BLS pushing ALS drugs in a "pinch"

[NREMT-Basic]

Bravo! Well said. That is the sort of answer I had in mind when I started the thread. People's opinions and not a thread which would degenerate into bashing other people, though I dont know why that should surprise me.

[PRPGfirerescuetech]

Wow.

Im with you guys normally, but your off base on this one. If you trust your basic, verify the med and 5 r's, the actual push of MS is a mechanical act, that cant really be messed up under your supervision. Your splitting hairs here.

Should it happen? No

Will it continue to happen until ALS providers are given a third arm at graduation with their nifty NREMT patch? yes

[NREMT-Basic]

Well said! Of course bls responders should not as a rule be doing things outside of their protocol. However, it situations as I described when I started the thread, there may need to be an understanding between the medic and his partner and things just have to get done. Its like my medic partner on a long transfer asking me to spike a new iv bag while he does something else. By protocol, Im not supposed to have anything more to do with IVs than handing them to my partner. But if I know how to change a bag out and do so under his supervision, this is the way that I help my partner and we gain a trusting working relationship between us.

[whit72]

Nremt B some things about your post concern me, I agree it dosent take a rocket scientist to push a med. Explain to me a situation in which a medic would need a basic to push a med.

I have been on some pretty nasty gut wrenching calls, never in my experience have I been in a situation where I would have to jump in a push a med for someone. What are the circumstances where the morphine would be so important that it couldn't wait twenty-seconds for the medic to complete what he was doing. The pt was screaming bloody murder so obviously she had an airway and a heartbeat. What else would he be doing?

Remember its not your emergency tell your friend and his partner next time to take a minute to pull themselves together. Get a handle on the situation. Then go from there.

First of all you would do what the medic ordered, well thats very noble of you. Be a good soldier. You can be pals at dairy queen when you both get popped for practicing out side your scope. I know in your vast experience you have been exposed to only fantastic superstar medics. There are however some I wouldn't let start an IV on the pumpkin sitting on my porch. Think of that next time some medic hands you a syringe.

Your posts and responses prove how little you know about EMS, people in the real world don't risk their pts well being and their careers by breaking all the rules put in place. They are there for a reason. They wait twenty-seconds to finish what they are doing to push the morphine. We all know your skills are top notch, and your self education is second to none. However after a year, no offense, but you or your so called "pal"don't know dick about EMS at your level never mind the ALS level.

If the situation did ever arise, and it hasn't, you can bet I wouldn't be on a forum risking both are careers, so I could prove that a EMT could provide an ALS skill.

[vs-eh?]

I am actually surprised that people are saying that this happens with any frequency or seem to have this "do what you have to do" attitude. Sorry, it's my job and there's. You have your scope of practice and I have mine, we play the game within those rules. I know FOR A FACT that this NEVER happens here, people are too scared. Decertification's? Job loss? yup... Our doctors don't take too kindly stepping grossly (and yes a PCP pushing an IV med here would be gross) out of their scope.

NREMT-Basic = I applaud your friend for being scared.

- What exactly was this paramedic doing with this open femur fracture, that the basic had to suggest morphine? What service do they work for that supplies morphine in a pre-load? What ALS only intervention was he/she totally engrossed in that prevented them to do their job of IV drug administration?

- You also (paraphrase) said that you can only pass a paramedic things during intubation, but if a tough tube comes up you will help him and do what you have to do. What exactly would that entail? Perhaps drawing up sedatives? analgesics? paralytics? Where do you draw the line? Preloads? Simple drawn up meds? Is that ok?

Is it a mechanical procedure? Yes. Is it difficult? No. Is an IV as a psychomotor skill inherently difficult? No.

The lying on documentation is a whole other matter...

For those paramedics that allow this to happen or think that it is "ok" given a set of circumstances (6 R's, etc...), then I ask you to do this...

Approach your medical director/base hospital physician and ask for your standing orders/protocols to be ammended to allow BLS to push IV medication or draw up and push medication that is outside of their scope. Give all the stipulations under which you would allow BLS to administer medications (like it already apparently does that's "ok"). Tell them that you also concede that you will outline on the form when and why this had to happen. Ask them to do this...or see what they say...

I'd be interested...

[paramedicmike]

I understand the point being made by those of you who say it's a mechanical act and, when supervised by the medic, should not be problematic. And, to a certain extent, I agree. It's merely mechanical in that you push the plunger and give the medication.

But there is a problem. If the medic is too busy to do it him/herself then the basic is administering a medication unsupervised. Supervision implies that the medic is watching what's happening (and can intervene immediately should something go wrong). How can that happen if s/he's too busy to do it personally (i.e. tied up with other interventions)?

Also, while pushing a plunger may, in fact, be a mechanical act, do you (a general you, not to anyone in particular) know how fast to push? Or does this med (depending on the med and the situation) get pushed slowly? This ties in to the supervision aspect, too. If the medic is so busy that s/he can't personally push the medication, how can it be expected that the supervision will be provided by that medic to ensure the drug is given effectively?

Morphine given too quickly will cause a patient to puke. Unfortunately for me and a patient I had as a brand new medic, I learned that the hard way. Hell, I've been given morphine before and the brand new RN who gave it to me learned the same lesson.

There are many things I will trust a basic partner to do. This isn't one of them.

-be safe

edit: VS and (I can hardly believe I'm saying this :wink: ) Whit, well said. You posted while I was writing. Spot on. Both of you.

[JPINFV]

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.

None of the posts before this was bashing EMT-Bs. Simply put, unless you have an expanded scope of practice, pushing IV medication is out of the scope of an EMT-B. If you do not want to listen to people disagree with you then don't post a topic on a discussion board.

[whit72]

Nremt b wrote:

Its like my medic partner on a long transfer asking me to spike a new iv bag while he does something else.

This has to be the busiest paramedic I have ever heard off, he sounds more lazy then busy. Spiking a bag is not we are talking about here. We are talking about pushing a controlled narcotic.

this is the way that I help my partner and we gain a trusting working relationship between us.

No sir, how you gain a trusting working relationship is for you both to competently complete the aspects of "your" job.

[nsmedic393]

Approach your medical director/base hospital physician and ask for your standing orders/protocols to be ammended to allow BLS to push IV medication or draw up and push medication that is outside of their scope. Give all the stipulations under which you would allow BLS to administer medications (like it already apparently does that's "ok"). Tell them that you also concede that you will outline on the form when and why this had to happen. Ask them to do this...or see what they say...

I'd be interested...

Actually our medical director approached us... One day out of the blue the policy came out to allow BLS providers to draw up and administer medications under the direct supervision of the attending ACP.

Aparently he thinks that there is some benifit and it may not be such a crazy idea after all.

[vs-eh?]

Actually our medical director approached us... One day out of the blue the policy came out to allow BLS providers to draw up and administer medications under the direct supervision of the attending ACP.

Apparently he thinks that there is some benefit and it may not be such a crazy idea after all.

Oh fair enough, that's cool. But you have standing orders that allow PCP's (BLS) to due this without any qualms or repercussions (all things being equal). You have set guidelines, ones I wish we had here.

The issue is that this person was stepping out of scope to do this "benign" procedure. I have zero issue with BLS giving drugs IV under ALS supervision if you have standing orders/medical direction to do so. You would have no need to falsify/be vague in specific documentation because it is within your scope. No problem.

Also, there is a substantial educational difference between EMT-B's and PCP's (regardless of simply "pushing a plunger") that plays as well.

nsmedic393 - Do you have a link to this guideline?