Taking Blood Glucose - Scope of Practice

[DV_EMT]

Alright... so heres a random one that an EMT buddy asked me the other day...

So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).

My question is this... If NREMT allows a Nationally Certified EMT-B to do something... but the County you work for doesn't include it in their scope of practice... who has the final "say" County or National?

Also... what if your licenced in... lets say TX... but not licenced in Ca. and you are witness to a heart attack (in CA) and are allowed "under TX scope of practice" to adminsiter aspirin. Are you allowed to give the aspirin to the PT in CA... even though what you did was your "usual" scope of practice.

Thanks in advance!

 

[MrBrown]

Alright... so heres a random one that an EMT buddy asked me the other day...

So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).

My question is this... If NREMT allows a Nationally Certified EMT-B to do something... but the County you work for doesn't include it in their scope of practice... who has the final "say" County or National?

National Registry has no regulatory power or licensing clout whatsoever which is why it was so frustrating trying to get reciprocity in California as each County's EMSA set the scope of practice. So it's the county.

 

[Shishkabob]

The NREMT is a testing agency, nothing more. They have no say in what you can or cannot do in scope of practice... Just make test on national standards.


As for what we can do in other states, if I'm working in an EMT capicity I have to follow that states rules. If I'm acting in the capicityoff a lay person, as that is what I am if I don't work there, scope of practice for their EMTs is irrevelent.

 

[gamma6]

go with the county COGs not NR. NR is just a standard.

 

[guardian528]

under most circumstances, if there are ever 2 different regulations on the same thing, the stricter one must be followed.

however, we're getting expanded scope next year

 

[gamma6]

i'm noticing that here in texas we can do a lot load more stuff......i've heard that cali has some strict rules....

 

[DV_EMT]

under most circumstances, if there are ever 2 different regulations on the same thing, the stricter one must be followed.

however, we're getting expanded scope next year

lol... i'll talk to salvucci MD and Lampola about that... salvucci's pretty liberal nonetheless about scope of practice... even in VC... if he even brings Activated charcoal back... i'll be shocked.

 

[Aidey]

The scope of practice set out by the NREMT is just a guideline that explains what each level is supposed to be taught.

Your county/agency protocols are what you are legally bound to, and what you have to follow. Those are the things that your MD is willing to let you do while practicing under their license.

In your TX vs CA scenario it's basically moot because you aren't legally certified in CA. Anything you do can be considered practicing without a license/certification.

Something like administering ASA, which is taught to lay persons, may be ok. I would be very hesitant to do anything that is considered invasive, or anything that could be considered an intervention beyond CPR/rescue breathing or other things taught to lay people.

 

[Seaglass]

I'm certified in multiple states. I can do several things, like taking blood glucose or administering activated charcoal, in one that I can't touch in another. If I'm in a state where I'm not licensed and happen across something, I'm just a bystander who knows first aid and can give a coherent report... which is pretty similar to what I am if I run across something in a county where I'm licensed, since it's not like I run around with a bag full of gear.

Like everyone else said, the county has the authority. When in doubt, follow the stricter protocol. CYA and all that.

 

[trevor1189]

Alright... so heres a random one that an EMT buddy asked me the other day...

So in NREMT... they state that as a basic you can check a PT's blood glucose by doing a needle stick... BUT.. Santa Barbara and Ventura County EMT-B scope of practice does not include this (inculding admin of aspirin, activated charcoal and the such).

My question is this... If NREMT allows a Nationally Certified EMT-B to do something... but the County you work for doesn't include it in their scope of practice... who has the final "say" County or National?

Also... what if your licenced in... lets say TX... but not licenced in Ca. and you are witness to a heart attack (in CA) and are allowed "under TX scope of practice" to adminsiter aspirin. Are you allowed to give the aspirin to the PT in CA... even though what you did was your "usual" scope of practice.

Thanks in advance!

Since the NREMT does not have a "national medical director" you have no standing orders to give ASA or any other procedure/treatment they test you on that you cannot do under your county/state scope of practice. If you really think someone could benefit from ASA, 1. You might say have you taken an Aspirin? This might encourage them to do it. Most likely won't hurt, assuming they aren't allergic in which case they might reply no because I'm allergic to it. 2. Call 911, I know here 911 operators are told have Pt.'s chew 324mg ASA if that's where their EMD cards take them.

As for the TX vs CA thing, if your not certified in CA you are simply a lay person who knows advanced first aid. You have no scope of practice. You can recommend people to do what seems logical in an emergency, if you don't tell them you're an EMT, their probably not going to find out.

BTW if you can "see" the person is having a MI, my guess is the are already receiving medical attention ie ECG.

2 cents, no legal advice.

 

[DV_EMT]

Thanks everyone for the input. Most of your responses were what I was thinking... but I always like to get second... third, fourth opinions.

 

[trevor1189]

I would also like to throw in that I think taking BGLs should be part of the EMT scope. It's very simple, it doesn't cost much to implement and it is a nice little diagnostic tool to have with some pt.'s.

Ok, so that's 4 cents.

 

[JPINFV]

lol... i'll talk to salvucci MD and Lampola about that... salvucci's pretty liberal nonetheless about scope of practice... even in VC... if he even brings Activated charcoal back... i'll be shocked.

One of the issues with charcoal is that charcoal isn't in the state SOP of basics, but included as an add on. Saying that, somehow OC just put glucose monitoring in for basics provided that the basic is being supervised by a paramedic. Now I personally don't see an issue with basics doing D-sticks when working with paramedics provided proper training, however I'm not quite sure where in state law this is in the scope of basics without the rest of the skills package.

 

[JPINFV]

The scope of practice set out by the NREMT is just a guideline that explains what each level is supposed to be taught.

Point of clarification. The National Highway Safety Administration (NHTSA) sets the national scope of practice and educational guideline recommendations that each state can choose to follow. These guidelines are what the NREMT designs their exams off of. NREMT doesn't set the guidelines themselves.

 

[daedalus]

under most circumstances, if there are ever 2 different regulations on the same thing, the stricter one must be followed.

however, we're getting expanded scope next year

Who? Santa Barbara or Ventura? It is definitely not going to happen down here in Ventura and many in SBC are going to protest this. I am hoping Salvucci will pass on getting EMTs do anything more than what they are allowed to do now, which is already far to much for their amount of education.

Oh, and to answer the question about EMTs doing blood sugars or giving ASA, absolutely not in the OP's County, and most of California. It does not matter what the national curriculum says you can do, if your county medical director does not allow it, you cannot do it.

 

[Scott33]

I would also like to throw in that I think taking BGLs should be part of the EMT scope. It's very simple, it doesn't cost much to implement and it is a nice little diagnostic tool to have with some pt.'s.

The problem has never been the taking of the actual blood glucose, but what to do if your patient is hypoglycemic. In the absence of a gag reflex that would usually be transport or call for ALS.

Funnily enough, many ALS agencies (FDNY for example) don't use glucometry in the field, as hypoglycemia can easily be suspected and treated without the need for a glucometer.

A good history and physical exam can be as useful as any glucometer - all you would lack is a number for the PCR.

 

[VentMedic]

lol... i'll talk to salvucci MD and Lampola about that... salvucci's pretty liberal nonetheless about scope of practice... even in VC... if he even brings Activated charcoal back... i'll be shocked.

JPINFV started this thread almost two years ago.
Activated Charcoal: The Next EMS Myth?

http://www.emtlife.com/showthread.php?t=6625

As far as the blood glucose, it would really be nice if schools taught the difference between the NREMT, the state scope of practice and what the medical directors allow. I can not believe all the posts on this forum where some think the NREMT is "a scope of practice" to be followed instead of the protocols from one's medical director.

 

[guardian528]

Who? Santa Barbara or Ventura? It is definitely not going to happen down here in Ventura and many in SBC are going to protest this. I am hoping Salvucci will pass on getting EMTs do anything more than what they are allowed to do now, which is already far to much for their amount of education.

Talking to our Clinical Education Specialist, he says its already through, and that we are going to be training and implementing it next year. possibly this is just for our company (amr), but one of the fire departments(it was either lompoc or guadalupe fire) already has expanded scope for EMT's so it is already somewhere in SB county.

 

[emt1972]

i'm noticing that here in texas we can do a lot load more stuff......i've heard that cali has some strict rules....

It is because of the abundance of hospitals in close proximity. In the more desolate counties of California, the scope of practice is expanded.

It would be nice to be able to do finger sticks... because is it hypoglycemia or something else? Oh well...

 

[gamma6]

It is because of the abundance of hospitals in close proximity. In the more desolate counties of California, the scope of practice is expanded.

It would be nice to be able to do finger sticks... because is it hypoglycemia or something else? Oh well...

i could see that with the hospitals being close by..

can you guys take saline bags during a transfer from a hospital?