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

[Shishkabob]

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.

Exactly! Not a single difference between spiking a bag and drawing a med.

 

[mycrofft]

Technical versus professional.

SPIKING BAG= go to the shelf, pick the primary bag, pick the drug, stick the spike into the bag, mix premeasured correct chemical into known volume primary IV solution (a premeasured and strictly mechanical act), then hang it or pass it over or whatever. If you can read and keep your cool anyone can do it.

DRAWING UP A MED: right med, right time, right dose, right patient, right route, and all that? Requires measurement and decision-making, unless it is a premeasured med and it is in only one form and dose on the vehicle.

A pharm tech could under supervision. A paramedic could because their training includes drugs, measures, and admin, and because the paramedic will also be giving it.

 

[Shishkabob]

I don't know about you, but I have multiple IV solutions on my truck, from NS to LR to 5%, to Lidocaine, Dopamine and others. Trusting your EMT to grab the right one, you should still double check it before you start the line, no?


So, what if you give your EMT the specific medication by hand? You're taking the decision making process away from them and now making it, as you stated, a purely technical skill.




So... what's the difference?

 

[TransportJockey]

SPIKING BAG= go to the shelf, pick the primary bag, pick the drug, stick the spike into the bag, mix premeasured correct chemical into known volume primary IV solution (a premeasured and strictly mechanical act), then hang it or pass it over or whatever. If you can read and keep your cool anyone can do it.

DRAWING UP A MED: right med, right time, right dose, right patient, right route, and all that? Requires measurement and decision-making, unless it is a premeasured med and it is in only one form and dose on the vehicle.

A pharm tech could under supervision. A paramedic could because their training includes drugs, measures, and admin, and because the paramedic will also be giving it.

I trust my partners here to measure up exactly how much I tell them. I'll tell them ccs and mgs and trust them to do the rest. When they give it to me, I double check the dose, then push it when I feel is the right time. Our basics learn IM/SQ/IN drug admin, so it's different than in some states

 

[mycrofft]

Dose has to be drawn properly.

(Shaken, rolled, or not aggitated; correct amount; menicus issues; assess if it has sediment or ought to be clear and colorless; effervesence from shaking or bubbles).

After stopping to check the drug or hand it to them, then stopping to check the dose, why not just do it all yourself and save the potential time in the witness box or the boss's office?

Trust is good, but if it fails it nails you and your assistant and the pt.

I'm just going over what we had drilled into us in nursing, then on the job by our employer after the DEA reamed us a new one (while I was off premises) for for improper procedures. This isn't DC Comix, it's real life.

 

[Farmer2DO]

I don't know about you, but I have multiple IV solutions on my truck, from NS to LR to 5%, to Lidocaine, Dopamine and others. Trusting your EMT to grab the right one, you should still double check it before you start the line, no?


So, what if you give your EMT the specific medication by hand? You're taking the decision making process away from them and now making it, as you stated, a purely technical skill.




So... what's the difference?

While I understand what you are saying, I don't agree with you. Spiking a bag is not measuring. I'm assuming that any bag that's spiked will then have the rate set by the paramedic, a process that requires confirming the fluid/drug and concentration. Sure, a basic can spike a pre-mix bag of dopamine, but he's not setting the rate.

The only non-paramedics that draw up drugs are paramedic students or paramedic interns that are clearing with me as an FTO, and this is under my direct supervision. I will let my student/partner draw up, but I hand him the vial, watch him draw it up, and confirm the empty vial and the correct dose in the syringe, and then watch him closely as he pushes it. I'm the one responsible, and the only thing I will let others do (that aren't student or intern) is put together prefilled syringes during a code. Our company won't even let an intern draw up controlled substances under my supervision. I'm not allowed to pass controlled substances off to any one at any time, for any reason (unless it's a supervisor, say if I get injured or sick). They insist on making the new paramedic's first time giving controlled substances in the field their first time ever doing it in an ambulance. I don't agree, but in NYS this is taken VERY seriously.

 

[TransportJockey]

While I understand what you are saying, I don't agree with you. Spiking a bag is not measuring. I'm assuming that any bag that's spiked will then have the rate set by the paramedic, a process that requires confirming the fluid/drug and concentration. Sure, a basic can spike a pre-mix bag of dopamine, but he's not setting the rate.

The only non-paramedics that draw up drugs are paramedic students or paramedic interns that are clearing with me as an FTO, and this is under my direct supervision. I will let my student/partner draw up, but I hand him the vial, watch him draw it up, and confirm the empty vial and the correct dose in the syringe, and then watch him closely as he pushes it. I'm the one responsible, and the only thing I will let others do (that aren't student or intern) is put together prefilled syringes during a code. Our company won't even let an intern draw up controlled substances under my supervision. I'm not allowed to pass controlled substances off to any one at any time, for any reason (unless it's a supervisor, say if I get injured or sick). They insist on making the new paramedic's first time giving controlled substances in the field their first time ever doing it in an ambulance. I don't agree, but in NYS this is taken VERY seriously.

I know in my area, that attitude would be ridiculous, since our basics can actually give IM/SQ some of th drugs I'm asking them to draw up. Narcs and Benzos still only get drawn up by me, but if I need benedryl, I see no reason they can't take the vial from me, draw up 2ccs like I tell them to, I double check the dose before I push it.
After all, don't we all double check the dose we draw up ourselves before we push it? I know I check drug, dose, and route about 3-4 times from vial out to pushing.

 

[Farmer2DO]

That exact situation got a paramedic in trouble in my area a few years ago. She was treating a presumed allergic reaction, and had her basic partner draw up the "benadryl" and then she (the paramedic) pushed it. She gave 3 doses of IV "benadryl" because the patient wasn't improving (yes, I know we don't repeat doses of benadryl in that short of a time period) and it wasn't until the patient care had been transferred to hospital staff that she realized the bottle in her bag that had been opened was 1:1000 epi, and not benadryl. She had given 1 mg epi 1:1000 IVP X3. The patient was in V. tach, had to be cardioverted, and had a troponin spike.

Granted, she didn't check to make sure it was the right drug, right dose etc. But the system came down hard, and only in a cardiac arrest can non-ALS providers do anything, and that's assembling pre-loads.

One of my friends was new at the company, and his partner set up the neb with 2 unit doses of albuterol, 1 unit dose of atrovent (our standard first line cocktail) and then threw out the vials. He dumped them out and did it himself, since he couldn't confirm the right dose. Partner got mad, ALS chief backed him up. And I agree with him.

Again: my card, my number, my responsibility. I call the shots. Only interns and students handle drugs under my supervision.

 

[Anjel]

basics here don't touch any meds. Period.

If I did I probably would loose my job.

 

[MrBrown]

Brown does not mind a Technician (Ambulance Officer) administering any medicine for which they are qualified, drawing up saline or setting up an IV bag.

Adrenaline and morphine (our Paramedic drugs) can only be handled by, *gasp, the Paramedic.

 

[Pneumothorax]

I know in my area, that attitude would be ridiculous, since our basics can actually give IM/SQ some of th drugs I'm asking them to draw up. Narcs and Benzos still only get drawn up by me, but if I need benedryl, I see no reason they can't take the vial from me, draw up 2ccs like I tell them to, I double check the dose before I push it.
After all, don't we all double check the dose we draw up ourselves before we push it? I know I check drug, dose, and route about 3-4 times from vial out to pushing.

here in our EMS system EMT-B's can draw up and mix glucagon and admin, under our protocols.

and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig. Its way easier to suck some unmixed juice up in a syringe.

& wherever you are you should always check the med if you didnt draw it up yourself--

 

[sir.shocksalot]

and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig. Its way easier to suck some unmixed juice up in a syringe.

I'm confused, do you plan on injecting unmixed juice?
As a side note, what the heck is unmixed juice? Is that the fruit that the juice is made of?

 

[CAOX3]

here in our EMS system EMT-B's can draw up and mix glucagon and admin, under our protocols.

and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig. Its way easier to suck some unmixed juice up in a syringe.

& wherever you are you should always check the med if you didnt draw it up yourself--

You draw saline into the syringe then you inject it into the glucagon vial, remove syringe, shake, reinsert the syringe the medication will be at the bottom of the vial draw up the desired dose and leave foam in the vial.

There is no juice its medication, it isn't a difficult undertaking for most.

 

[Pneumothorax]

I'm confused, do you plan on injecting unmixed juice?
As a side note, what the heck is unmixed juice? Is that the fruit that the juice is made of?.

by juice I mean the liquid in the vial...sorry---

 

[usalsfyre]

here in our EMS system EMT-B's can draw up and mix glucagon and admin, under our protocols.

and let me tell you, thats serious business. because its pretty difficult to be fudging around with that stuff trying not to make it foam in the back of a rig. Its way easier to suck some unmixed juice up in a syringe.

& wherever you are you should always check the med if you didnt draw it up yourself--

Never really had much of an issue with glucagon. Now back when amiodarone came in the 5ml ampules...imagine trying to draw up a bubble bath

 

[MagicTyler]

My paramedic instructor told us a story from at an agency he used to work at in the mid 90s:

A medic instructed his EMT to "put a gram of lidocaine in the line" (meaning put it in the NS bag), the EMT did exactly as he was told and put it right in the IV. The patient coded (and obviously died). Both were fired, and the medic lost his cert, the medic was charged in court. The EMT was not charged in court, and the state EMS office did not pull the cert of the EMT (even though he was outside his scope of practice). They determined that he was only following his medics orders and was not in a position to refuse.

 

[HotelCo]

We only have NS here, so meds and spiking a bag ARE two completely different things.

My basic/spec partners don't touch anything inside the drug box.

Sent from my iPhone using Tapatalk

 

[Chief Complaint]

Its very rare that there is a Basic riding on a rig in the county i have done my internships with, but i have seen one handling meds. It was at the request of the medic who had his hands full and the Basic only grabbed them from the drug box, didnt draw anything up or push.

Ive heard stories of Basics pushing D50, but ive never seen it.

 

[AMF]

Its very rare that there is a Basic riding on a rig in the county i have done my internships with, but i have seen one handling meds. It was at the request of the medic who had his hands full and the Basic only grabbed them from the drug box, didnt draw anything up or push.

Ive heard stories of Basics pushing D50, but ive never seen it.

D50 and narcan are both in the basic scope of practice in nm

 

[dixie_flatline]

As a B in Maryland, I don't touch any ALS medications really, with the exception of spiking a bag. However, we only carry 500 bags of LR, so it's not really possible to get the wrong bag. All I do is assemble the bag+drip kit, and maybe get a saline lock ready.

The closest I get to touching "real" meds is when I'm cleaning up sharps.