Los Angeles County EMT-1 Expanded scope of practice EMT-1 Expanded Scope Los Angeles County EMT-1...

Los Angeles County EMT-1 Expanded scope of practiceLos Angeles County EMT-1 Expanded scope of practice

EMT-1 Expanded EMT-1 Expanded ScopeScope

Los Angeles County EMT-1 Los Angeles County EMT-1

Expanded Expanded Scope of Scope of PracticePractice


Implementation Implementation

February 28, 1997February 28, 1997 became became policy(#802)policy(#802)

(revised February 01, 2011)(revised February 01, 2011)

May 30, 1997 May 30, 1997 after this date all EMT-1’s after this date all EMT-1’s certified or recertified in LA County must certified or recertified in LA County must have attended EMT-1 expanded scope have attended EMT-1 expanded scope training.training.


Title 22 Title 22 State ScopeState Scope of Practice of Practice

What 2 drugs?What 2 drugs?

IV monitoring - NO ADDITIVESIV monitoring - NO ADDITIVES


IV monitoringIV monitoring

may monitor, maintain, & adjust may monitor, maintain, & adjust a preset rate of flow.a preset rate of flow.

shut off IV if there are signs of shut off IV if there are signs of infiltration. infiltration.


Expanded ScopeExpanded Scope

Los Angeles County onlyLos Angeles County only

Policy 802Policy 802

If finer points of this policy are If finer points of this policy are difficult to remember difficult to remember use cheat use cheat cards! cards!


Assists with MEDSAssists with MEDS

EMT-1’s may assist the patient or EMT-1’s may assist the patient or allow the patient to self administer allow the patient to self administer the following medications:the following medications:

NitroglycerinNitroglycerin

EpinephrineEpinephrine

Bronchodilator inhalerBronchodilator inhaler


Parameters Parameters

1- The 3 medications - What are they?1- The 3 medications - What are they?

2- patient condition must indicate use 2- patient condition must indicate use (specifically & conclusively)(specifically & conclusively)

3- must be prescribed to patient3- must be prescribed to patient

4- must be patient’s own medication4- must be patient’s own medication

5- doses PTA count5- doses PTA count


WARNINGWARNING

YOU ARE NEVER ALLOWED TO YOU ARE NEVER ALLOWED TO CARRY THESE MEDICATIONS ON CARRY THESE MEDICATIONS ON THE UNIT OR IN YOUR JUMP KIT.THE UNIT OR IN YOUR JUMP KIT.

If you are told otherwise IT IS If you are told otherwise IT IS WRONG.WRONG.


If you administer...If you administer... You must have an ALS unit enroute.You must have an ALS unit enroute.

oror The patient must be transported The patient must be transported

immediately to the nearest* hospital .immediately to the nearest* hospital .

Never treat & release - this is emergency Never treat & release - this is emergency supportive therapy. supportive therapy.

* most accessible * most accessible


Review of Drug RoutesReview of Drug Routes IV – IntravenousIV – Intravenous SL – SublingualSL – Sublingual PO – By mouth PO – By mouth IM – IntramuscularIM – Intramuscular SQ or SC - Subcutaneous SQ or SC - Subcutaneous IO - InterosseousIO - Interosseous TranscutaneousTranscutaneous IN – InhaledIN – Inhaled PR – Per rectumPR – Per rectum


Review of DICCEReview of DICCE

D – Dose D – Dose I - IntegrityI - Integrity C - ConcentrationC - Concentration C - ClarityC - Clarity E – Expiration DateE – Expiration Date


NitroglycerinNitroglycerin

Indication: Indication: Chest painChest painRoute:Route: sub lingualsub lingual

Repeat:Repeat: Max of 3 dosesMax of 3 doses

Contraindication: Contraindication: BP less than 100 systolicBP less than 100 systolicViagra w/in 24 hrsViagra w/in 24 hrs3 doses prior to arrival3 doses prior to arrivalHead injuryHead injury


NoteNote

comes in tablet, spray or skin comes in tablet, spray or skin patchpatch

always check blood pressure after always check blood pressure after administration.administration.


Epinephrine auto Epinephrine auto injectorinjector

Indication: Indication: severe allergic reactionsevere allergic reaction

Repeat:Repeat: as prescribedas prescribed

Route:Route: IMIM

Site:Site: upper-outer thigh only!upper-outer thigh only!


NoteNote there are several brandsthere are several brands 1 dose only1 dose only injection into buttocks, arm, hands, injection into buttocks, arm, hands,

will result in inadequate absorption will result in inadequate absorption & soft tissue damage. & soft tissue damage.

IV admin. could cause MI or CVAIV admin. could cause MI or CVA Side effects: tachycardia, pallor, Side effects: tachycardia, pallor,

dizziness, chest pain, headache, dizziness, chest pain, headache, n/vn/v


Bronchodilator InhalersBronchodilator InhalersIndications:Indications: DyspneaDyspnea, associated with , associated with

bronchospasm (asthma, bronchospasm (asthma, bronchitis, COPD)bronchitis, COPD)

Repeat:Repeat: as prescribedas prescribed

Contra:Contra: patient unable to use patient unable to use devicedevice

maximum doses taken maximum doses taken PTAPTA


NotesNotes

In cold environmentIn cold environment

Inhale slowly and continuouslyInhale slowly and continuously


Commonly Prescribed Commonly Prescribed BronchodilatorsBronchodilators

albuterol - terbutaline - metaproterenolalbuterol - terbutaline - metaproterenol

Proventil - Ventolin - Bronkosol - Proventil - Ventolin - Bronkosol - Bronkometer - Alupent – Meteprel - Bronkometer - Alupent – Meteprel - Brethine ...Brethine ...


Form / devices include Form / devices include

InhalerInhaler Inhaler Inhaler with a spacerwith a spacer hand held nebulizer*hand held nebulizer* Pulmonaid device*Pulmonaid device*

* patient or caretaker must set up if * patient or caretaker must set up if EMT is unfamiliar with equipment.EMT is unfamiliar with equipment.


Document properlyDocument properly

Assessment Assessment AND THE FOLLOWING:AND THE FOLLOWING:

medicine prescribed by MDmedicine prescribed by MD medicine is patient’smedicine is patient’s other factorsother factors VITALS & REASSESSMENT after VITALS & REASSESSMENT after

treatment treatment


IV monitoringIV monitoring

AdditivesAdditives


Monitor IV with Monitor IV with additivesadditives

Folic acid - 1mg / 1000ml maxFolic acid - 1mg / 1000ml max Multivitamins - 1 vial /1000ml maxMultivitamins - 1 vial /1000ml max Magnesium Sulfate – Magnesium Sulfate –

2grams/1000ml (in conjunction 2grams/1000ml (in conjunction w/MVIw/MVI

Thiamin - 100mg / 1000ml maxThiamin - 100mg / 1000ml max

monitor, maintain, & adjust a TKO monitor, maintain, & adjust a TKO rate of flow. rate of flow.


Additives requiring an Additives requiring an infusion pumpinfusion pump

Potassium chloridePotassium chloride Total Parental Nutrition (TPN)Total Parental Nutrition (TPN)

These additives may not be These additives may not be transported without an infusion transported without an infusion pumppump


Patient Controlled Patient Controlled Infusion PumpsInfusion Pumps

may be implanted or externalmay be implanted or external may only be activated by patient may only be activated by patient

or caregiver.or caregiver. transport lockedtransport locked

Insulin - Demerol - Morphine Insulin - Demerol - Morphine


Other Devices..Other Devices..

Central linesCentral lines Indwelling vascular access device Indwelling vascular access device


MAY NOT TRANSPORTMAY NOT TRANSPORT

1 - Central venous monitoring 1 - Central venous monitoring devices*devices*

2 - Swan Ganz catheters2 - Swan Ganz catheters

3 - Arterial lines3 - Arterial lines


ChemotherapyChemotherapy

There are risksThere are risks

Exposures can occur from IV Exposures can occur from IV leakage or spillsleakage or spills


Acute Risks of Acute Risks of ExposureExposure

IrritationIrritation BurningBurning Tissue destructionTissue destruction


Chronic Risks of Chronic Risks of ExposureExposure

Genetic Genetic damagedamage

Birth defectsBirth defects CancerCancer


PrecautionsPrecautions

Wear protective clothing - Wear protective clothing - universal precautions.universal precautions.

Nursing mothers should not have Nursing mothers should not have any contact with patient.any contact with patient.

HAVE A SPILL KITHAVE A SPILL KIT


Contents of Spill KitContents of Spill Kit

2 pairs of gloves - thick (.007 inch)2 pairs of gloves - thick (.007 inch) gown & shoe coversgown & shoe covers gogglesgoggles maskmask disposal bags & equipmentdisposal bags & equipment


First AidFirst Aid

SkinSkin wash immediately with wash immediately with soap & water.soap & water.

EyesEyes flush with normal saline flush with normal saline or water for 5 or water for 5

minutes.minutes.


THE ENDTHE END

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