BLS pushing ALS drugs in a "pinch"

[Redcell19512]

In the case described I don't understand why the medic couldn't just give the morphine himself. He had the time to start the IV and look at the drug (assuming he actually did that). Why couldn't he take the extra minute to push it himself?

An EMT performed and illegal action. The paramedic lied on a report, another illegal action. So what else are they hiding?

[EMS49393]

=D> KSEMT122, I couldn't have said it better. It is becoming rather pointless to reply to a post when you know the original poster will become confrontational if you disagree with their position.

As a paramedic, I wouldn't let my basic partner push any medications. As a basic, I never pushed any ALS medications. Now, couldn't the paramedic push the drugs and let the basic control the bleeding? Seems to me the medic should have had the basic control bleeding, after all that is a basic skill, and then attend to the ALS portion of the call. By the same token, the basic should have used their words, and told the medic they would be more then happy to control bleeding, but they are uncomfortable with giving medications, since it is not in their scope of practice.

NREMT-Basic states, "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." More excuses. :roll:

[Ridryder 911]

If the Paramedic is busy, and if it is a pre-dose syringe, all has been cleared with the 5 R's.. so what ? I am watching them... so they stuck the needle in the the tubing & plunged the syringe.. it is a mechanical maneuver, just like an IV or med pump.. nothing more!

I don't care who is pushing the barrel as long as it is the right med, dose, route, and appropriate way... it again is a mechanical thing.

R/r 911

[Just Plain Ruff]

There is no way that I'm gonna let a EMT push a drug. Plain and simple. It's my license and I'm not gonna lose it for something like that.

That being said, I know of it having happened several times and each time it was a bad thing because one crew got caught.

But I know it happens and such but I would never personally let it happen to me.

[NREMT-Basic]

Guys...calm down for one second and read my original post. Because I ask some controversial questions and then a bunch of you get your knickers in a twist as if I was the one that pushed the drug. Read the frigging question that started the thread and if you cant be civil and answer it as it was written, why should you expect that I would be less than confrontational when responding to something that I posted as a question, that had nothing to do with me personally, that I was seeking "educated opinions" on. God for-freaking-bid. Its like I ask a question or start a thread because I am genuinely trying to learn from those with more education and training than myself, alot of responders dont bother to stay on topic, i get blasted for it and then I get blasted for blasting back. Read how this thread started. Read how the EMT/Medic relationship thread started...I asked simple, civil questions or in the case of the EMT pushing MS, asked what you guys thought and if you know if this goes on very much. Then somebody hijacks the thread to say "I wouldnt ever let an EMT take a p*** without checking with me" and I get blamed for it because I respond in kind. You guys need a new hobby.

[nsmedic393]

Like i said earlier and rid as well stated... I don't care who pushes the plunger as long as the patient gets the right drug. That is not to say I think less of people who follow the rules to a T 100% of the time either. What they do in their truck is their business and I don't think any less of them for it. I hope that when it comes down to one person or annother pushing on a plunger, they would feel the same of me.

[paramedicmike]

Should it happen? No.

Does it happen? Yes.

Do I allow it to happen if I'm working with an EMT partner? No.

Does your friend have a right to be nervous about this? Yes. Especially now that it's posted on the internet for all to see. (Don't think for a second any of this is anonymous.)

Did both of these providers do something wrong? Yes. The EMT worked outside his scope. The medic falsified a legal document. Both are grounds for termination and cert/licensure revocation (depending on location).

-be safe

[Thunderchild145]

Lets be honest. In an ideal situation, the paramedic is able to do every single thing he needs to do in an orderly manner with plenty of time to spare and there won't be any problems.

Is EMS an ideal world? Sheeyah. Right.

There are 5 rights to med administration. If I check all those and then give it to a basic to push, I am sure the patient is getting the drugs he needs. I'm not saying I do this. I don't. I'm simply stating that for example, if I'm on the other side of the patient from the drug box or the monitor or whatever ALS instrument, and something needs to happen..

Say the patient codes. I look at the monitor and interpret a V-fib, and I say "Charge it and shock him!". I see that as the same thing. I make the judgement. I don't do the actual mechanical part of it, but I'm supervising -everything-. While I don't let my partner push drugs, I don't hesitate and niether does my partner in a "Charge it and shock him!" situation.

So yeah. In the end, I'm not saying it's legal, or even right. Quite the opposite. But I can see where it comes into play.

[Redcell19512]

Why did the medic lie on his chart? Because he knew what he did was wrong. For those of you who don't think it's a big deal who pushes the plunger so long as the right drug and dose requirments are all met let me ask you this.

Would you let an EMT administer a medication and if so, would you document that they did it in your chart?

[Asysin2leads]

The way I look at it is up to the medic. It will come down on him. Pushing the plunger is no big whoop. Certain medications have to be given at a controlled rate of administration, or like D50 you have to be extra special vigilant in giving it. Morphine, if its the right dose, is hard to screw up. If it was just me and say I was up to my elbows in a difficult airway and I had an EMT I played pool with on the weekends, I could see it happening.

As for the documentation, yes, its wrong to lie and falsify documents, but please try and bear in mind that our biggest goal is to the treat the patient. Proper documentation is essential, but don't become one of the English teachers we have working who bust some poor overworked paramedic because they made a boo boo on their PCR. No one likes that. If this situation arose, and I as the medic was working, my documentation would state "5mg Morphine IVB administered", I'm stating what happened. Anything else is between me, my partner, and the patient.