Steth & BP cuff in EFR Kit?

RedNeonTiger

I have noticed on several different suppliers kits for EFR's they include a stethoscope and BP cuff. The CPG's have blood pressure monitoring at EMT so why are suppliers including it an EFR's kit?

DesertCreat_15

Because an EFR is essentially our assistant.

sjb25

To charge more I'd say

ectoraige

Perhaps they were in the old skills lists? I always thought the GTN cpg is a bit silly, telling us not to give it if bp is less than 90, but that we're not allowed check it. So we have to get an EMT to check the bp, and then tell them they're no longer needed?

EMT1964

According to EFR CPG'S one of the Contra Indcations is Systolic <90 but as EFR can not check BP then i was told to ignore that bit and check all other Contra-Indcations , if all ok then give GTN But also don't forget that EFR can only assist with administration, so there for to help with administration a patient must have been perscribed GTN to start with.

bilirubin

Taking Blood Pressure by Palpation and using a Pulse Oximeter are 2 skills expected by Civil Defence EFRs as they are considered beneficial to their skills base and for the administering or assisting in the administrating certain medications. And like DesertCreat_15 has mentioned they can assist Practitioners take vital signs.

ectoraige

EMT1964 wrote: »

According to EFR CPG'S one of the Contra Indcations is Systolic <90 but as EFR can not check BP then i was told to ignore that bit and check all other Contra-Indcations , if all ok then give GTN But also don't forget that EFR can only assist with administration, so there for to help with administration a patient must have been perscribed GTN to start with.

Yes, it was explained away to me that it would be prescribed GTN we'd assist in administering and as such it wouldn't be prescribed to somebody susceptible to lowered blood pressure. Still doesn't sit right with me, there's always a first time surely. We were shown how to use it, but also told not to use it ourselves.

GoProGaming

bilirubin wrote: »

Taking Blood Pressure by Palpation and using a Pulse Oximeter are 2 skills expected by Civil Defence EFRs as they are considered beneficial to their skills base and for the administering or assisting in the administrating certain medications. And like DesertCreat_15 has mentioned they can assist Practitioners take vital signs.

but phecc make the cpg's, so the civil defence is expecting something which currently their efr's cannot do.

GoProGaming

ectoraige wrote: »

Yes, it was explained away to me that it would be prescribed GTN we'd assist in administering and as such it wouldn't be prescribed to somebody susceptible to lowered blood pressure. Still doesn't sit right with me, there's always a first time surely. We were shown how to use it, but also told not to use it ourselves.

Yeah the way i read it and teach it (efr instructor) is you may assist with the patients own medication, and they wouldn't have it if their doctor thought they could have hypo tension, assuming they regularly get checked up.

I always say to efr's complaining about their low skill set is what do you expect from a 40 hour course?? if you want to do/ know more, sit an emt course.

bilirubin

GoProGaming wrote: »

but phecc make the cpg's, so the civil defence is expecting something which currently their efr's cannot do.

I'm not sure what you mean? CPGs don't mention Spinal Boards or log rolling either but these are skills EFRs should know. There is nothing stopping an organisation having expectations for their volunteers. Also there is nothing stopping any lay person (with no official training) learning the skill of taking Blood Pressure. Lidl even sell automatic BP devices and I dont remember seeing any PHECC warning label on it saying EFR's cannot do BP.

GoProGaming

bilirubin wrote: »

I'm not sure what you mean? CPGs don't mention Spinal Boards or log rolling either but these are skills EFRs should know. There is nothing stopping an organisation having expectations for their volunteers. Also there is nothing stopping any lay person (with no official training) learning the skill of taking Blood Pressure. Lidl even sell automatic BP devices and I dont remember seeing any PHECC warning label on it saying EFR's cannot do BP.

well if you look at the rear of the cpg's in the skills matrix, it does clearly state what level of responder/ practitioner can do what skill.

By that logic sure i may as well go out and borrow an intubation kit, sure i know how to shove in an igel and a king lt already.
You wont kill anyone by taking a blood pressure i know, but in principal where does it stop?

timmywex

GoProGaming wrote: »

well if you look at the rear of the cpg's in the skills matrix, it does clearly state what level of responder/ practitioner can do what skill.

By that logic sure i may as well go out and borrow an intubation kit, sure i know how to shove in an igel and a king lt already.
You wont kill anyone by taking a blood pressure i know, but in principal where does it stop?

Nothing stopping anyone doing blood pressure/spo2 with a patients permission and being signed off on by the higher clinical level.

Also BP and spo2 are in EFR education and training standards, and as mentioned are contraindicated for GTN/oxygen respectively, no EFR would get in trouble for using them, they are non invasive and PHECC would have one massive fight on their hands arguing why they cant be done! Apparently they should be in skills matrix but were left out in the last CPG's as an oversight...

ectoraige

timmywex wrote: »

Nothing stopping anyone doing blood pressure/spo2 with a patients permission and being signed off on by the higher clinical level.

Also BP and spo2 are in EFR education and training standards, and as mentioned are contraindicated for GTN/oxygen respectively, no EFR would get in trouble for using them, they are non invasive and PHECC would have one massive fight on their hands arguing why they cant be done! Apparently they should be in skills matrix but were left out in the last CPG's as an oversight...

That wouldn't surprise me. I personally think the CPGs are rather poorly presented and inconsistent. For example, the Primary Survey CPG includes checking for catastrophic bleeding as a mandatory step, but doesn't give the same emphasis to head tilt, chin lift/jar thrust should the casualty not have an open airway. Likewise, in the Basic Life Support, applying the AED pads is again highlighted as 'mandatory', but nothing else is, not airway, not compressions, even after no shock advised. For Haemorrage control, Apply Sterile Dressing is mandatory, yet PEEP isn't.

The indicator to show medication that can be administered by CFR or higher is a grey cylinder, and a purple cylinder for EFR. However, in the actual CPGs where salbutomal/gtn are indicated, the purple cylinder appears with in a grey box with the words "Assist patient to administer" - which could be read to indicate that a CFR can assist the patient, and EFR administer.

Sometimes to indicate that only a particular level can proceed with a step they have a flag with the minimum level beside it e.g. "OFA", other times they have the levels not allowed in a crossed-out sign e.g. "CFR"

Overall, there's no consistency which I think makes things more complicated for students trying to learn exactly what they can and cannot do. I know their instructors do this too, but reference sheets shouldn't required further explanation. PHECC could also do with considering that people are likely to be printing them on A4, or displaying them on projectors - the text size can be very small. Also, the colour distinctions aren't always clear, especially with poor colour printers.

I've had that rant stored up for a while, this seemed like the best opportunity to air it...

ectoraige

GoProGaming wrote: »

well if you look at the rear of the cpg's in the skills matrix, it does clearly state what level of responder/ practitioner can do what skill.

By that logic sure i may as well go out and borrow an intubation kit, sure i know how to shove in an igel and a king lt already.
You wont kill anyone by taking a blood pressure i know, but in principal where does it stop?

In principle you could possibly kill somebody by taking a blood pressure incorrectly though and giving the medication they shouldn't then receive. Teaching people contraindications but not ensuring they are able to test for them correctly could lead to a laissez-faire attitude - if one ignores BP on the basis that it's probably not a problem, what else does one ignore?

Mycroft H

Anyone even assisting in the administation of GTN should be at least taking a palpable BP.

Feeling for a radial pulse and assuming things are grand because it has to be above 90mmHG systolic has been shown numerous times to be just wrong (I've palpated a radial pulse with a 70/48 BP before, it just ain't reliable)

ectoraige

Mycroft H wrote: »

Anyone even assisting in the administration of GTN should be at least taking a palpable BP.

Feeling for a radial pulse and assuming things are grand because it has to be above 90mmHG systolic has been shown numerous times to be just wrong (I've palpated a radial pulse with a 70/48 BP before, it just ain't reliable)

I love the vagueness of 'assisting'.

Since it's the patients' prescribed medications we're talking about, we can't exactly prevent them from taking it. Without a cuff we should be warning the patient that you can't say if it's safe to take, even if you can find a radial pulse; if we're suspecting angina/MI in the first place, they probably are showing symptoms common to hypotension. Failing to locate a radial pulse might this warning more urgent, but still doesn't confirm what the BP is.

If you hand them their own medication and then tell them you can't be sure if it's safe to take, have you assisted if they go on to self-administer? Or is the line only crossed at spraying it under their tongue?

truebluesac

The CPG's and drug formula are generic in so far as a particular drug is read the same regardless of clinical level from efr -EMT-paramedic - AP

For EFR's and OFA's they can assisit with a patients own medication regardless of BP .

This raises the question of descripency .

It is easy to say add it to an EFR's coursebut the try explaining effects of mascictomy or bilateral mascictomy' and the effect on bp etc

bilirubin

RedNeonTiger wrote: »

I have noticed on several different suppliers kits for EFR's they include a stethoscope and BP cuff. The CPG's have blood pressure monitoring at EMT so why are suppliers including it an EFR's kit?

Hi OP, the latest PHECC EFR CPG 2014 edition now mentions it in the EFR skill matrix.
If you go to phecc dot ie website follow "Clinical resources => Clinical practice guidelines "
you can get a digital copy of it.

timmywex

bilirubin wrote: »

Hi OP, the latest PHECC EFR CPG 2014 edition now mentions it in the EFR skill matrix.
If you go to phecc dot ie website follow "Clinical resources => Clinical practice guidelines "
you can get a digital copy of it.

BP by palp, not auscultation I believe?

bilirubin

timmywex wrote: »

BP by palp, not auscultation I believe?

I haven't fully read it yet but i haven't seen the wording BP by palp mentioned anywhere in the CPG, just says "Blood Pressure" in the skills matrix and has SA beside the tick.
GTN still says contra indication SBP <90 mmHg and i dont see any special box on the GTN med page saying that EFR doesn't need to take this reading.

timmywex

bilirubin wrote: »

I haven't fully read it yet but i haven't seen the wording BP by palp mentioned anywhere in the CPG, just says "Blood Pressure" in the skills matrix and has SA beside the tick.
GTN still says contra indication SBP <90 mmHg and i dont see any special box on the GTN med page saying that EFR doesn't need to take this reading.

Yeh the SA means its only by palp I think. Similar to the BVM usage being SA as is a two responder job as opposed to one

Also the updated training standards only mention bp by palp so would make sense.....