n MVA, and need additional resources (helicopter, 5 more ambulances, PD because one of the drivers is waving his gun around because he's drunk, etc) since you have no radio or cell coverage, how do you call for help?
A drug like D50W can cause severe tissue necrosis and is given SIVP (slow IV-push) for this reason,
Colorado EMTs with IV endorsement are able to push all non-waived medications via an IV or IO route under the direction of a paramedic if the patient is in "extremis." Extremis is not defined anywhere, for what it's worth. Should I direct my EMT(s) to do that, I document it under my name.
I understand the definition of the word, I just find it odd that the Colorado Acts Allowed do not define what that means despite defining pretty much every other term in the EMS vernacular. The effective practice is that EMTs push medications drawn up and ordered by paramedics in many, many different patient presentations.A patient in extremis is a common definition.
Definition of in extremis
: in extreme circumstancesespecially : at the point of death.
I understand the definition of the word, I just find it odd that the Colorado Acts Allowed do not define what that means despite defining pretty much every other term in the EMS vernacular. The effective practice is that EMTs push medications drawn up and ordered by paramedics in many, many different patient presentations.