Scope of Practice Question

[Ely]

Hi everyone! I had question about the scope of practice of emts... i know it varies throughout states but I'd really appreciate your opinion anyway! so here's my question:
As EMTs, what do you think would help you save more lives if you were just allowed to do it? As in, what areas of your scope of practice would help you better serve your patients if it were expanded ?

 

[VentMonkey]

so here's my question:
As EMTs, what do you think would help you save more lives if you were just allowed to do it?

Get the patient to the hospital, in a quick yet safe, and efficient manner.

 

[DesertMedic66]

What will help BLS providers save lives? Being competent in BLS treatments. CPR, BMV, AED, and bleeding control are the major ones

 

[Ely]

What will help BLS providers save lives? Being competent in BLS treatments. CPR, BMV, AED, and bleeding control are the major ones

Are you saying EMTs aren't well prepared or trained at performing these tasks? What I meant was what else could they do to better serve their patients that they are not allowed to do now under their scope of practice? for ex, checking blood sugar. As far as I know emts don't even carry a glucometer.

 

[DesertMedic66]

Are you saying EMTs aren't well prepared or trained at performing these tasks? What I meant was what else could they do to better serve their patients that they are not allowed to do now under their scope of practice? for ex, checking blood sugar. As far as I know emts don't even carry a glucometer.

The majority of EMT programs are a 120 hour class that can be done in easily 3 weeks. 120 hours is barely enough time to touch the surface on many topics let alone be competent in them. Just because you were trained on how to BVM a patient does not mean you can do it affectively.

More skills come with more education which comes with higher certificate levels (AEMT, Medic). It's not as simple as just adding in additional skills. What also must be taugh is the side effects of these skills and when we should not preform these skills (which is usually not taught in most EMT programs).

No point in adding more skills when the skills that are already in the protocols a huge number of EMTs struggle with.

 

[TransportJockey]

Are you saying EMTs aren't well prepared or trained at performing these tasks? What I meant was what else could they do to better serve their patients that they are not allowed to do now under their scope of practice? for ex, checking blood sugar. As far as I know emts don't even carry a glucometer.

Basic skills vary by location. In my area, bls carries and uses glucometry, capnography, pulse oximetry, cpap, blind insertion airways, and have more meds than places lkke California. But the education at the basic level is inadequate for all of this, let alone anything else. Its why i wish AEMT was the entry to practice

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[Clare]

If you really want to think of what will be clinically significant in terms of the biggest impact of saving a life then I'd say the following:

- Arrest arterial haemorrhage (CAT or equivalent)
- Defibrillation of VF and pulseless VT, and cardioversion of VT
- Open and maintain an airway (OPA, NPA and LMA or equivalent)
- Remove foreign airway body (laryngoscopy and forceps)
- Ventilate and oxygenate (oxygen and a bagmask)
- Obtain a 12 lead ECG to identify STEMI and enable shortest possible time for direct to cardiac cath lab
- Use the FAST test to identify possible stroke and enable shortest possible time to thrombolysis if ischaemia stroke
- Bind a fractured pelvis
- A small number of medicines, specifically:
1. IM adrenaline in anaphylaxis and severe asthma,
2. IM ceftriaxone for meningococcal septicaemia or septic shock.
3. IM and IN midazolam for status epilepticus,
4. IM and IN naloxone for opiate poisoning
5. IM glucagon for hypoglycaemia

All of the above can be performed our EMTs (except laryngoscopy, naloxone and midazolam) and First Responders (except laryngoscopy, LMA, 12 lead ECG, midazolam, naloxone and arguably cardioversion but if they put the pads on and analysed and the VT was fast enough it'd cardiovert).

 

[EpiEMS]

Hi everyone! I had question about the scope of practice of emts... i know it varies throughout states but I'd really appreciate your opinion anyway! so here's my question:
As EMTs, what do you think would help you save more lives if you were just allowed to do it? As in, what areas of your scope of practice would help you better serve your patients if it were expanded ?

More practice at the skills I am permitted to do and more A&P education. My list of skills is pretty sufficient - given that I add a couple that the national scope leaves out (CPAP, epinephrine auto-injectors, glucometry, selective spinal immobilization).

All of the above can be performed our EMTs (except laryngoscopy, naloxone and midazolam) and First Responders (except laryngoscopy, LMA, 12 lead ECG, midazolam, naloxone and arguably cardioversion but if they put the pads on and analysed and the VT was fast enough it'd cardiovert).

Dear New Zealand, this 'murican would like to apply for citizenship and EMT licensure.

In all seriousness, though - that's a good list of truly basic skills that make a difference.

Its why i wish AEMT was the entry to practice

This, 1000x, this. For IFT, EMT works just fine. For the truly emergency part of EMS, dual AEMT ought to be the minimum level for transporting 911 ambulance staffing. I say this as an EMT who would upgrade to AEMT if it were available to me and I could actually practice at that level (non-existing in NYC and basically useless in CT, to date).

 

[NysEms2117]

As an EMT-B on an ALS rig, i agree with @TransportJockey, if i didn't have such a good cc-paramedic partner, that has an insane amount of patience, and willing to teach me i would be so out of place it would not even be funny. As an EMT-B they can't add to many things for you to do, 300 hours or less is nowhere near enough time to trust people with procedures. Speaking a little bit out of place here: I have heard some paramedics(non critical care) say they can do too much as it is, and do not necessarily feel 100% comfortable with the protocols they work under.

 

[chitownmedic11]

Depends on location and ride time/clinicals I'm sure students in NYC will be faster and more competent then say a student in merriville Indiana


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[StCEMT]

If you really want to think of what will be clinically significant in terms of the biggest impact of saving a life then I'd say the following:

- Arrest arterial haemorrhage (CAT or equivalent)
- Defibrillation of VF and pulseless VT, and cardioversion of VT
- Open and maintain an airway (OPA, NPA and LMA or equivalent)
- Remove foreign airway body (laryngoscopy and forceps)
- Ventilate and oxygenate (oxygen and a bagmask)
- Obtain a 12 lead ECG to identify STEMI and enable shortest possible time for direct to cardiac cath lab
- Use the FAST test to identify possible stroke and enable shortest possible time to thrombolysis if ischaemia stroke
- Bind a fractured pelvis
- A small number of medicines, specifically:
1. IM adrenaline in anaphylaxis and severe asthma,
2. IM ceftriaxone for meningococcal septicaemia or septic shock.
3. IM and IN midazolam for status epilepticus,
4. IM and IN naloxone for opiate poisoning
5. IM glucagon for hypoglycaemia

All of the above can be performed our EMTs (except laryngoscopy, naloxone and midazolam) and First Responders (except laryngoscopy, LMA, 12 lead ECG, midazolam, naloxone and arguably cardioversion but if they put the pads on and analysed and the VT was fast enough it'd cardiovert).

Good stuff on that list. Also, welcome back, haven't seen ya around in a while.