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CPG's 2014
#41
(01-08-2014, 05:04 PM)EMTeabreak Wrote:
(01-08-2014, 02:11 PM)sprinter22 Wrote:
(01-08-2014, 08:43 AM)vidar Wrote:
(01-08-2014, 12:45 AM)sprinter22 Wrote: Dont think EMT's will ever need NPA's tbh. In the near 4 years ive been in omac, I've only ever seen an OPA being inserted once, what good is an NPA going to bring over it?

Remember that not all EMT practice is done with vols, I agree that in that's setting NPA not really needed, In over 10 years in a vol iv only seen an OPA have to be used once, but there have been two or three occasions in work for me where an NPA would have been better to have


Good point. I didnt think there was many EMT's left in actual Emergency Ambulances with NAS or DFB, but then I forgot about the Intermediate Care Vehicles responding to calls.
Thats who the king lt tube was brought in for. Nas didn't want to buy igels and the lt. So lt was added to emt skills for ICOs

The KING LT was coming in before the iGel, it took over but hasn't been found to be as effective for varying reasons

Therefor they have reverted back to the original plan of the King LT, not because of ICV but as they already wanted

NPA's are a much under utilised piece of equipment in general and would/could be used more than people realise. They can be tolerated by people with gag reflex, they are extremely useful in trauma to the mouth or the mouth is locked. I would predict them been of more use than some of the drugs
The man who never made a mistake never made anything!
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#42
(02-08-2014, 01:34 AM)Actual Paramedic Wrote:
(01-08-2014, 05:04 PM)EMTeabreak Wrote:
(01-08-2014, 02:11 PM)sprinter22 Wrote:
(01-08-2014, 08:43 AM)vidar Wrote:
(01-08-2014, 12:45 AM)sprinter22 Wrote: Dont think EMT's will ever need NPA's tbh. In the near 4 years ive been in omac, I've only ever seen an OPA being inserted once, what good is an NPA going to bring over it?

Remember that not all EMT practice is done with vols, I agree that in that's setting NPA not really needed, In over 10 years in a vol iv only seen an OPA have to be used once, but there have been two or three occasions in work for me where an NPA would have been better to have


Good point. I didnt think there was many EMT's left in actual Emergency Ambulances with NAS or DFB, but then I forgot about the Intermediate Care Vehicles responding to calls.
Thats who the king lt tube was brought in for. Nas didn't want to buy igels and the lt. So lt was added to emt skills for ICOs

The KING LT was coming in before the iGel, it took over but hasn't been found to be as effective for varying reasons

Therefor they have reverted back to the original plan of the King LT, not because of ICV but as they already wanted

NPA's are a much under utilised piece of equipment in general and would/could be used more than people realise. They can be tolerated by people with gag reflex, they are extremely useful in trauma to the mouth or the mouth is locked. I would predict them been of more use than some of the drugs
+1 for NPA's, they are a great piece of kit! And definitely under utilised. I had to fight to get a proper stock of them in the ambulance, they only had a cursory effort. It certainly could be an EMT skill, but I guess they are worried that inappropriate use could cause concerns.
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#43
There is inappropriate use of skills, meds and equipment across all levels but the higher you go the more others look down on the lower levels and criticise but wouldn't like the same been done to them by lower levels.

I'd predict Narcan at some festivals would be overused on unresponsive patients, everyone who says they have asthma may get a neb from some medics. Then again that's down to training and audit to recognise trends and issues.

PHECC can only do so much and provide the CPG's due to evidence and need for them.
The man who never made a mistake never made anything!
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#44
I don't disagree that it happens at all levels! But the point of higher ups looking down and criticising is prob why the MAC withheld the likes of NPAs from EMTs, that's the point I was trying to make. As a regulatory body they have to err on the side of caution and assume the lowest denominator when it comes to skills and knowledge.
I am a great believer in reflective learning and after any serious call I will chat it through with everyone, including EMTs and I encourage honest constructive feedback and questions. It's the best way to learn!
I'm not 100% on them giving nebs without a listen to the chest. A wheeze is probably one of the easiest breath sounds to identify, so I'm sure it would have been reasonable to introduce with the nebs.
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#45
But is there any harm in being instructed, as an EMT, in recognising a wheeze? Surely you could listen to the chest anyway. It's not like giving meds.... It shouldn't get you in trouble.
"Private Number Calling" - As if im going to answer that!!!
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#46
Auscultation to my mind is a skill that EMT's should have had ages ago, listening to a chest isn't invasive and can give greater insight into respiratory patients.
As for the training in it, not too hard but it would be down to the EMT's to be listening to every patient and then using their experience alongside tutors, doctors, AP's and paras to educate them with each patient

Paras have the same issue and they can do it, it's a new skill to them and it's constant experience and using a stethoscope regularly that enables them to become proficient at it
The man who never made a mistake never made anything!
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#47
(02-08-2014, 08:38 AM)Actual Paramedic Wrote: There is inappropriate use of skills, meds and equipment across all levels but the higher you go the more others look down on the lower levels and criticise but wouldn't like the same been done to them by lower levels.

I'd predict Narcan at some festivals would be overused on unresponsive patients, everyone who says they have asthma may get a neb from some medics. Then again that's down to training and audit to recognise trends and issues.

PHECC can only do so much and provide the CPG's due to evidence and need for them.


Yeah I have that feeling about the narcan too. It seems to me like a lot of patients at festivals have just taken a few E-tablets. What kind of effects would narcan have on someone unresponsive with nothing more than ecstacy and drink in them?

Am I right in thinking nalaxone is just for opiodes? The CPG isnt very specific, just says "aloc or inadequate resps following narcotic overdose". That could be determined differently by people.

I've used salmol nebs quite a few times before with AP's and doctors so I'm used to them, but others may not know when its more appropriate to use the inhaler over the nebs.

I guess we'll just have to wait for upskilling and see what we're told.
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#48
Narcan I'm sure others will also say has little or no side effects and doesn't harm been given but why give a drug when not necessary! That's my issue, some people will jump and give it because they want to be seen using it.

How often are staff in the emergency system using Narcan?

Little really unless in high risk areas so I'd predict it would be used seldom by vols
The man who never made a mistake never made anything!
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#49
Ya, I'm sure there will be a couple of cases where narcan is given to non opiate OD, but as AP said the side effects are generally rare (although can br serious). It really will have limited use except for high risk areas. Our Christmas markets are definitely a high risk event, so we may have EMTs seeing it or perhaps "seeing" it when it's not really there. But I think the EMTs in the voluntary organisations will be well able for the upskilling and should have the governance to monitor their implementation.
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#50
Actual Paramedic dateline=' Wrote: That's my issue, some people will jump and give it because they want to be seen using it.

You could say the same about Epi pens & Glucagon or any other med EMTs have. EMTs are governed by the same duty to care & clinical responsibility as Ps & APs, so why would you think they would be less responsible than other grades on the register?

I think the introduction of IN Narcan, may allow for other IN meds to be introduced in the future. IN is a safe & effective way for EMTs to administer the less commonly used meds on their schedule. Also I think IN Morphine or Fentanyl for Para's would also be a great addition.
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#51
I agree Florence, and also as AP said I've seen Salbutamol given to a wet chest.......it didn't seem to matter when we got it first as long as there was reduced air entry. Bronchospasm didn't seem to matter. I've disagreed with my partners on different occasions too.......like when a pt is putting it on or having a panic attack?

The wheeze is in the pts throat, not on the pts chest.
It's not the HSE's opinion, it's not managements opinion, it's mine. All mine.
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#52
The field guide app is open to the public ATM
Volunteers Are Unpaid , Not Because They Are Worthless. But Because They  Are Priceless !!!
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#53
Just up for testing on the Apple store I believe. Should be officially out in a week or so.
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#54
It's been up ages only been publicly opened ( it synced so I can actually see it and not the log in page )
Volunteers Are Unpaid , Not Because They Are Worthless. But Because They  Are Priceless !!!
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#55
[Image: hvG8mDQ.png]
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#56
I broke the system :P
[Image: du6upyga.jpg]
Volunteers Are Unpaid , Not Because They Are Worthless. But Because They  Are Priceless !!!
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#57
Bobby you're up in the big smoke and in the know! Any word when omac are expected to start upskilling us?
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#58
End of the month at the latest upskilling will be at regional level regional staff / national staff currently creating the upskill courses to be run / arranging dates 19
Volunteers Are Unpaid , Not Because They Are Worthless. But Because They  Are Priceless !!!
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#59
(31-07-2014, 10:10 PM)amboman bobby Wrote: here you go Vidar : https://www.facebook.com/groups/57559610...ment_reply

Oh, this FB page is great
Today there is lots of "discussion" re Morphine for EMTs (let's give EMTs a controlled drug...not!) & "how unjust" the entry potential requirements for the BSc Paramedic Science are, eg leaving cert.
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#60
Yup some real gems over there, in fairness a few voices of sense too, I see the lad that wanted manual defib etc his posts are gone
Those who can, do.

Those who can't do, teach.

Those who can't do or teach....... Manage!
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