There are some things that are normally considered advanced care paramedic skills that probably should be Primary Care paramedic skills.
For example needle decompression of a tension pneumothorax is a lifesaving procedure that must be done immediately once a clinically significant tension ptx (that is causing cv compromise) is diagnosed.
Given the tools that we have in the prehospital environment to diagnose a tension pneumothorax, by the time we can diagnose the pneumothorax it is more than likely clinically significant and requiring treatment.
Anyone that does a 12 lead (a pcp skill) can landmark for a needle decomp.
In penetrating trauma, the risk benefit is in favour of benefit - although not w/o risk those pts will usually get a chest tube.
Same w blunt trauma and a tension ptx, the ptx will kill the patient before you can get them to "someone else". In this case, 'remote setting' is greater than about 90-120 seconds from the trauma bay at the hospital.
Trauma termination of resus protocols w/o the ability to do bilateral chest decompression is just a bad idea. If you are going to call it, dart both sides of the chest before you do. Both the original issue and/or overaggressive ventilation can cause a tension ptx - a reversible cause of trauma arrest.
Other things include some meds.
Firstly, EPInephrine for anaphylaxis is a basic life support intervention that is standard of care. Period!
Again if you're 10 minutes from the emergency department when your patient has a life threatening anaphylactic reaction then you are 10 minutes too far from hospital.
Anaphylaxis is an immediately life threatening rxn that must be treated immediately, not 5-10 min (at best) later.
The world allergy association guidelines cite several papers demonstrating that failure to administer epi promptly was the single most common reason for death from anaphylaxis.
Further, the guidelines cite other resources that state the median time to complete cardio-respiratory arrest from food and sting allergies is approx 10-15 min. This is from initial antigen exposure to cardiac arrest.
The Dx is pretty simple (this definition for EMT-B/EMR- you can still have anaphylaxis if you do not meet this definition):
An illness consisting of cardiovascular instability (hypotension ) and/or respiratory compromise PLUS signs of an allergic rxn (e.g. itching, hives) or exposure to a suspected or known allergen is automatically anaphylaxis until proven otherwise.
Look up the world allergy association guidelines.
EPInephrine is a basic life support intervention for anaphylaxis. To get around the issues with people giving it when not needed, you use a checklist. These checklists work and are used by organizations such as Ontario's lottery and gaming corporation who stocks their medical kits in casinos with epi.
But it is unacceptable that in 2014 we are still fighting to get epi recognized as a bls lifesaving intervention...
EPInephrine is the standard of care for anaphylaxis. It is pretty much negligence to withhold this intervention from a pt suffering from anaphylaxis.
Next is meds such as salbutamol. Salbutamol is a very safe drug, is the standard of care for asthma exacerbation and other cases of moderate to severe bronchoconstriction.
Although like any drug there are risks, salbutamol is relatively benign, and the only major risks are tachycardia if given in excess and possibly hypokalemia w massive doses. Dosing is simple: 600-800 mcg q5 min x3 prn. Assess breath sounds in between each dose. Even if it was given in absence of bronchoconstriction, the any side effects are likely to be minimal.
ASA is standard of care for MI pts, this is a BLS skill and is negligence to not give in mi if indicated with no contras (which are few and far between).
Tylenol and advil are safe otc analgesics for minor to moderate pain and can be given together if no contras exist for each drug. When given only in one dose, the contras are few, namely allergies, liver or renal impairment, and for ibuprofen, major bleeding/peptic ulcers, pregnancy.
Glucagon is safe as a pcp drug and probably for EMR as well. Simple to use and gives tx option for severe hypoglycemia w/ unresponsive pt. BGL is a bls skill and should be in all providers scope of practice. If you can't figure out how to do and interpret a BGL, you shouldn't be practicing any form of medicine, even bls.
Benadryl and gravol are also very safe drugs that can play a major role in treatment of allergic rxns and nausea/vomiting, respectively. Again, very few contras to these drugs. Given IM or PO if the provider is not IV certified. Can be used by pcp medics and use by EMR level wouldn't be a bad idea.
Supraglottic airways are bls, when used after bls measures are inadequate or ineffective. Not having any backup for failed bvm ventilation is a bad idea.