BLS pushing ALS drugs in a "pinch"

[NREMT-Basic]

Here is a BLS topic that would benefit from hearing from all of our ALS friends. This morning, I have a friend of mine call me absolutely freaking out. He and his ALS partner responded to an open femur fracture. The medic was trying to accomplish alot of things while the patient was screaming in pain bloody murder. The EMT got the medics attention and sort of mouthed the word" Morphine?" The medic nodded and handed the basic the keys to the med box, the Basic pulled out what I gather was a pre-dosed syringe and started to hand it to the medic. The medic took it, confirmed right med right dose and handed it back. From what I can understand, the medic, having just established a line, indicated that the Basic should uncap the syringe and give the doseage of MS. The run report apparently reads "Meds Given: 5.0mg MS given by IV access by Medic." My BLS pal actually pushed the drug. Is this something that happens sometimes or was the medic off his nut for telling the Basic to do it, or was the Basic off his nut to do it. As much as I know the shite that could rain down on my head if i were ever in this situation, I am pretty sure that I would do what the medic ordered, myself having been trained to use IV access to administer drugs, though this is not someting I can do under our protocols. I was just shown how to do it during by clinicals by a medic and he said, basically if there is ever a call where the patient is screaming and the medic is working and cant stop, this may happen. Anyone have any experience with it....?

[Niftymedi911]

The medic obviously trusted the EMT. It's technically not allowed all ALS drug are supposed to be administered by the medic. But if the medic on the truck trusts you, you have a good working relationship together, he double checks the 5 right's of the medications prior to administration, and keeps the best intrest of the p/t in his mind as well as you. There should no cause for conern. Now if the medic just opensly gives you the med without checking it etc, then I would say there's a problem. Not only that, but what technically are we EMT's? We handle priority 3's with BLS care we are in charge of getting our medics to and from the scene safely, we are also the paramedic's assistant. That's why EMT's and medics work together. Believe it or not I would take any experienced EMT over a second medic on the truck any day. Sometimes medics get used to riding in the back and sledom drive, thus an EMT with experience is technically worth more b/c of the driving experience. Believe it or not it has saved me more then twice, having an EMT that can drive.

[AZCEP]

This probably happens more than people want to admit.

The EMT was outside their scope, the medic should have administered the drug. The documentation of the event is the only legal protection they have, and now it is known that it was altered from the actual events.

[NREMT-Basic]

Yes he told me that the report was altered from actual events, but I dont think that they protection of documentation will be in jeopardy because my friend told me or even talked about it all. Though I didnt tell him that the next time a report is sanitized, it stays between you and your partner. If you know a report is "sanitized for your protection" keep your mouth shut. I cant imagine being so traumatized by this as my BLS pal is that I would tell someone else that there were lies in the run report. I think more than that I was just wanting to know if this kind of thing happens often and if there are any protocols which allow for a Basic to perform an ALS intervention or push ALS drugs if ordered to do so by the medic and if there is no question of it being done correctly. That was really more the crux of my question.

[flight-lp]

Short and sweet, the EMT should not have pushed the Morphine. If any remote complication would have presented, all the patient would have to do is point his finger at who gave it, and voila, both certifications gone with the wind. While the act of a EMT who is not educated in pharmacology pushing a narcotic analgesic does bother me, the bigger issue here lies with false documentation and the fact that the crew "freaked out". If I was the pt. and I saw my EMS providers "wigging", I would have very little faith in their performance. This medic, feeling hurried by the pts. screams, lost effective control of this emergency. Calmness and composure, 2 essentials for a proficient medic.................

Of course the whole legal issue of lying on a run record may also ruin their day............

Two thumbs down to both members of that crew! [-X

[NREMT-Basic]

If you intend to quote me, please do so correctly. I did not say that the crew freaked out during the call. I said that my friend called me and was freaking out because of what had happened.

And I know I asked for some opinions, but what I asked for was to know whether there are cases where this should ever happen. Though shown how to push drugs IV, I have never done it as it is not a BLS protocol. However, if something occurs as it did in that call and the medic was trying to control bleeding along with probably a million other things, should the EMT take the order and push the drug. The other thing that bothers me here is that we have been having this ongoing discussion here in these forums about what the BLS/ALS relationship should be. I brought up the point several times about a Basic being given what he knows to be an improper order and got from many sources that the basic does what he is told to do by the medic because the medic is in charge and if the spit hits the spam its his butt, not the basics. Would ya make up your minds? Do you want blind obedience on scene from your Basic or do you want him to say "Oh, no, that is an ALS skill and as soon as we get back to quarters I am reporting you." Lets come up with a party line a stick to it. No wonder Basic sometimes get put into positions where they dont know what to do. Should he have called medical control and said "the medic wants morphine pushed but cannot do this at this time. He has advised me to push the morphine IV...please advise?" Yeah. That would have been great.

[nsmedic393]

This type of thing has happened for years. I have given drugs as BLS at the request of my ALS partner and have asked my BLS partners to push a drug since I became ALS that I'm ALS. I know that technically it is wrong but the way we look at is we are both trying to take care of the patient in the most efficient manner possible.

I can't be such a off the wall idea since our medical director just put out a policy allowing BLS medics to push ALS drugs. The medic is the one who makes the dicision on the drug, dose and route and has to witness their BLS partner pushing the drugs. There is also a caviat that both the ALS partner and the BLS partner need to be comfortable with it.

We have also had a longer standing policy that intermediates when working with a advanced care paramedic can exceed there maximum doses of drugs up to the maximum dose allowed by the ACP. They also do not need to patch for drugs that they would normally patch for when they have a ACP partner.

[NREMT-Basic]

Short and sweet, the EMT should not have pushed the Morphine. If any remote complication would have presented, all the patient would have to do is point his finger at who gave it, and voila, both certifications gone with the wind. While the act of a EMT who is not educated in pharmacology pushing a narcotic analgesic does bother me, the bigger issue here lies with false documentation and the fact that the crew "freaked out". If I was the pt. and I saw my EMS providers "wigging", I would have very little faith in their performance. This medic, feeling hurried by the pts. screams, lost effective control of this emergency. Calmness and composure, 2 essentials for a proficient medic.................

Of course the whole legal issue of lying on a run record may also ruin their day............

Two thumbs down to both members of that crew! [-X

Legally, in the USA, no the Basic should not have pushed the drug. That being said, we have all been or at some point will be in situations where due to absolute necessity, things will need to be done by who can do them, regardless of rightness or wrongness. Second, you werent on the scene and I should think as a paramedic, a flight paramedic no less, that you have come across situations where its all hands on deck, doing what needs to be done. And as I have already said, I never said that the Medic or his Basic assistant were "wigging" or "freaking out." The freak out came after the call when my friend got off duty and contacted me. So no patient saw anyone "wigging." And if you are a patient who has a broken midshaft femur with a compromised artery, do you think you give two flips who gives you that MS where it was within protocol or not. I have since learned from talking to my pal via IM that the medic was trying to control bleeding, monitor his patient and do about 100 other ALS interventions at the same time. I am sure that we would all like to think that the Medic can do all of these things at the same time but sometimes it just isnt possible. Let me ask you this? If medical control had given the ok to the medic for 5mg MS and the medic was never able to push it because of the situation, and you were the patient, would you be screaming louder that a Basic gave you a "narcotic analgesic" or that you never got it at all because other more immediate interventions were necessitated. Sure they were 11 minutes out from ED, but just try to imagine what that patient would have said once he finally got pain meds in the hospital "They wouldnt give me anything for pain" most likely. And if that had happened once medical control gave orders to the Medic for 5 mg MS IV...well then whose neck is in the block. I find it hard to understand how someone, a flight medic no less, can say tsk tsk and wag their lttle cyber finger when you were no where near that scene, dont know the situation and are thinking sheerly out of protocol and not reality. As NSMedic seems to indicate, sometimes things need to be done as they need to be done for the benefit of the patient. Our BLS protocols here in IL allow us to do nothing during an ET intubation but hand things to the medic, but if the medic has a hard tube on his hands and asks me to do this or that, you can better believe I would do it, rather than sitting there watching the patients sats fall. There is protocol and there is what happens in the box and often, like in Vegas, what happens in the box stays in the box. I can see your concern about the one untrue sentence in the run report. Honestly in your opinion, all things happening which did, should the medic have said "I was attending to multiple interventions and gave an order for the Basic to push the MS IV?" Yeah. I think the outcome there would have been some suspensions of licenses. In my so far limited experience in comparison to so many who post here, I think that this probably occurs more often than we think. Things are done to take the patient out of pain. The medic checked the 5 rights on the drug. If you can honestly say, "No. Under no circumstances would I do that" then I have to wonder about someone who would rather let a patient suffer than make sure their BLS partner has the right med at the right dose and watches him introduce that into the IV line. As I have seen written so many times in these forums...dont say oh no thats wrong, they should have their licenses pulled, unless you were there.

[KSEMT122]

I can't believe more people aren't posting a reply condeming this act at all costs. The only thing I can figure is that people have given up on answering NREMT-Basic's posts because they are usually confrontational, which this one is no exception.

The fact of the matter is that it does happen and go on. I, as an EMT feel it should not go on unless it has been added under the EMT scope of practice. It has been said 100 times that if you want to be a medic, go to medic school. I condem the Medic who allowed this, and the EMT who did it as well and didn't say. "Uh no". This not only opens the Service, Medical Director, and the Techs up to severe administrative penalties, it also opens them ALL up to Civil action in a court of law. Unless you are trained to do something, you should not do it!!! Just because a Medic that trusts you shows you how to do an IV DOES NOT MEAN you can do it! Common sense.

I would like to be able to administer drugs and all the other fun things in EMS, I am an EMT and have limited ability to do so. So my decision it to embark upon Paramedic School next September, I suggest ANY EMT who wishes to do more, join me.

[MedicNorth]

And while we are at it, let's get the OR nurse to do that appendictomy because the surgeon is too busy or involved to do it himself.

If this is in your comfort zone as BLS, go for it, but you would not catch me dead going beyond scope in something of this magnitude.