Paramedics in Colorado

[EMT-B2B]

Ok. I just started the EMT course on Saturday. The instructor told us that paramedics are able to run chest tubes here in Colorado. Is this standard around the country? Or is it something that is just limited to a few states? Just curious and am wondering if this is a national thing or state.

 

[Sasha]

http://www.dora.state.co.us/medical/rules/500.pdf

Scroll down to the "Skills" portion. "Chest tube insertion" is a straight "N" across the board! Isn't it a surgical procedure? The field is waaaaay too dirty!

 

[EMT-B2B]

Thanks for the info Sasha. Maybe the this pertained to an ED environment. Not to sure. Would that make a difference, if it was in the field or in the ER? I guess I will have to clear that up. I would imagine that in the ER it would be the responsibility of the MD on duty?

 

[Shishkabob]

Yes there's a difference, as in the hospital, PRE-hospital regulations mean nothing.


EMT-B's can be equivalent of Medics in hospitals and do pretty much the same things.

 

[medic417]

Ok. I just started the EMT course on Saturday. The instructor told us that paramedics are able to run chest tubes here in Colorado. Is this standard around the country? Or is it something that is just limited to a few states? Just curious and am wondering if this is a national thing or state.

I know several services that allow field chest tubes. But most just do chest dart decompression in the field and let the hospital place the tube. It is really not a complicated procedure. If patient needs it to live then the additional risk of infection is an acceptable risk. So in the field you will not see paramedics do chest tubes unless in a rural area with a long transport time.

 

[Elliot]

Yes there's a difference, as in the hospital, PRE-hospital regulations mean nothing.


EMT-B's can be equivalent of Medics in hospitals and do pretty much the same things.

hmmmm thats interesting where are your sources to prove this?

 

[sir.shocksalot]

I work in Colorado so I may be able to help here. Flight NURSES can start chest tubes, that is the only person other than a doctor that can start a chest tube, so maybe that's were the confusion came in. Be happy you are getting into EMS in this state though, we have a lot of very progressive protocols in most of the state, with Thompson Valley Ambulance having the most progressive, not to mention the highest paid as well, aside from the FDs that is.

 

[Shishkabob]

hmmmm thats interesting where are your sources to prove this?

You mean besides personal experience and having friends in the ED's?

Why, I guess none!

 

[Aidey]

Most states allow for expanded scopes to be created if you follow through the proper channels. A case of this I can think of are occupational medics who are authorized to give out antibiotics. It may be that in some hospitals the medics/EMTs have an approved expanded scope that they work under.

 

[gillysaurus]

I work in Colorado so I may be able to help here. Flight NURSES can start chest tubes, that is the only person other than a doctor that can start a chest tube, so maybe that's were the confusion came in. Be happy you are getting into EMS in this state though, we have a lot of very progressive protocols in most of the state, with Thompson Valley Ambulance having the most progressive, not to mention the highest paid as well, aside from the FDs that is.

Another Coloradan here and I have to echo, Thompson Valley rocks. If you can get up and ride with them sometime you'll have a great learning experience. They do mutual aid for the service I'm interning with and I've never met a medic from TVEMS who wasn't really knowledgeable and kind.

Colorado is a very progressive state for EMS. I'm not sure how many other states let EMT-Bs get their IV certification and start lines in the field, as well as being able to push D50 and IN Narcan. It's a good state to live and learn in ^_^

Where are you taking your class? I would ask your instructor if they really meant chest tubes or was talking about something else, like chest decompression.

 

[medic417]

Colorado is a very progressive state for EMS. I'm not sure how many other states let EMT-Bs get their IV certification and start lines in the field, as well as being able to push D50 and IN Narcan. It's a good state to live and learn in ^_^
.

A reason not to visit Colorado. Giving the uneducated skills to save money providing real ALS.

 

[EMT-B2B]

Ive heard good things about Thompson Valley. Unfortunately Im in the Springs and taking the course at PPCC. The instuctor is a Paramedic for AMR and unfortunately AMR is the only service down here, besides the local FDs. I do also like the concept of EMT-B's being able to run IV's in the field after cert. Thanks for all the good info guys. It's greatly appreciated.

 

[sir.shocksalot]

A reason not to visit Colorado. Giving the uneducated skills to save money providing real ALS.

Last time I checked you have to be educated to be an EMT, I also believe our state has some of the highest required hours for certification. I know full well the indications contraindications and complications that can be caused by the administration of both Naloxone and D50. Don't assume just because EMTs in your state are too dumb to administer IV dextrose or IV naloxone that ours aren't.

 

[medic417]

Last time I checked you have to be educated to be an EMT, I also believe our state has some of the highest required hours for certification. I know full well the indications contraindications and complications that can be caused by the administration of both Naloxone and D50. Don't assume just because EMTs in your state are too dumb to administer IV dextrose or IV naloxone that ours aren't.

Last time I checked EMT-B was a glorified first aid course that focuses on skills with no real foundation in medicine given or required prior to taking. Sorry I was a basic, I am an instructor. I know what it includes, it can not be called education, only training, big difference. Before you spout crap off I was working way above what your basics do in your protocols when I was a basic. I am fully aware of the limitations and because of that any and all advanced procedures should be limited to properly educated Paramedics, not even diploma mill medics should have advanced skills.

 

[Shishkabob]

A reason not to visit Colorado. Giving the uneducated skills to save money providing real ALS.

Wow, if that isn't one of the most ignorant and un-educated post I've ever seen. And from someone purportedly "more educated" too!


I'm not going to argue this item again, as it got the topic locked last week. Everyone knows where everyone stands on the matter.

 

[Chimpie]

Let's keep it friendly.

 

[medic417]

Let's keep it friendly.

Like the smiley.

 

[medic417]

Wow, if that isn't one of the most ignorant and un-educated post I've ever seen. And from someone purportedly "more educated" too!

With the respect not granted me by you I just want to say that I to felt that as a basic I could do anything. I thought that the few hours of extra training given gave me enough to do all the extras. Well now with education I see what all the training left out. I speak from experience not out of disrespect. You know what you find out as you gain education thats theres a whole lot more education needed. Honestly the more you learn the less you will realize you know. I as an educator do disagree with Colorado and even Texas and others that allow basics to get "trained" to do advanced procedures.

As to the OP yes Paramedics are allowed chest tubes in some systems. It is a skill like many that should not be taken lightly and should only be used when the only other option would be to cause harm to your patient by not acting immediatly. Most city Paramedics would have no need for chest tubes as chest decompression using 14g caths would buy enough time to get to the hospital and allow doctors to provide more definitive care.

 

[Shishkabob]

With the respect not granted me by you I just want to say that I to felt that as a basic I could do anything. I thought that the few hours of extra training given gave me enough to do all the extras. Well now with education I see what all the training left out. I speak from experience not out of disrespect. You know what you find out as you gain education thats theres a whole lot more education needed. Honestly the more you learn the less you will realize you know. I as an educator do disagree with Colorado and even Texas and others that allow basics to get "trained" to do advanced procedures.

I respect your opinion, but luckily, the call comes down to doctors, who have more education then you and me on the matter.

So you're basically saying the doctors are wrong? Doesn't that go against your "education trumps all" theory?

 

[medic417]

I respect your opinion, but luckily, the call comes down to doctors, who have more education then you and me on the matter.

So you're basically saying the doctors are wrong? Doesn't that go against your "education trumps all" theory?

Actually most times the doctors are bowing to pressure from services or states to keep costs down. So the doctor can fight it and lose their check or they can give in and turn skills over to basics. Many medical directors have tried to fight and have been fired or asked to resign. There is always another doctor that will take the money and require some "training" and then allow the service to save money by having basics do advanced skills for basic pay. Actually basics should be offended by the abuse that they are getting. They should demand Paramedic pay if doing the Paramedics job.