Scope of Practice, the Introduction

I've been having a lot of conversations recently regarding scope of practice, more specifically skills that are included in protocol. This has been a hot topic in VA recently, as it has been nation wide as well, due to the future changes that the national registry will supposedly be undergoing in the near future.

However, this discussion or protocol and scope of practice has always been a hot topic. Just check out one of the many blogs in the EMS blog-o-sphere (maybe AmboDriver or StreetWatch?) and you'll come across many posts that discuss the inclusion or exclusion of certain skills, drugs, etc. from protocol, and the merits of each.

But rather than focus on reforming the skills that EMTs around the country should undoubtedly have access to, I'd like to talk about several skills and pieces of equipment that I have found indispensable in my own experience while running at a rural rescue squad; in fact, I believe they are indispensable no matter where you run.

If you run with my service, you're looking at--unfailingly--at least a half hour transport to the nearest hospital, most likely closer to 45 minutes, maybe even an hour if you get sent on a mutual aid request. This exceedingly long transport time, potentially with a critical patient, is something that I don't think a lot of big city (or small city) providers fully understand the reality of. At my station, the majority of volunteer crews mark up at the basic level. Our medic level providers are few and far between, and as a result we rely heavily on a nearby county career-staffed station for medic-level services. QRVs are virtually unheard of, and if you have more than one crew in the building a shift, then you're the exception not the rule. While we do have access to a helicopter service for some of those calls that you know are going to be bad when you hear them go out, if you don't put them in the air immediately, there is a distinct possibility that ground transport may be just as efficient as flying them out. And you would be shocked to realize how long 30 minutes in the back of an ambulance with a patient who is seizing uncontrollably (and you have no medic-level rendezvous in your near future because they're on a call in their own first due) can feel.

So given that context, I want to talk about the merits of having the following three skills approved at the Basic level: 12-Leads, King LT Airways, and CPAP. In the following three posts, I will discuss some of my personal experience with these skills and pieces of equipment, as well as potential advantages and disadvantages. On the whole, I will be straightforward and say that I think these three skills are significantly more beneficial than they are problematic, but if you disagree, I would like to hear your ideas.

Coming soon: 12 Thoughts about 12-Leads.

Til next time,
CW