What we can and cannot do...

Yo,

Still grading stats exams. Yech. It has been FREEZING cold here the last few days (as in below zero F). No ambulance calls for my agency in almost a week! Cold must be keeping people inside.

Last week MacMedic and aoblog (see blog links at right) gave a rundown of provider levels and allowed drugs/procedures for their regions. I find it interesting to read what prehospital care providers can and can’t do in other areas and thought I’d contribute. Please note that this will be boring as H&LL if you are not involved in the field …

OK, in my region there are the following levels:

CFR: Certified First Responders. Frankly, I don’t know what they can do and don’t see it listed anywhere. Mostly controlling immediate threats to airway, breathing and circulation until a higher level provider arrives.

Basic EMTs: Nasal and Oral Airways; PASG pants; Semi-Automatic defibrillators; Oxygen; Activated Charcoal (with medical control); Albuterol; Epinephrine with an “Autoinjector”; oral glucose; assist patient with their own inhaler/nebulizer; assist patient with their own nitroglycerine.

AEMT-I: Start an IV of normal saline on patients 16 years and older when they have responded and ALS intercept (AEMT-CC or AEMT-P; see below) has been called. Intubate patient with agonal respirations or in respiratory arrest if pt is 16 y/o or older. NO DRUGS except those listed above for basics.

AEMT-CC (“medics”): This is the level I am currently in training for… IV on patients 5 and older. Tube patients 5 and older. See drugs below. Routes allowed: PO, SQ, IM, PR, IV, ETT. Also: Glucose monitoring, pulse ox.

AEMT-P (“paramedics”): Add: Needle Decompression; Needle Cricothyroidotomy; Dopamine drips; IV & ETT all ages (including I/O; no facilitated intubation…); more latitude to use “standing orders” vs needing online med control orders. Routes allowed: PO, SQ, IM, PR, IV, ETT, IO.

Drugs used by medics and paramedics in my region:

Activated Charcoal with Sorbitol; Andenosine; Albuterol; Atropine; Baby Asprin; Bretylium; Dextrose 50%; Diazepam; Diphenhyramine; Epinephrine (Sub Q, IV and ETT); Furosemide; Blucagon; Lidocaine; Magnesium Sulfate; Morphine; Nalbuphine; Naloxone; Nitroglycerine; Procainaminde; Solumedrol; Thiamine; Verapamil.

Let me know if you have questions.

DJ