EMT-I EXPANDED SCOPE OF PRACTICE

 

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Optimal patient care requires that the EMT-I understands the expanded scope of practice adopted by Los Angeles County. The following items are included in the expanded scope of practice and will be discussed during this lesson:

 

·                      Transport patients with specified medications added to IV solutions

 

·                      Transport patients with patient operated medication pumps

 

·                      Transport patients with various tubes & indwelling vascular access lines

 

·                      Assist patients with administration of physician prescribed medications

 

LESSON OBJECTIVES

At the end of this lesson, the participants will be able to:

 

1.                  List at least 4 IV solutions or additives that are within the EMT-I expanded scope of practice when transporting patients.

 

2.                  Explain why a spill kit must be available when transporting a patient who is receiving an infusion of a chemotherapeutic agent.

 

3.                  Define the following terms: infusion pump, patient controlled analgesic pump, and volume-control set device.

 

4.                  List at least 3 types of tubes or medical devices that are within the EMT-I expanded scope of practice when transporting patients.

 

5.                  Demonstrate the procedure for suctioning a patient with a tracheostomy tube.

 

6.                  Name the 3 medications the EMT-I may assist the patient with administering or may allow the patient to self-administer.

 

7.                  Discuss the actions, indications, contraindications, and administration for the 3 physician prescribed medications referred to above.

 

8.                  Describe the purpose of a spacer device and how it is used.

 

9.                  Describe the purpose of epinephrine auto-injector devices and explain how these devices are used.

 

 

SKILLS

·                      Assist with administration of physician prescribed medications: nitroglycerin, bronchodilator inhaler, and epinephrine auto-injector

 

·                      Tracheostomy tube suctioning

 

KEY VOCABULARY

The following terms will be used during this lesson:

 

·                   EMT-Basic – Same as EMT-I, but has an expanded scope. Name used by the Department of Transportation and the National Registry to denote basic life support providers. Los Angeles County will continue to use the name of EMT-I until regulations change.

 

·                      Infusion pump – A pump that allows for a specific IV volume to be infused over a specific time.

 

·                      Patient controlled infusion pump – A pump that is set to deliver a specific amount of medication per activation by the patient. Medications administered are insulin or analgesics such as morphine or meperidine (Demerolâ).

 

·                      Volume-control set device – An infusion pump or device that is directly attached to the IV tubing and allows for a specific IV volume to be infused over a specified time.

 

KEY CONCEPTS

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

 

EMT-I EXPANDED SCOPE OF PRACTICE

Expanded scope of practice allows the EMT-I to:

 

·                      Transport patients with specified medications added to IV solutions.

 

·                      Transport patients with patient operated medication pumps.

 

·                      Transport patients with various tubes and indwelling vascular access lines.

 

·                      Assist patients with administration of physician prescribed medications.

 

 

 

 

Transport patients with specified medications added to IV solutions:

Intravenous Solutions:

 

·                      Glucose solutions

·                      Isotonic salt solutions such as normal saline and lactated ringer’s

 

IV Solution Additives:

 

·                      Folic acid

·                      Multivitamins

·                      Thiamine

 

Additives/Solutions Requiring Infusion Pump For Transport:

 

·                      Potassium chloride

·                      Total Parenteral Nutrition (TPN)

·                      Chemotherapeutic agents

 

Precautionary Measures When Transporting Patients Receiving Chemotherapy:

 

·                      Spill kits should be available in case of IV leakage or spills.

 

·                      Protective clothing must be worn.

 

·                      Direct contact with chemotherapeutic agents can lead to cancer, genetic damage, birth defects, local irritation and burning, and tissue destruction.

 

·                      Chemotherapeutic agents are excreted in body fluids.

 

·                      Contact to skin – wash immediately with soap and water.

 

·                      Contact to eyes - flush immediately with water for 5 minutes.

 

·                      A physician must evaluate all exposures.

 

Transport patients with patient operated medication pumps:

·                      Insulin

·                      Meperidine (Demerol)

·                      Morphine

 

Patient operated infusion pumps:

 

·                      May be internal or external.

·                      May ONLY be activated by patient or caregiver.

·                      EMT-I should be given emergency shut off instructions.

·                      Monitor patient’s status.

 

 

Transport patients with various tubes and indwelling vascular access lines:

EMT-Is may transport patients with the following tubes and medical devices:

 

·                      Nasogastric tube

·                      Gastrostomy tube

·                      Heparin/saline locks

·                      Foley catheters

·                      Tracheostomy tubes (Refer to Suctioning –Tracheostomy Tube skill sheet)

·                      Indwelling vascular access device

 

 

EMT-Is may NOT transport patients with the following tubes and medical devices:

 

·                      Central venous monitoring devices

·                      Arterial lines

·                      Swan Ganz catheters

·                      Peritoneal dialysis catheter

·                      Thorocostomy tube to closed water seal drainage system

 

 

Assist with administration of physician prescribed medications:

·                      Administration is supportive only.

 

·                      ALS unit must be en route or patient must be transported immediately.

 

·                      Medication must be prescribed for the patient.

 

 

EMT-Is may assist the patient with or allow the patient to self-administer the following medications:

 

·                      Nitroglycerin

·                      Epinephrine device (auto-injector)

·                      Bronchodilator inhaler

 

* Refer to pharmacology handouts for each medication.

 

Documentation on EMS Report

·                      Patient problem

 

·                      Name of medication, dose, route and site; whether it was administered by patient or if assisted by EMT-I; physician who prescribed medication; and reassessment of patient status in response to medication.

 

·                      Name of IV additives/solution and rate of infusion.

 

·                      Infusion pump if used.

 

·                      If patient controlled pump, number of times patient administered medication.

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