View Full Version : 2nd draft of proposed EMS Scope of Practice Model Released
The 2nd draft of the proposed EMS Scope of Practice has been released. It can be viewed at http://www.emsscopeofpractice.org/It appears there has been extensive overhaul of the proposal from the initial draft. Feel free to take a look at the proposal. We would appreciate your comments in the forums section.
I'll be the first to go out on a limb and say that it still sucks.
I'll be the first to go out on a limb and say that it still sucks.
I didn't want to be the first negative person. I've been to negative lately.
It still needs work, but it is certainly better than the first draft.
OARMedic
04-13-2005, 23:16
I did notice the disappearance of the Advanced Paramedic level. It is good to see a level between EMT and paramedic, no matter what you call it. The position of no endotracheal intubation and "required transport" for the AEMT is a little disheartening. Well, it is just a draft, and a draft of a guideline at that.
I didn't want to be the first negative person. I've been to negative lately.
No problem. ;)
I did notice the disappearance of the Advanced Paramedic level. It is good to see a level between EMT and paramedic, no matter what you call it. The position of no endotracheal intubation and "required transport" for the AEMT is a little disheartening.
One level of paramedic- good with me. Intermediate-type level- great with me.
AEMT with no real meat on the bones- not cool. Gutted EMT level- NOT COOL.
hageremtp
04-14-2005, 01:38
BiPAP/CPAP
Needle chest
decompression
Chest tube monitoring
Percutaneous
cricothyrotomy
ETCO2/Capnography
NG/OG tube
Endotracheal intubation
Non-paralytic,
pharmacologically
assisted intubation
(without paralytics)
Nasotracheal intubation
Airway obstruction
removal by DL
PEEP
IT concerns me that they are going to take away paralytics. I know that we do not use it all that often, but when we do use it, we need to use it. Maybe most of the times we could get by with pharmacologically assisted intubations, but I still do not like the idea of taking away some thing we have now and something that we have had the need to use.
I agree, Hager. RSI should certainly be an option at the Paramedic level. I hate seeing us lose skills.
Also, I find it funny that an EMT can utilize manually triggered and automatic transport ventilators but they can't use a combi-tube.
Overall, I like the levels (EMR, EMT, AEMT, Paramedic)...but they still need to adjust the respective scopes.
Here in Texas a basic can use a combi tube but not a vent. (Don't hold me to it; I've just never seen a basic with a vent before.)
At one point I had heard a rumer of basics using BiPAP or CPAP though.
OARMedic
04-14-2005, 23:48
In Virginia, by the state regulations, an EMT-B may, with the operational medical director's approval, intubate. I DO NOT know of any agency that an OMD has approved this, but it is allowed.
I agree with you 100% AMK...it's a futile endeavor.
I agree with you 100% AMK...it's a futile endeavor.
:bow: Yes it is; plus I kind of feel like my state's rights are being effected by this.
DaSharkie
04-18-2005, 10:27
Remember that there are numerous studies that have been published that show EMS and RSI may not be the best mix.
However, with using a combination of Versed and Morphine, the same effects can be obtained without a complete paralasis.
Remember that there are numerous studies that have been published that show EMS and RSI may not be the best mix.
However, with using a combination of Versed and Morphine, the same effects can be obtained without a complete paralasis.
That is so true, but so many people think it is cool to use RSI. Those people are what ruin it for those of us that would use it only when it is needed.
hageremtp
04-18-2005, 14:53
RSI is not just about paralyzing patient, RSI is actually Rapid Sequence Induction, that was first performed with "sedation" medications. While RSI can be completed with many different medications, there are instances that paralyzing agents must be used. Would one want to use Morphine or Versed on a hypotensive patient with a head injury?
Each EMS system is different, each system is unique, its hard to make one blanket statement that will fit each system. There are many places where TPA or TNKase has never been considered as a prehospital medication. Many places feel that it should be left to the hospital only, but when you have a 60 mile transport, TNKase is the only option that may keep some patients alive. If RSI does not work for your system, then fine, but RSI is working in my sytem and for now, I dont want to see it taken away.
celestialdaisy
04-18-2005, 15:33
Seems like a lot of effort to come up with what's already in existence today in many areas: 4 levels of caregiver (first responder, basic, intermediate, paramedic).
Hey, we don't have intermediate around here. We've only got 3 levels. which kinda sucks. They're trying to get I's, butso far it hasn't worked. :bang: The propsal's going in again, maybe we'll have better luck this time. (Lack of funding for new programs sucks) :flame:
I wish we had it, there are cases when I could have used it; however I think we have one person who would abuse his ability to use RSI.
DaSharkie
04-19-2005, 10:29
RSI is not just about paralyzing patient, RSI is actually Rapid Sequence Induction, that was first performed with "sedation" medications. While RSI can be completed with many different medications, there are instances that paralyzing agents must be used. Would one want to use Morphine or Versed on a hypotensive patient with a head injury?
Each EMS system is different, each system is unique, its hard to make one blanket statement that will fit each system. There are many places where TPA or TNKase has never been considered as a prehospital medication. Many places feel that it should be left to the hospital only, but when you have a 60 mile transport, TNKase is the only option that may keep some patients alive. If RSI does not work for your system, then fine, but RSI is working in my sytem and for now, I dont want to see it taken away.
Precisely why this will get tossed by several states. I only stated that I am not a fan of MAI because most of the times I have seen a service run it, the QA/QI and education and training for it are substandard - from what I have seen.
Add to that, the fact that MAI is most frequently done in large cities where there is a hospital on every other street corner, but those of us who work in the rural areas have a 30+ minute drive to an ED have nothing to work with. These rural services would probably (just an assumption) have the least oversight, QA/QI, education, training, and probably fewer opportunities to use MAI (thus requiring the higher level of training and education.)
In the end run, a state or community will allow a service to do what they feel is appropriate and this standard will be thrown on its ear, but then there are the legal ramifications of throwing something like that to the wind.....
WELLAGEDEMT
04-19-2005, 15:43
In my humble opinion, I don't agree with the person/persons drafting the protocol for all the EMS. Some of the major procedures are being written out of service and some others added to a different level. I think the cross section of EMS hasn't had enough input. What is the level of the writers? I feel that some common sense is needed here. We do many things that are not allowed in other areas and we are trained to do so. If a cross section of Medical Directors instead of "book smart-street dumb" were writing these protocols it might make much more sense. It's their license that we operate under and they should be the ones setting the guidelines, with input from the masses.
hageremtp
04-19-2005, 16:41
We must remember that these are the minimun skills, my state has drafted its own skill sets that will meet and exceed these skills.
It's my understanding from reading it that the goal is for the 50 state EMS heads to get together and hammer out recognition/reciprocity, such that if I'm initially trained and certified in Texas, I can move to Indiana, for example, without having to challenge the National Registry, and vice versa. (I had to do exactly that some years ago.) I also agree with the rest of you that gutting EMT and taking away a medic's paralytics is plain stupid, especially when one of the things discussed in the "Future of EMS" document on the SoP site is us giving short-acting thrombolytics and IV antioxidants!
Warning: :soapbox: ahead!
What happens if you give paralytics and for whatever reason, cannot complete an intubation? Simple: you bag the patient, probably with a combitube in place, until the sux wears off.
What happens if you give thrombolytics and your patient has had a fall they forgot to tell you about, in which they did a face-plant and frac'd their maxillary sinus? (had it happen with a patient we had to inter-hospital transfer-60 miles) The long and short of it, boys and girls, is that the patient got 2 units of blood in the ED before we left, another 4 en route, and still died at the receiving hosp. The back end of my truck looked like Freddy Krueger decided it was playtime. (We transported with my partner-du-jour driving and an ED nurse who is also a medic in the back with me.)
Now... since the SoPs don't allow a mere medic to hang blood, the end result is that the patient will be DWPA*.
OK, yes, I'm a little upset :mad: at the turn of events and more so at the idea of our profession being disallowed the use of a life-saving intervention that we've already proved we are competent to use. I think the question that the SoP team needs to answer is if they want EMTs and medics to be more or less effective in the field, or if they want to hand our jobs over to nurses who of course are so much more competent with the training they have to "do what the doctor orders". :bang: :v:
* Dead With Paramedic Assistance
How about we stop spending so much time trying to fix levels that already work and start figuring out a way to raise the pay.
LongIslandEMSGuy
05-10-2005, 22:12
How about we stop spending so much time trying to fix levels that already work and start figuring out a way to raise the pay.
AMEN, AMEN, AMEN, AMEN, AMEN, AMEN, AMEN, AMEN, AMEN, AMEN, AMEN, AMEN
I'm kind of insulted by the whole degree vs. certification thing too. As a paramedic who is trying to become a doctor, I don't have time to take a lot of EMS based classes that won't transfer to a university for my pre-med/biology degree. Plus in Texas there is nothing more that a degreed paramedic knows than a certified.
If you want to play the certification game, I have more certs then the degreed paramedics here adn I don't see them bending over backwards to give me anymore pay.
Tacmedic
05-30-2005, 11:52
What is with the degree all the the sudden? My Paramedic class offered an AA degree but why go through all that extra class and spend all that extra money when the pay is the same? Just becuase someone has a degree dosen't mean they are qulified to be out in the field. I also don't feel they sould remove RSI. This is a fantastic tool when utilized properly, as long as skills are being maintained and the medical director feels comfortable with this it should be left alone. Leave it up to services and their medical director's if they want to utilize it.
totalpatrol
06-02-2005, 11:46
I kinda like the new draft. As long as our states support extended scopes, RSI, on-scene C-spine clearance, stuff like that. :D And I fully support the degrees. Anyway we can further professionalize ourselves is better, and I kinda feel that if we all started carrying AA's, AS's, and BS's (pref BS's) we'd probably get paid more. We may even get a louder voice when it comes to lobbying and union activities.
One thing that I think these organizations should be working on that they are not, is standardizing our pay and benefits as well as our education. I know that in my state, there are some folks who are wanting to make it required that all Emergency ambulances are part of municiple services (county EMS, City Fire, City EMS, ETC...) I think that with proper direction on funding and salaries, this is a great idea.
Well, as far as for here in alabama, we need something to help us. alabama is so far behind everyone else in the ems rules, it kinda stinks, half the stuff we learn in class and that the national registry says we can do, alabama says we can't, just for example, by national registry, basics can administer asprin, well, in alabama we can't. and they hinder the paramedics even more. and as far as pay goes, basics are lucky to get 7 to 8 an hour and paramedics are lucky to get 10 to 12 and hour
celestialdaisy
07-10-2005, 01:42
That's how it is here in PA too.
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