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r/ems•
snapdangle

What is in the BLS scope of practice in the US?

I've been lurking in this subreddit for a while and see terminology like EMR, EMT, EMT-B, and AEMT. I realize that Paramedic qualification is ALS and EMR is basically a driver/helper, but I'm curious to know what other BLS providers can do. I live and work BLS in Canada and the difference between provinces is surprising. Starting IV's and giving (a small list of) drugs IV is pretty much the standard in my province, but 3 and 12 leads are considered an ALS skill. There are other provinces that have longer BLS training programs and can interpret 12 leads but have fewer options for drugs.

In my province we can give: Narcan IM/IV/SC D10W IV Glucagon IM TXA IV Nitroglycerin SL Epi IM Gravol IM/IV Benadryl PO (this was just removed for some reason) Salbutamol NEB Entonox Self-admin ASA PO Ketamine is currently in trial

Posted Mar 8, 2018, 5:29 PM UTC

343
KrAzyDrummer•

Oh boy I can't do shit. In CA for some reason, EMT-B's are thought of as kindergarteners eating crayons.

We carry oxygen and glucose. That's it. WE DON'T EVEN CARRY EPIPENS, WTF?!

We were only just recently allowed to start taking temps on our own (oh boy, thermometers!). Can't take a pulse ox (?) though many of use just carry our own oximeters and say the nurse did it. Can't take a blood glucose unless your company has special permission and training to teach you to do it (ours is rolling out glucometers by the end of 2018).

In the counties around me, unless on scene time to in the hospital time is within 10 min, you HAVE to call ALS upgrade for any code 3s. Hell, one county basically makes it impossible for a BLS unit to go L&S anywhere.

By law, if a BLS unit witnesses a first on scene, they are required to call ALS. Can't treat and transport, but just assess and wait for ALS to show up. We're not allowed to transport any MVA patients unless a paramedic specifically orders us to and rides with us.

We're glorified Uber drivers. But the silver lining is 911 runs P/B units and is always short staffed, so I'm hoping to get into county 911 asap.

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TheComebacKidLiteral Heavy Rescue•

California Title 22 has been updated this year for EMTB scope. EMTs will now carry glucometry, epi 1:1000 (EpiPen in a vial) and CPAP.

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coloneljdogr/EMS QA Supervisor•

It's in our scope now officially at the state level but not required to be stocked in the ambulance, is my understanding.

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TheComebacKidLiteral Heavy Rescue•

Ah, my mistake.

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14inthehandMr. Medic•

This. It's available for emts but each county needs to adopt it for it to be required on a rig.

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snapdangleOP•

Whoa.. That sucks dude I'm sorry. Hand holding like that doesn't enforce confidence or competence at all. Thanks for your input and good luck lol

1
YankeeSamuraiEMT•

Even in CA, it depends where you work. In Kern county, it wasn't THAT much better, but at least we were issued pulse oximeters and thermometers and carried aspirin and King airways with standing orders to use those meds/interventions. We didn't have any bullshit mandatory ALS requests or can't-treat-the-patient restrictions. Of course we couldn't be cowboys and run cardiac calls all by ourselves despite ALS nearby, but if we did our assessment and found no indication for ALS, we had the power to cancel or downgrade Fire and/or ALS as needed.

My friend, an EMT at my company, was dispatched to an MVA due to ALS level zero and ended up pronouncing a patient deceased. I believe BLS Fire might've been on scene with them, but there were definitely no ALS providers present. As the attendant on the transporting unit, my friend was in charge of the show. When ALS is unavailable or at a distance, Kern County BLS ambulances respond to and transport whatever goes out, including medical unresponsives, shootings, and so on.

I know this is par for the course in other parts of the country and is not on the level of EMTs doing CPAP or drawing up Epi on standing orders, but hey - we'll take what we can get. All California EMTs should try to work in Kern County for a taste of real EMS.

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tkirk34NY EMT-B•

thats if your medical director doesn't neuter your protocols.

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bgl210AED Battery Tester•

And not even really nitro. As an EMT in NYS you can assist a patient with taking their nitro IF it’s prescribed to the patient and if their systolic is over 120 with a complaint of chest pain.

What is interesting too is EMTs can administer epi as a last resort, with med control approval, for asthmatics if albuterol isn’t providing improvement.

Don’t forget oxygen too. #1 BLS drug.

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bgl210AED Battery Tester•

From the REMO region:

IM administration of epinephrine should be used if the patient is in severe distress and tidal volume is so small that nebulized medications will not work

I think they operate under the assumption that either you’ll have an ALS intercept by then or be to the hospital, since what is stressed for BLS providers is expedient transport to definitive care as opposed to “staying and playing”.

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RoughConstant•

CPAP and 12 lead transmission are optional too.

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whineforwine•

And oxygen. We technically can't even read ECG

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FlanyoGeriatric Uber•

Same for us in Chicago

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troopasaurusBC - ACP•

Best way I have figured to translate scope and training is this: BC EMR is like EMT-B, PCP-IV is similar to AEMT, ACP = EMT-P. The FR in Canada would be an EMR in the US. These don't line up in all states as they can vary greatly but as a generality it seems to work.

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cohenisababe•

I’m a basic in IL. I carry:

Narcan Albuterol Aspirin Nitro Glucagen Instant glucose Epi (vial, not pen)

Oxygen obviously. Allowed to do CPAP and King Airways. We carry a lifepak 15 and do 12 lead ekg.

Our EMRs carry Narcan, aspirin, and the instant glucose. Will soon be able to use Kings as well.

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kieranfbUK - BRC Ambulance Crew•

Our lowest level of ambulance crew in the Red Cross in UK can give:

O2, Entonox, Paracetamol, Ibuprofen, Aspirin, GTN, Salbutamol (Neb/PMDI), Loratadine, Glucogel, Glucotabs

If you take an extra course, you can give all above plus:

Naloxone, Atrovent, Adrenaline 1:1000, Glucagon

In terms of 'vitals' we can do pulse ox, BP, BGL, peak flow, tympanic temp, and if you do an additional course you can do 12 leads but not interpret them.

(Most people on 999 work have done the additional course to allow the extra drugs and ECGs)

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HeresCyonnahChief Cheif, EMT-B, TX•

Depends where you are in the US.

It can be as bad as cali, or PA, or in places like Texas it can include IM epi, taking BGLs, using a pulseox, albuterol nebulizers, a few PO drugs (OTC), SGAs, then the usual stuff.

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nilnocCO-EMT•

As others have said, protocols vary wildly by state and even county, with the added changes of medical directors and waivers. In Colorado I’m lucky that Basics have a wider scope than many other states. We can perform IVs, start CPAP, use supraglottic airways such as a King tube. Having only worked in Colorado, it blow my mind seeing how restricted some basics are. Supposedly we will be getting IV Zofran and IO capabilities in a waiver soon, but who really knows.

Here’s a link to a quick reference sheet published by my county as to what each level can perform: https://imgur.com/a/qXI9E/

Edit: We can also perform pulse oximetry and BGLs, which is really shocking to me that some areas cannot do that.

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SHREDDEDMedic•

o2 and transport

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THRWY3141593PCP student•

BC, huh? I'm not sure, but I think it's the only province that doesn't do 3-leads.

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snapdangleOP•

Yes, and I believe that is the case. I think the reasoning is that they want us to focus on the basics instead of giving us tech that we can't interpret or do anything about. Or maybe it is because they were only recently able to afford to pay more than 2$ an hour for employee's to be on call lol

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StevegapBCAS PCP. Actually like my job.•

Was going to say, that scope looks familliar. I think there's an eastern province or two that doesn't either.

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mekanik3521•

In Texas your scope of practice as a basic is what your specific medical director authorizes you to do. Your scope goes under their license and they can make it as broad or narrow as they want with their protocols

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cohenisababe•

In Illinois, my MD Is great about keeping us up to date with what the state says we can do. Our resource hospital had 98% rural agencies. Hopefully by the end of the year, we’ll be doing IM Benadryl and EPI for cardiac. We’ll see. Also rumblings of IVs in a few years for us in IL.

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GarbomedicTN, Paramedic•

Look up NREMT Advanced EMT and Basic EMT scope of practice. Every state has their own scope of practice for each level but for the most part they try and follow the national standard put forth by the DOT office of EMS and the NREMT. Basicly cardiac monitors, vents, cardiac meds, pain meds, advanced airway procedures, psyc meds, and some basic airway meds. If it's ACLS is ALS. This is me being overly simplistic of course.

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Mortiferumhera•

In the US BLS sop depends on the state and county as well as who you work for. For example in NC I can do a lot more (administer more medications and such) then I can in SC...it really depends.

Edit:Basics can't start IVs anywhere here im 99% sure however placing a 12 lead is common practice, we just cant "interpret" it.

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Forgotmypassword7053•

It's regional down to the county level in someplaces

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SteveBB10•

If your service isn’t IV autonomous in Ontario . And your running a dual pcp crew in some services down south or way up north that removes Dextrose, and Nitro for your nitro virgin patients.

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The_Savage_SaxonTN - AEMT•

You have to be EMT-B to work on an ambulance, IIRC. EMR is more of a cert for volunteer firefighters and medical responders at job sites and factories.

AEMT is basically EMT-b + IV, IO, supraglottic airways, and a few more drugs. It depends on the state, but in my area you need to be AEMT if you want to be on an ALS truck with a Paramedic partner. It’s usually seen as a stepping stone to Medic, and around here you need to be an AEMT to get into Medic school.

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DocButton•

Oxygen, oral glucose, and activated charcoal. Epinephrine, nitroglycerin and inhalers with the supervision of a physician.

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J_T_09EMT•

I’m in an EMT-B in Minnesota. We carry the following:

Albuterol Aspirin Glucagon Epi Narcan Nitro (I think there’s more, but I can’t remember off the top of my head.)

We can do CPAP, nebs, I-Gels, 12-leads and IVs.

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M8o8vMainBattleTankEMT-Basic bitch•

Basics can do IVs in Minnesota? I didn't realize basics could do IVs in any state. What IV meds can you use? Or do you just start it and the medic does meds?

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J_T_09EMT•

We don’t do meds. We do a slow drip of saline until we intercept with ALS or get the the ER.

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FattybitchtitsNYC EMT-B•

We have Narcan IN, Aspirin, Epi (draw up and autoinjector), Orlando glucose, Albuterol (neb), and nerve agent kits (Pralidoxime and Atropine auto-injectors. We have CPAP, pulse oximetry, and glucometers, no cardiac monitoring. They send us as the primary unit to all trauma and non critical medicals, and we back up ALS on high priority medicals, and they give us ALS for high priority trauma if we ask or if they decide to based on the call information. Overall it’s pretty good here, we can do more than most BLS and they actually trust and utilize us for actual emergencies when we aren’t busy picking up drunk homeless guys.

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deadlybacon7Emergency Medical Teenager•

As an EMT-B in Northern Virginia this is what I'm allowed to do:

  • Oxygen

  • Oral Glucose

  • Tylenol

  • Narcan

  • Aspirin

  • Epipen (if the patient has it prescribed and available)

  • Nitro (if the patient has it prescribed and available)

  • Pretty much any diagnostic test we can initiate. We can independently take 12 leads according to protocol and send them to ALS providers or the hospital, but can't interpret them. Can do pulse ox, BGL, etc

  • I can't start IVs or anything like that unless I get hired by a hospital. Tryna get hired by a hospital so I can poke poke

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BoozeMeUpScotty•

In Florida, you can give 02 and your pt’s own nitro, aspirin, epipen, oral glucose, albuterol MDI, and activated charcoal. We don’t get narcan, which is ridiculous because they’ve allowed police to administer it without medical training, but somehow BLS EMTs can’t? We can do OPA and NPA, King tubes and LMAs, nebulizer treatments, 12 leads, iv setups, hard and soft catheter suctioning, glucometer (approved locally by our med control but not everywhere, which is ridiculous) and restraints. Most of the trucks that respond to 911 have ALS on them anyway, so it’s less relevant than in places where you actually have to wait for ALS backup, but it’d still be nice to be able to do more.

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