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

[FireGirl911]

Nahhh, it's more fun to sling insults at each other. :roll:

That is a pretty detailed protocol FireGirl911, scaramedic is impressed. Do not take anything here personal, you walked into the middle of a pretty heated debate.

13 pages so far, that's one page short of the record for EMS discussion. Go team! :wav:

Peace,

Marty

:thumbleft:

Well let's see if we can push it to 14 then............................................................................

...........................................

Yup, New Mexico has an amazing scope, which I have attached just to fuel the fire... :twisted:

F. EMS First Responders (EMSFR):

(1) The following allowed skills, procedures, and drugs may be performed without medical direction:

(a) Basic airway management.

( Use of basic adjunctive airway equipment.

© Suctioning

(d) Cardiopulmonary resuscitation

(e) Obstructed airway management

(f) Bleeding control via direct pressure

(g) Spine immobilization; basic splinting.

(h) Scene assessment, triage, scene safety.

(i) Use of statewide EMS communications system.

(j) Emergency childbirth.

(k) Glucometry

(l) Oxygen

(2) Medical direction is required for the following items :

(a) Allowable Skills:

(1) Mechanical positive pressure ventilation.

( Allowable Drugs and Routes:

(1) Oral glucose preparations.

(2) Aspirin PO for adults with suspected cardiac chest pain.

© Service Medical Director Approved:

(1) Semi-automatic defibrillation (including rhythm documentation of cardiac activity).

(2) Insertion of the laryngeal mask airway

(3) IM drug administration by auto-injection device

(4) IM auto-injection of the following agents for treatment of chemical and/or nerve agent exposure

(i) atropine

(ii) pralidoxime

(5) Albuterol via inhaled administration

(d) Wilderness Protocols: The following skills shall only be used by providers who have a current wilderness certification, from a Bureau approved Wilderness First Responder Course, who are functioning in a wilderness environment as a wilderness provider (an environment in which transport time to a hospital exceeds two (2) hours, except in the case of an anaphylactic reaction, in which no minimum transport time is required.), and are authorized by their Medical Director to provide the treatment.

(1) administration of epinephrine

(2) minor wound cleaning and management

(3) cessation of CPR

(4) field clearance of the Cervical-spine

(5) reduction of dislocations resulting from indirect force of the patella, digit, and anterior shoulder

G. EMT-BASIC (EMT-:

(1) All items in the EMS First Responder scope of practice

(2) The following allowed skills, procedures, and drugs may be performed without medical direction:

(a) Emergency procedures as taught in standard EMT-B courses.

( Splinting.

© Wound management.

(3) Medical direction is required for the following items:

(a) Allowable Skills:

(1) Use of multi-lumen airways (examples: PTLA and Combi-tube)

(2) Pneumatic anti-shock garment. *

( Allowable Drugs and Routes:

(1) Activated charcoal PO.

(2) Acetaminophen PO in pediatric patients with fever

© Service Medical Director Approved:

(1) Transport of patients with nasogastric tubes, urinary catheters, heparin/saline locks, PEG tubes, or vascular access devices intended for outpatient use.

(2) Administration of naloxone by SQ, IM, or IN route

(3) Administer the following drugs under on-line medical control. When on-line medical control is unavailable, administration is allowed under off-line medical control if the licensed provider is working under medical direction using approved written medical protocols.

(i) Epinephrine, 1:1000, no single dose greater than 0.3ml, subcutaneous injection with pre-measured syringe or 0.3ml TB syringe for anaphylaxis or status asthmaticus refractory to other treatments

(ii) Administer a patient’s own sublingual nitroglycerine for unrelieved chest pain, with on line medical control only.

H. EMT-INTERMEDIATE (EMT-I):

(1) All items in the EMT-Basic scope of practice

(2) Medical direction is required for all items in the EMT-Intermediates scope of practice

(3) Allowable Skills:

(a) Peripheral venous puncture/access.

( Blood drawing.

© Pediatric intraosseous tibial access - May be used only after two peripheral intravenous attempts have failed or if there is no reasonable possibility of securing peripheral intravenous access. Limited to one attempt, unless second attempt authorized by online medical control at the receiving institution.

(4) Allowable Drugs and Routes:

(a) Administration of approved medications via the following routes:

(1) Intravenous.

(2) Nebulized inhalation.

(3) Sublingual.

(4) Intradermal

(5) Intraosseous tibial infusions in pediatric patients.

(6) Endotracheal (for administration of epinephrine only, under the direct supervision of an EMT-Paramedic, or if the EMS service has an approved special skill for endotracheal intubation).

( I.V. fluid therapy (except blood or blood products).

© 50% Dextrose - intravenous

(d) Epinephrine (1:1000), subcutaneous for anaphylaxis and known asthmatics in severe respiratory distress (no single dose greater than 0.3 cc).

(e) Epinephrine (1:10,000) in pulseless cardiac arrest for both adult and pediatric patients. In pediatric patients may be given IO in 1:1000 concentration per PALS protocols. Epinephrine may be administered via the endotracheal tube in accordance with ACLS and PALS guidelines.

(f) Nitroglycerin (sublingual) for chest pain associated with suspected acute coronary syndromes. Must have intravenous access established prior to administration.

(g) Morphine, for use in pain control with approval of on-line medical control.

(h) Diphenhydramine for allergic reactions.

(i) Glucagon, to treat hypoglycemia in diabetic patients when intravenous access is not obtainable.

(j) Promethazine

(5) Drugs Allowed for Monitoring During Transport:

(a) Monitoring I.V. solutions during transport that contain potassium (not to exceed 20 mEq/1000cc or more than 10 mEq/hour).

(6) Immunizations and Biologicals: Administration of Immunizations, Vaccines, Biologicals, and TB skin testing is authorized under the following circumstances:

(a) To the general public as part of a Department of Health initiative or emergency response, utilizing Department of Health protocols. The administration of immunizations is to be under the supervision of a public health physician, nurse, or other authorized public health provider.

( Administer vaccines to EMS and public safety personnel

© TB skin tests may be applied and interpreted if the licensed provider has successfully completed required Department of Health training.

(d) In the event of disaster or emergency, the State EMS Medical Director or Chief Medical Officer for the Department of Health may temporarily authorize the administration of other immunizations, vaccines, biologicals, or tests not listed above.

I. EMT-PARAMEDIC:

(1) All items in the EMT-Intermediate scope of practice

(2) Medical direction is required for all items in the EMT-Paramedic scope of practice

(3) Allowable Skills:

(a) Direct laryngoscopy.

( Endotracheal intubation.

© Thoracic decompression (needle thoracostomy)

(d) Surgical cricothyroidotomy.

(e) Insertion of nasogastric tubes.

(f) Cardioversion and defibrillation.

(g) External cardiac pacing.

(h) Cardiac monitoring.

(i) Use of Infusion Pumps.

(j) Initiation of blood and blood products with on-line medical control.

(4) Allowable Drugs and Routes:

(a) Administration of approved medications via the following routes:

(1) Intraosseous

(2) Topical.

(3) Endotracheal.

(4) Rectal.

( Adenosine

© Amioderone

(d) Atropine Sulfate.

(e) Benzodiazepines

(f) Bretylium Tosylate .

(g) Calcium preparations.

(h) Diphenhydramine

(i) Dopamine Hydrochloride

(j) Epinephrine

(k) Furosemide

(l) Glucagon

(m) Lidocaine.

(n) Magnesium Sulfate.

(o) Narcotic analgesics.

(p) Oxytocin.

(q) Phenylephrine nasal spray.

® Sodium Bicarbonate.

(s) Thiamine.

(t) Topical anesthetic ophthalmic solutions.

(u) Vasopressin.

(v) ipratropium

(5) Drugs Allowed for Monitoring in Transport: Requires an infusion pump when given by continuous infusion unless otherwise specified.

(a) Potassium (no infusion pump needed if concentration not greater than 20mEq/1000cc)

( Fibrolytic Drugs (i.e., tPA, streptokinase, etc.).

© Procainamide.

(d) Heparin.

(e) Mannitol.

(f) Blood and blood products. (no pump required)

(g) Aminophylline.

(h) Antibiotics.

(i) Dobutamine

(j) Sodium Nitroprusside

(k) Insulin.

(l) Terbutaline.

(m) Norepinephrine

(n) Glycoprotein IIb-IIIa inhibitors/antagonists

(o) Octreotide

(p) TPN

(q) Beta blockers

® diltiazem

(6) Skills Approved for Monitoring in Transport.

(a) Internal cardiac pacing.

( chest tubes

(7) Medications For Administration During Patient Transfer.

(a) Retavase (second dose only).

( Protamine Sulfate.

© Non-depolarizing neuromuscular blocking agents in patients that are intubated prior to transport

(8) Patient’s Own Medication that May be Administered

(a) epoprostenol sodium

Pretty amazing huh?

**did we do it? did we make 14?**

Marty, thanks for the kindness.

[Dustdevil]

Congratulations. You have just shown yourself to believe in the number one most hated thing on this board: all scope and no education. "Skills" based medicine without a sufficient concern for the knowledge foundation of the practitioners. Doing things "because we can" as opposed to "because we should." All that is required for any medical intervention is a protocol saying "we can." Nice. :roll:

Your skillset is not a penis extension. It will not compensate for the shortcomings of your education. I don't care what your monkeys have been "trained" to do. I want to know how well they have educated in order to make the sound clinical judgements (not following a cookbook recipe) necessary to safely provide advanced life support.

Want to impress us? Show us a breakdown of the EMT curriculum that is required of your people practising at this level. Show us that they had at least as much medical education required before putting drugs into human beings as they had fire training before squirting water on grass fires. I'd bet money it doesn't even come close.

[FormerEMSLT297]

I have been a medic for 20 years,,,, i worked in a very heavy herion OD area... and used it dozens and dozens of times... Im not going to belabor the point but i agree with chbare and others, medics who give this med must be grounded in its effects, actions, etc.... and there have been times when we withheld Vitamin N or gave just a 0.4 or .8 to prevent some of the more serious problems. So, if EMT-I's want to give this med. they must not just shoot in the dark,, they/you have to understand the potential harm you can do and the potential harm the patient, whom you awake and or arouse from a drug induced high, can do to you and your crew if vitamin N is used improperly.

Remember, Do no harm, dont be a cook book medic.

Former

[PRPGfirerescuetech]

I have been a medic for 20 years,,,, i worked in a very heavy herion OD area... and used it dozens and dozens of times... Im not going to belabor the point but i agree with chbare and others, medics who give this med must be grounded in its effects, actions, etc.... and there have been times when we withheld Vitamin N or gave just a 0.4 or .8 to prevent some of the more serious problems. So, if EMT-I's want to give this med. they must not just shoot in the dark,, they/you have to understand the potential harm you can do and the potential harm the patient, whom you awake and or arouse from a drug induced high, can do to you and your crew if vitamin N is used improperly.

Remember, Do no harm, dont be a cook book medic.

Former

Has anyone yet asked how long, or how intensive firegirls education is? Im hoping not were not jumping the gun, assuming she is of a lackluster breed.

Im comfortable saying this, haven already given my opinion.

Firegirl, is the EMT-I course in your state the NREMT standard, or is there additional didactic and practum education applied?

Of course, im aware of the answer, but the bases should get covered...

[chbare]

PRPGfirerescuetech, I cannot speak for FireGirl911's education, but I graduated from a New Mexico approved EMT I course in February 2006. We were able to take the NREMT-I/85 written and practical exam. (and had too for the military) The anatomy, physiology, and pharmacology was pretty basic and the course was about 216 hours long. It was designed for Army National Guard Medics so it may have differed from the standard New Mexico EMT-I curriculum, but it was still a NM approved course.

Take care,

chbare.

[EMS49393]

216 hours! It can't be. That has to be a mistake. You mean 216 hours is enough to perform invasive procedures because you feel like it, and jack with someones homeostasis because you can? I've had well over 1500 hours didactic coupled with several hundred hours of clinical rotations in EVERY department in the hospital. Seems to me that I got screwed. I could be having all this fun for 216 hours instead. What a jip. (By the way, that's sarcasm.)

I want a refund.

[EMS49393]

I started the 14th page. :wav: Snoopy dance time!!

[itku2er]

Well...

IF you dont like the system......then FIGHT to change it....dont keep bellyaching about how you dont like this or you dont like that and you shouldn't do this or you shouldn't do that..Then come back and we can talk.... :roll:

THE SQUEAKY WHEEL GETS THE GREASE....

Just my $0.02 worth....

[JPINFV]

Well...

IF you dont like the system......then FIGHT to change it....dont keep bellyaching about how you dont like this or you dont like that and you shouldn't do this or you shouldn't do that..Then come back and we can talk.... :roll:

THE SQUEAKY WHEEL GETS THE GREASE....

Just my $0.02 worth....

Well, maybe some of us DO have plans. We're just a few or more years away from being in any sort of place to even attempt to implement it.

[AZCEP]

The difficulty in changing the system is not simply a matter of making more noise about how it needs changed. Even with the latest revision to the National Scope of Practice, it was pretty obvious that legislators are unwilling to increase requirements at the expense of those that think they are adequately trained.

Most are still holding to the idea that an intermediate is adequate to provide ALS more affordably than full paramedic service. So, reduce the requirement, you get EMT-I instead of EMT-P. Education isn't as expensive, it doesn't take as long to get through class, and the reduction in care won't be readily apparent.

Now, let's say, this EMT-I decides to move to another state, or even a different part of their current state. They can't find a job that allows them to practice. The new location's medical direction doesn't recognize the intermediate level. What are they to do? They usually are given the option of dropping to the basic level or taking a full paramedic course.

Either way more money is lost. Drop to basic, accept the fact that the intermediate course you took was a waste of time/money, and take a lower paying position. Advance to paramedic, accept the fact that the intermediate level was a waste of time/money when you first took it, lay out more cash to get through class, find a paramedic level position somewhere, and not come close to recouping the lost revenue.

Not such a simple thing to fix, now is it. The fix definitely needs to happen, but until you can get more lawmakers to agree that standards need to be the same for everyone, it will never happen as it needs to.