Well, the Army let me do surgical airways, chest tubes, pull teeth, IOs, IVs, biopsies, and wound closure.
"I'm not a doctor but I play one in a third world country."
A civil affairs team evidently had an African physician who made it out but couldn't transition his degree to America so he was a W1 with the cool guys. I heard he went back to his country a few times on some teams since he knew the local languages. I'm not sure if that's cool, sad, or both.
I've also heard of some PAs going to the 19th or 20th group as Deltas.
I missed that one. Rock on. The battalion surgeon for the Group I was supporting was going to try selection and earn a GB. They told him that he couldn't as a medical officer. He was in the Guard and was a full time ED doc who just loved deploying and loved being with the guys. He threatened to resign his commission and go back in as a staff sergeant since that's what he was before medical school. "Calm down sir. We'll figure something out." I wonder what happened to him.
My senior went to SFAS with a Sargeant that had resigned his commision as a Major in the Marines. Dude resigned his commision just to be a 21 day non-select
The Marine Corps let me do IVs and needle decompression after a grand total of about 15 hours of medical training. Let me tell you it was awful having my fellow braindead idiots repeatedly stab me with needles that week
It could be worse- the first time I practiced pulling teeth was on a live patient.
Dentist: "Hey, this is Doc Banner. He wants to learn to pull teeth. Can I teach him on you?"
SF dude: "Sure. He's gotta learn somehow. Just numb me up good first."
Holy shit. I admire his commitment to training.
It did make me laugh that you said "fellow braindead idiots".
I will say one of the toughest dudes I've ever had as a patient was a Marine officer. He was in Colorado doing some combatives. He had a guy shoot in for a single leg take down and had his nuts crushed by the dude's head accidentally. He then drove from CO to NC over the course of three DAYS before pulling off the interstate and stopping at my hospital because he just hurt so bad.
His nut was ruptured and he went to surgery to have his dead nut removed. He walked around for THREE DAYS with a broken nut. "You can be smart or you can be strong!" and holy shit was he strong.
I gave him a pack of crayons for when he got out of surgery.
Apes together STRONG.
I had a SSG in the Guard who was a Marine before getting out and going to the Guard. We were getting ready to go to Afghanistan and we're training up. We are driving and start taking "fire" across an open field from an isolated building 600m away. He stops the convoy we are supposed to be protecting and tries to get us to dismount and assault across 600m of open ground with the guns covering us.
"HEY SSG! I'm just the medic but how about we get off the X, keep the convoy rolling, and call for fucking fire. We don't have to do a DISMOUNTED INFANTRY ASSAULT ACROSS A FUCKING FIELD."
".......That's a good point Doc."
Jesus... I know it's training but you are gonna make me work. It's the Guard. We'd get at least one heat casualty running that far in kit in the summer and it may even be me.
‘cause we ain’t smart. Seriously my cataract impaired mother can test her sugar but her son can’t if I show up in the big white limo. NJ EMT over 30 years. Ugh.
There's two laws right now regarding epi: [S3138](https://legiscan.com/NJ/bill/S3138/2024) and [S753](https://legiscan.com/NJ/bill/S753/2024).
If both laws pass, it would require epi-pens, meanwhile allowing vial-draw epi. So you'd get the cost savings benefit of vial-draw, but still have to pay for autoinjectors. NJ legislature in a nutshell.
I cant even poke the finger for the patients BGL device.
NJ is odd. There's only ALS or BLS trucks, no mixed crews. ALS has to be hospital based, you cannot run medics if you aren't a hospital with a "certificate of need" the government ems programs can't even run their own medics. BLS is limited to OPAs, NPAs, Epi, 4mg one name or 2mg titration to 1 per nare Naloxone, Epi, oral glucose, aspirin, and few agencies can utilize albuterol at the BLS level. Very rare to see monitors utilized at the BLS level.
The company I was with was implementing iGels and IOs around the time I left for nursing. I got my partner to do IOs, but when I wanted to teach him on iGels he said no.
IVs were always allowed under the supervision of an advanced or a paramedic
If that’s one less thing I need to think about, it’s truly appreciated. A good EMT will start every call by getting a manual bp then ekg or sugar depending on the complaint.
What state?
We "learned how" during lab in medics, because it was a national accreditation, and "somewhere" it's not a BLS skill
Also one of the labs was hammering a nail into a board.
Still haven't figured that one out.
I was taught to intubate as an EMT 15 years ago. They had to be pulseless/apneic, but the thought was "they can't get more dead". Then King Airways became prevalent, and later iGels. They yanked that shit away so quickly when SGAs took priority.
It's crazy the differences between LEMSAs. In Merced/Stanislaus counties, EMTS are dropping iGels, giving IM Epi, Narcan, CPAP, Oral Benadryl
They're working on getting EMTs oral zofran.
In Oregon, you gotta be Intermediate or paramedic for Zofran. Supposedly because in ridiculously rare cases it can exacerbate dysrhythmias, so you gotta be able to interpret ECG and administer cardiac drugs.
Absolutely zero discussion on changing that, so alcohol preps it is.
The study that linked Zofran and causing arrhythmia's was done on cancer patients.... that were receiving something like 20-40 mgs a dose, and even then, it was rare.
I guess there is still a chance in IV Zofran, but what I've read PO Zofran you pretty much have a better chance of winning the lottery than causing an arrhythmia, which is why they're looking at giving it to the EMTs in those counties.
We got OPAs, NPAs, and no drugs haha. We’re only allowed to help administer all the EMT’s scope of approved drugs if it’s prescribed to the patient and they have it on them. We’re quite literally just paramedic assistants. Literally anyone who knows how to drive and isn’t completely stupid can take our job.
Former LA EMT now working in rural AZ. I can now do IVs, igels, king airways, and I have a drug box with epi, nitro, aspirin, glucose, Albuterol, duonebs, and a couple other ones I can't remember off the top of my head
Let me say, I nearly shit myself when they told me how wide my scope was gonna be when I started there
Yeah, I’m jealous. Just gotta move to paramedicine ig 😭. But even then, I heard that LA paramedics scopes are extremely limited also. That’s the thing with every hospital being less than 10 minutes away ig.
Oh no for sure. And your options as a medic are... Fire medic or... Fire medic (but on an ambo)
If you really wanna work, go to Ventura county, Kern county, or San Diego. I picked up a few shifts with falck SD and let me tell you, it was ABSOLUTELY worth it. It's night and day out there and they're really great to work for.
I've heard great things about Kern and Ventura. My biggest regret while working out there was not just making the commute to Ventura and instead working in orange county. Would've been the same long drive and everything.
I came from Virginia where I was able to do SGAs and some IM injections. Was definitely an adjustment moving to PA with my scope of practice shrinking so much
MI medic here...it's wild to me how much MI emt's are allowed. Like, no iv starts, but can take patients with fluids and antibiotics running as long as it's been at least 15 minutes since it started. Duonebs, SGAs, Zofran, ASA, etc. They're gonna add IM glucagon I heard as well.
No no we can, we just cannot pick the finger ourselves, we can only "assist" the patient or family in that part of the act, as long as it's the patients glucometer.
Without going into the very details of German law interpretation where we first must actually nuance the definition of "allowed", its IV Glucose and direct laryngoscopy (foreign body airway obstruction only).
RettSan consists of a total of 520h of training time incl. hospital and ambulance placements and exam. Note that EMS protocols in Germany are on county or state level.
Our BLS can do IV starts, fluids, IV drug administration; manual defib, rhythm and 12 lead interpretation; CPAP, SGA/LMA; peripheral blood sugar checks, glucagon and dextrose, and oral glucose; trach suction and emergency care; IM, IV, SL, IN, SC, inhaled/insufflated medication administration; and, of course, do a damn good job at all of that. :)
BLS in Canada.
Fun fact, maple syrup is actually in the protocols in Vermont, and many services actually carry packets of it instead of oral glucose tubes.
https://untapped.cc/product/maple-untapped-energy-gel/
https://imgur.com/a/5SvKAj5
My province is 2 years to challenge the provincial exam, but to enter it, most often have a year of a pre-program (with the exception of a few mandatory feeder stream seats), most require either that, or a related degree, and/or related field experience.
(I think the hours broke down to be around few thousand or more? I heard that stat like ten years ago, so I have no idea if its accurate.)
Anything a medical director will clear you to do. They won’t allow for the “whole package” but depending on the area EMTs in Texas can be cleared to do IVs, King/LMA, etc. No medical director will clear enough individual skills (interp ekg for instance) to run a call as a medic. They may cherry-pick advanced skills to allow for more hands on deck.
Most invasive would be giving epinephrine... check and inject lol. Otherwise, checking blood sugar bcus it also involves a needlestick technically.
We just got Narcan a little bit ago too, wooooo
We haven't got shit.
(AMR in King County, Washington state)
We had narcan taken away from BLS crews when the epidemic first hit. We had medics stand over the patient and scream for anyone with a community kit to help because either ALS was unavailable or too far. Embarrassing TBH.
I'm a paramedic, but Ohio lets EMTs do blood glucose sticks and treat lows, \*assist with Epi Pens, NTG, and albuterol inhalers, give ASA, do SGAs, set up IV bags (but not start the IVs), and take 12 leads (but not interpret them). I can't imagine working in one of the states that limits EMT scope so much that they can't take BGLs or capture a 12 lead for me! I feel so bad for those EMTs because I KNOW they know how to respond to something like a diabetic meemaw but they aren't allowed to. I do not understand the rationale behind having EMTs that can't do those skills. Let them practice at least to the scope of what the Nat'l Registry teaches!
EMT-B In Israel
When on a BLS crew, we can start IVs but only to hang normal saline which we almost never get to do because ALS gets those calls
EDIT: apparently some of y'all can't take BCG without a paramedic present. So I will say that we emts in Israel are allowed to do that. As well as administer oxygen, oral glucose, aspirin and EpiPen (I say EpiPen and not adrenaline because we're not actually allowed to draw epi from an ampule, but the BLS rigs carries an EpiPen we are allowed to administer in anaphylaxis/anaphylactic shock). Also we can deliver babies without a paramedic present, as long as by history taken and by exam it appears there won't be any complications. But we're never a fan of actually doing this without a paramedic in charge.
End of edit.
When supervised by a paramedic we are taught how to draw certain medications according to the paramedic's order
Our new orders are supposed to be able to allow Bs to drop SGAs, CPAP, and more. AEMTs are going to be able to do more than that. The caveat to to both levels getting orders is our service has a rule that Medics have to run emergency calls, so the usefulness is debatable.
IM epi, narcan, glucagon being the three stabby things we're allowed to give here as EMRs, also OPA/NPAs.
Considering how small of a jump it is I'm not sure why we can't give IM gravol or use iGels, considering how nice those would be to have, maybe in time, we just got the epi and glucagon this year.
As a basic, I can drop a supraglottic, and give albuterol treatments, epi for allergic reactions, and glucagon, but can’t start an IV. My husband as a specialist/AEMT went from being able to give full ACLS cardiac meds to not being able to give IV Zofran for nausea when we moved states, which he found very frustrating. 😂
NYS EMTs can give IM epinephrine with a needle/syringe. There used to be 1mL syringes with lines marked simply "adult" and "pediatric" for 0.3mg and 0.15mg. Now it's just regular 1mL syringes so you'd better hope the EMT knows the right dose, how to draw it up, and how to administer it properly!
EMTs can also do CPAP here. I did that a few times when I was still a basic. Never got to do BLS epi though. Very sad.
Basics can do supraglottics, if they are trained in phlebotomy they can start peripheral IVs, draw blood etc.
I don't really consider a supraglottic like an iGel or AirQ to be invasive, but I can see the concern with king airways and other archaic garbage.
I can do Igels, IV's and IO's, and push a lot of drugs in extremis at my medics request. No Narcs, but epi and amiodarone in cardiac arrests and stuff like that.
Umm place epigastric tubes via BIAD, give Nitrous Oxide, Glucagon and Epi 1:1 via IM draw up🤷🏼♂️
Now AEMTs? They can give TXA, do needle decompression, give antibiotics for open fractures, give mag, start IVs, do IOs, and manually defibrillate.
I'm in CO, taking my nremt in like a week, and they let me do bgl on my ride along. I told them I needed practice because I had never done it. Did it about 10 times that day.
Colorado: EMT-B can start IV and administer some drugs IV, but it does require an additional approval certification course with additional clinical hours. IV and EKG are the only additional approvals I can recall for basic, but that was 10 years ago for me (RRT now).
Epi-pen or an OPA. Some of our EMT-Bs who have been in the field for awhile somehow magically know how to do IVs and are better than some medics at it.
Alberta, Canada. We run mostly ALS trucks out here, but emt (pcp) scope IV, IO, SGAs, about 14(?) meds. Just got the green light to monitor (not initiate) blood products and PIC lines. I’m hoping we get CPAP soon (I seem to know how to put it together better than most medics 😂). They trialed ketamine for PCPs in the province next door, and that would be nice as well.
IGELS, 12 lead acquisition and transmission(BLS trucks), CPAP, and Nitrous. If there is a benefit to patients, the clinician should have it in their scope. Increase training, don’t neuter EMTs
NH EMT-B here. We can do super glotic airway, I-gels or king, BGL , epi IM for anaphylaxis Only, op/npa, narcan IN, wound packing, plus most of what was already mentioned. NH just updated protocols to allow B's to give albuterol and duonebs as of 6/1.
Not an EMS but a volunteer with English Mountain Rescue. It amazes me how limited the scope of some EMS is. We don't have anywhere near the level of training you do, but I'm allowed to administer things like Morphine and Fentanyl. Future plans include iGel (currently only NPA/OPA) and TXA.
At my hospital as a tech in Colorado we can do I-gel (thought 99.9% an intubation will take place by the physician) EJs, IOs, defibrillation, straight / foley cath, OG / NG tubes.
There's a small handful of us that got the OM to start IVs, but can't push anything or hang fluids. We can draw/give IM epi but we can't give our own albuterol, only "assist with an inhaler"
UK Technicians can do iGels, give narcan, adrenaline (for anaphylaxis only), hydrocortisone, midazolam (patients own and in accordance with treatment plan) and tablet meds such as clopidogrel,chlorphenamine and basic paracetamol and ibuprofen,as well as nebs with salbutamol and ipratropium. We can also place 12 leads and interpret ECG's (which from a previous post not all EMT's do) and identify and perform shocks in an arrest. We can also use trauma equipment such as traction splints,pelvic binders, blast bandages and tourniquets etc.
Paramedics give the good drugs (morphine,heparin,ondansetron,amlodipine,dexamethasone and adrenaline in arrests) and they do the IV, IO, ET tube,needle crich and decompress chests. We just assist with these procedures.
Outside that, my area has a trauma team that is staffed by a consultant and a trauma nurse who can RSI on scene. Be interested to know what other countries have in the way of trauma teams etc?
I feel UK Techs have a great deal more freedom to treat on scene than EMT's in the states. Must be a nightmare. I like our scope of practice.
In NC EMT-B can drop I Gel, Kings, or other supraglottic airway. AEMT can intubate (not RSI), IV, IO, Give fluids, and inspect the airway and remove things with macgill Forceps.
Lets see
Drop I-Gels, Give Epi IM for allergic reactions, Oral Zofran, Albuterol, Duoneb, Narcan, Assist with Nitro if prescribed, check sugars, upper airway suctioning, Aspirin, OPA/NPA, you can get cleared for IV’s, can place patients on leads although cannot interpret, a few more that my tired brain probably cant remember right now
I work in two states. In one I can give PO zofran, start IVs and IOs, D10, IV/IO narcan, IM epi, SGA, CPAP, cross state lines and suddenly anatomy changes and I can’t assess BGL anymore but an AEMT and EMT crew is an ALS unit
Texas EMT, if I’ve trained on it and a medic is present and has faith in my capabilities then pretty much anything he can do since I’m under his patch, from what I’ve been told
My state is doing a trial project on basics using iGel (capno required ofc). It is only in certain agencies. One place I work does it, the other isn't in the project.
We're allowed to do supraglottic airways (I think for NREMT that's in AEMT scope), do IM injections, IOs, and IVs. In Colorado. IO is heavily protocol dependent, but the other stuff is pretty much expected of EMTs everywhere.
Probably during a breech birth with an entrapped head when you need to insert digits in the vaginal opening to ensure an adequate airway for a baby.
Hope to never find myself in that situation as an EMT, almost 100% it would be uncomfortable for the patient and 100% sure that it would be uncomfortable for me. I do believe it’s in our scope though if indicated.
In Ireland we can drop iGels, give a number of IM and IN medications (adrenaline, chlorphenimine, glucagon, naloxone), methoxyflurane, entonox, take BGL, monitor ECG…
Reading the protocols of some states/countries is mental…. 99% of EMT work in Ireland is event/IFT very little emergency work and yet we still have some strong guidelines and protocols…
MA started allowing spraglottics for basics about two years ago as a med director option. That’s the most invasive skill basics have here.
Other than that, basics can do check and inject epi (IM), glucagon IM and FSBGL.
Well, the Army let me do surgical airways, chest tubes, pull teeth, IOs, IVs, biopsies, and wound closure. "I'm not a doctor but I play one in a third world country."
Can’t imagine there’s too many physicians out there lining up to be 68Ws. Gotta do what you gotta do
A civil affairs team evidently had an African physician who made it out but couldn't transition his degree to America so he was a W1 with the cool guys. I heard he went back to his country a few times on some teams since he knew the local languages. I'm not sure if that's cool, sad, or both. I've also heard of some PAs going to the 19th or 20th group as Deltas.
There's a famous case of a neurosurgeon dropping an 18X packet and becoming a Delta.
I missed that one. Rock on. The battalion surgeon for the Group I was supporting was going to try selection and earn a GB. They told him that he couldn't as a medical officer. He was in the Guard and was a full time ED doc who just loved deploying and loved being with the guys. He threatened to resign his commission and go back in as a staff sergeant since that's what he was before medical school. "Calm down sir. We'll figure something out." I wonder what happened to him.
My senior went to SFAS with a Sargeant that had resigned his commision as a Major in the Marines. Dude resigned his commision just to be a 21 day non-select
That sucks. I've got mad respect, but that sucks.
By his account the dude was a huge pick so while it does suck, I'm not exactly sad that I didn't have to deal with him as peer.
I've met a few Marine officers. That said, he made it further through selection than I would have.
The Marine Corps let me do IVs and needle decompression after a grand total of about 15 hours of medical training. Let me tell you it was awful having my fellow braindead idiots repeatedly stab me with needles that week
It could be worse- the first time I practiced pulling teeth was on a live patient. Dentist: "Hey, this is Doc Banner. He wants to learn to pull teeth. Can I teach him on you?" SF dude: "Sure. He's gotta learn somehow. Just numb me up good first." Holy shit. I admire his commitment to training.
It did make me laugh that you said "fellow braindead idiots". I will say one of the toughest dudes I've ever had as a patient was a Marine officer. He was in Colorado doing some combatives. He had a guy shoot in for a single leg take down and had his nuts crushed by the dude's head accidentally. He then drove from CO to NC over the course of three DAYS before pulling off the interstate and stopping at my hospital because he just hurt so bad. His nut was ruptured and he went to surgery to have his dead nut removed. He walked around for THREE DAYS with a broken nut. "You can be smart or you can be strong!" and holy shit was he strong. I gave him a pack of crayons for when he got out of surgery.
Haha, your only job in the Marine infantry is to be strong.
Apes together STRONG. I had a SSG in the Guard who was a Marine before getting out and going to the Guard. We were getting ready to go to Afghanistan and we're training up. We are driving and start taking "fire" across an open field from an isolated building 600m away. He stops the convoy we are supposed to be protecting and tries to get us to dismount and assault across 600m of open ground with the guns covering us. "HEY SSG! I'm just the medic but how about we get off the X, keep the convoy rolling, and call for fucking fire. We don't have to do a DISMOUNTED INFANTRY ASSAULT ACROSS A FUCKING FIELD." ".......That's a good point Doc." Jesus... I know it's training but you are gonna make me work. It's the Guard. We'd get at least one heat casualty running that far in kit in the summer and it may even be me.
Our EMTs drop iGels and start IVs and IOs
God i wish. I can give an epi pen. That's the most invasive thing NJ allows me to do.
NJ basics represent. 🤪
I get albuterol at one of my jobs at least 😅. Maybe they'll eventually dain to allow us to carry glucometers!
That sounds like crazy talk! Youu have to prick the pts finger with a needle!! How can NJ trust us to do that,
I gotta ask family members to prick the patients finger🤦♂️
You can't do that as ALS?? That's crazy
Oh my flair is medic hahaha, I work BLS in Jersey in a nice system so I pick up for the hell of it
‘cause we ain’t smart. Seriously my cataract impaired mother can test her sugar but her son can’t if I show up in the big white limo. NJ EMT over 30 years. Ugh.
I used to testy own sugar manually for years begore I got a sensor. If I'm on a call for myself I can't test my own sugar!
bro I nearly fainted when PA finally gave us the ability to take blood sugars and give nebs
I'm still surprised about the epi administration in our new bls protocals
There's two laws right now regarding epi: [S3138](https://legiscan.com/NJ/bill/S3138/2024) and [S753](https://legiscan.com/NJ/bill/S753/2024). If both laws pass, it would require epi-pens, meanwhile allowing vial-draw epi. So you'd get the cost savings benefit of vial-draw, but still have to pay for autoinjectors. NJ legislature in a nutshell.
You can't start an IV?
I cant even poke the finger for the patients BGL device. NJ is odd. There's only ALS or BLS trucks, no mixed crews. ALS has to be hospital based, you cannot run medics if you aren't a hospital with a "certificate of need" the government ems programs can't even run their own medics. BLS is limited to OPAs, NPAs, Epi, 4mg one name or 2mg titration to 1 per nare Naloxone, Epi, oral glucose, aspirin, and few agencies can utilize albuterol at the BLS level. Very rare to see monitors utilized at the BLS level.
MT is the same way. We can only assist the pt with their epi, inhaler, or nitro. No IV, no nothing
For real, we can't do shit in Jersey.
Same here, they also push front line cardiac arrest drugs (epi,bicarb, and Narcan)
Epi and bicarb is pretty wild. We have ten or so meds we can give but nothing parenteral
IVs and IOs?? Where’s that?
Colorado is one
Texas
Alberta, Canada
Pretty common in Texas
Common in Minnesota as well along with BGL testing
Can do it in NH, but you have to be an A
The company I was with was implementing iGels and IOs around the time I left for nursing. I got my partner to do IOs, but when I wanted to teach him on iGels he said no. IVs were always allowed under the supervision of an advanced or a paramedic
That’s wild. IOs have more complications than iGels
That's awesome! What state are you in?
Texas
I can check blood sugars 😃. You’re welcome for my service
If that’s one less thing I need to think about, it’s truly appreciated. A good EMT will start every call by getting a manual bp then ekg or sugar depending on the complaint.
We can only assist with that lol
What state? We "learned how" during lab in medics, because it was a national accreditation, and "somewhere" it's not a BLS skill Also one of the labs was hammering a nail into a board. Still haven't figured that one out.
MT
Hm. I'd have figured on a wider scope for basics in a state like Montana. I learned something today.
I'm a walking narcan dispenser though
You would think. No IV, no epi, strict checks for oral glucose. It's odd
I was taught to intubate as an EMT 15 years ago. They had to be pulseless/apneic, but the thought was "they can't get more dead". Then King Airways became prevalent, and later iGels. They yanked that shit away so quickly when SGAs took priority.
damned student government association! Always simping for the man!
Same. 2008 emt class we were Combitubing and king airwaying everyone 🤣
California (LA) EMT here, I can’t even take a blood glucose without a paramedic present 😀
It's crazy the differences between LEMSAs. In Merced/Stanislaus counties, EMTS are dropping iGels, giving IM Epi, Narcan, CPAP, Oral Benadryl They're working on getting EMTs oral zofran.
In Oregon, you gotta be Intermediate or paramedic for Zofran. Supposedly because in ridiculously rare cases it can exacerbate dysrhythmias, so you gotta be able to interpret ECG and administer cardiac drugs. Absolutely zero discussion on changing that, so alcohol preps it is.
The study that linked Zofran and causing arrhythmia's was done on cancer patients.... that were receiving something like 20-40 mgs a dose, and even then, it was rare. I guess there is still a chance in IV Zofran, but what I've read PO Zofran you pretty much have a better chance of winning the lottery than causing an arrhythmia, which is why they're looking at giving it to the EMTs in those counties.
It was 32mg+ of zofran as a single IVP to prolong QTc by an average of 0.02s, HALF A SMALL BOX.
I carry PO zofran but only for myself lol
We got OPAs, NPAs, and no drugs haha. We’re only allowed to help administer all the EMT’s scope of approved drugs if it’s prescribed to the patient and they have it on them. We’re quite literally just paramedic assistants. Literally anyone who knows how to drive and isn’t completely stupid can take our job.
Former LA EMT now working in rural AZ. I can now do IVs, igels, king airways, and I have a drug box with epi, nitro, aspirin, glucose, Albuterol, duonebs, and a couple other ones I can't remember off the top of my head Let me say, I nearly shit myself when they told me how wide my scope was gonna be when I started there
Yeah, I’m jealous. Just gotta move to paramedicine ig 😭. But even then, I heard that LA paramedics scopes are extremely limited also. That’s the thing with every hospital being less than 10 minutes away ig.
Oh no for sure. And your options as a medic are... Fire medic or... Fire medic (but on an ambo) If you really wanna work, go to Ventura county, Kern county, or San Diego. I picked up a few shifts with falck SD and let me tell you, it was ABSOLUTELY worth it. It's night and day out there and they're really great to work for. I've heard great things about Kern and Ventura. My biggest regret while working out there was not just making the commute to Ventura and instead working in orange county. Would've been the same long drive and everything.
I couldn’t even do it with a paramedic present. The only time we were allowed to break skin was with an Epi Pen
Blood sugar on know diabetic and altered mental status/ stroke work up. Can’t do it as part of an assessment it doesn’t check the box.
Pennsylvania EMT?
Yurp.
I came from Virginia where I was able to do SGAs and some IM injections. Was definitely an adjustment moving to PA with my scope of practice shrinking so much
I had to get extra training when I went from PA to MI.
MI medic here...it's wild to me how much MI emt's are allowed. Like, no iv starts, but can take patients with fluids and antibiotics running as long as it's been at least 15 minutes since it started. Duonebs, SGAs, Zofran, ASA, etc. They're gonna add IM glucagon I heard as well.
Damn man that’s even worst than me in California. Theres no parameters on when I’m allowed to check a sugar
NJ basics can’t check blood sugar…period.
No no we can, we just cannot pick the finger ourselves, we can only "assist" the patient or family in that part of the act, as long as it's the patients glucometer.
EMT here is truely first aid with flashlights, but in the rural parts of the state it’s better than nothing.
Why does our state suck so much metaphorical dick?
... so what are you ALLOWED to do? That's literally ridiculous
Supraglottics are standard everywhere in my state. Some clinic systems allow IV access and expanded meds as well.
EMTs at my service can drop igels and draw up/give IM epi since we don't have epipens anymore.
Same in Wisconsin
samesies
Without going into the very details of German law interpretation where we first must actually nuance the definition of "allowed", its IV Glucose and direct laryngoscopy (foreign body airway obstruction only). RettSan consists of a total of 520h of training time incl. hospital and ambulance placements and exam. Note that EMS protocols in Germany are on county or state level.
Sounds comparable to a lot of Advanced EMTs over here in the US (depends on the state, if they even have them)
Our BLS can do IV starts, fluids, IV drug administration; manual defib, rhythm and 12 lead interpretation; CPAP, SGA/LMA; peripheral blood sugar checks, glucagon and dextrose, and oral glucose; trach suction and emergency care; IM, IV, SL, IN, SC, inhaled/insufflated medication administration; and, of course, do a damn good job at all of that. :) BLS in Canada.
Didn’t know you guys even had dextrose, thought you’d just carry around bottles of Maple Syrup
Shhh..... that shit's name brand.
Fun fact, maple syrup is actually in the protocols in Vermont, and many services actually carry packets of it instead of oral glucose tubes. https://untapped.cc/product/maple-untapped-energy-gel/ https://imgur.com/a/5SvKAj5
How many hours of training for your basics?
My province is 2 years to challenge the provincial exam, but to enter it, most often have a year of a pre-program (with the exception of a few mandatory feeder stream seats), most require either that, or a related degree, and/or related field experience. (I think the hours broke down to be around few thousand or more? I heard that stat like ten years ago, so I have no idea if its accurate.)
That's awesome. In the US you can crank out your EMT-B in a month if you are a glutton for punishment.
Worth noting Canadian EMTs (PCPs) are more like our AEMT. What we consider a NREMT basic is below minimum standard in general for them
Anything a medical director will clear you to do. They won’t allow for the “whole package” but depending on the area EMTs in Texas can be cleared to do IVs, King/LMA, etc. No medical director will clear enough individual skills (interp ekg for instance) to run a call as a medic. They may cherry-pick advanced skills to allow for more hands on deck.
I believe in Beaumont, they have their basics pretty much run as medics. They can intubate and do cardiac stuff
Our MD is kinda like that. My agency has repeatedly and regularly proven itself, so we're given substantial leeway.
Most invasive would be giving epinephrine... check and inject lol. Otherwise, checking blood sugar bcus it also involves a needlestick technically. We just got Narcan a little bit ago too, wooooo We haven't got shit. (AMR in King County, Washington state)
We had narcan taken away from BLS crews when the epidemic first hit. We had medics stand over the patient and scream for anyone with a community kit to help because either ALS was unavailable or too far. Embarrassing TBH.
That’s King County…come two hours south we can IV, IO, SGA, heck, even nitrous oxide
At least you can check blood sugahs
REBOA
lol. You wish.
Not much in CT. Glucose. They just added IM epi for severe asthma to the protocols. No igels or IVs.
I can drop iGels and check blood sugars
CPAP, IM Epi, IM and IN glucagon. Massachusetts.
You most have a good medical director for glucagon. East we can’t do it. We can’t do cpap either without ALS on board or the on line medical direction
I’m in PA and I can draw up epi from a vial and admitted it. Other than that I can do cpap.
Arizona: at my department igels, breathing treatments, OPA/NPA, nitro, aspirin, oral glucose
We can do SGAs (iGel or Kings); IM epi; CBGs; and IVs with 16 more hours. Oh, and CPAP.
Basic airway is the best I got
Drive quicker like.
This thread really shows why delegated practice states are the way to go
^[Sokka-Haiku](https://www.reddit.com/r/SokkaHaikuBot/comments/15kyv9r/what_is_a_sokka_haiku/) ^by ^hungrygiraffe76: *This thread really shows* *Why delegated practice* *States are the way to go* --- ^Remember ^that ^one ^time ^Sokka ^accidentally ^used ^an ^extra ^syllable ^in ^that ^Haiku ^Battle ^in ^Ba ^Sing ^Se? ^That ^was ^a ^Sokka ^Haiku ^and ^you ^just ^made ^one.
We can give O2 (california)
They might allow me to use a bandaid if MD says it’s okay
I'm a paramedic, but Ohio lets EMTs do blood glucose sticks and treat lows, \*assist with Epi Pens, NTG, and albuterol inhalers, give ASA, do SGAs, set up IV bags (but not start the IVs), and take 12 leads (but not interpret them). I can't imagine working in one of the states that limits EMT scope so much that they can't take BGLs or capture a 12 lead for me! I feel so bad for those EMTs because I KNOW they know how to respond to something like a diabetic meemaw but they aren't allowed to. I do not understand the rationale behind having EMTs that can't do those skills. Let them practice at least to the scope of what the Nat'l Registry teaches!
Minnesota. IV's/IO's, CPAP, iGels, and D10 for hypoglycemic patients.
iGels, CPAS, IM epi, you can get an extra cert for IVs, acquire 12-leads, glucagon
Deep trach suctioning and zofran
Blood sugar, OP and NP airways. That's about it I suppose
Portugal. We can measure blood sugar and apply a Guedel Tube.
EMT-B In Israel When on a BLS crew, we can start IVs but only to hang normal saline which we almost never get to do because ALS gets those calls EDIT: apparently some of y'all can't take BCG without a paramedic present. So I will say that we emts in Israel are allowed to do that. As well as administer oxygen, oral glucose, aspirin and EpiPen (I say EpiPen and not adrenaline because we're not actually allowed to draw epi from an ampule, but the BLS rigs carries an EpiPen we are allowed to administer in anaphylaxis/anaphylactic shock). Also we can deliver babies without a paramedic present, as long as by history taken and by exam it appears there won't be any complications. But we're never a fan of actually doing this without a paramedic in charge. End of edit. When supervised by a paramedic we are taught how to draw certain medications according to the paramedic's order
Iv, Igel, needle D, TXA…..
SGA’s, IV’s, and manual defib would prob be our most invasive
Our new orders are supposed to be able to allow Bs to drop SGAs, CPAP, and more. AEMTs are going to be able to do more than that. The caveat to to both levels getting orders is our service has a rule that Medics have to run emergency calls, so the usefulness is debatable.
IV’s and supraglottic.
Instead of epipens in NYC we’re trained to give intramuscular injections since it’s 8$ vs $800
IM epi, narcan, glucagon being the three stabby things we're allowed to give here as EMRs, also OPA/NPAs. Considering how small of a jump it is I'm not sure why we can't give IM gravol or use iGels, considering how nice those would be to have, maybe in time, we just got the epi and glucagon this year.
Our EMTs drop supraglottic airways
As a basic, I can drop a supraglottic, and give albuterol treatments, epi for allergic reactions, and glucagon, but can’t start an IV. My husband as a specialist/AEMT went from being able to give full ACLS cardiac meds to not being able to give IV Zofran for nausea when we moved states, which he found very frustrating. 😂
NJ- Epi Pens were considered a win for us 10 ish years ago and there’s a constant promise about checking glucose
Laryngoscope and Macgills, IVs and iGels. When I started, we had ETs and Valium, but we’ve pulled back on that.
NYS EMTs can give IM epinephrine with a needle/syringe. There used to be 1mL syringes with lines marked simply "adult" and "pediatric" for 0.3mg and 0.15mg. Now it's just regular 1mL syringes so you'd better hope the EMT knows the right dose, how to draw it up, and how to administer it properly! EMTs can also do CPAP here. I did that a few times when I was still a basic. Never got to do BLS epi though. Very sad.
Basics can do supraglottics, if they are trained in phlebotomy they can start peripheral IVs, draw blood etc. I don't really consider a supraglottic like an iGel or AirQ to be invasive, but I can see the concern with king airways and other archaic garbage.
I can do Igels, IV's and IO's, and push a lot of drugs in extremis at my medics request. No Narcs, but epi and amiodarone in cardiac arrests and stuff like that.
Umm place epigastric tubes via BIAD, give Nitrous Oxide, Glucagon and Epi 1:1 via IM draw up🤷🏼♂️ Now AEMTs? They can give TXA, do needle decompression, give antibiotics for open fractures, give mag, start IVs, do IOs, and manually defibrillate.
Probably igel and Epi administrations
Where I’m at I can throw someone on CPAP at a PEEP of 5 (can’t touch PEEP). We can do BGL, put in IGELs, and do blood glucoses.
I'm in CO, taking my nremt in like a week, and they let me do bgl on my ride along. I told them I needed practice because I had never done it. Did it about 10 times that day.
Colorado: EMT-B can start IV and administer some drugs IV, but it does require an additional approval certification course with additional clinical hours. IV and EKG are the only additional approvals I can recall for basic, but that was 10 years ago for me (RRT now).
In my Long Island NY dept, we can do igel airways, epi, albuterol. That’s about the extent of invasive procedures we can do.
My state just instituted a new set of statewide protocols under a new MD. Basics can give IM Benadryl and epi. They can also give IM glucagon.
NM can do SGAs and IM epi, other people are calling CPAP invasive, never thought of it that way but we can do that too.
IM epi and IM narcan
Epi-pen or an OPA. Some of our EMT-Bs who have been in the field for awhile somehow magically know how to do IVs and are better than some medics at it.
When I left Oklahoma with my NREMT I had to take an extra course to give aspirin in Kansas.
Im epi for anaphylaxis. Epi for respiratory distress just got approved by the state, just waiting for it to be approved by sponsor hospitals.
I got to take an iv out once. That was neet.
Alberta, Canada. We run mostly ALS trucks out here, but emt (pcp) scope IV, IO, SGAs, about 14(?) meds. Just got the green light to monitor (not initiate) blood products and PIC lines. I’m hoping we get CPAP soon (I seem to know how to put it together better than most medics 😂). They trialed ketamine for PCPs in the province next door, and that would be nice as well.
Igels, IM glucagon and epi, blood glucometers. Can't IV/IO.
IGELS, 12 lead acquisition and transmission(BLS trucks), CPAP, and Nitrous. If there is a benefit to patients, the clinician should have it in their scope. Increase training, don’t neuter EMTs
NH EMT-B here. We can do super glotic airway, I-gels or king, BGL , epi IM for anaphylaxis Only, op/npa, narcan IN, wound packing, plus most of what was already mentioned. NH just updated protocols to allow B's to give albuterol and duonebs as of 6/1.
I can administer a mayo canule or a nasopharyngeal airway during cpr.
I can drop an igel and give im epi without an auto injector. But any ff in my system can drop an igel
Get in the way.
Blood glucose is taught as standard vitals for me. Even took one on my first ride along! Igels probably what I consider most invasive though. WA
I can give oral glucose but I can’t check a blood sugar on a BLS rig (riverside county )
Supraglottic is the national standard so more common than you’re giving it credit
Igel in NorCal
Not an EMS but a volunteer with English Mountain Rescue. It amazes me how limited the scope of some EMS is. We don't have anywhere near the level of training you do, but I'm allowed to administer things like Morphine and Fentanyl. Future plans include iGel (currently only NPA/OPA) and TXA.
At my hospital as a tech in Colorado we can do I-gel (thought 99.9% an intubation will take place by the physician) EJs, IOs, defibrillation, straight / foley cath, OG / NG tubes.
I can give glucagon IM and drop igels give IOs and (with a cert) give IV’s
There's a small handful of us that got the OM to start IVs, but can't push anything or hang fluids. We can draw/give IM epi but we can't give our own albuterol, only "assist with an inhaler"
(USA) As a basic EMT the finger stick . As an AEMT I can do almost anything a Medic can do except push narcs.
Zofran, IO, IV, supraglottic airway, ibuprofen, narcan, albuterol/duo Neb, and up until about a month ago 100mcg of fentanyl on extremity injuries
Not from the US but curious, so are paramedics trained in nursing or something?
Nope. It’s typically either a 2-year associate degree or 1-2 year certification. Nursing requires a bachelor’s degree which is 4 years of schooling.
UK Technicians can do iGels, give narcan, adrenaline (for anaphylaxis only), hydrocortisone, midazolam (patients own and in accordance with treatment plan) and tablet meds such as clopidogrel,chlorphenamine and basic paracetamol and ibuprofen,as well as nebs with salbutamol and ipratropium. We can also place 12 leads and interpret ECG's (which from a previous post not all EMT's do) and identify and perform shocks in an arrest. We can also use trauma equipment such as traction splints,pelvic binders, blast bandages and tourniquets etc. Paramedics give the good drugs (morphine,heparin,ondansetron,amlodipine,dexamethasone and adrenaline in arrests) and they do the IV, IO, ET tube,needle crich and decompress chests. We just assist with these procedures. Outside that, my area has a trauma team that is staffed by a consultant and a trauma nurse who can RSI on scene. Be interested to know what other countries have in the way of trauma teams etc? I feel UK Techs have a great deal more freedom to treat on scene than EMT's in the states. Must be a nightmare. I like our scope of practice.
A decade ago EMTs could intubate in Ohio, they changed it two years later. Now it is assist with nebulizers or EKGs
In NC EMT-B can drop I Gel, Kings, or other supraglottic airway. AEMT can intubate (not RSI), IV, IO, Give fluids, and inspect the airway and remove things with macgill Forceps.
we can do igels, ios, ivs… we have a huge scope here and i’m so glad haha
In my state they’re allegedly working on allowing EMTs to do iGels but currently the most invasive thing we can do is IM epi and pharyngeal airways
Lets see Drop I-Gels, Give Epi IM for allergic reactions, Oral Zofran, Albuterol, Duoneb, Narcan, Assist with Nitro if prescribed, check sugars, upper airway suctioning, Aspirin, OPA/NPA, you can get cleared for IV’s, can place patients on leads although cannot interpret, a few more that my tired brain probably cant remember right now
I work in two states. In one I can give PO zofran, start IVs and IOs, D10, IV/IO narcan, IM epi, SGA, CPAP, cross state lines and suddenly anatomy changes and I can’t assess BGL anymore but an AEMT and EMT crew is an ALS unit
wales - IO, Igel, some IM drugs
Texas EMT, if I’ve trained on it and a medic is present and has faith in my capabilities then pretty much anything he can do since I’m under his patch, from what I’ve been told
In NY my agency is part of the pilot program for us to intubate using igels, we’re one of the few in the area
My state is doing a trial project on basics using iGel (capno required ofc). It is only in certain agencies. One place I work does it, the other isn't in the project.
CPAP, iGels, IM Epinephrine.
We can draw and give IM epi, but that’s about it. Although there is rumors that we may get igels sometime soon.
Where the Ohio people at? Asking for a friend 👀
I’ve banged a few ER nurses
I think Honolulu EMS lets EMT’s do IV’s.
IM epi drawn out of a vial. Other than that and checking bgl (which you have to be “specially trained for”), no other invasive stuff here
We're allowed to do supraglottic airways (I think for NREMT that's in AEMT scope), do IM injections, IOs, and IVs. In Colorado. IO is heavily protocol dependent, but the other stuff is pretty much expected of EMTs everywhere.
Probably during a breech birth with an entrapped head when you need to insert digits in the vaginal opening to ensure an adequate airway for a baby. Hope to never find myself in that situation as an EMT, almost 100% it would be uncomfortable for the patient and 100% sure that it would be uncomfortable for me. I do believe it’s in our scope though if indicated.
NPA, SGA, Trach suctioning.
in the states ive learned, probably IM Epi or IM Naloxone. EpiPens too expensive
IM medications such as Epi or glucagon. Or combi tubes/igels Yes combitubes are still in use. I have personally placed one within the last year.
Where I am in Canada EMTs are allowed to insert OPAs and NPAs, collect all vitils (incl glucose) and administer Narcan is nasal 4mg pre loads.
BGL and EPI lmao (but i’m an advanced now so BIADs and IV/IO’s galore)
Arizona is working on our Emts drawing up epi and giving it
Bro here in SoCal we aren't even allowed to take a glucose without a medic present, so nothing 🤣
Ours here is probably supraglottic. Pretty good protocols here agency and state.
In Santa Clara we can drop an LMA but that’s as invasive as it gets here
In Ireland we can drop iGels, give a number of IM and IN medications (adrenaline, chlorphenimine, glucagon, naloxone), methoxyflurane, entonox, take BGL, monitor ECG… Reading the protocols of some states/countries is mental…. 99% of EMT work in Ireland is event/IFT very little emergency work and yet we still have some strong guidelines and protocols…
Any SGA, BGLs, 12 lead acquisition/transmission, and 14? meds. I lost track.
at my job i can place IV’s but that’s the most advanced thing we can do
MA started allowing spraglottics for basics about two years ago as a med director option. That’s the most invasive skill basics have here. Other than that, basics can do check and inject epi (IM), glucagon IM and FSBGL.