2. Los Angeles County EMT-1 Expanded scope of practice EMT-1 Expanded Scope Los Angeles County EMT-1 Expanded Scope of Practice

3. Los Angeles County EMT-1 Expanded scope of practice Implementation l February 28, 1997 became policy(#802) (revised February 01, 2011) l May 30, 1997 after this date all EMT-1’s certified or recertified in LA County must have attended EMT-1 expanded scope training.

4. Los Angeles County EMT-1 Expanded scope of practice Title 22 State Scope of Practice l What 2 drugs? l IV monitoring - NO ADDITIVES

5. Los Angeles County EMT-1 Expanded scope of practice IV monitoring l may monitor, maintain, & adjust a preset rate of flow. l shut off IV if there are signs of infiltration.

6. Los Angeles County EMT-1 Expanded scope of practice Expanded Scope l Los Angeles County only l Policy 802 l If finer points of this policy are difficult to remember use cheat cards!

7. Los Angeles County EMT-1 Expanded scope of practice Assists with MEDS EMT-1’s may assist the patient or allow the patient to self administer the following medications: NitroglycerinEpinephrine Bronchodilator inhaler

8. Los Angeles County EMT-1 Expanded scope of practice Parameters 1- The 3 medications - What are they? 2- patient condition must indicate use (specifically & conclusively) 3- must be prescribed to patient 4- must be patient’s own medication 5- doses PTA count

9. Los Angeles County EMT-1 Expanded scope of practice WARNING l YOU ARE NEVER ALLOWED TO CARRY THESE MEDICATIONS ON THE UNIT OR IN YOUR JUMP KIT. l If you are told otherwise IT IS WRONG.

10. Los Angeles County EMT-1 Expanded scope of practice If you administer... l You must have an ALS unit enroute. or l The patient must be transported immediately to the nearest* hospital. l Never treat & release - this is emergency supportive therapy. * most accessible

11. Los Angeles County EMT-1 Expanded scope of practice Review of Drug Routes l IV – Intravenous l SL – Sublingual l PO – By mouth l IM – Intramuscular l SQ or SC - Subcutaneous l IO - Interosseous l Transcutaneous l IN – Inhaled l PR – Per rectum

12. Los Angeles County EMT-1 Expanded scope of practice Review of DICCE l D – Dose l I - Integrity l C - Concentration l C - Clarity l E – Expiration Date

13. Los Angeles County EMT-1 Expanded scope of practice Nitroglycerin Indication: Chest pain Route:sub lingual Repeat:Max of 3 doses Contraindication: BP less than 100 systolic Viagra w/in 24 hrs 3 doses prior to arrival Head injury

14. Los Angeles County EMT-1 Expanded scope of practice Note l comes in tablet, spray or skin patch l always check blood pressure after administration.

15. Los Angeles County EMT-1 Expanded scope of practice Epinephrine auto injector Indication: severe allergic reaction Repeat:as prescribed Route:IM Site:upper-outer thigh only!

16. Los Angeles County EMT-1 Expanded scope of practice Note l there are several brands l 1 dose only l injection into buttocks, arm, hands, will result in inadequate absorption & soft tissue damage. l IV admin. could cause MI or CVA l Side effects: tachycardia, pallor, dizziness, chest pain, headache, n/v

17. Los Angeles County EMT-1 Expanded scope of practice Bronchodilator Inhalers Indications:Dyspnea, associated with bronchospasm (asthma, bronchitis, COPD) Repeat:as prescribed Contra:patient unable to use device maximum doses taken PTA

18. Los Angeles County EMT-1 Expanded scope of practice Notes l In cold environment l Inhale slowly and continuously

19. Los Angeles County EMT-1 Expanded scope of practice Commonly Prescribed Bronchodilators l albuterol - terbutaline - metaproterenol l Proventil - Ventolin - Bronkosol - Bronkometer - Alupent – Meteprel - Brethine...

20. Los Angeles County EMT-1 Expanded scope of practice Form / devices include l Inhaler l Inhaler with a spacer l hand held nebulizer* l Pulmonaid device* * patient or caretaker must set up if EMT is unfamiliar with equipment.

21. Los Angeles County EMT-1 Expanded scope of practice Document properly l Assessment AND THE FOLLOWING: l medicine prescribed by MD l medicine is patient’s l other factors l VITALS & REASSESSMENT after treatment

22. Los Angeles County EMT-1 Expanded scope of practice IV monitoring Additives

23. Los Angeles County EMT-1 Expanded scope of practice Monitor IV with additives l Folic acid - 1mg / 1000ml max l Multivitamins - 1 vial /1000ml max l Magnesium Sulfate – 2grams/1000ml (in conjunction w/MVI l Thiamin - 100mg / 1000ml max monitor, maintain, & adjust a TKO rate of flow.

24. Los Angeles County EMT-1 Expanded scope of practice Additives requiring an infusion pump l Potassium chloride l Total Parental Nutrition (TPN) These additives may not be transported without an infusion pump

25. Los Angeles County EMT-1 Expanded scope of practice Patient Controlled Infusion Pumps l may be implanted or external l may only be activated by patient or caregiver. l transport locked l Insulin - Demerol - Morphine

26. Los Angeles County EMT-1 Expanded scope of practice Other Devices.. l Central lines l Indwelling vascular access device

27. Los Angeles County EMT-1 Expanded scope of practice MAY NOT TRANSPORT 1 - Central venous monitoring devices* 2 - Swan Ganz catheters 3 - Arterial lines

28. Los Angeles County EMT-1 Expanded scope of practice Chemotherapy l There are risks l Exposures can occur from IV leakage or spills

29. Los Angeles County EMT-1 Expanded scope of practice Acute Risks of Exposure l Irritation l Burning l Tissue destruction

30. Los Angeles County EMT-1 Expanded scope of practice Chronic Risks of Exposure l Genetic damage l Birth defects l Cancer

31. Los Angeles County EMT-1 Expanded scope of practice Precautions l Wear protective clothing - universal precautions. l Nursing mothers should not have any contact with patient. l HAVE A SPILL KIT

32. Los Angeles County EMT-1 Expanded scope of practice Contents of Spill Kit l 2 pairs of gloves - thick (.007 inch) l gown & shoe covers l goggles l mask l disposal bags & equipment

33. Los Angeles County EMT-1 Expanded scope of practice First Aid Skinwash immediately with soap & water. Eyesflush with normal saline or water for 5 minutes.

34. Los Angeles County EMT-1 Expanded scope of practice THE END Next?