States and EMT-B Morphine Administration

[JPINFV]

An important distinction needs to be made regarding terminology. Is "push" in the concept of medical interventions the administration of anything outside of the classic EMT scope of oxygen, activated charcoal, and oral glucose (so any other oral medications, sub-Q, intramuscular, intranasal, IV, or various other routes), or does "push" mean only the administration of a bolus of medication through an IV ("IV push")? In terms of the latter, intranasal naloxone or IM glucagone are not "pushed" in the sense of an IV bolus.

 

[Hal9000]

For the sake of the EMT-B part of this thread, I suppose we should simply consider medications regardless of route. While fentanyl IN may be easier, I'm somewhat more interested in the concept of EMT-Bs being given the ability to give the medication sans direct ALS supervision, regardless of how they get it there. The TN deal sounds a lot more advanced, relatively, than what MT does.

Glucagon is given unit dose in the standard quick-syringe layout, and morphine is being put forth as auto-injector, much like the Epi-Pens that -Bs use.

However, any specifications for the method of delivery are given to minimize the chance of a trained (not educated) EMT-B hurting a patient. Thus auto-injector.

 

[BLSBoy]

Severe pain + 2mg morphine = severe pain.

Win...........

 

[medicRob]

MT also has glucagon and dextrose, but not Narcan. Of course, most of these are EMT-B plus a couple hours for an endorsement here and there. I'm not familiar with the levels in TN.

Regarding , would you elaborate?

I assume we are speaking of EMT-B, not i/85 trained B's but rather EMT-B. Can an EMT-B explain the pharmacodynamics and kinetics of morphine? Have they had enough physiology to understand the mechanisms at play at the cellular and molecular level? Some of the EMT-B programs mentioned on here do not even require clinicals. There is no way in hell an EMT-B should be allowed to administer morphine. Is the EMT-B ACLS certified and an ALS provider? What if something goes wrong? What if they accidentally give too much are they prepared to handle that? What if the patient goes into respiratory arrest?

 

[Hal9000]

I assume we are speaking of EMT-B, not i/85 trained B's but rather EMT-B. Can an EMT-B explain the pharmacodynamics and kinetics of morphine? Have they had enough physiology to understand the mechanisms at play at the cellular and molecular level? Some of the EMT-B programs mentioned on here do not even require clinicals. There is no way in hell an EMT-B should be allowed to administer morphine. Is the EMT-B ACLS certified and an ALS provider? What if something goes wrong? What if they accidentally give too much are they prepared to handle that? What if the patient goes into respiratory arrest?

Yes, very Basic EMTs.

And I concur with all your points, and believe that the safety levels (BLS units suddenly keeping narcotics with little or no training as to security procedures) will be diminished as well.

However, a group of physicians determines these protocols, so my opinion means little, in the end.

On the other hand, I don't think that MT will be starting a trend by doing this...

 

[medicRob]

Yes, very Basic EMTs.

And I concur with all your points, and believe that the safety levels (BLS units suddenly keeping narcotics with little or no training as to security procedures) will be diminished as well.

However, a group of physicians determines these protocols, so my opinion means little, in the end.

On the other hand, I don't think that MT will be starting a trend by doing this...

I am not against EMT-B pushing medications as a whole. Some medications can be pushed by the EMT effectively, I don't think EMT-B would be prepared for this, However EMT's trained at the i/85 level should have no problem with some of the meds. However, morphine is not one of these meds.

 

[clibb]

I am not against EMT-B pushing medications as a whole. Some medications can be pushed by the EMT effectively, I don't think EMT-B would be prepared for this, However EMT's trained at the i/85 level should have no problem with some of the meds. However, morphine is not one of these meds.

I assume we are speaking of EMT-B, not i/85 trained B's but rather EMT-B. Can an EMT-B explain the pharmacodynamics and kinetics of morphine? Have they had enough physiology to understand the mechanisms at play at the cellular and molecular level? Some of the EMT-B programs mentioned on here do not even require clinicals. There is no way in hell an EMT-B should be allowed to administer morphine. Is the EMT-B ACLS certified and an ALS provider? What if something goes wrong? What if they accidentally give too much are they prepared to handle that? What if the patient goes into respiratory arrest?

I agree with this. You can argue all about the extra training and all that, but that's what makes you a Paramedic compared to an EMT-B. I would never want to administer someone Morphine even if the doctor gave me the go ahead. I don't have the training on what to do if someone goes south from me administering Morphine.

 

[LonghornMedic]

Personally, I think EMT-B should be done away with. Just have EMT-Intermediate and EMT-Paramedic. Both can start IV's, manage airways, administer drugs, etc. EMT-B's are really nothing more than glorified first aid. With EMT-I's you could add morphine to their formulary, as you already have access to narcan should a reaction occur. I feel more comfortable letting EMT-I's administer morphine that EMT-B's.

 

[medicRob]

Personally, I think EMT-B should be done away with. Just have EMT-Intermediate and EMT-Paramedic. Both can start IV's, manage airways, administer drugs, etc. EMT-B's are really nothing more than glorified first aid. With EMT-I's you could add morphine to their formulary, as you already have access to narcan should a reaction occur. I feel more comfortable letting EMT-I's administer morphine that EMT-B's.

TN doesnt even license EMT-B anymore. The lowest level is trained to the i/85 curriculum.

 

[Shishkabob]

Win...........

Not my saying (That credit goes to the Rogue Medic) but alas it holds true.

 

[clibb]

Personally, I think EMT-B should be done away with. Just have EMT-Intermediate and EMT-Paramedic. Both can start IV's, manage airways, administer drugs, etc. EMT-B's are really nothing more than glorified first aid. With EMT-I's you could add morphine to their formulary, as you already have access to narcan should a reaction occur. I feel more comfortable letting EMT-I's administer morphine that EMT-B's.

In Colorado we have EMT-B who are allowed to start IV and administer D-50, Saline, and other medications.

 

[fortsmithman]

Personally, I think EMT-B should be done away with. Just have EMT-Intermediate and EMT-Paramedic. Both can start IV's, manage airways, administer drugs, etc. EMT-B's are really nothing more than glorified first aid. With EMT-I's you could add morphine to their formulary, as you already have access to narcan should a reaction occur. I feel more comfortable letting EMT-I's administer morphine that EMT-B's.

Why not have a Paramedic only system.

 

[Shishkabob]

Why not have a Paramedic only system.

Because more isn't always better.

 

[Ridryder911]

Because more isn't always better.

True.. look at Florida.. BUT... we need quality not quanity! Making multiple levels in lieu of the true gold standard is not nor will ever fix the problem.

R/r 911

 

[the_negro_puppy]

Why not have a Paramedic only system.

Which is what we have here. Having said that, you dont get to use your ALS skills as much as many jobs/calls are BLS only

 

[JPINFV]

I wonder how physicians keep their "ALS" skills up when they see all of the "BLS" patients that either show up on their own or is transported by EMS.

 

[CAOX3]

I wonder how physicians keep their "ALS" skills up when they see all of the "BLS" patients that either show up on their own or is transported by EMS.

Its called fast track, where I get to see a PA in twenty-minutes or less.

 

[LonghornMedic]

Why not have a Paramedic only system.

We do here. Keeps burnout down. When you are a Medic working with a EMT, there are days where you tech all the calls. That gets old. In a dual Medic system, the work load is shared evenly.

 

[LonghornMedic]

Because more isn't always better.

Works well here. But we don't have to deal with FF/Paramedics. Having worked in a system where everyone and their brother on scene was a Paramedic, it was a real pain in the ***.

 

[JPINFV]

Because more isn't always better.

There's a difference between a medic or two on every ambulance and a medic or two on every vehicle that has emergency lights and siren.