National Scope of Practice

[fireflymedic]

Yes everybody, I think this is a good thing, however, I'm starting to wonder if we aren't digressing with the basics just a bit with it. Taking away their combi tubes, nitro (though I didn't like the idea of giving it without a line anyway even if BP was okay it could still really drop it), then adding IV's giving narcan, D-50, and sub Q and IM epi. I don't know about other states, but here our basics already hold most of those skills short of the IV's. Do they plan to do pharmacology along with these meds and increase the training along with it?

I'm glad we are moving towards having standard skills across the country and not having 50 levels of providers. On the flip side though, how many feel we are taking a step back in progression regarding basics or do you feel we are improving things with the institution of advanced emt as opposed to intermediates despite the reduced privledges (depending on I 85 or I 99). IV's, IO's, narcan, d 50, nitro, and of all things nitrous? All for people with just a few hours over basic training? How many hours will they add on to get people to this level and will bridges be offered? Also, my understanding was that critical care paramedic was going to be considered in the scope, but in the final outcome I'm not seeing it so are they refusing to recognize that certification or will it be simply an additional endorsement?

Any insight on this is appreciated. I know TN went to this (short of narcan which they are now considering) a few years ago and seem to have had good success, but it also eliminated first responders and almost did basics (no new certifications). Cross the border a bit and head to OH and you have basics intubating. GA, you can't even get on an ambulance without being at the I 85 level. These are just the states I have experiece with. How do you see this going over across the country and do you see some states bucking up and refusing to adopt the new standards? Give me some input.

[BEorP]

Who would want to give narcan?

[dougd]

Cross the border a bit and head to OH and you have basics intubating.

I've heard in southern OH and very rural areas this is true. It is taught as a basic skill up here, but I assure you, I don't know of a single medical director in the greater Cleveland area this is allowing basic's to intubate.

I'm not sure I like the idea of pulling the rescue airways. Although, with everything I've read in the forums here, it sounds like most of you don't think the combi-tube was really buying the patient anything more than an oral airway and effective bagging would have. If the patient is unresponsive to the point they'll actually tolerate one, you really need an ALS provider and an ETT anyways. However in communities that don't have ALS or ILS, this would probably be viewed as a "bad thing." Without research one way or another, it's difficult to make any sort of informed decision. (I might see a library search in my future tonight.)

Another step in the wrong direction, I believe, is moving BGL to the "Advanced EMT" level. If we can't agree that getting a d-stick is pretty basic stuff, we have a problem. On a squad running B/P, it frees the paramedic up to take care of other parts of the assessment and on a BLS squad it at least gives you an idea of what you're dealing with. Sure, if they're down far enough they're going to need a line, but if we can identify and treat our hypoglycemic patients before we have to move to an invasive intervention, I'm all for it.

do you see some states bucking up and refusing to adopt the new standards?

As long as the national registry's headquarters remains across the street from the Ohio EMS Board, I suspect we're going to see OH following whatever NREMT likes, regardless of what NHTSA publishes.

[Eydawn]

I've never really understood why the BGL is considered an advanced skill... I mean.. if you can teach grandma to do her BGL at home, why can't a Basic do it? It's another piece of information, even if they can't obtain IV access to correct it.

Thoughts?

Wendy

CO EMT-B

[AZCEP]

The national scope of practice is a myth.

It is the minimum that DOT curriculum adherent programs will educate to. Then the individual regulatory bodies will decide what is/is not acceptable locally. Chances are there won't be many changes to what is already in place anyway.

[Just Plain Ruff]

actually I made some phone calls the other night to various EMS agencies around Ohio and all of them said that they as EMT's with their medical directors approval were allowed to intubate pulseless apneic patients. If they don't meet the pulseless and apneic criteria then no intubation.

I'd have to look at who I called but there were several agencies who confirmed that their emt's could intubate on calls.

[dougd]

actually I made some phone calls the other night to various EMS agencies around Ohio and all of them said that they as EMT's with their medical directors approval were allowed to intubate pulseless apneic patients. If they don't meet the pulseless and apneic criteria then no intubation.

I'd have to look at who I called but there were several agencies who confirmed that their emt's could intubate on calls.

Oh, I'm not saying it isn't a basic skill in OH - it is. I'm just not aware of anyone around me that is doing it. If I moved an hour south, I'm sure I'd see it.

[afib]

i know jersey would have a giant issue with this, thats why i left. they are stuck in the stone ages. then again some of these people i wouldnt touching my dead cat.

[chute]

Until and unless all states can agree on standards, EMS in the US will never have a national scope of practice for EMS providers. Some states call it certification and some call it licensure however no matter where you work in the USA as an EMS provider, you still work under the auspices of a physician. Plus, no matter where you go to work as an EMS provider, you still have to take more tests and jump thru many hoops to work even if you have current certs etc. and it just is not commensurate with the responsibilities and pay/benefits. (unless you go fire or flight). Tough all around eh! I had NREMT and two current state certs plus all my cards, (ACLS,PALS,PHTLS,AMLS, CPR etc), and I moved to FL. They said great, we will allow you to take our state test ($85). Then when I could apply for a service, I had to take more tests etc etc. Its been the same in a few other states as well. Tough to travel as an EMS provider. Anyhow, ya gotta do it if you want to work thats just the way it is with EMS in this here good ole USA! Best to all EMS providers thanks!

[Christopher.Collins]

As an EMT-B in Connecticut I might as well be glorified first responder... and they dont train EMT-Is anymore either.

As an EMT-B in RI I can administer epi sub-cue as well as a few other meds.... inflate mast, intubate with the eoa and do some other stuff. And I believe an EMT-I there is practically a medic (just a few less narcs is the difference I believe)

These two states border eachother... any questions?