EMT's checking BS

[chaz90]

First pulse is always palpated. Second is off pulsox if the first few beats match what I get while palpating to make sure it is accurate.

I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...

 

[ffemt8978]

So, you're in the minority. I'll admit, maybe I shouldn't have used "overwhelming", I guess it is up to your own imagination as to what that means. I suppose to some people it is like saying 99.99999% when it could mean 80%. My bad.

What is the basis for your claim that ALS services are the majority of services out there? You made the claim, now lets see the proof. Or is it a case of you think it's that way but can't prove it?

 

[broken stretcher]

i check BGL in NYS however in the scope of things how does it really change my treatment as BLS?

 

[medicsb]

What is the basis for your claim that ALS services are the majority of services out there?

That was not my claim. I NEVER said that the majority of services are ALS. I'll let you go back and read what I wrote. If you need clarification, let me know. (As you are now straying from the topic, shouldn't you make another thread? )

 

[ffemt8978]

There can still be some component that is BLS. This is common in many places. E.g. ALS ambulance, BLS engines. ALS engines, BLS ambulances. ALS ambulances, BLS volunteers going right to the scene. At least to me, "all-ALS" is any system where a medic is sent on every call, which is the overwhelming majority of EMS systems.



So, we agree. (Or are we going to have to go over this a few more times?)



Yeah... that is the sort of thing I used to see that'd have me question the assessment of certain BLS crews (or whole squads/services). Some squads, I set my expectations as low as them just showing up with a working ambulance, with anything beyond that (e.g. vitals, working suction, etc.) being a bonus. Others, I expected a lot more.

Anyhow, I assume you woke her up in the ambulance before transporting and let her decide whether or not she wanted to go to the hospital. I did that plenty of times. It was always nice when BLS actually gave oral glucose so that we could assess and then triage back to BLS if the BGL was "normal" and mentation back to baseline (could do this even if they already initiated transport).

So, you're in the minority. I'll admit, maybe I shouldn't have used "overwhelming", I guess it is up to your own imagination as to what that means. I suppose to some people it is like saying 99.99999% when it could mean 80%. My bad.



Ok, so, by your logic, even though it probably makes no difference in terms of patient care, EMTs should be allowed to use glucometers so that they feel trusted.



No one has argued that EMTs are unable to check a blood glucose properly, or that they couldn't interpret it.



You've just stated logical reasons: "Does it make much of a difference... probably not" AND "...costs money".

BAM. There you go. Two SOLID reasons to not allow something.

Again, to put it out there for those who haven't read previous posts: My argument is that if it doesn't change patient care or disposition, then it is not needed. If it is an "all-ALS" system (i.e. a medic is sent in some way to EVERY patient), then glucometry for BLS will change nothing for the patient.

That was not my claim. I NEVER said that the majority of services are ALS. I'll let you go back and read what I wrote. If you need clarification, let me know. (As you are now straying from the topic, shouldn't you make another thread? )

Let me highlight what you said, which is in red.

You made the claim, now back it up. You said that ALS is the "overwhelming majority" of EMS systems.

Prove it...if you can.

 

[medicsb]

Let me highlight what you said, which is in red.

You made the claim, now back it up. You said that ALS is the "overwhelming majority" of EMS systems.

Prove it...if you can.

Yes, with good reading comprehension, I did say that the "overwhelming majority" of EMS systems (not services) are "all-ALS". But, sure, you win, I can not definitively prove that the majority are "all-ALS". (Though, I could ask you to prove that the majority are not "all-ALS".)

You did make a point of stating that not all systems are "urban", etc. (thanks for emphasizing that which most of us know). Be that as it may, about 70% of the US population is within "urbanized areas" and another ~10% live in urban clusters (http://www.census.gov/geo/reference/ua/urban-rural-2010.html). So, if I was a betting man, I'd still bet on the majority being all-ALS. For what its worth, I would love to know of more tiered EMS systems, so please divulge any you know of.

 

[unleashedfury]

I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...

A lot of medics around my ways make you take manual vitals. I know one that when they are doing a BLS transport with a EMT/Medic crew he will take the Monitor and the Pulse oximiter and place them in the front seat with him. His opinion is how many EMT's rely heavily on the automatic cuffs and pulse oximeters for vitals so they can't take manual vitals. Now you don't have a choice.

 

[Rockies]

Wait, we could'nt do that?

 

[Mariemt]

A lot of medics around my ways make you take manual vitals. I know one that when they are doing a BLS transport with a EMT/Medic crew he will take the Monitor and the Pulse oximiter and place them in the front seat with him. His opinion is how many EMT's rely heavily on the automatic cuffs and pulse oximeters for vitals so they can't take manual vitals. Now you don't have a choice.

The medic drives as the EMT monitors the pt? If he is going to complain, I'd make him do it! .
I'd be pissed if he took my equipment. For one, we titrate all our o2. Yes I realize o2 SATs are just a tool in titration, but an important tool. I need my pulse ox. For another, he isn't my father. I take all my vitals manually the first time. If we are moving and the automated cuff has an odd reading, I will palpate the BP. Heart rate ? Always.

 

[Sandog]

The pulse oximeter has made EMTs lazy. I absolutely loathe seeing them get the pulse rate off of a pulse ox.

Well, that is your issue.

If an EMT wants to do more, then that EMT should put in the time for medic or RN training, or even higher. The EMT is but just a stepping stone, and those that wish to transverse it will. As most EMT's are young, they will find their path in due time. Good things come to those that work for it.

 

[exodus]

I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...

Way I do it, I throw them on the pulse ox and palpate at the same time and see if the beats are coordinated to the "waveform bars" on the lcd display. If they are, and it's not irregular, perfectly fine to use that number as your heart rate.

Edit, if it's irregular, or seems off. Then a manual is is obtained.

 

[unleashedfury]

The medic drives as the EMT monitors the pt? If he is going to complain, I'd make him do it! .
I'd be pissed if he took my equipment. For one, we titrate all our o2. Yes I realize o2 SATs are just a tool in titration, but an important tool. I need my pulse ox. For another, he isn't my father. I take all my vitals manually the first time. If we are moving and the automated cuff has an odd reading, I will palpate the BP. Heart rate ? Always.

You are one of the few. a lot of EMTs I ran into use the automated cuffs or wait till a medic arrives so they don't have to do manual vitals.

if the patient is complaining of respiratory distress it would be an ALS call requiring 02 titration thus a pulse oximeter is needed.

If its a patient who fell and hurt his ankle. with no other complaints, some EMT's (not all) will just grab the life pack and place them on the SP02 and automated cuff for vitals. I am a strong believer in one solid set of manual vitals to get your baseline.

 

[Akulahawk]

The medic drives as the EMT monitors the pt? If he is going to complain, I'd make him do it! .
I'd be pissed if he took my equipment. For one, we titrate all our o2. Yes I realize o2 SATs are just a tool in titration, but an important tool. I need my pulse ox. For another, he isn't my father. I take all my vitals manually the first time. If we are moving and the automated cuff has an odd reading, I will palpate the BP. Heart rate ? Always.

There are times when I "delegate" VS tasks to the machine... and there are times that I do it myself via the manual method. If I take equipment away from my EMT partner, it's for a good reason, and would have been discussed ahead of time. Now if it's a medic that is doing the driving and he's not part of my crew, I would be exceedingly angry about him taking the equipment because I'm responsible for that equipment and if he breaks it, it's on me.

 

[EEEMMMTTT]

I vote no for glucometer for EMT. There's no point to it.

 

[usalsfyre]

I vote no for glucometer for EMT. There's no point to it.

Huh? How do you figure?

 

[Akulahawk]

I vote no for glucometer for EMT. There's no point to it.

Really? As an EMT, I would have loved to be able to use the glucometer. Why? When we go to a suspected stroke patient, one of the things I want to know is the blood glucose level because if that is out of the normal range (especially if low), then it very well could make a difference whether I take the patient to a hospital that's a stroke center or not. I may not be able to do something about the symptoms right then, but since transport is a treatment that I can provide (along with an appropriate destination), that one piece of information may actually change what I do and where I take that patient.

 

[Glucatron]

Here in CO, we can: 1.start IVs and administer NaCl 2. Monitor pulse ox, 3. Test blood sugar, 4. Give D50 (if ALS), narcan, ASA, nitro, 5. Put in King, combitube airways. 6. Place 12 leads. It wouldn't surprise me if in 5-10yrs they start to allow EMT-Bs to do IOs. There are a lot of things we can unofficially do if our partner trusts us such as medication administration during a cor, IO drilling, giving zofran or other non-narcotic medications. Again this is for an ALS ambulance. I can understand lower SOP in low call volume areas but if you are in a busier system they really should be raising the SOP.

 

[Tigger]

BLS agencies in Colorado can carry D50, and EMTS are permitted under Chapter 2 rules to administer medications under the direction of a paramedic if the patient is in extremis. There are also several agencies statewide that allow EMTs to perform IOs under waivers.

 

[toxik153]

EMT's should be able to check blood glucose levels. I have enough patients in my IFT transports that are diabetics, picking them up from ALF's or their residence going to an ER and I feel like I'm lacking information to report such as BGL's and o2 SAT.

 

[BigBad]

My emts can drill IOs, give narcan and give adrenalin IM because epi pens are too expensive