Scope of Practice Alternative

[Guest guest]

I have been studying the new National Scope of Practice paper very closely

and have taken some people's comments with a large grain of salt, but I

would like to offer a second edition to the Scope of Practice.

First let me start by saying, I think the National Scope of Practice is a

great start, but needs definite tweaking for it to somewhat meet the needs

of Texas EMS. We definitely need this type of continuity across the nation

with skill sets and education if we are going to increase the

professionalism of EMS.

I would like to re-define each level with small changes. I believe that

each level should have a basic skill set and then have a list of

approximately four or five skills for each level that a medical director may

chose from to allow that level of responder under his medical direction to

perform. For example,

Emergency Medical Responder (EMR) - Leave the basic skills set the way the

current National Scope has it, but add " The medical director in which this

level of medic practices under may teach or require certain educational

classes and allow the following skills to be added after their approval; 1)

Spinal Immobilization 2) PASG 3) Oxygen saturation monitoring 4) Blood

Glucose monitoring. These are just examples, but give the medical director

some room for their own skills decision.

I would also allow the EMS provider to petition the State for a " EMR

Exception " that allows an EMR to be a functioning member of the ambulance

transport team, only if there is a higher level medic providing care also.

This means that there may be an EMR on the transport team as long as there

is also an EMT or Paramedic on board also.

Education would be consistent with the Scope as read or I agree with Dr.

Bledsoe in requiring 80 hours. This may be taught as it is today with State

qualified Course Coordinators.

Emergency Medical Technician - One of the biggest changes I would make is

allowing an EMT to make " No Ride " or transport decisions after conversing

with the on-line medical control. The current skill set under the EMT is

permissible, but again the medical director needs a little latitude in

approving other skills permitted such as 1) IV administration 2)

Intubation 3) Ipecac and 4) Defibrillation (or others). Again, these

are only examples but we should allow the medical director some room to add

some limited skills with proper educational requirements behind them.

Education would be consistent with the way it is now and require a minimum

of 160 to 180 hours of instruction through either a school of higher

education or approved State Course Coordinator. There would also be

educational requirements for the add on skills the medical director chooses.

Emergency Medical Technician - Intermediate - I feel we need to add this

level back into the scope and address this middle ground in between the EMT

and Paramedic. I feel this is to large of a step between the two. The

Intermediate would be real close to the way it is now with IV and Intubation

as normal skill sets and be se up under the 1999 Intermediate Scope of

Practice. Again the medical director would have latitude in approving some

add on skills such as 1) Defibrillation, 2) pleural decompression 3)

Intraosseous insertion 4) Giving some cardiac drugs. Again these are only

examples, but the idea is to give the medical director some room to add on

additional skills with appropriate training and/or education.

Education would be consistent with the EMT-Intermediate of today with

classes given by an institution of higher education or an approved Course

Coordinator

Paramedic - I believe skills sets should remain the same except for giving

the medical director the authority to add on skills such as 1) Use of

Paralytics 2) Emergency airways 3) Tube thoracostomy 4) Initiation or

maintenance of blood products. Again these are only examples. I believe

there is a definite need for the medical director to have some room for

skills add-on only if there is appropriate education done to substantiate

those skills.

Allow the paramedic classes to be taught by institutions of higher education

or approved Course Coordinators that have the appropriate resources and

experience in teaching higher level programs. If taught at Colleges or

Universities, this could be offered as an Associates degree plan. There

would still need to be clinicals included in the field and in-hospital.

Advanced Practice Paramedic - In my mind, this would still be an upper level

skill set as proposed in the current Scope and needs to be at the bachelor's

degree level in an institution of higher education. This would be for

someone who wants to do more than ride in an ambulance or helicopter.

These are just my random thoughts on some changes to the National Scope of

Practice that we may able to live by here in Texas. Please don't flame,

just state your disagreement and offer a solution.

Ron A. Derrick, LP NREMT-P

Director of Emergency Services

City of Fredericksburg