Level of practice

maglite

As it stands at the moment as far as i understand it.

We have people who are licensed to give drugs, and those certified to.
Take for example a CFR they can give aspirin and O2. As o2 is a prescription drug it must be got on the authority of a doctor? and used in the way the doctor tells you to = protocol. Am i right so far?
Now take a Red Cross first responder/ SJA first responder. Both organisations at the moment have a medical director. Is it on his say that the Red X EMFR can use Entonox and the SJA FR cant? Or indeed any treatment.
Will this still be the case when the EMT comes in? Could one organisation say in addition to glucagon you can give say, morphine?

How does it work for Paramedics and AP's do they work of the direct orders of a doc so to speak, or are the licensed to in effect prescribe drugs, can they wander in to a chemist and get any of the drugs on their list.

Bang Bang

maglite wrote: »

How does it work for Paramedics and AP's do they work of the direct orders of a doc so to speak, or are the licensed to in effect prescribe drugs, can they wander in to a chemist and get any of the drugs on their list.

Paramedics and Advanced Paramedics are licensed to administer certain drugs. Advanced Paramedics are allowed to administer up to 10mg of Morphine IV and an additional 10mg IV under the direction of a doctor. This direction can be given over the phone by an Emergency Department Doctor.

Neither Paramedic or AP can "wander" into a chemist and get drugs. Drugs are signed out from the station and documented as a legal requirement as well as record keeping.

coolmoose

maglite wrote: »

Will this still be the case when the EMT comes in? Could one organisation say in addition to glucagon you can give say, morphine?

No, once EFR and EMT training commences in the voluntaries (as it has done already) then EFR or EMT members qualifying in these organisations and achieving PHECC Registration (at EMT level) will work according to their appropriate PHECC CPGs.

This means that an OMAC trained EMT will have the same scope of practice, medications and CPGs as a IRC, CD or SJA trained EMT. PHECC set the training standards, the vol org teaches to this level, members complete this training and then sit an independent PHECC exam.

maglite wrote: »

How does it work for Paramedics and AP's do they work of the direct orders of a doc so to speak, or are the licensed to in effect prescribe drugs, can they wander in to a chemist and get any of the drugs on their list.

No this does not happen. Medications are signed in and out of station stores on a daily basis, and are kept in sealed and tagged bags. PHECC Registered Ps and APs carrying medications in their own kits must receive them through their employer or through a voluntary organisation.

coolmoose

maglite wrote: »

Take for example a CFR they can give aspirin and O2

CFR can only administer Aspirin. Oxygen is for EFR certified memebrs or higher.

timmywex

All levels have thier own clinical practice guidelines to work from, these dictate the treatments to an extent.

www.phecit.ie

Hooch

coolmoose wrote: »

CFR can only administer Aspirin. Oxygen is for EFR certified memebrs or higher.

Correct. PHECC people!!! See their CPGs. Thats what you follow. Not what the red cross or OMAC or anyone else tells you. PHECC CPGs (clinical practice guidelines) are gospel. Follow them and you can never go wrong.

If a practitioner is accused of malpractice the first question asked is ''did you follow your cpg's?''

sgthighway

Its all about CPGs but there seems to be a bit of confusion regarding the administration of some drugs. I could be wrong but I think the 3rd Edition Medication Formulary conflicts with some CPGs or is it the OSCEs.
Take Morphine for example. I believe an EMT can also administer this when a Doctor cannot be there (e.g. up a mountain). They might also have to give Cyclizine. As far as I remember both are part of the OSCE's to become an EMT.
As an EMT I can administer:

• Asprin
• Epinephrine (1:1 000)
• Glucagon
• Glucose Gel
• GTN
• Entonox
• Oxygen
• Paracetamol
• Salbutamol

AFAIK and EFR can administer:

• Aspirin
• Glucose Gel
• GTN
• Oxygen
• Salbutamol

A CFR can only give Aspirin.

In some of the above cases the medication has to be prescribed.

maglite

I'm interested in seeing this thread run a course.
But i was interested to know could Dr. Bob of xVol set out a standing order and CPG for the admision of Ydrug that is not on the PHECC list for that level. Same re proceedure.



Say xVol is involved in remote areas and they have a PHECC EMT. Can under a written existing CPG, from DR Bob, that EMT carry and admin ibuprofen/Morphine/Andrews/Imodium etc

sgthighway

If any PHECC Registered Practitioner including an EMT administers something that is not in their CPG they can get hauled in front of a PHECC Committee for bad practice. There is a Drug/Medication Formulary Book set out for everyone telling us what you can give however some CPS have what they call "Special Authorisations".

I could be wrong but there are NO Voluntary Trained PHECC Registered EMTs. Some have passed their exams, got the cert and PIN and their registration has gone in but they have not got the "Card". I think the Voluntary Orgs will be setting rules on where to get drugs, store them, dispose of them, etc.

emer tech

I could be wrong but there are NO Voluntary Trained PHECC Registered EMTs. Some have passed their exams, got the cert and PIN and their registration has gone in but they have not got the "Card". I think the Voluntary Orgs will be setting rules on where to get drugs, store them, dispose of them, etc.[/quote]


They have passed their exams, got the cert and PIN, the card (licience) is on the way

Elessar

maglite wrote: »

I'm interested in seeing this thread run a course.
But i was interested to know could Dr. Bob of xVol set out a standing order and CPG for the admision of Ydrug that is not on the PHECC list for that level. Same re proceedure.



Say xVol is involved in remote areas and they have a PHECC EMT. Can under a written existing CPG, from DR Bob, that EMT carry and admin ibuprofen/Morphine/Andrews/Imodium etc

Doctors don't set the PHECC drugs or CPGs, PHECC do. If it doesn't come from PHECC, you don't do it.

However, I have the EMT CPGs in front of me and it states specifically that "Special Authorisation" is given to EMTs/Paramedics to administer IM Morphine for a specific patient in an inaccessible location under the authorisation of a registered medical practitioner.

Though these are the 3rd edition CPGs and these, aswell as some of the drugs listed above have not been signed off yet - so, technically, they are not to be followed yet. This is causing confusion for some!

DubMedic

If I hear the words 'PHECC CPGs 3rd Edition' & 'delay' in the same sentence again... ( In general , not just you Elessar ).

.

Hooch

sgthighway wrote: »

I could be wrong but there are NO Voluntary Trained PHECC Registered EMTs. Some have passed their exams, got the cert and PIN and their registration has gone in but they have not got the "Card". I think the Voluntary Orgs will be setting rules on where to get drugs, store them, dispose of them, etc.

There are several Voluntary PHECC registered EMTs. Their PINs have been issued but cards are not printed yet.....another problem for another day:pac:. The voluntarys will NOT be setting their ''own'' rules for medication storage etc. Morphine in particular!!! PHECC will be closely monitoring this once voluntarys roll it out.

Elessar wrote: »

Doctors don't set the PHECC drugs or CPGs, PHECC do. If it doesn't come from PHECC, you don't do it.

However, I have the EMT CPGs in front of me and it states specifically that "Special Authorisation" is given to EMTs/Paramedics to administer IM Morphine for a specific patient in an inaccessible location under the authorisation of a registered medical practitioner.

Though these are the 3rd edition CPGs and these, aswell as some of the drugs listed above have not been signed off yet - so, technically, they are not to be followed yet. This is causing confusion for some!

PHECC 3rd Edition CPGs are not in effect at the moment so follow the 2nd editions. Hope to be put in place by September of this year......Doctors do set the CPGs, there is a medical director of PHECC and a medical council filled with A/E doctors, a nurse and several Paras. The special authorisation was placed in for EMTs and Paras in a cave or cliff hours from a Doctor or A/P and this alone. I cant see that anyone will ever get the premission for a Doctor to give Morphine. Too much of a high risk

DubMedic wrote: »

If I hear the words 'PHECC CPGs 3rd Edition' & 'delay' in the same sentence again... ( In general , not just you Elessar ).

.

Who you telling:rolleyes:

maglite

There is the facility for practioners to administer drugs and provide treatment outside their scope as described by PHECC. A number fo organisations are currently going down this road. Additional modules are being thought and are being signed off by a phecc reggnised institution.


Thank you for your time.

Hooch

maglite wrote: »

There is the facility for practioners to administer drugs and provide treatment outside their scope as described by PHECC. A number fo organisations are currently going down this road. Additional modules are being thought and are being signed off by a phecc reggnised institution.

.

PHECC recognised institutes.....but not PHECC recognised practices;).

On your own if anything happens.