What direction is BLS goin in your state?

[TraumaJunkie]

I know that this is going to stir up some controversy but here we go.
What is the scope of practice in your state, outside of the common BLS skills At the company I work for we are allowed to do Blood Sugars, Albuterol Neb Treatments, Nasal Narcan (special Mass OEMS Research Waiver), pulse oximetry , and we will be starting an additional special research program with the state for the BLS use of Combi tubes. What are you guys doing????

( ALS members please refrain from giving neg feedback, I just want to know what other states are doing @ the BLS LEVEL not whether its wrong or right in your eyes)

 

[medic417]

Talk in the area is that the state is about to increase the education requirements. The basic idea I get is we will only have Paramedics. I guess they are starting to understand that just adding all these alphabet monkey skill classes without actual education is not benefiting the patients. Only time will tell though.

 

[mikeN]

I work for a private in the Boston area and my company does not want our basics to do blood sugars because we can't fix it and nasal narcan because it is less controlled than intravenious. They are seriously considering albuteral treatment. I know cataldo and Atlantic carries glucometers and nasal narcan on the basic level.

 

[marineman]

I guess I never really thought of any of these things as special skills since they're normal for BLS in WI but we can use CPAP, Albuterol/Atrovent Nebs, Pulse Ox (is that seriously a skill?), combitube (first responders have had combitubes for 5 years now), we can take blood sugars, I don't know probably more things once someone else mentions them but I don't feel they're special skills right now since they're just normal here.

 

[lightsandsirens5]

In addition to "normal" BLS procedures:

pulse ox. (I agree with marineman. How much knoledge does this take?!?!)
blood sugar/oral glucose
combi-tube
defib and rythm recognition
albuterol
IV therapy (with seperate class)


thats all I can thik of at the moment that is different.

I wish we could do nasal narcan!

 

[JPINFV]

Considering that basic class doesn't really cover things like the physiology behind oxygen use and transport, a pulse ox simply provides a number that far too many will use to adversely affect their treatment plan.

 

[marineman]

Considering that basic class doesn't really cover things like the physiology behind oxygen use and transport, a pulse ox simply provides a number that far too many will use to adversely affect their treatment plan.

At the BLS level everyone gets a NRB at 15LPM... let people feel cool hooking up an extra gadget.

 

[JPINFV]

So basically your system doesn't think that their EMT-Bs are bright enough to decide on an appropriate level of supplemental oxygen treatment, but thinks that they can someone interpret a pulse ox reading? Amazing.

 

[jrm818]

PA (home away from home) just got CPAP BLS, still can't do BGL's, have Epi Pens, no albuterol, no airways except I think rural areas might be able to do Kings or Combitubes, but I work for an ALS service so that's all moot for me.

CPAP really excites me...not as a skill monkey, but because I think its a great way to dramatically improve patient outcome.

Its extremely disappointing that it's not used in MA (at least that I know of) even at the ALS level. Heck I've not even heard of it being used in the local hospital...everyone gets a tube.

 

[lightsandsirens5]

Considering that basic class doesn't really cover things like the physiology behind oxygen use and transport, a pulse ox simply provides a number that far too many will use to adversely affect their treatment plan.

WA state covers pulse ox. And whats so hard about telling the difference between 98% and 80%?

We use NRBs @ 10 and 15 LPM and NCs at 4 and 6 LPM.

 

[medic417]

NCs at 4 and 6 LPM.

Wow. Not at 2LPM? 6LPM is going to dry out nasal passages really quickly.

 

[JPINFV]

. And whats so hard about telling the difference between 98% and 80%?

Hell, why stop at pulse ox then, why not EtCO2?

 

[A36]

CPAP really excites me...not as a skill monkey, but because I think its a great way to dramatically improve patient outcome.

Its extremely disappointing that it's not used in MA (at least that I know of) even at the ALS level. Heck I've not even heard of it being used in the local hospital...everyone gets a tube.

One department in MA does in fact use CPAP on the ALS level (there may be more). Don't know how often they're used but one medic told me they're a pain because they blow through D tanks relatively quickly.

MA is extremely varying depending on the company, but OEMS seems willing to advance BLS (though I had not heard about the combitubes). And not having worked BLS yet in SC I couldn't give an accurate opinion.

 

[Shishkabob]

In Texas, you're allowed to do anything your MD teaches you and puts in your protocols.


But as for the norm in the area's I'm used to;

Albuterol
Blood glucose readings
Glucose tube
Activated charcoal
NTG
ASA
Epi-pens
Pulse ox

 

[jrm818]

outta curiosity...where in MA? hopefully it keeps spreading...MA is way behind the times on this one. ALS where I am definitely doesn't...to the point that the first time I asked (pt. was pretty much a perfect CPAP candidate...ended up getting tubed instead) the medic looked at me like I had 3 heads and said "you mean the machine for sleep apnea?" I don't think he believed me when I told him there was a version made for EMS. I still don't get that...has he never heard of bipap even? Similar idea...

It does burn through O2 pretty good, but most everyone who uses it gives it rave reviews...including the patients who don't get tubed and physicians who see better outcomes even long term. Just have to get them on the main O2 tank pretty quickly...its not good to DQ it once you start. I would hope a medic wouldn't withhold it just because it uses a lot of O2.

EDIT:

I forgot...PA just removed charcoal as a required drug. We pulled it off the trucks. Fine with me...
No ASA in PA either
do have pulse-ox

 

[Shishkabob]

They don't allow you to give ASA?

What's the reasoning behind that?

 

[jrm818]

No clue. That's another one that's moot for me b/c I work with a medic whenever I'm working in PA, so I never bothered to ask. I'm sure it has to do with possible side effects, interactions, maybe worried that we'll forget that ASA isn't given to kids..heh.

 

[A36]

outta curiosity...where in MA? hopefully it keeps spreading...MA is way behind the times on this one. ALS where I am definitely doesn't...to the point that the first time I asked (pt. was pretty much a perfect CPAP candidate...ended up getting tubed instead) the medic looked at me like I had 3 heads and said "you mean the machine for sleep apnea?" I don't think he believed me when I told him there was a version made for EMS. I still don't get that...has he never heard of bipap even? Similar idea...

That would be Boston EMS. They tend to be rather progressive compared to other services in MA.

 

[TheMowingMonk]

I think with the Shift towards ALS, eventually EMTs with go the way of the DO DO since its getting harder and harder to get EMT jobs as they are getting replaced by Medics, as least thats the way things seem to be going around here

 

[colafdp]

WA state covers pulse ox. And whats so hard about telling the difference between 98% and 80%?

We use NRBs @ 10 and 15 LPM and NCs at 4 and 6 LPM.

but the pulse ox isn't just about reading the number...read your patient. i've heard (and saw one on practicum) people witholding oxygen because the pulse ox said 100% so they didn't need any O2.

On a side note, do they teach the whole disassociation curve, and patho behind the SPO2 in the American EMT-B courses? Or is it a hit and miss thing that differs between schools? I'm not trying to be ignorant or anything, I just don't know what they teach down there.