Why aren't all EMTs are least trained with ALS?

KingCountyMedic

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Our EMT's are some of the finest in the country. They do check and inject Epi, nasal narcan, ASA, assist patients with own nitro and albuterol, carry pulse oximetry, check BGL....and coming soon to a King County BLS unit near you: The iGel airway for cardiac arrest.

There is need to know and nice to know. I don't think we should cloud up an EMT's brain with more information than they can use. You need to know "sick not sick" and go from there. If you're providing high quality BLS you're already solving 90% of the worlds problems.
 

Tigger

Dodges Pucks
Community Leader
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I've probably summarized this before but Colorado EMTs can (with additional training):
  • Start IVs and IOs (cardiac arrest for all, we have a waiver for "unresponsive patients with a low BLG" [yikes])
  • Hang NS and LR
  • D50
  • IV/IM/IN Narcan
  • IM/IV/ODT Zofran
  • Provide their own Albuterol nebulizer treatments
  • Draw and give IM Epi
  • Place supraglottic airways and use EtCO2 (colormetric or waveform) to confirm
  • Obtain and transmit 12 lead EKGs
  • CPAP
This is really not a bad BLS scope. My EMT partner can handle lots of "sick people" and EMT first responders have access to some pretty important interventions. My issue is that we just keep adding to the IV class that EMTs take. It's now 30 hours long, but it teaches nothing but the skills. Since AEMT just adds Atrovent, Benadryl, and Glucagon along with EJs I wish we just transition to this scope but that's *gasp* too many hours.
 

DrParasite

The fire extinguisher is not just for show
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I'm not sure if that's an awesome BLS scope because they can do so much, or a scary BLS scope because they can do so much with so little education (particularly in the starting IVs, and giving all those medications via IV and IOs)
 

johnrsemt

Forum Deputy Chief
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Dr Parasite: I should have clarified: that A&R was about 15 years ago, and was open county wide most services there had BLS trucks (2 basics) and then ALS trucks (either Medic/Basic or 2 medics). It did bring up a problem that the basics and some of the medics didn't know the basic protocols.
They did do an annual protocol test: When I did it as a basic I always took both, because the medics I worked with made me learn the ALS protocols so they could double check themselves against me. and as a medic I always took the Basic test, so that I knew them too.
Turned out some departments and services would let their employees take the tests open book. So they started giving the tests at the hospitals, with doctors watching them. Surprising how many failed them at that point.
They started training with them a lot more, and from what I understand they don't have a problem as much (I have been gone from there 11 years now).

Also agree with you on the awesome BLS scope of practice: except the IV part. We had a medic instructor that taught his 7 year old daughter how to do IV's and she was pretty good at it; better than her dad; Meds and IO's would be scary with little training.
 
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