Asysin2leads Posted June 16, 2006 Share Posted June 16, 2006 Okay, ummm, someone's going to have to clue me in here, stupid old paramedic me... Did I read that Rhode Island allows basics to administer Epi-pens for treatment of COPD? Just what in the wide, wide world of sports is going on here? I mean, I thought it was a pretty much a given in prehospital emergency care the equation COPD = Old person + (multiple health problems x almost certain cardiac problems) and therefore we should NOT go hitting them with the most powerful, non specific sympathetic agonist we have in our arsenal, which is epinephrine 1:1000. So, please, someone, tell me what the FUCK is going on, because I'm starting to doubt my own sanity now after reading this thread. Seriously, I had to go pull my protocols off of my shelf to look at our COPD protocol, and as I had thought, it is identical to the Asthma protcol except that its MISSING the IM/SQ injection of 0.3 mg Epinephrine 1:1000, along with magnesium sulfate infusion. So, you know, we here west of Connecticut pretty much consider epinephrine contraindicated in someone presenting with an exacerbation of COPD. I don't know about things is Rhode Island, maybe people have different anatomy or something, or maybe the state EMS council is trying to close the Medicare budget gap by offing a few old people. Somebody please weigh in on this, my head hurts, I need a drink and I then I'm going to go lay down for a while. Link to comment Share on other sites More sharing options...
Scaramedic Posted June 16, 2006 Share Posted June 16, 2006 Your not crazy Asysin2leads, I had the same thoughts. When the Rhode Island protocols refers to COPD, they put it under the same heading as Asthma. With a medical control contact for pts over 50. I'm assuming they cover emphysema, chronic lung disease under a different protocol. I would look it up but its bed time. Peace, Marty :sleepy2: Link to comment Share on other sites More sharing options...
whit72 Posted June 16, 2006 Author Share Posted June 16, 2006 I work in MASS now. I have not worked in RI in some time. Oh not only EPI pens, EPI im from multi dose bottles. Another drug given IM. They even think we can correctlly draw up a med with a syrynge. Like I said I dont make them up but they are there. I am really suprised no one has commented on the fact that we are allowed to Use a lifepack 10,12 for diagnostic and defib. purposes W/vifib, and pulseless V-TACH. Or that we are allowed to ETI with a 16 hour add on class. No one has a problem with this, but there worried about us giving glucagon IM. And thanks to all to who had somthing constructive to add to this debate. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted June 16, 2006 Share Posted June 16, 2006 It just shows that our systems is more trouble than we realize. I wonder what they allow Paramedics to do if Basics are able to perform advanced procedures ?.. The main reason is probably cheap care.. hey, why pay for a Paramedic when you can get a basic for half the price?.. Who cares if they know what they are doing.. put in a book? Chalk one up for demonstrating the need for a national scope of practice. Maybe we should start a national map on areas to avoid when driving or going with family members. Geez that state is f*cked up! R/r 911 Link to comment Share on other sites More sharing options...
TechMedic05 Posted June 16, 2006 Share Posted June 16, 2006 Chalk one up for demonstrating the need for a national scope of practice. Maybe we should start a national map on areas to avoid when driving or going with family members. Geez that state is f*cked up! R/r 911 That's why I asked. 8) Link to comment Share on other sites More sharing options...
medic429 Posted June 16, 2006 Share Posted June 16, 2006 OK...can someone enlighten me--maybe I missed something...does anyone know if these protocols that have been quoted are actually for BLS PROVIDERS?? I did not check out all the links, and maybe I did miss something...but on the one page I did see I don't remeber seeing it stated that these were BLS protocols!! and if it was there, i apologize for missing it...my head felt a little :offtheair: half way thorough this thread..... ugh. Link to comment Share on other sites More sharing options...
AZCEP Posted June 16, 2006 Share Posted June 16, 2006 Somewhere in the general guidelines it does say that BLS providers can perform some of these treatments, but since whit72 has apparently fallen off the planet, we will continue without him. Link to comment Share on other sites More sharing options...
Ace844 Posted June 16, 2006 Share Posted June 16, 2006 "medic429," It does differentiate, you just need to look HARD, as these protocols were written in the least user friendly way possible. Next I think it's interesting that this individual wants to discuss treatment modialities which he doesn't perform becuase he isn't employed in that state. Furthermore the state in which he is employed in, doesn't even remotely allow anything even close to this scope for basics...still no comments on things this individual can actually do in his professional practice. Hope this helps, ACE844 Link to comment Share on other sites More sharing options...
Ace844 Posted June 16, 2006 Share Posted June 16, 2006 Hi Everyone, Here's some literature about protocol deviations and omissions in the prehospital treatment of Chest pain. Hope this helps, ACE844 Abstract: Objective. Despite the widespread use of standard treatment protocols, there are few published data regarding paramedic protocol adherence. In this descriptive study, the authors sought to assess the frequency and nature of deviations from a standardized treatment protocol for the chief complaint of chest pain. They also sought to quantify any time delays in treatment of potential ischemic cardiac chest pain. Methods. A retrospective review of written documentation obtained from four ambulance services in a mid-Atlantic state was completed. A convenience sample of consecutive emergency medical services (EMS) records was obtained from January 2001 to May 2002, and 75 calls were selected from each service (N = 300). Results. Neither the median scene times nor the response times varied among the four services in the study. However, the suburban ambulance service (service 1) did have a significantly longer transport time (19 minutes) than the rural (14 minutes) and the urban (11 and 10 minutes) services (p < 0.05). Documentation of history and physical characteristics varied widely for each service. The patient took aspirin 10% of the time prior to EMS arrival, yet paramedics gave it additionally 50% of the time, while nitroglycerin was given in 73% of cases of suspected cardiac ischemia. Posttreatment vital signs for nitroglycerin were documented 30% of the time for three of the four services, while the other service documented these 75% of the time. Medical command contact varied by agency (80–100%), as did the receipt and completion of medical orders. Conclusions. Paramedics may delay transport of patients with potential cardiac ischemia. Deviations from protocol occur frequently and the care documented for prehospital patients with chest pain is variable. The expected care described by written protocols does not correlate with the treatment documented. Link to comment Share on other sites More sharing options...
AZCEP Posted June 16, 2006 Share Posted June 16, 2006 The quoted abstract is good reason to consider protocols to be guidelines rather than hard and fast regulations on how things must be done. You have got to enjoy the fact that to evaluate the situation, the researchers chose to study chest pain. Link to comment Share on other sites More sharing options...
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