Recently, a good bit of publicity has been devoted to allowing EMTs to administer Narcan intranasally to patients who have overdosed on opiates. speaking purely from a practical and clinical standpoint, these patients aren’t going to die from a lack of Narcan, but they are going to die from a lack of ventilation. We should be reinforcing good BVM skills rather than adding ALS interventions piecemeal based on the media’s epidemic du jour.
This is nothing new. Every few years, many BLS providers petition the powers that be for certain ALS skills. In my EMS career, I’ve seen a few of these skills added or considered from nebulized albuterol to nitroglycerin to Epi-pens and now Narcan. In most of these cases, we limit the application of these (now formerly) ALS skills to specific patients in specific situations. This is our attempt at managing and mitigating the risk of allowing an EMT with approximately 120 hours of training to perform a skill that was previously reserved for paramedics with over 1,000 hours of training. (I’ll save the training versus education debate for another day.). What we end up with is a cookbook, bastardized, piecemeal approach to the provision of advanced life support, based largely on public and political pressures as opposed to sound medical science. What we don’t end up with are providers who understand the how, when, where, or why to apply these newly acquired skills.
I’d favor EMTs being allowed to perform these ALS skills in two situations. First, where the skills are being performed under the direction and supervision of an ALS provider in an effort to provide a true “extra set of hands.” Second, and subject to strict clinical oversight, in rural systems without ALS access.
In my opinion, if you want to be able to perform ALS skills, you need the knowledge of an ALS provider. That means if you want to do the “cool” paramedic stuff, go to paramedic school. Otherwise, this trend to add ALS skills to the EMT protocols is yet an another example of the instant gratification model that continues to hamper EMS and EMS education in particular.
Yep, I think I’ve finally turned the corner and become one of those crusty (at least relatively speaking) and cynical older medics.