EMT-1 Expanded Scope

1
EMT-1 Expanded Scope

• Los Angeles County EMT-1
• Expanded Scope of Practice

2
Implementation

• February 28, 1997 became policy(802)
• May 30, 1997 after this date all EMT-1s
  certified or recertified in LA County must have
  attended EMT-1 expanded scope training.

3
Title 22 State Scope of Practice

• What 2 drugs?
• IV monitoring - NO ADDITIVES

4
IV monitoring

• may monitor, maintain, adjust a preset rate of
  flow.
• shut off IV if there are signs of infiltration.

5
Expanded Scope

• Los Angeles County only
• Policy 802
• If finer points of this policy are difficult to
  remember use cheat cards!

6
Assists with MEDS

• EMT-1s may assist the patient or allow the
  patient to self administer the following
  medications
• Nitroglycerin
• Epinephrine
• Bronchodilator inhaler

7
Parameters

• 1- The 3 medications - What are they?
• 2- patient condition must indicate use
  (specifically conclusively)
• 3- must be prescribed to patient
• 4- must be patients own medication
• 5- doses PTA count

8
WARNING

• YOU ARE NEVER ALLOWED TO CARRY THESE MEDICATIONS
  ON THE UNIT OR IN YOUR JUMP KIT.
• If you are told otherwise IT IS WRONG.

9
If you administer...

• You must have an ALS unit enroute.
• or
• The patient must be transported immediately to
  the nearest hospital .
• Never treat release - this is emergency
  supportive therapy.
• most accessible

10
Review of Drug Routes

• IV Intravenous
• SL Sublingual
• PO By mouth
• IM Intramuscular
• SQ or SC - Subcutaneous
• IO - Interosseous
• Transcutaneous
• IN Inhaled
• PR Per rectum

11
Review of DICCE

• D Dose
• I - Integrity
• C - Concentration
• C - Clarity
• E Expiration Date

12
Nitroglycerin

• Indication Chest pain
• Route sub lingual
• Repeat no repeat
• Contraindication BP less than 100 systolic
• Viagra w/in 24 hrs
• 3 doses prior to arrival
• Head injury

13
Note

• comes in tablet, spray or skin patch
• always check blood pressure after administration.

14
Epinephrine auto injector

• Indication severe allergic reaction
• Repeat none
• Route IM
• Site upper-outer thigh only!

15
Note

• there are several brands
• 1 dose only
• injection into buttocks, arm, hands, will result
  in inadequate absorption soft tissue damage.
• IV admin. could cause MI or CVA
• Side effects tachycardia, pallor, dizziness,
  chest pain, headache, n/v

16
Bronchodilator Inhalers

• Indications Dyspnea, associated with
  bronchospasm (asthma, bronchitis, COPD)
• Repeat May repeat sprays PRN as prescribed
• Contra patient unable to use device
• maximum doses taken PTA

17
Notes

• In cold environment
• Inhale slowly and continuously

18
Commonly Prescribed Bronchodilators

• albuterol - terbutaline - metaproterenol
• Proventil - Ventolin - Bronkosol - Bronkometer -
  Alupent Meteprel - Brethine ...

19
Form / devices include

• Inhaler
• Inhaler with a spacer
• hand held nebulizer
• Pulmonaid device
• patient or caretaker must set up if EMT is
  unfamiliar with equipment.

20
Document properly

• Assessment AND THE FOLLOWING
• medicine prescribed by MD
• medicine is patients
• other factors
• VITALS REASSESSMENT after treatment

21
IV monitoring

• Additives

22
Monitor IV with additives

• Folic acid - 1mg / 1000ml max
• Multivitamins - 1 vial /1000ml max
• Thiamin - 100mg / 1000ml max
• monitor, maintain, adjust a preset rate of
  flow.

23
Additives requiring an infusion pump

• Potassium chloride
• Total Parental Nutrition (TPN)
• Chemotherapy agents
• These additives may not be transported without
  an infusion pump

24
Patient Controlled Infusion Pumps

• may be implanted or external
• may only be activated by patient or caregiver.
• transport locked
• Insulin - Demerol - Morphine

25
Other Devices..

• Central lines
• Indwelling vascular access device

26
MAY NOT TRANSPORT

• 1 - Central venous monitoring devices
• 2 - Swan Ganz catheters
• 3 - Arterial lines

27
Chemotherapy

• There are risks
• Exposures can occur from IV leakage or spills

28
Acute Risks of Exposure

• Irritation
• Burning
• Tissue destruction

29
Chronic Risks of Exposure

• Genetic damage
• Birth defects
• Cancer

30
Precautions

• Wear protective clothing - universal
  precautions.
• Nursing mothers should not have any contact with
  patient.
• HAVE A SPILL KIT

31
Contents of Spill Kit

• 2 pairs of gloves - thick (.007 inch)
• gown shoe covers
• goggles
• mask
• disposal bags equipment

32
First Aid

• Skin wash immediately with soap water.
• Eyes flush with normal saline or water for 5
  minutes.

33
THE END

• Next?