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Do you allow your Basics to perform ALS Skills?


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Depends on what is classified as "ALS" remember, each state is different....in PA its ALS to "prick a finger" for a blood glucose....

I never even thought of that but that's a good point. In NM EMT-Bs can give IM/SQ Narcan and Epi, Neb Albuterol, use LMAs, Combi, and EOA, and do finger sticks for CBG all on standing orders. EMT-Is can do that and use IV as a med route. I guess in some states what my old states EMT-Bs do could be very much considered ALS

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Depends on what is classified as "ALS" remember, each state is different....in PA its ALS to "prick a finger" for a blood glucose....

I never even thought of that but that's a good point. In NM EMT-Bs can give IM/SQ Narcan and Epi, Neb Albuterol, use LMAs, Combi, and EOA, and do finger sticks for CBG all on standing orders. EMT-Is can do that and use IV as a med route. I guess in some states what my old states EMT-Bs do could be very much considered ALS

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New Zealand Ambulance Officers can only deliver care from a higher scope of practice while they are in the applicable education program and supervised by an Officer of equal or higher Authority to Practice.

For example Technician to Paramedic or Paramedic to Intensive Care Paramedic can perform the delegated interventions in the next step up on the Clinical Pathway only when supervised.

So, the short answer is no, and no I do not think it is a good idea for them to be doing it any other way.

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The EOA is not on the NM EMS procedural guidelines for any level of provider.

Take care,

chbare.

My mistake there. I was using the copy of SOP that I have on my HDD from before I moved. It had PTLA, EOA, Combi, and LMA. Looks like they finally took out EOA and added King (which was not allowed when I left NM earlier this year by any service. The date on the new ones on the website say 2008 but I wasn't certified until Jan 2008 and we were flat out told in all my education following that that Kings were not allowed in NM at that point. I dunno. I'll just smile and nod and stand corrected.

EDIT: Looking over the SOP from NMEMS.org, it looks like EOA might still technically be in scope since it can be classified as a supraglottic airway device. My first service I worked at still had a few of those laying around, fun to play with on a dummy :)

Use of multi-lumen, supraglottic, and laryngeal airway devices (examples:

PTLA, Combi-tube, King Airway, LMA)

Edited by JTpaintball70
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EMT's can hardly fart in BLS protocols. As I said finger stick we cant "legally" do, as well breathing treatments. Now in Illinois EMTs can, which is what hit jess with a brick wall when she 1st came to PA from there. Just last year EMT's in PA where allowed to use CPAP.

check out our BLS protocols

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I guess I'm not completely clear on what's BLS vs ALS either. Though, thank goodness my partner understands his role down to the letter.

If pushing ALS drugs is ALS then my BLS partner does it all the time. I believe, though have never researched it, that my partner can push any ALS drugs as long as it's supervised by a medic. He can not tech those pts to the hospital, but he can push the drugs.

Common COR scenario for us. My partner begins CPR while I attach the monitor, or vice verse, CPR is continued (we have QRT, Quick Response Teams that are trained to the first responder or basic level) by QRTs, my partner grabs the drug box while I set up for intubation, while I intubate he gets vascular access, (unless in the rare case that that requires I/O and then I gain access, though he preps it for me.) normally intubation and access happen near the same time, he runs the ACLS protocols, as he knows them as well as any medic at our service, I monitor the monitor, CPR, affirm the meds he calls before he pushes them and acknowledge that they have been pushed, rotate everyone in and out on ventilation and compressions and adjust where necessary, and then make the decision to move, stay on site, or call the arrest in place.

If that is what you mean, then yeah, my BLS partner does ALS procedures regularly. He doesn't intubate, though he's got more than 10 live intubations, he doesn't tech pts with anything more than BLS interventions on board, but other than that he's at least as smart as I am and participates in every other way. I don't consider him an 'average' BLS partner, but these are the things he does.

Is that what you were looking for?

Dwayne

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I am a little wary of our Technician level Officers utilising thier scope of practice (LMA, glucagon, ondansetron, paracetamol, salbutamol, ASA, GTN, methoxyflurane) and they have probably triple the education of your American EMT.

... so that considered, do we really 120 hour wonders doing anything "advanced"?

Edited by kiwimedic
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... so that considered, do we really 120 hour wonders doing anything "advanced"?

I'm guessing that the answer to your question is in my response to the thread. In a full arrest my partner is as qualified, or more so, than any advanced provider. He's not a 120hr wonder, he's a basic with 16yrs experience, and that seems to make a difference, at least to me.

What is the down side to him pushing meds while I manage the parts of the call that have been more scientifically proved to be effective? All of this assumes of course that i've verified my partners competency to push the meds mentioned. It really is not rocket science to pull a med, verify it, draw it up or prep it, verify it again, prepare to push it, verify it, and then push it in the manner most appropriate. (IVP, IVSP etc) Right?

I ran a COR (full arrest) with a brand new basic on our team. After I'd intubated I told him, "Your job now is to ventilate this pt. What that means is that you give a breath on every count of '6' and make sure that that tube doesn't shift from 23cm. Do you understand?" He bagged as asked, exactly, and I watched him as the pt regained pulses and everyone got excited, yet he never looked away from his tube, the duty I'd given him. Given another dozen or so experiences like that and I've no issues allowing him to push my drugs. See?

Dwayne

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I would like to add a few things to this topic as it is one I think about alot.

I am a Basic, not in para school, just your run of the mill basic. We have ALS support w/ chase vehicle in my local system. in NJ all ALS is hospital based and BLS is town based. So know you know a little of where I am coming from....

On the topic of ALS vs BLS SOP in NJ anything above giving an Epi autoinjector is considered ALS. No blood glucose, no asprin, nothing. Even NTG has to be "assisted" and the Pt own Rx. Inhalers (albuteral and the likes) we can watch you do it (pt that is) and monitor vitals. So in my system I do feel Basics should be allowed to at least take blood glucose levels, administer asprin, give NTG when indicated, give albuteral and the like for respitory patients when indicated. Above that I feel we should keep our hands to ourselves. ALS is ALS for a reason, they know the modalities, the pathways, the meds inside and out. Not because of some course they took but because of actual schooling and clinical rotations. I would not dream of infringing upon their area because I, as a basic, have not the skills or the experience to do their things.

Do they let us assist? Yes actually. But I must clarify, we ASSIST THEM, not do their things. They try and keep it all within our levels SOP but know a hand now and them is necessary. I will provide an example of what i am talking about. They will let BLS help with an IV, we (meaning BLS) will hang the bag they handed to us and get the line ready for the drip while they (meaning ALS) is inserting the IV and doing what they have to do. I then hand them the line from the bag, they clear it and attach. I didnt exceed my SOP and he didnt allow m,e to violate his. I just lent a hand where it was needed. As Dwayne said in a post about bagging a tubed Pt. We do that alot. ALS does all the intubation and then hand us the bag and tell us what they would like, every 4, every 6, what-have-you. Again not outside my SOP and not infringing on theirs. Usually the ALS crews have worked with us before so they kind of know our skill sets. My squad has BLS's with over 25 years experience so ALS almost doesnt have to ask them to do something its just done. Me? They teach me like a 4 year old and you know what, I am glad for that. Just because the bag goes on the hook, they dont assume I know it properly so they tell me what to do and I do it. This to me is great, i get the practice, knowlege, and skills to assist them and learn to do it correctly.

As far as meds go.. we only get the empties to verify for the PCRs what it is (can the make the names easier, sheesh) and the dose. Do we get to do anything with them... hell no. Closest I ever came to that was holding the syringe for the Medic while he was on with medical control and reading the meds off to them for verification. I'll tell you what, just holding it made me nervous. Only because of lack of experience. Now if i do it more I will feel more comfortable and it will be easier to lend a hand.

I feel certain things I should be allowed to do. Prick someones finger for a glucose level I dont feel needs to be done by ALS I feel a BLS should at least be allowed to do that. Now are their instances when it would be advisable for ALS to be there? OF COURSE, get someone with a 20 on the meter and I want my ALS buddies there to push the meds that they do. I cant give the glucose to an unresponsive so at that point it would be in the Pt best interest to have ALS there. Now if Im called to the house of a diabetic thats fully responsive but is feeling off then it would be benifical to both the Pt and me to take a quick test, see the level, administer glucose, wait a few minutes, retest and see where we stand. I have provided a good level of care, I have trends to monitor for both the Pts wellbeing, my knowlege, and the hospitals knowlege through the PCR. Another example, chest pain call. We get there, Pt describes 10/10 elephant on chest BP is over 100 no ED meds taken but is out of his Nitro pills. I feel a BLS should have them or asprin onboard and be able to administer a dose and do everything thats in our SOP. Which we can do if the pills are the Pts Rx. My only change is we as BLS should be able to carry them onboard. Would I still have ALS meeting me, YES, but in the mean time at least the Nitro or Asprin can do its work as a vasodialator and help the herat work less which would give the Pt more time to get to an ED without potential heart damage. Fine you dont want us having nito then at least bayer low dose, might not be much but something is better then nothing until the ALS meets us enroute, if they are available, and can push IV meds.

I feel we should all work inside our own SOP but be able to lend a hand, within reason, to one another. I think the examples I gave are reasonable and not stretching the rules into a grey area.

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