States and EMT-B Morphine Administration

[RocketMedic]

Really? I bet pt's would disagree. Especially when Firefighter/EMT's respond to the pt's before we get there. Just because *you think* a "glorified first aid" EMT gets in your way dosn't mean it dosn't matter medically to the pt.

You should remember whats infront of your patch Mr. *EMT*-paramedic

You seem a bit...bitter.

I don't think a good EMT or EMT-I is any worse than a good paramedic, but all things considered, I'd prefer to have a paramedic who can actually do what is indicated as opposed to someone who can follow orders well and blindly.

Competence isn't tied to a patch, but in general terms, I'd rather have more training.

 

[Basermedic159]

Where in my post did I bring up theft?

If youll look, someone stated something about EMT's administering morphine "until an auto injector comes up missing"

 

[Handsome Robb]

Really? I bet pt's would disagree. Especially when Firefighter/EMT's respond to the pt's before we get there. Just because *you think* a "glorified first aid" EMT gets in your way dosn't mean it dosn't matter medically to the pt.

You should remember whats infront of your patch Mr. *EMT*-paramedic

So make the firefighters upgrade to intermediate. It's not that difficult. Since the fire service seems to be justifying much of their funding with response to EMS calls why not make them more capable to provide comfort to the patients in those situations where the FD is on scene first and have an extended wait for an ALS crew?

99% of the time a basic isn't going to be able to do a whole lot medically for the patient and as someone else said, that is true of medics as well.

It's not EMT-Paramedic anymore boss, it's Nationally Registered Paramedic under the new national guidelines. As a new member it's not great practice to come in and start scolding and harassing people who have been around this place longer than you. There's lots of info hear and sources of education but no one is going to be nice to you if you come in guns blazing.

 

[Basermedic159]

There's a big difference between someone screwing up or losing a tube or oral glucose and an auto injector of morphine, and I'd hate to be the medical director the first time an audit comes up with a missing auto injector of morphine.

There ya go

 

[JPINFV]

...because theft is the only way to lose something?

 

[Handsome Robb]

JP :nosoupfortroll:

 

[Basermedic159]

So make the firefighters upgrade to intermediate. It's not that difficult. Since the fire service seems to be justifying much of their funding with response to EMS calls why not make them more capable to provide comfort to the patients in those situations where the FD is on scene first and have an extended wait for an ALS crew?

99% of the time a basic isn't going to be able to do a whole lot medically for the patient and as someone else said, that is true of medics as well.

It's not EMT-Paramedic anymore boss, it's Nationally Registered Paramedic under the new national guidelines. As a new member it's not great practice to come in and start scolding and harassing people who have been around this place longer than you. There's lots of info hear and sources of education but no one is going to be nice to you if you come in guns blazing.

Alot of fire departments are going to ALS, atleast around here they are. If OEMS would combine EMT-B and Intermediate together like they have been talking about for years, they wouldn't have to.

Not EMT-Paramedic anymore? Um yeah it is, all Paramedics are not nationally reistered? Your not a Nationally Registered Paramedic until you take the NR test...boss.

I may be new but I only "scolded" on the things I thought where incorrect,stupid etc. Im not coming in "guns blazing" I have also commented on other stuff. Just because I am new and said something you didnt like dosnt mean Im scolding anyone or have " my guns blazing" I may be new but I haven't broken any rules.h34r:

 

[Basermedic159]

...because theft is the only way to lose something?

Not at all, but now it seems you are insinuating that Basics can loose something more easily than Intermediates or Paramedics?

 

[RocketMedic]

Yes, because there's more of y'all, and as much as I hate to say it, there's less to lose. Paramedics aren't perfect, but they have sunk time into career advancement, and there's fewer of us than EMTs. Basics may be more mature as individuals, but as a group, y'all needs to meet our (relatively low) standard before the rest of the world trusts you with real medication.

Baser, your argument is weak. Our title is mere semantics. I don't care if I'm called a paramedic or an emt-p or an AD(RGIB). The point is that EMT-B needs more education or special circumstances to have drugs in their protocols.

 

[Flight-LP]

Alot of fire departments are going to ALS, atleast around here they are. If OEMS would combine EMT-B and Intermediate together like they have been talking about for years, they wouldn't have to.

Not EMT-Paramedic anymore? Um yeah it is, all Paramedics are not nationally reistered? Your not a Nationally Registered Paramedic until you take the NR test...boss.

I may be new but I only "scolded" on the things I thought where incorrect,stupid etc. Im not coming in "guns blazing" I have also commented on other stuff. Just because I am new and said something you didnt like dosnt mean Im scolding anyone or have " my guns blazing" I may be new but I haven't broken any rules.h34r:

OK, since we are going to play on the semantics....................

I am not a Nationally Registered Paramedic, I only currently hold a Texas License. No where in my title or licensure does it say EMT.

Why am I being an ***? Simple.........

You come in here with your smart a$$ attitude waving around unsubstantiated statements and then have the audacity to say you are "new" and only complaining about things that you "think are incorrect or stupid". Who are you and on what grounds does your inexperienced opinion hold any validation of fact? MY friend, everyone is entitled to an opinion. But remember the old saying about opinions?

I believe if you altered your approach a bit and became more inquisitive instead of confrontational, you may get farther with this crowd. You may also learn something along the way...........................

 

[Flight-LP]

Basics may be more mature as individuals........

The proof isn't in the pudding here lately in some of these posts...........

 

[JPINFV]

Not at all, but now it seems you are insinuating that Basics can loose something more easily than Intermediates or Paramedics?

The majority of EMTs I've worked were not as particular when it came to things like truck checkout and filling out the supplies used section of the PCR as they probably should have been. I'll fully admit to being anal bordering on OCD when it comes to checking out my ambulance and filling out my PCRs, but I've seen a lot of people who left more than a little to be desired for.

 

[ffemt8978]

I may be new but I haven't broken any rules.h34r:

Only because I haven't spent the time checking all off your posts yet.

 

[paradoqs]

Although I agree that the basic curriculum leaves alot to be desired, I think they can bring alot of value to the ems system. I think it is shortsited to say that basics are worthless because of their education. A bsn could say the same to a medic with only a diploma. First, how many pts do we run on would have no change in outcome if they got a taxi to the ed? Alot. In my system, there are no intermediates and you have to be a basiic for atleast a year before p school, and they are highly competitive. No one here wants to hire a medic with no exp as a basic. Also, my company charges alot less for a bls transport. Cost savings alone is a great argument for basics. Any good basic is going to know when als needs to be called in so why not start with bls atleast in ift systems. Educatiin shouldnt be the only thing that defines provider level anyway. Experience, judgement, and maturity are important too. And acting as a basic in an ems system can help achieve those things. I dont know about other systems, but emts are indespensible in mine. There arent enough medics to go around and not enough money to pay them with. Saying basics dont have a good education is true, but discounting their value in ems is condescending and falacious.

On another note, if an emt is acting with online med control to give opiods, he/she is really just acting as the eyes and ears of the md. So, any screw up unrelated to the med admin i.e. Dosage or route is the md' problem. And its pretty hard to screw up an autoinjector.

 

[AMF]

Although I agree that the basic curriculum leaves alot to be desired, I think they can bring alot of value to the ems system. I think it is shortsited to say that basics are worthless because of their education. A bsn could say the same to a medic with only a diploma. First, how many pts do we run on would have no change in outcome if they got a taxi to the ed? Alot. In my system, there are no intermediates and you have to be a basiic for atleast a year before p school, and they are highly competitive. No one here wants to hire a medic with no exp as a basic. Also, my company charges alot less for a bls transport. Cost savings alone is a great argument for basics. Any good basic is going to know when als needs to be called in so why not start with bls atleast in ift systems. Educatiin shouldnt be the only thing that defines provider level anyway. Experience, judgement, and maturity are important too. And acting as a basic in an ems system can help achieve those things. I dont know about other systems, but emts are indespensible in mine. There arent enough medics to go around and not enough money to pay them with. Saying basics dont have a good education is true, but discounting their value in ems is condescending and falacious.

On another note, if an emt is acting with online med control to give opiods, he/she is really just acting as the eyes and ears of the md. So, any screw up unrelated to the med admin i.e. Dosage or route is the md' problem. And its pretty hard to screw up an autoinjector.

+1. P/P systems are very hard to maintain. They are possible here in Maine, because our health care is subsidized, but the patients' bills can get pretty ridiculous. Basics make the US EMS system feasible (I don't fit into this category, if you're wondering) and, as a method of giving paramedic students field experience, are an invaluable part of paramedic training.
This does not really apply to paramedics themselves, however, in that higher trained paramedics would be a distinct advantage to the public health system, even if there were less of them. I've heard the phrase "enough rope to hand yourself" come up in conversations about PIFT, which allows a medical control-based scope of ~ a PA (minus procedures). There are a bunch of arguments for dealing with this, all of which make sense and none of which seem to work, but the fact that ALS providers find themselves woefully unprepared to deal with critical care patients speaks to the unreasonableness of giving basics the responsibility of administering pain medication without sufficient physiological and clinical background.
You might want to use spell check, though

 

[Tigger]

What does Severe pain + nothing for pain =?

Ever needed narcotic pain management? 2mg of morphine is not going to touch most patient's pain. What's the point of a procedure if it does nothing and also adds a significant degree of liability to the service.

Really? I bet pt's would disagree. Especially when Firefighter/EMT's respond to the pt's before we get there. Just because *you think* a "glorified first aid" EMT gets in your way dosn't mean it dosn't matter medically to the pt.

You should remember whats infront of your patch Mr. *EMT*-paramedic

The whole "we're all EMTs at heart" line of thinking is a total load of crap. A competent EMT-B (or EMT-B/IV) should know full well how massive the difference between them and and paramedics. It's not even the difference in skills and scope, it's the massive dichotomy in human body knowledge and assessment between the two provider levels that makes the difference here. Even crappy medics still have a tremendously greater amount of schooling than most basics.

Alot of fire departments are going to ALS, atleast around here they are. If OEMS would combine EMT-B and Intermediate together like they have been talking about for years, they wouldn't have to.

Not EMT-Paramedic anymore? Um yeah it is, all Paramedics are not nationally reistered? Your not a Nationally Registered Paramedic until you take the NR test...boss.

I may be new but I only "scolded" on the things I thought where incorrect,stupid etc. Im not coming in "guns blazing" I have also commented on other stuff. Just because I am new and said something you didnt like dosnt mean Im scolding anyone or have " my guns blazing" I may be new but I haven't broken any rules.h34r:

But whatever OEMS you speak of has not done so, these FDs are doing what they can do provide the best possible pre-hospital care that they can deliver to their citizens. Face it, unless you're city is full of trauma centers, a BLS EMS service is not providing the best care to the citizens.

What is the purpose in digging up old threads and saying you disagree with them? I just don't get the point.

 

[Tigger]

Although I agree that the basic curriculum leaves alot to be desired, I think they can bring alot of value to the ems system. I think it is shortsited to say that basics are worthless because of their education. A bsn could say the same to a medic with only a diploma. First, how many pts do we run on would have no change in outcome if they got a taxi to the ed? Alot. In my system, there are no intermediates and you have to be a basiic for atleast a year before p school, and they are highly competitive. No one here wants to hire a medic with no exp as a basic. Also, my company charges alot less for a bls transport. Cost savings alone is a great argument for basics. Any good basic is going to know when als needs to be called in so why not start with bls atleast in ift systems. Educatiin shouldnt be the only thing that defines provider level anyway. Experience, judgement, and maturity are important too. And acting as a basic in an ems system can help achieve those things. I dont know about other systems, but emts are indespensible in mine. There arent enough medics to go around and not enough money to pay them with. Saying basics dont have a good education is true, but discounting their value in ems is condescending and falacious.

On another note, if an emt is acting with online med control to give opiods, he/she is really just acting as the eyes and ears of the md. So, any screw up unrelated to the med admin i.e. Dosage or route is the md' problem. And its pretty hard to screw up an autoinjector.

Not trying to be that guy, but spell check will do a lot to make your point clearer. That said, I see no reason why anyone needs to work as a basic before being a medic. Especially if they're going to be working for an IFT company where they will not be exposed to a lot of acutely sick and complex patients. It takes about two days to become competent with ambulance operations, and not much longer to become comfortable speaking to patients (at least for many of the people I've worked with). Will these medics be behind the 8 ball a bit when starting clinicals? Yes, but I don't a competent student couldn't overcome this.

While EMS providers are the eyes and ears of the ED docs, those eyes and ears need to be well educated to provide a clear picture to the doc. Not to mention that morphine is not a benign drug (is there such thing anyway?) and basics in most places have no way to reverse the effects of morphine.

While I agree that maturity and experience can help measure the quality of a provider, there is no way to objectively measure either of these qualities, while it is possible to do this with education.

 

[Tigger]

+1. P/P systems are very hard to maintain. They are possible here in Maine, because our health care is subsidized, but the patients' bills can get pretty ridiculous. Basics make the US EMS system feasible (I don't fit into this category, if you're wondering) and, as a method of giving paramedic students field experience, are an invaluable part of paramedic training.
This does not really apply to paramedics themselves, however, in that higher trained paramedics would be a distinct advantage to the public health system, even if there were less of them. I've heard the phrase "enough rope to hand yourself" come up in conversations about PIFT, which allows a medical control-based scope of ~ a PA (minus procedures). There are a bunch of arguments for dealing with this, all of which make sense and none of which seem to work, but the fact that ALS providers find themselves woefully unprepared to deal with critical care patients speaks to the unreasonableness of giving basics the responsibility of administering pain medication without sufficient physiological and clinical background.
You might want to use spell check, though

Much of Massachusetts has P/P 911 trucks because it was once a legal requirement and many towns wish to keep it that way despite the law being repealed to allow P/B. Personally I don't care either way, I think every patient deserves to be assessed initially by a paramedic and then care and transport decisions can be made after that.

I don't see how working as BLS provider helps anyone be a better medic. I think it took me a week to get the hang of working a BLS truck, and while I enjoy working with my patients, I think anyone with some degree of social skills would not struggle if there first patient contacts were as a medic student.

 

[paradoqs]

Tigger, sorry, posting from my phone in the back of a moving ambulance while our 3rd rider drives around town is rough on my spelling ability. Most of the cars in our system do ift and emergent calls and thus see the whole range of patients. The fi process for medics is a couple of weeks and once they are cleared its sink or swim. For this reason and the ones I stated earlier, no one I know would agree with your assertion that one needs no basic experience to become a good medic. And although I can give narcan as a basic, I would be very uncomfortable if someone put morphine in my protocol.

I dont know why we need to objectively measure traits. You can be great in p school and still suck as a medic. And I can work with someone for a couple weeks and have a good idea of their maturity and professionalism without needing to see their diploma for it.

I should add that the basic in my system can start iv's and are allowed to give als drugs such as morphine when directed by the medic. So, in a sense they get alot of experience performing als skills which helps prepare them to become medics. In a system that only allows basics to drive, backboard and give 02 I could see basic exp being less helpful.

 

[Tigger]

Tigger, sorry, posting from my phone in the back of a moving ambulance while our 3rd rider drives around town is rough on my spelling ability. Most of the cars in our system do ift and emergent calls and thus see the whole range of patients. The fi process for medics is a couple of weeks and once they are cleared its sink or swim. For this reason and the ones I stated earlier, no one I know would agree with your assertion that one needs no basic experience to become a good medic. And although I can give narcan as a basic, I would be very uncomfortable if someone put morphine in my protocol.

I dont know why we need to objectively measure traits. You can be great in p school and still suck as a medic. And I can work with someone for a couple weeks and have a good idea of their maturity and professionalism without needing to see their diploma for it.

I should add that the basic in my system can start iv's and are allowed to give als drugs such as morphine when directed by the medic. So, in a sense they get alot of experience performing als skills which helps prepare them to become medics. In a system that only allows basics to drive, backboard and give 02 I could see basic exp being less helpful.

I have the same CO certification as you as you and work in a similar system in a different state. Even with the mix of calls, let's be honest, there's not a whole a true (non-IV) basic can do in non-immediately life threatening emergency besides get a good history, make the patient comfortable, and take the patient to the hospital.

I also do not mean that new medics should be learning basic patient contact skills once they're new medics, I mean that this can happen during their internship if they work at it.

My point about education being quantifiable was to respond to your point that

Educatiin shouldnt be the only thing that defines provider level anyway. Experience, judgement, and maturity are important too.

I agree that these are important traits, but you can classify a provider in terms of their scope of practice with these traits, this is only possible with education because you can actively test the provider's knowledge base. A mature and experienced basic might make a good medic or intermediate, but they are going to be awful if they cannot hack the education component. Education must always come first.

Also as far as I can tell, you're basics should not be giving Morphine, regardless even if it is under a medic's direction. Under the current 6 CCR 1015-3 - Chapter 2 – Practice and Medical Director Oversight
Rules Pertaining To The State Emergency Medical And Trauma Care System
(effective June 2011):

5.6 An EMT-IV may, under the supervision and authorization of a medical director, administer and monitor medications and classes of medications which exceed those listed in Appendices B and D of these rules for an EMT-IV under the direct visual supervision of an AEMT, EMT-I or
Paramedic when the following conditions have been established:
5.6.1 The patient must be in cardiac arrest or in extremis.
5.6.2 Drugs administered must be limited to those authorized by these rules for an AEMT, EMT-I or Paramedic as stated in Appendices B and D.
5.6.3 The medical director(s) shall amend the appropriate protocols and medical continuous quality improvement program used to supervise the EMS Providers to reflect this change in patient care. The medical director(s) and the protocol(s) of the EMT-IV and the AEMT, EMT-I or Paramedic, shall all be in agreement.

Based on this, EMT-IVs are permitted to give drugs out of their scope under a higher level provider's direction provided that the patient is in extremis, I'm not sure what use morphine would have for a patient in extremis. I am also unaware of any services having a waiver that changes this aspect of the state protocols.