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EMT-1 Expanded Scope

EMT-1 Expanded Scope. Los Angeles County EMT-1 Expanded Scope of Practice. Implementation. February 28, 1997 became policy(#802) May 30, 1997 after this date all EMT-1’s certified or recertified in LA County must have attended EMT-1 expanded scope training.

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EMT-1 Expanded Scope

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  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-1’s 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-1’s 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 patient’s 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 patient’s • 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?

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