What can the prehospital crews do in your area?

[nfdfiremedic]

In my region, I find that the paramedics really have their hands tied. Before returning to nursing school, I was a firefighter/medic for years (as my screen name suggests... I've used the same SN since the 90's and never changed it.) I relocated to this region (midatlantic) after graduating nursing school, and the prehospital crews here operate under a different set of protocols than I used when I was working on the road. I am quite taken aback by how limited they seem to be here!

Paramedics here can give pretty much all of the ACLS drugs. They can not pace. They can not perform RSI and thus carry no drugs that could be used for this purpose. They carry Morphine but can only administer it with an order from the Med Control doc. They carry Valium (not Ativan) and can give one dose to patients only if actively seizing. They are not allowed to carry McGill's forceps to facilitate removal of visualized foreign bodies in the airway. They are not allowed to perform nasal intubations.

One of the ED docs I work with is on the committee that decides their protocols and, when asked about this says that he "Does everything in his power to limit what they are allowed to do" because of "the quality of paramedics around here." I'm a bit baffled by this answer. I would think that any such problems would be easily remedied by reforms to the paramedic curriculum and teaching methodology, not by severely limiting the scope of practice of this very important group of professionals.

What is within the scope of practice of the prehospital providers in your areas?

[LegzRN]

Before ever attempting to do this procedure, please review your protocol with someone who is very, very experienced with neonates. There are some very fundamental priniciples you are missing or you are just too cocky to realize the need for training for specialized procedures. Even if it is in your scope of practice, it may not mean you should do it when you do not know much about it. If you have never done one, when was the last time you reviewed the procedure? The same for doing a cric. Too many cause more problems because they rely solely on the training they has in Paramedic school 10 years prior and hadn't reviewed the procedure since.

As I mentioned before, UVC cannulation was taught in PALS and NALS (which still exists as a hospital version and not to be confused with NRP) for emergency use. However, the location of the tip of the UVC must be taken into consideration for what can be infused. The location of the UVC determines what can be delivered.

I learned this technique in both PALS and APLS with real UVs... the chief ER doc pulled them out of this slimy goo, nasty. I practiced it 4 or 5 times, but believe me, I never, ever, want to do it in real life.

[AnnieOaklyRN, BSN, RN, EMT-P]

Before ever attempting to do this procedure, please review your protocol with someone who is very, very experienced with neonates. There are some very fundamental priniciples you are missing or you are just too cocky to realize the need for training for specialized procedures. Even if it is in your scope of practice, it may not mean you should do it when you do not know much about it. If you have never done one, when was the last time you reviewed the procedure? The same for doing a cric. Too many cause more problems because they rely solely on the training they has in Paramedic school 10 years prior and hadn't reviewed the procedure since.

As I mentioned before, UVC cannulation was taught in PALS and NALS (which still exists as a hospital version and not to be confused with NRP) for emergency use. However, the location of the tip of the UVC must be taken into consideration for what can be infused. The location of the UVC determines what can be delivered.

nice of you to make the assumption that I do not know anything about this procedure or neonates and that I am not smart enough to know that I need to review infrequent procedures, or that I have never cared for neonates, and that I do not have NRP, NALS, and PALS. You just keep assuming, your not worth this response, nor should I even need to explain myself to you. You must be one of those critical care transport nurse or just a nurse that thinks everyone is beneath you...keep dreaming, thats one of the reasons I left nursin, to many catty people with large egos with no reason! I JUST LOVE THE AUTONOMY IN EMS, Nothing like NOT having to ask a physician before assessing and treating patients! your the cocky one that started this conversation, remember that!

Happy

[TraumaSurfer]

nice of you to make the assumption that I do not know anything about this procedure or neonates and that I am not smart enough to know that I need to review infrequent procedures, or that I have never cared for neonates, and that I do not have NRP, NALS, and PALS. You just keep assuming, your not worth this response, nor should I even need to explain myself to you. You must be one of those critical care transport nurse or just a nurse that thinks everyone is beneath you...keep dreaming, thats one of the reasons I left nursin, to many catty people with large egos with no reason! I JUST LOVE THE AUTONOMY IN EMS, Nothing like NOT having to ask a physician before assessing and treating patients! your the cocky one that started this conversation, remember that!

Happy

I can only go by what you have posted on this forum and others.

Do you really believe you should have all this autonomy if you do not know what you are doing or if you have not given a med or done a procedure in a long time or since school?

You must remember in EMS we follow the protocols of a Medical Director (Doctor). We are not as autonomous as you believe nor are we independent practitioners like PAs or NPs.

Yes, you have made your hatred towards RNs well known on the internet especially on the EMS forums where you know you can get an audience to agree that RNs are stupid because you believe all RNs must call for every order. You obviously have never worked in the hospital situation where RNs have standing orders and protocols nor do you know anything about CCT or Flight RNs. By your posts I would say you didn't get the necessary hospital experience and education to become one of those critical care transport nurses. Too bad or you might have a better understanding of why some procedures should be taken seriously and just because they are in your state protocols does not necessarily mean you should do them unless you have the appropriate training.

What sometimes sets EMS apart from other health care professions is when an EMT or Paramedic read they have a skill in their state scope of practice, they believe they own it whether they do it everyday or if they have only read about it or did it only once on a plastic manikin in class. Unfortunately some EMS employers also embrace that concept and provide very little oversight for quality assurance. But, regardless, the Paramedic may claim that skill regardless of quality or if they have ever performed it.

Other health care providers may have an extensive scope of practice with skills they may not even be aware their profession could do. But, unless they meet competencies each year for each of their advanced skills, they may no longer lay claim to that skill and will not be allowed to use it thus losing their position or even job.

[AlmostJesus]

Soooooo in an attempt to get back on topic

I work in Iowa right now and I did my internship in South Dakota.

In South Dakota with the service I was at - ACLS drugs, RSI, Morphine(no need to call for orders for up to 10), Ativan (have to call for orders if it is for sedation), still carried lasix and used routinely, 12 leads

In Iowa - Morphine/Fentanyl/Toradol (8mg/100mcg/30mg without orders) along with Versed or Valium if they are in severe pain (no orders), Versed or valium for sedation, CPAP with more aggressive NTG and lasix, first line ACLS drugs (we have to transport codes), no need to call for orders on anything unless you question giving it

The thing that they have done right at the hospital I work at is they have the medics work in ER essentially as nurses, thus we get a ton of experience working with patients and understanding the ER course for these patients. It isnt uncommon that we are the main caretaker in ER and then work as the medic when we transfer them (continuity of care ftw) This is an excellent way for the hospital and the ambulance to gain trust and for the medical director to continue to be comfortable with the scope he gives us. It also gives us a better idea at how the doctors order things, this is good when you know the doctor doesn't like to give pain meds, you can get them loaded up before they get to the hospital.