IM injections

civildivil

hi folks,
I have done the paramedic upskilling. has many paramedics given IM injections? Over half of the staff in the station have given as least one IM injection. just curious about other areas.

sgthighway

Maybe the wrong section mate. This is a Recruitment section.
P.S. - No need to upskill to a Paramedic to give IM Injections. EMTs can give some of them. All the best as a Paramedic.

Hooch

Thread moved to main ES forum.

djtechnics1210

would be obliged if someone could answer.
was looking it up on PHECC website but it doesnt give much detail.

what IM injections can EMT give???
By IM injections does that mean using actual syringes or is it using the epi pen things???

boomer_ie

djtechnics1210 wrote: »

would be obliged if someone could answer.
was looking it up on PHECC website but it doesnt give much detail.

what IM injections can EMT give???
By IM injections does that mean using actual syringes or is it using the epi pen things???

Glucagon IM and Morphine IM

Full skills/drugs matrix is here

http://www.phecit.ie/Documents/Clinical%20Practice%20Guidelines/Clinical%20Handbooks/Practitioner%20-%20Responder%20Medication%20&%20Skills%20Matrix.pdf

djtechnics1210

thanks boomer.

are those administered through epi pens or actual syringes???
the reason i ask is, i was wondering do they have to make up the dose themselves or is it already in an epi pen..

saw emt carrying bag the other day and it had bottles of medicine in it (i suppose it could have been an AP's bag and he was just carrying it in for them)

Hooch

djtechnics1210 wrote: »

thanks boomer.

are those administered through epi pens or actual syringes???
the reason i ask is, i was wondering do they have to make up the dose themselves or is it already in an epi pen..

saw emt carrying bag the other day and it had bottles of medicine in it (i suppose it could have been an AP's bag and he was just carrying it in for them)

Morphine whould be in ampoules.....but no EMT could be carrying them!!

Glucagon is in a pre filled syring and a vial power, which you re constitute.

Epi pens are just that.....auto syrings that deliever a metered dose of epinephrine

sgthighway

An EMT cannot decide the patient needs Morphine and simple administer it; HOWEVER
An EMT can administer Morphine from an ampoule if instructed to do so by a Doctor (URMPIO) when the Doctor could not get to where the EMT/Patient is; e.g. Injured up on a Mountain.

URMPIO - Authorised under PHECC CPGs under registered medical practitioner’s instructions only

Elessar

Yep, Glucagon, Epinephrine 1:1000 and Morphine (under direction of a doctor only) can be given by EMTs IM. Glucagon is reconstituted and delivered via a regular needle/syringe, epinephrine is via an epipen.

That always puzzled me because as far as contraindications go, glucagon has two where epinephrine has none. So why are EMTs restricted to epipens (and only when they are prescribed to the patient!) whereas Paramedics can give it with a syringe and no requirement for a prescription? It's not as if epinephrine is more risky than glucagon.

Hooch

sgthighway wrote: »

An EMT cannot decide the patient needs Morphine and simple administer it; HOWEVER
An EMT can administer Morphine from an ampoule if instructed to do so by a Doctor (URMPIO) when the Doctor could not get to where the EMT/Patient is; e.g. Injured up on a Mountain.

URMPIO - Authorised under PHECC CPGs under registered medical practitioner’s instructions only

I did not say EMT couldnt deliever it.....I said they shouldnt have it. Morphine is a controlled the rest are not. Even Paramedics do not carry Morphine. If in my professional role stopped an EMT carrying Morphine....unless (s)he had a doctor alongside them the morphine would be siezed.

Elessar wrote: »

That always puzzled me because as far as contraindications go, glucagon has two where epinephrine has none. So why are EMTs restricted to epipens (and only when they are prescribed to the patient!) whereas Paramedics can give it with a syringe and no requirement for a prescription? It's not as if epinephrine is more risky than glucagon.

Simples really....it is more risky. I assure you know what glucagon does and what it releases so wont go into that. If you overdose on Glucagon all it does is try to release what not there......apart from a crazy headache, inducing vomiting and very bad case of dizzyness.

Epinephine on the other hand is much different. If you overdose on epinephine you effect the cardiovasular system. You can give a patient pulmonary edema effecting breathing severly and possibly fataily. You can also cause cornonary artery spasm which may, depending on the patient cause a Heart attack or even cardaic arrest.

So in essence although Epi has no contra indications, the wrong dose can be fatal on certain patients. To counter act this PHECC decided on an auto injector for EMT level so you deliever an exact dose. In regards being prescribed in their wisdom PHECC (ers) have decided that EMTs cant judge when a reaction is bad enough to use an epi pen.

Just to add that "most" EMTs are not front line and full time. When your not full time your skills go down....all our skills go down. Hense why all the drugs given to EMTs are simple and involves very little measuring (and any measuring will not be fatal).

Elessar

That makes sense. Although you'd often wonder what the logic is in having EMT grade at all. Without bringing the thread off course, i'm guessing the same logic applies to salbutamol?

Hooch

Elessar wrote: »

That makes sense. Although you'd often wonder what the logic is in having EMT grade at all. Without bringing the thread off course, i'm guessing the same logic applies to salbutamol?

I often wonder that myself.....seems PHECC and the HSE dont want EMTs out there. PHECC often make me wonder are they really there to better pre hospital care or make it worse.

Ya the same logic applies, although an overdose of Salbutamol normally only occurs in a hospital setting when it is frequently administered. And the overdose effects are very rarely fatal to the best of my limited knowledge.

Any input from Paramedics in regards to all this???

sgthighway

nice guy always wrote: »

If in my professional role stopped an EMT carrying Morphine....unless (s)he had a doctor alongside them the morphine would be siezed.

I am not a lawyer but I would seek advise on this if I were you. I can't say 100% that an EMT can carry it but why would PHECC (Professionals like yourself) have a CPG made up and approved for an EMT to give Morphine when a Doctor is not present.

Hooch

sgthighway wrote: »

I am not a lawyer but I would seek advise on this if I were you. I can't say 100% that an EMT can carry it but why would PHECC (Professionals like yourself) have a CPG made up and approved for an EMT to give Morphine when a Doctor is not present.

You are 100% there is a CPG......however the law in regards carrying of a controlled drug is a little bit more complicated than a CPG. CPGs are not law, they are guidelines set down by a statutory organisation. The laws of the land superceed these.

There is a big list of people who can carry controlled drugs. EMT is not on it. They may only carry it on specific directions of a medical practitioner, same as the use of it. Due to the nature of my work I could carry it being one of the exempted persons, however storage etc while off duty would be a huge issue. Also.....I see no need whatsoever for an EMT to have morphine.......its not that big an Island.

The reason PHECC added the CPG is simple and like alot of CPGs are taken up the wrong way. The reason EMTs can administer Morphine is when a Doctor cannot access a patient. I.E. - When a patient is half way down a cliff and the Doctor has no cliff rescue training......He can provide morphine to the EMT, send him down to access the patient and the RMP can then decide if the EMT is to administer it. I assume your not an EMT since you answered your own question in post #8???

Tango Alpha 51

Unless your particular organisation is signed off for using the PHECC Cpg's u shouldn't be using them anyway. NGA is quite right. Morphine is one of the most tightly controlled drugs in use. EMT's would not be carrying this in their bag & if any EMT is doing this, i would strongly urge you to cease this practice.

sgthighway

I'm a Registered EMT with PHECC and signed up to the 3rd Edition CPGs.
I don't carry Morphine regularly and agree with Buzzman that it should not be carried in a bag.
I only ever had it once before and it was issued to me as I was the leading registered practitioner on the duty.
I don't believe a member of AGS can take it off me if i can verbally justify having it and have my ID. I will check this at our next CPD meet.

Hooch

sgthighway wrote: »

I'm a Registered EMT with PHECC and signed up to the 3rd Edition CPGs.
I don't carry Morphine regularly and agree with Buzzman that it should not be carried in a bag.
I only ever had it once before and it was issued to me as I was the leading registered practitioner on the duty.
I don't believe a member of AGS can take it off me if i can verbally justify having it and have my ID. I will check this at our next CPD meet.

Thats the point.....you cant verbally justify it. Carry the RMP prescription and you would be fine....

Tango Alpha 51

sgthighway wrote: »

I'm a Registered EMT with PHECC and signed up to the 3rd Edition CPGs.
I don't carry Morphine regularly and agree with Buzzman that it should not be carried in a bag.
I only ever had it once before and it was issued to me as I was the leading registered practitioner on the duty.
I don't believe a member of AGS can take it off me if i can verbally justify having it and have my ID. I will check this at our next CPD meet.

Highway,
You state that you were the leading reg prac on "duty". What duty exactly did this entail. Also when you were on this duty, how was the morphine stored etc.

djtechnics1210

Sorry for an off topic question guys (didn't want to start a new thread for the question)

since it seems phecc and hse don't want emts in frontline ambulances and are only letting them work on patient transfers and for private Ambon services etc (or that's how it seems anyway)

do you guys think emt will at some stage be done away with as a level, and if so do you think phecc will make someway for current qualified emts (that trained privately) to upskill to para or whatever they see fit as a level above emt.

Is their currently anyway for someone to upskill from emt to para privately????

(mods feel free to move/delete/destroy/burn this post if needs be as I know I'm off topic)

Hooch

djtechnics1210 wrote: »

Sorry for an off topic question guys (didn't want to start a new thread for the question)

since it seems phecc and hse don't want emts in frontline ambulances and are only letting them work on patient transfers and for private Ambon services etc (or that's how it seems anyway)

do you guys think emt will at some stage be done away with as a level, and if so do you think phecc will make someway for current qualified emts (that trained privately) to upskill to para or whatever they see fit as a level above emt.

Is their currently anyway for someone to upskill from emt to para privately????

(mods feel free to move/delete/destroy/burn this post if needs be as I know I'm off topic)

You cannot upskill at present from EMT to Para....however I can see a certain training institute in the west have a Para course within the next year. They also have an up coming ambulance service I believe.....which will cover placements;)

ch252

Heard that too NGA, you would get a new car for the cost of it too. Interesting about the new ambulance service...

Elessar

I don't think EMT will be done away with. It should be imo. Practitioner level should be Paramedic and up. The levels are too close in terms of scope and abilities for EFR EMT and Paramedic to exist together. It makes little sense. In truth there is no need for the EMT. Or EFR with EMT.

I could see a case for EMT being dissolved and all current EMTs allowed to upskill to Paramedic. Then some or all of the abilities of the EMT to transfer to EFR. Or just dissolve EFR and have the EMT.

The current system is strange and I often wonder what the logic was in setting up the system as it is.

EDIT: Though I (and others) have heard on more than one occasion examiners in PHECC stating there wont be EMT exams any more in the near future. I don't know what it meant I only heard it in passing.

boomer_ie

I would suspect that the logic was for EMTs to be able to concentrate on Patient Transport with some skills for dealing with incidents they came across or to deal with Cat C calls similar in idea to ECA/ECSWs in the UK leaving Paras and Adv Paras to deal with 999s or High dependency PTS work.

Unfortunately it would appear that HSE is not yet going down this route at this point in time (maybe in the future?) as I would have thought that employing EMTs to do PTS work would have freed up paramedics to do 999 work at a cheaper cost than employing more Paramedics to do PTS and 999 work.

What is the opinion of HSE Paramedics / Adv Paramedics on this?

EDIT I should mention that the UK ECA/ECSW is supposed to work with a Paramedic however they can and do crew an ambulance with two ECA/ECSWs. Over here we now have a directive from PHECC that all emergency ambulances must have two paramedics on them so EMTs responding to Cat Cs may not be an option.

paraletic

civildivil wrote: »

hi folks,
I have done the paramedic upskilling. has many paramedics given IM injections? Over half of the staff in the station have given as least one IM injection. just curious about other areas.

i have given glucagon 3 times in the last year (all were indicated:p). it made me feel better than the patients:cool:

nice guy always wrote: »

I often wonder that myself.....seems PHECC and the HSE dont want EMTs out there. PHECC often make me wonder are they really there to better pre hospital care or make it worse.

Ya the same logic applies, although an overdose of Salbutamol normally only occurs in a hospital setting when it is frequently administered. And the overdose effects are very rarely fatal to the best of my limited knowledge.

Any input from Paramedics in regards to all this???

when i hear about EMTs wanting to give IM morphine it makes me wonder about PHECC. as a paramedic we aren't yet allowed give loads of drugs that would make huge differences to patients, morphine is one, nalaxone would be great too. the list goes on...
(PHECC don't like informing us about any thing important!!:()

in my opinion, EMT level is quite good, the problem is lack of experience and loss of skills through lack of use. it would be great if the fire services outside dublin had at least a handful of emts in each station. but it would be beter if paramedics had a reliable schedule for upskilling.

salbutamol is really very safe to use. and in prehospital use is probably imposable to have a serious OD on. (unless you filled a bucket with it and submerged the patients head:))

Sitric

I'm quite surprised to hear read you don't carry naloxone. Surely the ambulance service must come across a significant no of overdoses?

What is done at major burn trauma sites? Are patients transported to hospital before being given any pain relief?

Are paramedics allowed give iv medications? Put in an iv line? I know a lot of people know how to do it just wondering if they are allowed?

Hooch

darragh-k wrote: »

Heard that too NGA, you would get a new car for the cost of it too. Interesting about the new ambulance service...

May not cost as much for first course......placements would be paid placements.....as they may have a PAS;). One of the guys who works with me has his name in the hat for the first course.

Elessar wrote: »

EDIT: Though I (and others) have heard on more than one occasion examiners in PHECC stating there wont be EMT exams any more in the near future. I don't know what it meant I only heard it in passing.

I dont agree with your first part Elessar. Most EMTs are not capable of Paramedic. No before you go on the war path let me explain. EMT training is great. However when you dont use your skills in real life then they go rustly. Practicing in OSCEs can only go a 30% of the way. On the road work is where you really learn. So most EMTs loose their knowledge within a year. So heres the problem.......if they were Paramedics how would they keep current (unless full time PAS etc). IRC, OMAC etc are great services.....but they can only go so far. For Paramedic you need AS1 calls and a nice range of them. This should be same for EMT but alas its not.

On getting rid od EMT exams.....I havint hear anything like that.

paraletic wrote: »

in my opinion, EMT level is quite good, the problem is lack of experience and loss of skills through lack of use. it would be great if the fire services outside dublin had at least a handful of emts in each station. but it would be beter if paramedics had a reliable schedule for upskilling.

Exactly my thoughts.

Sitric wrote: »

What is done at major burn trauma sites? Are patients transported to hospital before being given any pain relief?

Are paramedics allowed give iv medications? Put in an iv line? I know a lot of people know how to do it just wondering if they are allowed?

Advanced Paramedics can give morphine themselfs. A/Ps can put in IVs but Paramedics can only maintain it.

boomer_ie wrote: »

Unfortunately it would appear that HSE is not yet going down this route at this point in time (maybe in the future?) as I would have thought that employing EMTs to do PTS work would have freed up paramedics to do 999 work at a cheaper cost than employing more Paramedics to do PTS and 999 work.

I do believe you will see a big change with this in the next few months......;)

Elessar

nice guy always wrote: »

I dont agree with your first part Elessar. Most EMTs are not capable of Paramedic. No before you go on the war path let me explain. EMT training is great. However when you dont use your skills in real life then they go rustly. Practicing in OSCEs can only go a 30% of the way. On the road work is where you really learn. So most EMTs loose their knowledge within a year. So heres the problem.......if they were Paramedics how would they keep current (unless full time PAS etc). IRC, OMAC etc are great services.....but they can only go so far. For Paramedic you need AS1 calls and a nice range of them. This should be same for EMT but alas its not.

I was merely thinking out loud. EMT grade in reality isn't going anywhere. I do believe practitioner level should be Paramedic and above and the EFR/EMT are largely redundant. If PHECC were to disband the EMT they couldn't simply remove people from the register and downgrade them to EFR, they would have to offer Paramedic. If they didn't they would effectively be forcing the numerous EMTs working around the country out of a job not to mention wasting the thousands of euro that hundreds of people have spent doing the course. Again, just my thoughts. I don't see why we need both EFR and EMT when one would suffice.

I mostly agree with what you are saying, but look at it this way. There are still a good number of Paramedics working either in private companies or voluntaries at the moment, who did the old EMT course and got bumped up in the transition. Should they lose their license? What about the people who came from abroad and got on the register? Should they also not be Paramedics?

Sitric

Thanks, I should have read the guidelines Boomer posted. It´s actually very broad, good development. How many AP´s do we have? And when did those reg´s come into force?

boomer_ie

Sitric wrote: »

Thanks, I should have read the guidelines Boomer posted. It´s actually very broad, good development. How many AP´s do we have? And when did those reg´s come into force?

http://www.phecit.ie/UserImages/Register/Statistics/Statistics%20page%20-%20Reg%20Graph.jpg gives the breakdown of the grades and numbers and DFB has the highest numbers. I was a bit surprised to notice a fair few EMTs in DFB as I thought they did Paras only so Im guessing that these are retained lads.

The March 2009 figures (the latest ones I could find on the PHECC website) are:

AP 159
P 2216
EMT 279

Hooch

Elessar wrote: »

I mostly agree with what you are saying, but look at it this way. There are still a good number of Paramedics working either in private companies or voluntaries at the moment, who did the old EMT course and got bumped up in the transition. Should they lose their license? What about the people who came from abroad and got on the register? Should they also not be Paramedics?

And I understand fully what your saying.....i'd like to be a Paramedic too!!

No EMT got bumped up to Paramedic by the way, there was a convertion course, 21 of them if I remember right the last one being in Cork in Feb 2007. It was a 7 week course that included a week of PHTLS.

Those who didnt do the convertion course stayed as EMTs and are drivers within the NAS....although I believe most have retired by now.

sgthighway

@buzzman; It was stored in a Parabag and I don't really want to specify too much about the duty (it would pin point who I am) but it was remote and cold. There were 2 EMTs in the Team.

The EMT Standard is good for the likes of Mountain Rescue & Aux Amb Associations where sometimes you are working with differernt crews and you can understand the scope of somebody elses skills. I don't know how the EFRs fair out but the EMTs in my area get together with a Phecc Tutor (mentor) and go through skills as part of our CPD.

Maybe PHECC need to review the PCRs and determine if some of the EMTs are doing too few calls to keep up their skill sets. If they aren't getting experience they could be called to be re-assessed?

Just to add - AFAIK all DFB have to be at least EMT even if they don't work on the Ambulances.