Taking Blood Glucose - Scope of Practice

[Sasha]

take for instance... the fentanyl is a transdermal SR medication... but a PCA is usually 50mL of straight Fentanyl, Dilaudid, or other medications. Thats 1mg/mL x50 mL's. Can you imagine the potential lawsuits and legal actions happen if a Basic decides that he wants to take that PCA? Perhaps he/she manages to get a hold of the PCA Pump Key (which isn't that hard to do) and while the PT is... let say asleep for a long transport... decides to swap the 60mL syringe with 60mL of NS or SW?

I'd be more worried about a paramedic doing that than a basic.. I don't know about there, but here basics on IFT trucks don't carry saline and syringes to do the switch.

 

[JPINFV]

Syringes are easy enough to come by if you're resourceful and every truck I've been on have had saline in bottles for irrigation (not IV bags).

 

[Lifeguards For Life]

I'd be more worried about a paramedic doing that than a basic.. I don't know about there, but here basics on IFT trucks don't carry saline and syringes to do the switch.

they dont have syringes in their airway kits, to inflate combitunes?

 

[Sasha]

they dont have syringes in their airway kits, to inflate combitunes?

Ask the EMTs on basic trucks where you did your clinicals if they even carried combitubes, LMAs or King Tubes.

 

[Lifeguards For Life]

Ask the EMTs on basic trucks where you did your clinicals if they even carried combitubes, LMAs or King Tubes.

i've never been on a basic truck at american, if that's who you are referring too. The majority of my rides have been at the fire houses, all ALS

 

[JPINFV]

Combitubes aren't in the scope of practice for basics everywhere.

 

[exodus]

Ask the EMTs on basic trucks where you did your clinicals if they even carried combitubes, LMAs or King Tubes.

We do in SD. Though, I would never use one :/ Never been properly trained on it's use...

 

[redcrossemt]

In LA county... you can transport any pt with an IV provided that they're on a pump that has been already set by a nurse. (there may be certain restrictions the the prior statement)

Does this include medications, or just fluids?

Re the PCA discussion, if it's a patient's home PCA, I don't see a problem with it. If it's an IFT to another hospital with a hospital PCA, then I would guess ALS transport is indicated.

 

[eveningsky339]

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!

Strict regulations like these befuddle me. If you, as an EMT-B, witness an MI, you cannot administer aspirin... a bystander with a touch of common sense, though, can stroll up and do so.

Same with epi, or nitro, or any other BLS drugs that an MD may prescribe-- the patient can administer it, but a basic can't, even though said basic probably has a greater degree of knowledge in pharmacology (as little as it may be).

But I digress...

 

[VentMedic]

Re the PCA discussion, if it's a patient's home PCA, I don't see a problem with it. If it's an IFT to another hospital with a hospital PCA, then I would guess ALS transport is indicated.

I would say the hospital to hospital IFT would definitely require a higher level of care. These patients may still be acute in their illness or surgical procedures. There are many issues to consider and things that can go wrong which is why these patients are often on a floor capable of tele - transmission of ETCO2 and pulse oximetry.

There are also some state licensing reguations as it pertains to who can handle narcotics. If these are locked in the PCA device, some could argue they are locked up safely.

 

[VentMedic]

but a basic can't, even though said basic probably has a greater degree of knowledge in pharmacology (as little as it may be).

But I digress...

Actually the person who has been prescribed the epipen or nitro probably has way more education about pharmacology and their disease process than the EMT-B even if they only got a few minutes from their doctor or pharmacist. The EMT-B, even for "expanded" scope, teaches very little about the actual pharmacology or the pathophysiology of the disease.

 

[eveningsky339]

Actually the person who has been prescribed the epipen or nitro probably has way more education about pharmacology and their disease process than the EMT-B even if they only got a few minutes from their doctor or pharmacist. The EMT-B, even for "expanded" scope, teaches very little about the actual pharmacology or the pathophysiology of the disease.

Unfortunately, I have to agree with you here. I couldn't believe how little pharmacology we were taught in basic school; ended up having a few long chats with the medics to help me better understand certain principles.

 

[Aidey]

I would say the hospital to hospital IFT would definitely require a higher level of care. These patients may still be acute in their illness or surgical procedures. There are many issues to consider and things that can go wrong which is why these patients are often on a floor capable of tele - transmission of ETCO2 and pulse oximetry.

What about a non acute patient? For example, a hospice patient being transferred from home to a hospice house because the family can no longer provide care for the patient? Would the presence of the PCA pump automatically qualify a transfer like that as an ALS run?

 

[VentMedic]

Unfortunately, I have to agree with you here. I couldn't believe how little pharmacology we were taught in basic school; ended up having a few long chats with the medics to help me better understand certain principles.

Excellent!

Now if you are really serious about pharmacology, enroll in a college level course before you enter Paramedic school. You might be surprised as how easy the Paramedic pharmacology will be but a little frustrated by how over simplified it is since few to no prerequisites are required.

This is why some believe it is "thinking out of the box" when a medication is used for a purpose they never heard of. But, there is just so much information one can fit on a 4x6 note card. If they had taken a college level pharmacology class they would already have known about the "thinking out of the box" stuff even if they medical director did not allow it due to everyone being held to the knowledge of the lowest denominator. However, if you advance to a progressive CCT or Flight team or even a good 911 ALS service, the advanced education and knowledge can be very useful.

 

[VentMedic]

What about a non acute patient? For example, a hospice patient being transferred from home to a hospice house because the family can no longer provide care for the patient? Would the presence of the PCA pump automatically qualify a transfer like that as an ALS run?

That would depend on your state and local statutes for medications and what constitutes their definition of locked, secure and licensed.

In a couple counties that I am familiar with in California, a heplock can be transported by BLS but if ANYthing is attached it gets ALS or CCT. If the IV, including the PCA, is a med a California Paramedic can not even babysit and that includes most meds unfortunately, a CCT with an RN is required.

 

[iacuras]

Quick question here. I've been doing quite a bit of international flying lately, and was wondering if someone on the plane had a medical emergency, and I was the only health care provider on the flight, what would I be able to do? I'm an EMT-B with an IV cert. Would I be able to start an IV?
My gut instinct would be to have the crew of the plane patch me through to a doc at an ER on the ground who could approve or deny my actions. Thoughts?

 

[akflightmedic]

Here are two threads to get you started.

I will recap very briefly but you should read those threads. What good is an IV going to do if you are the only medical person?

Second, on international flights, I assure you out of the 250-400+ on board, one of them has more medical training than you, even the Indian doctor who barely speaks English.

The attendants will ask to see your certs before rendering aid most times unless true crisis exists and then they will still ask to see them after all is said and done. They always patch you through to their medical control after verifying your status.

They carry full ALS kits on board with a wide range of pharmacology and airway support.

I have tended to many medical emergencies as I have been flying international coming up on 5 years now. I have NEVER been the only medical person on board, I may have been the only one stupid enough to volunteer, but never the only one.

(As a side note, I have received multiple gift baskets to my home address, several bottles of champagne including Dom, lots of free miles and over 1000 dollars off for future flights)...not that I volunteer to get these things but they are nice thank yous.


http://emtlife.com/showthread.php?t=12873&highlight=plane+emergency

http://emtlife.com/showthread.php?t=554&highlight=plane+emergency

 

[apumic]

Second, on international flights, I assure you out of the 250-400+ on board, one of them has more medical training than you, even the Indian doctor who barely speaks English.

True, although some may choose not to reveal themselves to avoid taking on liability. While it's quite sad, with medical malpractice such an issue, a physician lacking any advanced tools may feel fairly uncomfortable about trying to assess a pt in-flight and deciding upon whether or not some sort of emergency care (that they likely have minimal resources for on-board) needs to be rendered. Obviously, in those cases, an EMT-B (or even paramedic or flight nurse) is definitely not the best option; however, an MD may abstain from revealing him/herself to avoid being caught up in such a scenario. If advanced healthcare providers refused to reveal themselves, it might, in the rarest of circumstances, be possible for an EMS provider to be the one to raise his/her hand and volunteer to assist the potential pt.

 

[VentMedic]

True, although some may choose not to reveal themselves to avoid taking on liability. While it's quite sad, with medical malpractice such an issue, a physician lacking any advanced tools may feel fairly uncomfortable about trying to assess a pt in-flight and deciding upon whether or not some sort of emergency care (that they likely have minimal resources for on-board) needs to be rendered. Obviously, in those cases, an EMT-B (or even paramedic or flight nurse) is definitely not the best option; however, an MD may abstain from revealing him/herself to avoid being caught up in such a scenario. If advanced healthcare providers refused to reveal themselves, it might, in the rarest of circumstances, be possible for an EMS provider to be the one to raise his/her hand and volunteer to assist the potential pt.

You are going to be limited regardless. The ALS meds available will only last so long. If you can not add additional fluids, pressors and drips, the patient may still be FUBAR somewhere over the Atlantic or Pacific Ocean.

Regardless of the title, the airline's medical control will be on the communication line to help. The instructions are generally very clear.

You also seem a little eager looking to get your 15 minutes of fame.

I prefer not to board a flight wishing for someone to need medical assistance because I don't want bad health to happen to anyone and definitely not while several thousand feet in the air and a few thousand miles from land.

 

[DV_EMT]

In response to the comment about... "what is to stop a Medic or RN from stealing a narcotic"... my response would be that an RN or Medic probably has spent too many hours studying and in classes... as well as money to risk stealing a narcotic... whereas a basic has a semester of training only.


In response to the Airplane question,

There are very few medical emergencies that happen in the air... and like AK said, they do have a variety of equipment in the air.

However, i did read an article somewhere that the equipment bags are sometimes not as "up to par" as some medical staff need them to be. From what i recall from the article... they are assembled py people that have no medical training and work an assembly line type of job. Now i've never seen any of the packs personally... so I couldnt begin to ell you either way if its good or bad, but just keep in mind that, yes they have them, and most all i believe have an AED.