BLS doing ALS skills illegal? Immoral? Unethical?

[coloradoemt]

Exactly..if they get the idea in their head that they can do it they will complain when they can't.

I could care less if they complain about it. I just would not want them working ouside their scope and then blaming their FI for the mix up.

I would be willing to bet that in rural american EMS folks are afforded the opportunity more often to work outside their scope simply to save a pt who has to endure a long transport, or even more simple than that, save their life.h34r:

 

[FFEMT1764]

I would be willing to bet that in rural american EMS folks are afforded the opportunity more often to work outside their scope simply to save a pt who has to endure a long transport, or even more simple than that, save their life.h34r:

That may be true in your part of the country, but here in SC if you go outside your scope of practice the state takes your cert away, either for a short suspension or they take it away permanently, and forward that info the the NREMT...they take these violations very seriuosly here...you screw up you pay the price...and by doing this we maintain our providers statewide at a higher level and have a better standard of care because of it.

 

[coloradoemt]

What I was trying to say is this, if an ALS crew is out in the middle of nowhere and the medic can not get the pt intubated etc. do ya give the basic a shot or let the pt die?? I was not referring to rampant disregard for protocols or scope of practice. Nor was I saying it does happen.

 

[FFEMT1764]

What I was trying to say is this, if an ALS crew is out in the middle of nowhere and the medic can not get the pt intubated do ya give the basic a shot.

Basic's can intubate in SC...so here that would not be an issue...but I don't think I would let someone that doesnt know hoe to perform a skill make an attempt at it...but I have no problem letting my basic partner's attempt intubation prior to me sticking my nose in there and looking...after all 90% of the pt we tube are already in arrest...so why not give them a shot...if they cant get it in 1 or 2 tries, then I ask them to move and I take a shot at it...

 

[TripperAdam]

I'm feeling myself on both sides of the fence here:

I think that every student of every level could gain some valuable insight by witnesses protocals above their training; if someone with BLS training were to end up working alongside someone with ALS training, they should know what to expect the medic to do in a real situation.

The flipside of it is: by having seen this skill, and by probably being very keen to save someones life, a person could easily try and overstep their protocals.
I know that a tiny light in my own head would be blinking away... "try it; you've seen it done before!"

So it's both a benefit and a danger...

I think with your students: still show them... but seriously drive it into their heads why they shouldn't practice what they've seen ("you could get in serious trouble; theres a high chance you could screw up and do more harm than good")

 

[ffemt8978]

Welcome to our own little corner of dysfunction.

Please be sure to introduce yourself, 'cuz if you don't someone else will play 20 questions with ya'.

 

[Flight-LP]

What I was trying to say is this, if an ALS crew is out in the middle of nowhere and the medic can not get the pt intubated etc. do ya give the basic a shot or let the pt die?? I was not referring to rampant disregard for protocols or scope of practice. Nor was I saying it does happen.

No you do not let the basic attempt an intubation. You move on to your failed airway algorithm and drop a Combitube, or LMA if a C-Tube is not available.

If you are presented with a patient situation where you have a "crash airway", i.e. immediate need for an airway, the last thing a medic needs is an uneducated and non qualified basic attempting to work outside of their scope of practice.

 

[FFEMT1764]

The only thing we have a problem with here is the MFR hold the pt hand and saying its gonna be ok, especially bad if the pt is in arrest...or worse purple and cold! I dont personally let people do skills that they havent been trained in doing with the exception of placing the limb leads on the monitor, its sorta idiot proof, i.e., RA, LA, RL, LL.

 

[trauma1534]

Show them how to spike a line... how to tear the tape... where everything would be kept in the jump bag to assist the als provider. Show them how to get out the IV supplies... the differaneces in the size IV needles... teach them to get the stuff out and ready in case of a code... teach them the difference in a mac and miller blade and how to set up for intubation. I am ALS and I love it when EMT's know how to assist me. I don't like to have to stop the treatment of a patient to explain how I want my tape torn for an IV, or spike a line when someone else can do it for me while I am doing the stick. Teach them things that would help the team work smoother in the truck. There is nothing wrong with that, I think that should be a part of the EMT curriculim to teach them how to assist us. There is nothing no worse than to be working on a patient and have an emt in the truck setting there with their thumb up their butts, for lack of better term. Teach them to listen to breath sounds... teach them to hold c-spine, how to back board, better yet, how to find the back board. Teach them how to get a c-collor, how to apply spider straps (if you use these... I happen to think that they are the best thing since sliced bread!!!). Little things like that can take alot of time and they are learning usefull things as well. *smiles*

 

[firegal920]

I agree. Not only does it help, it encourages the "up and coming" to become better team members as well as spark their interest in becoming advanced. After all I have to be able to retire sometime. B) :blush:

 

[TTLWHKR]

I would be willing to bet that in rural american EMS folks are afforded the opportunity more often to work outside their scope simply to save a pt who has to endure a long transport

I sincerely doubt it, unless they have multiple scopes of practice working out of the rig. I've lived and worked in urban and rural >A<merica my whole career. And in my time in rural America, I've never seen work done on a BLS rig outside of their scope of practice.. Simply b/c if your rig is not equipped to do anything advanced, you can't do anything advanced.. However if you run BLS and ILS, but do not always have the ILS crew; I could see someone doing a Monday morning q-back. Even though they may not know what they are doing, b/c seeing someone else do it isn't the same as knowing what the hell you are doing.

I have had medic students in PGH jump in a try to start a line because they "are learning how to do it".. but not signed up to train with out rigs. Sometimes I wish they would have been able to bounce, because it would have been nice to physcially throw them out of the rig. h34r: In this day in age, I'm willing to teach anyone how to do my job.. In a classroom. Not on a live patient. People aren't as stupid as we think, if they get uncomfortable by someone doing a procedure, and ask in the ER.. Boom there goes their career and mine. If they haven't trained for months to do a procedure, and been granted rights to perform by some big-wig, then they aren't doing it on my patient. Not only does the patients life hang in the balance, not there for a little fun with skills training, but my whole career and certifications hang there too.