So i have a question... EMT-B Handling Meds

Pneumothorax

Pneumothorax

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So right now i function as an EMT-B(non transporting FD), I recently went on a call where my pt was seizing, when the Paramedics arrived.. i gave verbal report and assisted them in pt care. The medic asked me to draw up the versed , while he was starting the line and asking the pt more questions.

One of the commanding officers there with me and said that i cant draw the med up (medic told me what vial, syringe, needle etc to get..i wasnt trying to be a superhero) (&...the pt is actively seizing)...

now i checked my protocols & didnt see anything that said i cant assist the medic-- I wasnt going to give the drugs or anything...

I didnt back talk or anything..cuz that would be stupid. I just wondered if anyone else can fill me in if i was in the wrong? at any rate ill never do it again LOL.
 
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Pneumothorax said:
So right now i function as an EMT-B(non transporting FD), I recently went on a call where my pt was seizing, when the Paramedics arrived.. i gave verbal report and assisted them in pt care. The medic asked me to draw up the versed , while he was starting the line and asking the pt more questions.

One of the commanding officers there with me and said that i cant draw the med up (medic told me what vial, syringe, needle etc to get..i wasnt trying to be a superhero) (&...the pt is actively seizing)...

now i checked my protocols & didnt see anything that said i cant assist the medic-- I wasnt going to give the drugs or anything...

I didnt back talk or anything..cuz that would be stupid. I just wondered if anyone else can fill me in if i was in the wrong? at any rate ill never do it again LOL.
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I would never do it. That is your license.

Say something happens. They trace it back to you and then the lawyers have a field day because your not trained in how to do that in the first place. that's their suit right there.

Be very very careful
 
You shouldn't be handling any meds unless specifically authorized to by an ALS-assist class or protocols that allow you to give it under your own license/certification, especially narcotics. Ever. Unless you are signing the narc box in and out, and are trained to draw up meds, it's a bad idea. You're free to grab all of the components for the medic (syringe, needle, drug box), or can help them by doing other tasks (spiking an IV bag, if trained, preparing the monitor, readying the stretcher, etc).

Of course, each state and region is different, so please defer to local protocols. It might be worth doing some research of DEA documents, or what drug security policies are in your area.

Good Luck!
 
At scenes, wear a t shirt that says in big letters "EMT-B"

emt.dan's got it. Especially handling narcs.
 
emt.dan said:
You shouldn't be handling any meds unless specifically authorized to by an ALS-assist class or protocols that allow you to give it under your own license/certification, especially narcotics. Ever. Unless you are signing the narc box in and out, and are trained to draw up meds, it's a bad idea. You're free to grab all of the components for the medic (syringe, needle, drug box), or can help them by doing other tasks (spiking an IV bag, if trained, preparing the monitor, readying the stretcher, etc).

Of course, each state and region is different, so please defer to local protocols. It might be worth doing some research of DEA documents, or what drug security policies are in your area.

Good Luck!
Click to expand...

I'll give you a quick example of what I'm talking about. I am certified, and work as an EMT-Basic, but as the driver (Basic) on a PB ALS ambulance, doing some combination of 911 and IFT (mostly IFT). I am trained (and permitted) under our medical director to perform certain skills as an ALS-assistant (spike saline bag, perform BGL, administer albuterol, etc) that I would not be able to while working purely BLS (at this company).

However, while I can give an albuterol neb under the supervision of a medic without a problem, I cannot set up a combivent (ipratropium/albterol) treatment, despite the fact they are next to each other in the drug box, and set up the exact same way. I can spike a liter bag of saline, but not a liter bag of Lactated Ringers (using the exact same procedure). I don't have a set of keys to any of the medications, and although I sign the checkout of equipment and the truck, not the medications.

Working in EMS, and being responsible (or party to the responsibility) for not only highly controlled substances, but also tens of thousands of dollars worth of equipment comes at a price, and that's often what may seem to be ambiguous lines in the sand. I strongly urge the OP and other forum members to learn what those lines are for your service, medical director, region, state, etc. I've worked in situations where narcotics have gone missing, or been tampered with, and it is a truly unpleasant experience... if you learn nothing else from my rant, please stay away from narcs unless permitted.
 
Look closely at your protocols. Mine say nothing about assisting a medic but it does say that an EMT-1 (EMT-B) may not draw up or administer a med.

For me I would not have drawn them up even if the medic was yelling at me. That's one of the many reasons that I like having 2 medics on scene (1 fire medic, 1 ambulance medic).
 
If you are not comfortable doing it, do not do it.

Brown is quite territorial about this sort of thing; if Brown works with a Technician they can give GTN, nebules etc all they like or draw up saline flushes.

Any IV drugs like adrenaline or morphine Brown will draw up unless Brown is working with a Paramedic (ILS) or Intensive Care (ALS).
 
Can someone tell me the difference between letting an EMT spike an IV bag and drawing up a syringe of a non-controlled substance?




Hint: There is none.
 
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Sure, maybe .

I actually woke up last night thinking about this one.
If "spiking the bag" was simply plugging A into B, and A and B were the only way to go and were verifiable by the person giving it, then it is a technical act.Drawing up a dose is a professional act, involving judgement and knowledge.

If I let someone else draw up a med into a syringe, unless I am directly watching them every step and I check the resultant dose, then I cannot chart or claim to have given that dose of that medicine. The best I can do is "I asked the EMT to draw up 2.5 ml of Wundadrug SR. I then injected 2.5 ml of a clear liquid drawn up by so-and-so to that order".

Example: for shot lines in Air Guard, med techs who had experience, and maybe a trainee under direct supervision and whose work was kept separate for checking, would draw up vials of ONE type of vaccine, usually for influenza. They were placed in a separate tray and it was labelled. The med techs or a nurse could then all just pick up the tray and administer flu shots.

On the other hand, if we were doing custom "touch-ups" to individuals' shot records, each dose was drawn and given by the tech or nurse giving the shot, since there were multiple vaccines, multiple patients in line, etc.

If I subconsciously mumbled that I needed 5 mg's of Wundadrug SR IM and a helpful EMT appeared with a syringe, I would have to ask them to bring me a new syringe and a vial of the med, then inspect the vial before drawing and administering.
 
mycrofft said:
If I let someone else draw up a med into a syringe, unless I am directly watching them every step and I check the resultant dose, then I cannot chart or claim to have given that dose of that medicine. The best I can do is "I asked the EMT to draw up 2.5 ml of Wundadrug SR. I then injected 2.5 ml of a clear liquid drawn up by so-and-so to that order".
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If someone lets someone else draw up a medication, and they never double check it themselves before giving it, there are bigger issues to be had.


I don't care if it's an Intermediate, another Paramedic, or a nurse who drew up the meds... I want to see the vial.
 
Agreed.

But unless I actually check the vial beforehand and watch the needle go in, or there is verifiably no other vial there, I can't have direct knowledge. Unless this is a situation where my hands are tied up doing something immediately lifesaving (like doing a cric or fending off Young Frankenstein) but I can split my attention away to watch this dose occur (unlikely), I can't see where there is any benefit to having someone else draw up the dose.
Ask any clincial instructor; one of their worst nightmares is a student doing something like that and they don't catch it in time.

images
 
firefite said:
Look closely at your protocols. Mine say nothing about assisting a medic but it does say that an EMT-1 (EMT-B) may not draw up or administer a med.

For me I would not have drawn them up even if the medic was yelling at me. That's one of the many reasons that I like having 2 medics on scene (1 fire medic, 1 ambulance medic).
Click to expand...

i went over my protocols and it doesnt say anything about not drawing up the med. I wouldnt dare administer it LOL..thats just job suicide.

emt.dan said:
I'll give you a quick example of what I'm talking about. I am certified, and work as an EMT-Basic, but as the driver (Basic) on a PB ALS ambulance, doing some combination of 911 and IFT (mostly IFT). I am trained (and permitted) under our medical director to perform certain skills as an ALS-assistant (spike saline bag, perform BGL, administer albuterol, etc) that I would not be able to while working purely BLS (at this company).

However, while I can give an albuterol neb under the supervision of a medic without a problem, I cannot set up a combivent (ipratropium/albterol) treatment, despite the fact they are next to each other in the drug box, and set up the exact same way. I can spike a liter bag of saline, but not a liter bag of Lactated Ringers (using the exact same procedure). I don't have a set of keys to any of the medications, and although I sign the checkout of equipment and the truck, not the medications.

Working in EMS, and being responsible (or party to the responsibility) for not only highly controlled substances, but also tens of thousands of dollars worth of equipment comes at a price, and that's often what may seem to be ambiguous lines in the sand. I strongly urge the OP and other forum members to learn what those lines are for your service, medical director, region, state, etc. I've worked in situations where narcotics have gone missing, or been tampered with, and it is a truly unpleasant experience... if you learn nothing else from my rant, please stay away from narcs unless permitted.
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youre 110% right. i learned my lesson!

emt.dan said:
You shouldn't be handling any meds unless specifically authorized to by an ALS-assist class or protocols that allow you to give it under your own license/certification, especially narcotics. Ever. Unless you are signing the narc box in and out, and are trained to draw up meds, it's a bad idea. You're free to grab all of the components for the medic (syringe, needle, drug box), or can help them by doing other tasks (spiking an IV bag, if trained, preparing the monitor, readying the stretcher, etc).

Of course, each state and region is different, so please defer to local protocols. It might be worth doing some research of DEA documents, or what drug security policies are in your area.

Good Luck!
Click to expand...

yea. im gonna look some more stuff up, just so i can be completely informed.

everything was just so hectic and you know , we're there for the patient ultimately...but i guess i have to Cover my *** so i can continue to help :)

thanks!
 
maybe it's a good idea to have a good talk about meds with whomever you're working with beforehand. After reading this kind of thing, I'd almost want to make short list of things to discuss/ w co-workers w/ higher medical authority before getting into the thick w/ them. i dunno.
 
Well you learned a lesson, and it sounds like no one was really worse for wear about it.

I really place more blame on the medic for this one, he/she should have known better and not put you in such a precarious position. It was not right of them to do that to you.

You handled the situation correctly (other than making the initial mistake) by taking your licks and moving on.

This is a perfect example where you were counseled, learned your lesson, and moved on. Had you decided to be principled about the situation and try to justify it by claiming the medic authorized you, etc. it would have been much more trouble than it was worth I am sure, and probably would have resulted in a big deal being made out of a relatively minor situation.
 
emt.dan said:
However, while I can give an albuterol neb under the supervision of a medic without a problem, I cannot set up a combivent (ipratropium/albterol) treatment, despite the fact they are next to each other in the drug box, and set up the exact same way.
Click to expand...

To be clear, you are speaking of Canada?

Combivent in the US is an MDI and not a liquid ampule. It would not be the same set up as a nebulizer.

The Combivent liquid ampule at this time is not available in the US under that name. We do have Duoneb although most now just say ipatropium/albuterol since other pharmaceutical companies manufacture it.

To administer a Combivent MDI you would need to know the technique well enough to talk a patient through it. You would also need to document allergies and be able to reverse them if they did have a reaction to the lecithin in the propellant. However, this should be the only inhaler you would still have to worry about it and if you are in Canada, I doubt if this inhaler is still available and probably will not be much longer in the US.
 
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Journey said:
To be clear, you are speaking of Canada?

Combivent in the US is an MDI and not a liquid ampule. It would not be the same set up as a nebulizer.

The Combivent liquid ampule at this time is not available in the US under that name. We do have Duoneb although most now just say ipatropium/albuterol since other pharmaceutical companies manufacture it.

To administer a Combivent MDI you would need to know the technique well enough to talk a patient through it. You would also need to document allergies and be able to reverse them if they did have a reaction to the lecithin in the propellant. However, this should be the only inhaler you would still have to worry about it and if you are in Canada, I doubt if this inhaler is still available and probably will not be much longer in the US.
Click to expand...

My mistake!!! I was talking about the Duoneb. I was just writing about the Combivent somewhere else... and must have slipped. Thanks for catching!
 
Here in NM, the narcs are on my person so a basic can't 'assist' me with those. Almost all the other drugs on the bus I'll have them get ready for me if I need it, I just double check the doseage before I push it, every time. But a lot of the drugs (epi, Albuterol, narcan) I use on a regular basis the basics can give and use as well, so it's not an issue
 
Meh, my Versed and Fentanyl are in a safe to which only I have the code, and Ativan is in a cooler to which only I have the key.


But still, no one has been able to answer the difference between an EMT spiking a bag, and drawing non-controlled substances in to a syringe.
 
There's not one. All of my basics spike bags for me daily. They draw up meds like Zofran for me, daily. The person with the authorization to give the drug should be the one pushing it, not them.
 
I understand the need to draw up narcotics yourself. However, if you trust your partner what is wrong with them drawing up non narcotics while you handle something else. Of course check your dose, but if you trust your partner I don't see what's wrong with having them draw something up for you. But in other situations I would agree with handling the meds your giving from start to finish.
 
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