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  • How far should a basic be allowed?

    I have a question. We run BLS respond from the engines, and ladders when the engine is out. We carry basic kit, O2, AED, and are testing the AutoPulse. Our MD has OK use to use Kings tubes, CBG, IV (locks) and the administration is moving that way.
    I was wondering if any BLS engines are using;
    Autopulse
    IV (bag or lock)
    CBG
    King, CombiTube, EOA, PTL, ET,...
    portable ventilator

    I was a P instructor back in the mid 90s and really do not see a problem, but I would like to hear from those that are living it and could give some feedback on the good, bad, and the ugly of these skills in the hands of basics.
    I am not directly involved with the implementing of these skills onto the engines, but I have been ask and have discussed the possibility of these skills being put in service.
    Any real world experiences are welcome.

  • #2
    A vent and IV are most def ALS skills.
    AJ, MICP, FireMedic
    Member, IACOJ.
    FTM-PTB-EGH-DTRT-RFB-KTF
    This message has been made longer, in part from a grant from the You Are a Freaking Moron Foundation.

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    • #3
      We're doing Autopulse & King's (replacing CombiTubes) as BLS skills. There are some medical directors in Virginia that are allowing thier BLS providers to do IV's. I agree with BLSBoy that vent is an ALS skill.
      Career Fire Captain
      Volunteer Chief Officer


      Never taking for granted that I'm privileged enough to have the greatest job in the world!

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      • #4
        Could you elaborate on why you feel a ventilator should be a P only skill, and not a King\Combi?
        BLSboy, do you feel the gloucometer should also be ALS?

        Let me be clear, I AM NOT TRY TO START A FIGHT. Just to state my position, I am fine with all these skills as long as the training (on going training) is provided. I am looking for basics or Ps that have experience with these skills being used in a BLS setting. When posting please explain why you have taken your position.

        Again thanks.

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        • #5
          I believe according to the NREMT-B standards, the only real basic skills above are the King and the Autopulse (with training). The King LT is replacing the Combitube in many areas as a non-visualized airway. IMO, it is much easier to use and the success rate on first attempts is extremely high.

          In some areas, IVs and locks can be initiated with additional training and certifications. Visualized airways, such as an ETT, are an ALS skill. From what I know about the PTL and EOA, which I'll admit is minimal, they are non-visualized airways and would thus fall under a BLS skill.

          However, any skill must be approved in your medical protocols by the medical director that is authorizing you to operate under their license. So, I guess that they could technically allow a Basic to do any of the skills.

          In my dept, the Paramedics generally ride the engine and have a limited amount of their ALS supplies in a good sized Pelican style box. Our ambulances are generally staff by FF/EMT-B and then the medic jumps over to the ambulance (which is fully stocked) when a PT is transported ALS. Although I didn't write the policy, I believe this is for 2 reasons: first, most of our medics are senior guys and don't want to be on the ambulance anymore; and second, having the medic on the engine doesn't remove a paramedic from service for a BLS transport.

          Edit to add in reasoning: Check the EMT-B text book and you won't usually find instruction on the ETT, ventilator or IV. Usually only medic assist for these skills is mentioned. And I agree, if the basic is trained and comfortable doing the skills and medical direction has authorized them, rock on. But it's likely that if you're using some of these skills we're discussing, there's a good possibility you might need some of the other paramedic level skills (such as pushing meds).
          Last edited by zzyyzx; 07-04-2010, 11:07 AM.

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          • #6
            Thanks zzyyzx for the feedback. With a little more info. Our Parish runs an ALS service that is staffed with 2 to 3 paramedics and most days several have a doctor riding 8 hour day shifts. We are heavy on the transport side with ALS. By the time we start AED, AutoPulse, and BVM the Ps are rolling in. Our line of reasoning for going CBG, King, and IV (lock) would the Ps would be set to start ALS as they walked in the door.
            I agree with the you on the ET. I threw it in just in case there was a department that allows basics to use them. Also I have not seen a EOA or PTL in over 10 years, but they are still available an some may still be using them.
            I guess I should have limited the discussion to King and Combi.

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            • #7
              I think a vent is an ALS skill. Down here we have no basic EMT. You are either EMT-IV or Paramedic. The argument of a vent can be used by EMT basic is not a good one. If someone is heavily trained on any ALS skill they should be able to perform it. I think in the near future EMS training will have two levels. Bare bones do nothing First Responder or Paramedic. People want only the level of care and EMS training continues to add skills to the basic list.
              FF/Paramedic

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              • #8
                All of the apparatus, other than the paramedic squads of course, carry BLS equipment. Advance skills here include the King air-way, epinephrine, baby aspirin, and albuterol.

                It does get a little convoluted on days when we have more meds than squads. A piece of fireapparatus then may become a PFR (Paramedic first responder), and they carry a medic bag with ALS level meds and equipment.
                Crazy, but that's how it goes
                Millions of people living as foes
                Maybe it's not too late
                To learn how to love, and forget how to hate

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                • #9
                  Try being in Massachusetts. There are 5 EMS regions, each one run like its own little fiefdom and each with its own set of protocols...
                  ‎"The education of a firefighter and the continued education of a firefighter is what makes "real" firefighters. Continuous skill development is the core of progressive firefighting. We learn by doing and doing it again and again, both on the training ground and the fireground."
                  Lt. Ray McCormack, FDNY

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                  • #10
                    Note. The vent would only be used for CPR, not ALS patients in need of a vent. That instance would be left to the Ps.
                    Great discussion so far. Keep the opinions and info coming.

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                    • #11
                      Originally posted by TNFF319 View Post
                      I think a vent is an ALS skill. Down here we have no basic EMT. You are either EMT-IV or Paramedic. The argument of a vent can be used by EMT basic is not a good one. If someone is heavily trained on any ALS skill they should be able to perform it. I think in the near future EMS training will have two levels. Bare bones do nothing First Responder or Paramedic. People want only the level of care and EMS training continues to add skills to the basic list.
                      I agree on the only having two levels before long, Ga keeps on adding things that the EMT-I can do. ALS skills that a EMT-I can do include advanced airways combi, king ect, epi pens, IVs and fluid administration this includes transporting pts that have iv meds running as long as its not an ACLS drug , D-50, Nitro, asprin, cpap, cronic vent pt tranport.

                      I have a headache now.
                      Get the first line into operation.

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                      • #12
                        I can see why you might have basics do some of those tasks in your area. In my department, every station has a paramedic if no one is on vacation or sick. Only about half the stations have ambulances. Everyone on the dept hired since about 1990 must maintain at least an EMT-B. I think we only have 1 or 2 of the older guys that don't have that cert. So usually the paramedic is arriving within a minute of the BLS ambulance, if not before. If a BLS crew beats the medic, they're establishing an airway (dropping a King, Res-Q-Pod, BVM, O2, capnography), starting compressions and attaching the defib pads.

                        The Lifepaks we use on the ambulance don't have all the features of the ALS ones on the engines (such as manual defib, capnography, resp wave form, etc.) so the paramedic will usually bring their monitor to the ambulance. The BLS ones operate as an AED.

                        We also have the EZ-IO available to the medics. This comes in extremely useful during cardiac arrests for a couple reasons: We don't use AutoPulse (yet...) so there's a lot going on at the torso and head already. The lead medic will usually drill into the tibia and manage the arrest from there. They can watch the monitor and push their drugs. If there's a second medic, they'll manage the airway and assure compressions are going well.

                        Most FDs in my area don't have any ventilators. Only private transport ambulances mainly used for facility to facility transport might have them. But we're usually within a five minute transport of a facility with lights and siren. Also, on an arrest, we'll usually have about 6-8 FF/EMT-B and 2 FF/EMT-P, so we can shove the manpower needed to maintain compressions, BVM, medic and an alternate in the back of the ambulance if needed.

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                        • #13
                          We follow the new BLS EMT protocols which include King or Combi-tube, giving Nitro or Epi that is not the patients, pre-mixed Albuterol and ASA. Under the protocols EPI can be done without permission from med control, and the others can be done without contacting med control initially in emergent situations following specific standing orders. In non-emergent situations, or where manpower is available they prefer you contact med control before administering.

                          Basics have been using autopulse and doing thier own dextrose sticks here for several years.

                          There are rumors that LA will be moving towards IVs being a basic skill within a couple of years, but we are not there yet.
                          Train to fight the fires you fight.

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                          • #14
                            Originally posted by Acklan View Post
                            I have a question. We run BLS respond from the engines, and ladders when the engine is out. We carry basic kit, O2, AED, and are testing the AutoPulse. Our MD has OK use to use Kings tubes, CBG, IV (locks) and the administration is moving that way.
                            I was wondering if any BLS engines are using;
                            Autopulse
                            IV (bag or lock)
                            CBG
                            King, CombiTube, EOA, PTL, ET,...
                            portable ventilator
                            My thoughts on the subject are this:

                            I see no issue with the Autopulse, Glucometer and King LT airway being incorporated into the BLS skill set. The reason being, the autopulse is chest compressions, anybody with diabetes or a diabetic family member can check a blood sugar and it's pretty hard to screw up inserting a King airway.

                            As for the other stuff, what's the point in starting IVs as BLS if you can't administer IV medications? Even as a paramedic, the vast majority of the IVs I start provide no real "benefit" to the patient and get started simply because that's what the treatment protocols call for. Kind of similar to the "everybody gets O2" thing at the BLS level.

                            I agree that the autovent should be an ALS skill, not BLS. It's not so much that it's too complicated to use for a BLS provider, but more that there can be complications associated with it's use and the ALS provider is probably going to be more able to recognize those problems and be authorized to fix them should they occur. Plus, I'm having trouble picturing any scenerio in which you could truly justify its use at the BLS level other than maybe taking a vent patient to a routine doctor visit. Anything pre-hospital that necessitates the use of an autovent clearly should have an ALS response, so why would BLS need it?

                            Comment


                            • #15
                              Hey Acklan, just a heads-up for you in regards to AutoPulse/Vent combo. We've got the AutoPulse at our department, and tried a couple different vents with it, but the vents wouldn't cooperate due to the constant change in pressure in the chest from the AutoPulse compressions. We were trying to get it set up at our Department so that we could transport a full arrest with only 1 person in the back, as we get little-to-no first response from 4 of the 5 small towns in our county.

                              And, well, about the EMT-B scope of practice... in all honesty, if you guys want to go through with that, become an ALS service. EMT is an easy class compared to Paramedic, and the scopes should reflect that. I don't have a problem with EMT-Bs utilizing equipment to do something they were taught, like the AutoPulse and advanced airways. But I don't like adding completely new items, such as IVs. That's what your Paramedics are for. If you want to do these additional procedures, take on the extra responsibility and become a Paramedic. Many of us already have.

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