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

[JonTullos]

When I'm a medic, my partner will only do things that are within their scope of practice (vitals, O2, etc.). That includes drawing up meds. Absolutely not. That's my patch on the line if something goes wrong. I have no problem spiking a bag because all that's doing is putting a drop set into a bag of fluid and flushing the air. There's no reason that another provider couldn't do that.

 

[NomadicMedic]

I think it depends on where you work, what level the EMT is uptrained to, and how comfortable you are with their skills. I worked in a very busy 911 system where most of the EMTs were intermediates. They were expected to be the medic's assistant. Would I allow an EMT I didn't know to touch my med box? No way. But my partner was trained, able, and expected to help me when I needed it. In many cases, my EMT-I partner would start a line while I was doing other stuff. It's called teamwork, and why I think a medic and I are the a great team.

 

[CAOX3]

EMTLady, There are things that happen for the good of the patient that do not get mentioned or discussed. . . it's called "street med."

Really, if your medics need assistance drawing and administering medications they should be working double medic.

Street med, please there is no secret society of EMTs that on a regular basis work outside of their scope. If they do the system is broken.

Your EMTs should be able to handle the aspects of their job, while the medic tends to his responsibilities. I have done a million codes, traumatic arrests, stabbings, shootings you name it with only one medic on scene and never once been asked to step outside my scope.

You need strong EMTs, if he doesn't have to worry about what your doing then he can concentrate on his obligations.

 

[EMTBHillbilly]

"I have done a million codes, traumatic arrests, stabbings, shootings you name it with only one medic on scene and never once been asked to step outside my scope."

Really? Come on, I mean, really?

 

[usalsfyre]

Is drawing up the med (NOT administering it) really "working outside your scope"? If it is, then is turning on the monitor working out of scope? Or handing the medic a ETT? Because we could get into some REALLY high level ridiculousness.

What is everyone so scared of?

 

[Shishkabob]

Is drawing up the med (NOT administering it) really "working outside your scope"? If it is, then is turning on the monitor working out of scope? Or handing the medic a ETT? Because we could get into some REALLY high level ridiculousness.

What is everyone so scared of?

Ta-da.



You can't separate spiking an IV bag from drawing up other medications. Same exact premise people.

 

[CAOX3]

Is drawing up the med (NOT administering it) really "working outside your scope"? If it is, then is turning on the monitor working out of scope? Or handing the medic a ETT? Because we could get into some REALLY high level ridiculousness.

What is everyone so scared of?

Scared? No.

Where do you draw the line then? First it's drawing up the medication, next it's a little more, then a little more, finally the situation is out of control,

You want EMTs to know their place but then you blur the lines, that's when the problems start.

And spiking a bag and drawing up medications is not the same, if it is then I challenge you to note it in your report "had EMT draw up 2mg of ativan, then I administered it" let me know how that works out for you.

Its not the act its the premise.

I'm no policy/protocol monkey by any stretch and I have the rips to prove it. Its about the example you set and this isn't a good one.

 

[usalsfyre]

Scared? No.

Where do you draw the line then? First it's drawing up the medication, next it's a little more, then a little more, finally the situation is out of control,

The line? The line is simple, "who actually performs the invasive procedure".

You want EMTs to know their place but then you blur the lines, that's when the problems start.

Less "knowing your place" and more "stay with in your credentialing", which has to do with patients, not other ancillary stuff.

And spiking a bag and drawing up medications is not the same, if it is then I challenge you to note it in your report "had EMT draw up 2mg of ativan, then I administered it" let me know how that works out for you.

There's four different fluids on my truck, not counting NTG, dopa and lidocaine infusions. So I've got to check what they do regardless. As far as charting who drew up the med, that's not appropriate charting. Again, do you chart who applied the electrodes? Who handed you the cath for an IV? Nope, the guy who performs the intervention is responsible for it.

Its not the act its the premise.

Not sure what's wrong with the premise?

I'm no policy/protocol monkey by any stretch and I have the rips to prove it. Its about the example you set and this isn't a good one.

Every Basic at my service is taught to draw up a med and administer it (epi 1:1000 IM). So what's wrong with having them use half that skill?

 

[CAOX3]

So if its accepted practice, put it on paper.

I mean thats the only true test, isn't it?

What are you scared of?

Rules and boundaries are in place for a reason, no I don't agree with them all, they are in place for a reason and if we start allowing the lines to be crossed, then the system will collapse. Like it is doing right now. When I began in EMS there were EMTs and paramedics each had a defined scope now there are hundreds of different levels, expanded scopes and add on's.

When you need a paramedic, you ned a paramedic, not an EMT with additional weekend of training. I have an expanded scope and I don't agree with all of it, because there its no substitute, for a experienced and educated paramedic and I think allowing EMTs to do a little more only muddies the water. I can draw medications and we even administer a few, so I wouldn't have an issue theoretically, in practice I don't agreed with it because it s just opening a can of worms an the one time your busy and forget to check the vial and the wrong medication is administered everone is going down, from top to bottom. Good providers who simply made a mistake.

I don't think its worth the hassle and I have yet to see the paramedic who doesn't have the time to tend to his duties, let the EMTs operate at their level and you should have plenty of time to operate at yours.

 

[usalsfyre]

So if its accepted practice, put it on paper.

I mean thats the only true test, isn't it?

But it's not good charting. It's like charting the color of the patient's shirt. Totally irrelevant. Most EMS charting laughable anyway, throwing crap like this in makes it beyond idiotic.

Rules and boundaries are in place for a reason, no I don't agree with them all, they are in place for a reason and if we start allowing the lines to be crossed, then the system will collapse. Like it is doing right now. When I began in EMS there were EMTs and paramedics each had a defined scope now there are hundreds of different levels, expanded scopes and add on's.

There's been a stupid number of levels for years. Look at VA, they've had four levels pretty much since inception.

When you need a paramedic, you ned a paramedic, not an EMT with additional weekend of training. I have an expanded scope and I don't agree with all of it, because there its no substitute, for a experienced and educated paramedic and I think allowing EMTs to do a little more only muddies the water.

EMT education focuses on absolutely the wrong things. Their job, in most systems is "paramedic assistant". Yet we insist on trying to cram enough info into 120 hours to make them an independent provider. None of my patients will ever get "an EMT with a few weekend courses" because my system recognizes that putting a paramedic at bedside is the best way of operating. As such, focusing the EMT's role on ways to assist the paramedic helps onscene efficiency.

I can draw medications and we even administer a few, so I wouldn't have an issue theoretically, in practice I don't agreed with it because it s just opening a can of worms an the one time your busy and forget to check the vial and the wrong medication is administered everone is going down, from top to bottom. Good providers who simply made a mistake.

How's it different than grabbing the wrong vial yourself? Answer? Don't be caviler with meds, no matter who handles them. It will bite you in the backside.

I don't think its worth the hassle and I have yet to see the paramedic who doesn't have the time to tend to his duties, let the EMTs operate at their level and you should have plenty of time to operate at yours.

So your medics can start an IV with one hand and draw up epi with the other?

 

[Shishkabob]

And spiking a bag and drawing up medications is not the same, if it is then I challenge you to note it in your report "had EMT draw up 2mg of ativan, then I administered it" let me know how that works out for you.

Ativan is a controlled substance. Lactated Ringers is not. Benadryl is not.


Our agency allows EMTs to administer Epi 1:1, SQ/IM... not from an Epi-pen, but from a syringe that they draw up themselves. They are taught how to do this in our orientation academy, and are expected to be able to when called upon for it. Clearly our agency has weighed the risks/benefits of allowing EMTs to draw meds in to syringes.

 

[TransportJockey]

I agree w/ Linuss and usalsfyre again. My basic partners are trained to draw up meds during class in this state. They can administer two different meds they drew up IM/SQ. So... why is it a problem if I'm working an anaphylactic shock patient, and I'm starting the IV, if I have them draw up benedryl for me to push when I've got the IV in place? Hell, half the time they're drawing up and pushing the Epi IM for me while I'm getting everything else ready. If they're not doing that, they're tossing the patient on 5mg Albuterol (again, very much in their scope) while I'm doing the Epi.

And as for charting... What is documented (both when I worked in a hospital and on a truck) is who did the invasive skill, not who prepared it. My basics spike bags of LR or NS all the time for me. But I've never seen a PCR that states 'NS/LR spiked by EMT-B ____', have you? Same with meds.

 

[usalsfyre]

As much as we hate on paramedic education around here, EMT training (cause I can't bring myself to call it education) is so jacked we'd be better off scrapping the whole thing.

 

[TransportJockey]

As much as we hate on paramedic education around here, EMT training (cause I can't bring myself to call it education) is so jacked we'd be better off scrapping the whole thing.

No arguments from me there.

 

[usalsfyre]

No arguments from me there.

And the funny thing is with some adjustments I think Intermediate is a pretty good starting point.

 

[TransportJockey]

And the funny thing is with some adjustments I think Intermediate is a pretty good starting point.

I'd say a 2 semester EMT-I program that has more focus in A&P (like A&P1 during semester 1 and A&P2 w/ cadaver lab in semester 2) would make for a great entry level EMS position. And make requiring an AAS for EMT-P as a minimum make more sense.

 

[jjesusfreak01]

EMT education focuses on absolutely the wrong things. Their job, in most systems is "paramedic assistant". Yet we insist on trying to cram enough info into 120 hours to make them an independent provider. None of my patients will ever get "an EMT with a few weekend courses" because my system recognizes that putting a paramedic at bedside is the best way of operating. As such, focusing the EMT's role on ways to assist the paramedic helps onscene efficiency.

Personally, I like the way its done where I live. My EMT-B class was 190 hours of training in medical science, skills, and equipment. This qualifies you to work convalescence with no further training. To work EMS, I have a number of months of training in paramedic assist skills and driving. I'll have spent more than 250 hours as a third rider before I move to second. So, would you trust an EMT with 500 hours of training to draw up meds, to care for basic level patients, to drop a King airway (the coolest skill in my scope)?

This is the way it should be. No EMS system should trust that a person's EMT-Basic class prepared them to work in the field. The agency should be ultimately responsible for training and testing their employees on the skills they expect them to use.

At the same time, there is always going to be a place for the EMT Basic certification. I think its perfect for convalescence and firefighters. A convalescence EMT might occasionally need to suction a patient, will often need to administer O2 based on the needs of a patient, and will need to make transport decisions based on the condition of a patient (we occasionally have to refer pts to EMS, but this has to be an educated decision, not a CYA decision, as we often transport pts with AMS and very diminished vitals). A firefighter, on the other hand, can benefit from a basic cert by knowing how to take basic vitals, including BGL, knowing how to assist in immobilizing the pt, and having a general knowledge of some of the conditions faced by their patients.

 

[mike1390]

heres my thing if I really trust my partner then why not? would I ever not look over the dose? NO would I expect them to do my math for me? NO. prime example diabetic, Im tying to get a line and on my 3rd attempt I tell my EMT partner screw it get my glucogon... while I tend to my now pin coushin. once he draws up the easiest med then ill give it. Could be just me but again this is only if i really trust my partner not somebody im just working with.

 

[CAOX3]

I guess I'll agree to disagree.

My EMT class was two semesters, fourteen college credits, three days a week, anatomy and physiology were pre-reqs to be accepted.

The class has now been replaced, enrollment was down because you can get the same certification in three weeks.