The final US NationalScope of Practice model/Draft..

[Ace844]

Hi All,

In case you haven't seen it here's the The National EMS Scope of Practice Final draft version 4....Does anyone else think it's lacking???? Also to be more active in the advocacy here's a link...:::EMS workforce for the 21st Century

Out here,

Ace844

[vs-eh?]

A few things...

- Are the education requirements changing? Or is this simply a national minimum scope of practice for each level? There will always be regional/state/county differences I assume in overall scope.

- AEMT looks like it is approaching PCP in Canada.

- The vent thing for EMT's? I don't agree.

- Venturi mask? I have only seen one outside of the classroom environment in close to 3 years, in all levels of practice.

- Pt. assisted med? Again, this must be an American thing. I still don't understand what that truely means. In theory yes, but I assume this is only for "symptom relief" meds....i.e. NTG, puffers....Not, "yes sir, let me help you to take your senokot, or something..."

- MAST/PASG? I have never seen one, and I assume they aren't used anymore.

AEMT

- IV appears not to include bolus or first time use of certain meds i.e. NTG. If not you eliminate I'd say 75% of it's uses.

- IO? meh, no point really unless you are working with a paramedic. Beyond that there is minimal (read < 1%) usage.

- Narcan. I have never only seen narcan given once. Never prehospital. And even if it somehow is required it is better to give it IM or SQ not IV...IV is for the controlled hospital environment or to reverse PAI using a narcotic. Support A+B prehospital and let the hospital sort it out.

[PRPGfirerescuetech]

A few things...

1.) The vent thing for EMT's? I don't agree.

2.) MAST/PASG? I have never seen one, and I assume they aren't used anymore.

1.) Why?

2.) Depending on the provider, and the service, sometimes are utilized quite frequently. Rarely, in my experience, are they used for traumatic hypotension, and more for splinting of suspect pelvic fx's, bilateral hip fx's and such...

[Ace844]

1.) Why?

2.) Depending on the provider, and the service, sometimes are utilized quite frequently. Rarely, in my experience, are they used for traumatic hypotension, and more for splinting of suspect pelvic fx's, bilateral hip fx's and such...

Seems to me we recently had a "spirited" discussion about this not to long ago as well..!?!?!?

[PRPGfirerescuetech]

Seems to me we recently had a "spirited" discussion about this not to long ago as well..!?!?!?

Which is the reason why I didnt go in too deep with it.

I have a question for everyone...does anyone know of any states that havent fallen in line? Or is everyone working to adopt this and make it a true standard.

[Dustdevil]

Has it even been accepted by the committee? After all, this is the fourth version that has been titled the "final" draft. And if it is truly only a draft, who would rush to adopt it? And why?

This thing started out with a wonderfully noble purpose of elevating the profession and assuring that high minimum standards are met across the board. Unfortunately, it has become nothing but a political football, being tossed about haphazardly -- mostly reverse and laterally -- on a field occupied by more than the usual two teams. And as always happens in these bush league kids games, the biggest a-hole on the playground (IAFF/IAFC) wants to just take his football and go home without even playing the game.

Of the educators and administrators I have talked with, I have found none who are the least bit interested in rushing to adopt any of this. In fact, most threw their hands up months ago.

[PRPGfirerescuetech]

If I had to guess, it will be adopted for the same reason that many other legislative "reccomendations" have passed.

The federal government will threaten to withdrawl federal highway funds, federal openspace funds, or any other federal (insert cause name here) funds necessary to cause the good ole' fiddy states to collectively wet themselves and become obedient.

[Ridryder 911]

As a former bureaucrat I am assure it is being used as a political ace in the hole. ...Some reason or another some one (or group) really wants this pushed through. I too do not agree with basics using a vent and the EMT Advanced administering NTG... ( oh great her comes the hypotension!) I see they are trying to introduce licensure to each state with allowances of credentialing. This will be a shot in the arm for our professional status. Like Dustdevil said this has been kicked around... we will see since it states it will have no jurisdiciton ... then describes states training shall adhere to minimal standards as close as possible. ... hmm a little double talk?

Be safe,

R/R 911

[Dustdevil]

The federal government will threaten to withdrawl federal highway funds, federal openspace funds, or any other federal (insert cause name here) funds necessary to cause the good ole' fiddy states to collectively wet themselves and become obedient.

That's a very good point, with significant historical precedent. But I don't see it as a problem, really. What will be pushed is that the states will have to meet that changed minimum standard, which is *mostly* a good thing. But again, I don't see this affecting anybody as far as limiting their potential for advanced practice standards on a local level.

Rid also makes an excellent point in that the problem is that there seems to be some push for increased ALS skills by basic providers without a significant increase in educational standards. Increasing the capability of entry level providers is a wonderful thing, and I am all for it. But if it is done on a piece mail basis, without appropriate educational increases, then I wholeheartedly oppose it. And the more progressive states will do so also, regardless of what this committee of politicians disguised as fire chiefs says.

[PRPGfirerescuetech]

That's a very good point, with significant historical precedent. But I don't see it as a problem, really. What will be pushed is that the states will have to meet that changed minimum standard, which is *mostly* a good thing. But again, I don't see this affecting anybody as far as limiting their potential for advanced practice standards on a local level.

Rid also makes an excellent point in that the problem is that there seems to be some push for increased ALS skills by basic providers without a significant increase in educational standards. Increasing the capability of entry level providers is a wonderful thing, and I am all for it. But if it is done on a piece mail basis, without appropriate educational increases, then I wholeheartedly oppose it. And the more progressive states will do so also, regardless of what this committee of politicians disguised as fire chiefs says.

I absolutely agree. To piecemeal skills together without giving the appropriate education is a disaster waiting to happen.

I can see this effecting each state differently, depending on their current scopes of practice, educational standards, and levels or limitations of education.

Every state will have to develop bridge courses, transition courses to bring their perspective levels to par with the NSOP. Each state is subsequently going to be effectively.

This is a great idea, everyone will implement it im sure.

Its just going to be a nightmare during the transition.

IMHO-PRPG