There are some big cities and urban areas which also have a few advanced protoools that differ from the norm. There are also a few other Paramedics from some very rural areas on different forums who are willing to discuss and share their protocols without attitude by the country bumpkin thing. They do so with pride and don't mind being questioned. Usually when you cop to that you can't provide the information requested such as initiation or titration parameters.
What if EMT/Paramedic was one program instead of 2?
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There are some big cities and urban areas which also have a few advanced protoools that differ from the norm. There are also a few other Paramedics from some very rural areas on different forums who are willing to discuss and share their protocols without attitude by the country bumpkin thing. They do so with pride and don't mind being questioned. Usually when you cop to that you can't provide the information requested such as initiation or titration parameters.
DrankTheKoolaid
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Certainly would be nice to have here in far Northern Rural CA along with POC chemistries. Unfortunately the CA BRN will continue to fight it tooth and nail like they always have for insulin and ABX. Though we did just get ABX approved for IFT and hopefully after a few more sepsis studies, field intiated.
VFlutter
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Just read a great thread over on flightwebs about this. There is a lot that goes into field ABX initiation.
http://www.flightweb.com/forums/index.php?showtopic=4737
medic417
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Again you have my "protocol" - accepted medical practice for any tool or drug I have. You have to base your deciscion on what to use and how much to use on each patient. So no I can not give you a set number etc. Some patients at 200 will get insulin started some over 500 may not. It depends on each patient. I take pride that I actually practice medicine rather than just follow a cookbook.
DrankTheKoolaid
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Yeah read the same, the forum is a huge wealth of info. In Ca there is an existing field POC lacate study but it is trauma specific.
EpiEMS
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Why do the nurses fight EMS providers wanting to provide better care for sepsis etc.? That is, how is it in their advantage to fight insulin and prehospital antibiotics?
HOLY DOG S*IT! Texas!
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VFlutter
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Ok then........so if you do not give insulin based on specific BGL what do you use to decide? Signs and symptoms? Again how much do you give for a specific BGL? Just draw up however many units you think the patient needs? I take pride in the fact that I practice medicine, more specifically evidence based medicine.
I will try to dig up the articles I have on BGL control and relation to body processes and general recovery. There is a very specific window. I worked in a Neuro ICU where we kept very strict control over blood sugar with Q1 hour checks. We had very specific protocols which resulted in very consistant blood sugar over the course of a patients stay. Am I not practicing medicine? Am I not doing what is best for my patient? I guess I am just following my cookbook
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VFlutter
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A big issue seems to be the potential for the proliferation of drug resistant organisms with overuse of broad spectrum ABX. It's generally much better to get a culture and sensitivity test before initiating therapy. Also ABX selection is an issue.
EpiEMS
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Technically speaking, aren't your engaging in the practice of critical care or ICU nursing, not medicine? As an EMT, you're practicing medicine, sure, but not as an RN or RN student, right?
EpiEMS
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Double post, whoops!
VFlutter
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If you want to go into semantics.....
Per good old Wikipedia.....Medicine is the applied science or practice of the diagnosis, treatment, and prevention of disease.[1] It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness in human beings.
So you think that an EMT practices medicine more so than an RN? Not trying to be defensive I'm just trying to see your point
DrankTheKoolaid
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That is certainly another reason.
Consider this, What seperates an RN from a Paramedic, skills wise? Foley insertion for the RN - Intubation for the Paramedic unless a RN is specialized there is no other seperation as we access and use central lines, give IV/IM/SQ/IN and PR meds and can monitor TPN and blood along with hanging more units of blood while in transit. The glaring difference with medications is the Abx and Insulins. Give those to Paramedics and then what is the justification for staffing a ER or other floor with more expensive RN's when the medics can do it at a cost savings.
Dont take this as me questioning a RN's knowledge as that isnt my point. I completed all the same pre-req's and know the work they went through to get into school. But in reality in most ER's you could remove 2/3 of the RN staff and replace them with Medics if they were given Insulin and ABX abilities at a huge savings to hospitals while the left over RN's do anything out of bound like the odd med and *cough* foley insertion.
Consider this, What seperates an RN from a Paramedic, skills wise? Foley insertion for the RN - Intubation for the Paramedic unless a RN is specialized there is no other seperation as we access and use central lines, give IV/IM/SQ/IN and PR meds and can monitor TPN and blood along with hanging more units of blood while in transit. The glaring difference with medications is the Abx and Insulins. Give those to Paramedics and then what is the justification for staffing a ER or other floor with more expensive RN's when the medics can do it at a cost savings.
Dont take this as me questioning a RN's knowledge as that isnt my point. I completed all the same pre-req's and know the work they went through to get into school. But in reality in most ER's you could remove 2/3 of the RN staff and replace them with Medics if they were given Insulin and ABX abilities at a huge savings to hospitals while the left over RN's do anything out of bound like the odd med and *cough* foley insertion.
Can you provide proof that the BRN is stopping you? POC falls into Clinical Labs and not nursing for regulation of where, when, how and who can do POC. Nursing could care less about EMS since they also must abide and beg for the privilege of doing POC testing from the lab and accrediting agencies.
Transporting someone on antibiotics is not the same as initiating them in the field. If you are involved in IFT you should have a better understanding as to why antibiotics are given out like candy at random for everything. The emphasis in the past decade has to become more specific rather than the broad random administering to "cover it all". Some of the bad habits in EMS have been formed when it comes to care with intubation and IV sticks because it was thought antibiotices could be given broadly to cover the lax care in the field.
What do you know about giving insulin? Again just transporting it from point A to B may not seem to be that big of a deal but you really should not be messing with anything you have not been thoroughly educated in. The same for antibiotics.
VFlutter
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So does that mean if they let me intubate I could replace all the medics out there? I see your point however I doubt that is really the reason nursing is against it. I will not get into a pissing contest but I think you over simplified the differences just a little bit.
EpiEMS
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True, true. But medicine as a professional practice is defined by a specific educational model. Nursing is a separate form of professional practice that encompasses similar basic science, but applies them to a totally different sort of practice. Hence why a NP is practicing nursing when he or she prescribes a drug, while a MD, DO, or PA is practicing medicine, I guess.
I would argue that the EMT is the most basic level of medical practitioner. He or she is trained in a medical model (of course, at a more fundamental level), and expected to assess, diagnose, and treat in the medical model under minimal direct supervision. That is the very definition of the practice of medicine: applying knowledge of anatomy, physiology, and pathology to provide diagnosis and treatment of illness and injury, at least, as far as I conceive of it.
I have nothing but respect for nursing, and I know you're just as proud of being an EMT as you are a soon-to-be RN.
DrankTheKoolaid
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Wasnt refering to POC with the BRN, was refering to ABX and Insulin. My knowledge is strictly academic and through example after watching and questioning the medical staff and RN's during my 10 years in a ED along with self study. I would never want to be allowed the use of any skill or medication I did not have a thorough knowledge of, and as a Clinical Coordinator I would not allow others the use of them either until a full didactic and cognitive understanding was demonstrated.
I think you are confusing the training by medical model and the nursing model.
EMTs do not practice medicine.
VFlutter
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I know you're just as proud of being an EMT as you are a soon-to-be RN.
nope not really....it took me 3 months to be an EMT. I have been in school the past 4 years to be an RN. :wacko:
EpiEMS
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In one sense, you're right -- the emergency skills that a paramedic can perform is broader than the set of RN skills (though I believe an acute care NP can reach the level of skills that a medic can provide, viz. http://www.ena.org/IQSIP/Practice/NursePractitioner/Documents/NPCompetencies.pdf).
Then again, RNs are mandated to have at least an associates degree, and the standard is moving to the BSN. Paramedics, not so much. This is a difference, though I'm certainly not sure if it improves outcomes (I'd wager it doesn't, if the lack of difference in outcomes between midlevels and physicians is any guide).
Paramedics could probably supplement or supplant emergency room RNs, but I doubt many would want to. Think about what the ER RNs do, after all -- they're not doing intubations or running codes or pushing drugs autonomously.
DrankTheKoolaid
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Agreed, but would certainly be a path for Medics to take should they choose. And like I have always told people about my time in the ED. You will learn more in a year in the ED, then you would spending 5 years in the field.