Noloxone...should EMT-I's be able to administer?

[Asysin2leads]

Just thought I'd clarify something here and try to strenthen Candian-American relationships.

In Canada, the lowest level provider, what they consider "BLS", the PCP, is far more greatly trained than an American EMT-B. Its really comparing apples to oranges. I only learned this after reaming out a Canadian "BLS provider" for not calling ALS on a chest pain patient even if the transport time was short when he informed me ACP's can start lines, give nitro, aspirin and run 3 leads, which if you have a short transport time on a chest pain patient is just fine, of course.

There's an article about Canadian EMS here

http://en.wikipedia.org/wiki/Paramedics_in...Care_Paramedics

Personally I think us Yanks could borrow a page from them. How much good could we do if the lowest level of provider on an ambulance was akin to a PCP? How great would that be? Okay, continue debating, so long as everyone is informed. I'll bring the hot dogs and the hamburgers, they can bring the poutein, some Moosehead beer, and some of those chicks from Smallville. Especially Lana. Please bring Lana.

[hammerpcp]

Hammer; Yes, I agree with you. I'm well aware that there is always a higher level of care. This is one reason why I want EVERY ambulance to be ALS, with CCPs doing intercepts. This is purely a Canadian training thing, but still.

Again, its a monetary issue. Ideally we would all be doctor-medics riding around on the ambulances.

Secondly, although I do not have flumazenil at hand to counteract the potential apnea received from one of the benzos I may elect to give, I do have at my disposal advanced airway management techniques (ETT, LMA, surgical cric to name a few) as well as a thorough and comprehensive understanding of respiratory physiology and airway maintenance procedures. Not only that, if I'm administering this medication, I can anticipate any side effects and include that in my prealert to the receiving facility..

I'm not sure how intubation made its way into this discussion, and we weren't talking about Valium either. As far as anticipating side effects of medications you administer that applies to everyone and all medications. Did you administer NTG as a PCP without knowing the potential adverse reactions? I hope not, since that is part of the PCP skill set. Also, many PCP's have LMA's and combitubes in there repertoire. And surgical crics? Have you ever done one? Never mind, that is off topic.

Third, as scaramedic stated, Narcans half-life is MUCH shorter that most opiates. So perhaps in an extreme case, if I'm transporting this terminal cancer patient (come on, let's get away from the stereotypical heroin junkie) who's overdosed on their morphine, purely out of a palliative attempt, and I've maxed out my protocol, I still can ensure proper airway management through intubation. Can you?

You wouldn't contact BH for orders? Airway management without intubation is not ideal, I don't dispute that. What the hell are we talking about here anyway? Narcan is good, and so is IV access.

And, my logic is not flawed thank you very much. My logic is as follows: "Not always right, but never unsure."

It's good to be convinced and unwavering about something that is untrue. :roll:

peace

P.S. Trust me, you're not the first to have thought of the 'morphine for withdrawal'

edits: TOO many spelling errors

I say morphine for everyone!

[daisypr]

I don't know but it seem to me that the problem in here is there aren't standars protocol for all USA

every coutry or state has different Protocols or systems for example In some states, the emt b can use

glucometer or pulse oxymeter and in others they can't. I think this is problem we are driving the same car

in differents routes without any results. I read yesterday an article that in Boston the emt b

are using Nasal Narcan 2mg(n as a trial with wonderful results. Every system has different rules or

Protocols that's when you came from others states or coutries you have to start over for example:

I was paramedic in Puerto Rico when I came here I had to start over again I passed the emt-b

at once and I know the people from here who didn't. That's mean to me that I was well trained in there, also

I had a classmate who came from Texas and had the same situation. but if you are a nurse

the rules are differents you can work in any State if you want to (travels nurses) and they also

import nurses from others countries I think this is not fair for us. In here CT the emt b can't use pulse oxymeter

or glucometer but in PuertoRico you can, as far as I know.

You see this not make any sense we are back and foward all the time that's we can expend all day debating

without any Results :roll:

[Lithium]

Medibrat, again, I think this discussion has been beaten to death in other threads. By allowing PCPs to have expanded scopes, it's allowing communities to arrest their citizens of true ALS care. Even Lasix has it's side effects. Have you ever seen someone develop an dysrythmia because you attempted to diurese them, not realizing they were already potassium depleted? How are you going to correct that? Wait for an arrest? I must digress ... Oh yes, and about my 2 mg IV ... come on, I was a student

Hammer, a few points. First, doctor medics? Ha ... come on now, Im sure you know what its like to have 2 ACPs on scene arguing. Could you imagine what it would be like if we were all MDs treating patients in the field, then trying to hand off care to another MD 20 minutes later at the hospital? Oh boy ...

No, we weren't talking about Valium. You brought up the issue that ACPs don't have antagonists to benzos (romazicon for instance), I was just trying to impress upon you that although the benzos we administer may cause apnea (among a plethora of other effects), we do have the ability to secure an airway more effectively then a PCP.

Again, no, I would not contact BHP for more orders of narcan. To me, if 2 mg isn't having a response on this patient, then there's some other etiology happening, I'm not just gonna keep giving this patient more and more. This is another issue, Narcan (atleast in Ontario) is thought of as a diagnostic aid. If the patient responds to it, you can most likely suspect it was just an overdose. If the patient doesn't ... keep looking.

Yes, both Narcan and IV access are good, but not for glorified PCPs.

Concerning my logic, that could be a whole other issue not suitable for these forums ...

Morphine my friend? No thanks ... I say haloperidol

peace

[Dustdevil]

but if you are a nurse the rules are differents you can work in any State if you want to (travels nurses) and they also import nurses from others countries I think this is not fair for us.

Oh how I wish we could freely import medics from other countries! Let them all in, I say! Flood the market with them! Then all the slugs that are already here will have to either elevate their game or get out. And there will be much rejoicing!

In here CT the emt b can't use pulse oxymeter or glucometer but in PuertoRico you can, as far as I know.

They can't treat it. Why should they be encouraged to sit on a scene with a patient and hook him up to machines that do not treat him? The hospital is going to run it all over again. Hell, why don't we just do MRI's and CAT scans in the ambulance? Sure, we can't treat anything we find, but hey, since when did that ever matter to EMT's?

[akroeze]

They can't treat it. Why should they be encouraged to sit on a scene with a patient and hook him up to machines that do not treat him? The hospital is going to run it all over again. Hell, why don't we just do MRI's and CAT scans in the ambulance? Sure, we can't treat anything we find, but hey, since when did that ever matter to EMT's?

I'm sorry but are you saying that your EMT-Bs can't even correct Hypoxia and Hypoglycemia??

[JakeEMTP]

I'm sorry but are you saying that your EMT-Bs can't even correct Hypoxia and Hypoglycemia??

Sure they can. O2 for Hypoxia, oral glucose for Hypoglycemia and a diesel bolus to the ED.

[Sassafras]

Is it just me or is this thread going no where fast... amazing the vote is pro EMT- I's administering it, but no major rationale as of yet.

Exactly what I've been thinking. :roll:

[Dustdevil]

I'm sorry but are you saying that your EMT-Bs can't even correct Hypoxia and Hypoglycemia??

Depends on their local system. But no, the standard scope for most EMT-B's in this country does not include any injection except for an Epi-Pen, and even then, usually only if it is prescribed to the patient.

As for hypoxia, yes they can correct it, but they are not given adequate education to assess and evaluate it utilising pulse oximetry. And the use of a pulse ox only encourages them to treat the machine instead of the patient. Their patients should be getting oxygen regardless of what a pulse ox says, so the expense of the machine and the time expended dicking around with it on a scene is too costly.

What do you expect out of 110 to a maximum 250 hours of training?

[akroeze]

Depends on their local system. But no, the standard scope for most EMT-B's in this country does not include any injection except for an Epi-Pen, and even then, usually only if it is prescribed to the patient.

As for hypoxia, yes they can correct it, but they are not given adequate education to assess and evaluate it utilising pulse oximetry. And the use of a pulse ox only encourages them to treat the machine instead of the patient. Their patients should be getting oxygen regardless of what a pulse ox says, so the expense of the machine and the time expended dicking around with it on a scene is too costly.

What do you expect out of 110 to a maximum 250 hours of training?

I can see your arguement for the pulse ox and conceed the point

The other though... what if you have someone who is slightly confused, part of your "routine work up" is to do a BS on this pt. You find them to by hypoglycemic so get them something sweet to drink thus correcting it.